John Hunter ED nurses get workload relief after voting to close ambulance bay beds.

Emergency department nurses at Newcastle’s John Hunter Hospital have won a major staff increase above the award after warning management they would close beds in the interests of safety.

Hunter New England Health (HNE LHD) agreed to fund an additional five full-time equivalent (FTE) nursing positions, which gives the ED an extra 24 hours of frontline nursing staff per day.

The decision came after NSWNMA members voted unanimously to shut three of five ambulance bay beds until they were given sufficient nurse numbers to staff them safely.

The branch’s main demands were:

• The three resuscitation beds be covered by three experienced resuscitation registered nurses permanently 24 hours per day, seven days per week.
• Triage nursing hours be increased permanently to ensure there are two triage registered nurses on shift 24 hours per day, seven days per week.

The branch called off the closures after HNE LHD agreed to these demands.

HNE LHD has started to recruit the additional permanent staff and is using voluntary overtime – mostly from casuals and part-timers – to fill the positions during the recruitment process.

Nursing hours boosted

The win means resuscitation nursing hours are boosted by 16 hours per day, seven days per week. The three resuscitation beds are now staffed by three nurses on all three shifts as compared to three on afternoon shift and two on night and day shift.

Triage nursing hours have increased by eight hours per day, seven days per week. That gives night shift a triage nurse and clinical initiative nurse (CIN) instead of just one nurse who could be responsible for up to 45 patients.

“We’re really happy with the outcome,” said ED nurse Remi Black, an alternate delegate for the NSWNMA’s John Hunter branch.

“Management is acting quickly to recruit more nurses and until that happens, casuals and part-timers 
are picking up a lot of extra hours,” she said.

“Branch members voted unanimously for the bed closures in a secret ballot and we got a huge turnout at branch meetings.”

ED nurse and branch alternate delegate Kieran Patterson said nurses had sent the branch many messages of thanks for the work done to achieve the result.

“The outcome has really changed the way we work and made our jobs and the level of care we can provide so much better,” Kieran said.

“People can already see the benefits of the new arrangements. One nurse wrote to say how much better night shift was even on a very busy night.”

Management listened

She said the branch spent about six months arguing for a staff increase before deciding to take action.

“We put our case at meetings of the workloads committee and showed how we had rejigged the roster and staff placements to try to safely cope with the patient load.

“Our managers were very supportive and were doing what they could do with no extra funding. We worked with them to write business proposals for the additional staffing and had multiple meetings with senior management.

“We had regular branch meetings on the issue and the numbers in attendance built up over time.”

In a letter to the hospital’s director of nursing and midwifery, Sally Milson-Hawke, NSWNMA branch secretary Suzanne McNeill and vice-president David Pfanner thanked management for “listening to the professionals working in John Hunter ED and providing the increase in nursing hours on a permanent basis to allow nurses to continue to provide the quality of care required for the people of Newcastle and surrounds.”

Above-average rise in John Hunter ED presentations

The number of people attending John Hunter Hospital ED during January to March was up 7.8 per cent from the same time last year, to 20,947.

The increase exceeded the 5.9 per cent rise in ED attendances across the state, according to the Bureau of Health Information.

The bureau said the “timeliness of care” provided to patients had declined on a statewide level.

At John Hunter, the number of patients using a resuscitation bed increased from around 470 in the month of January 2016 to over 500 in December 2018. Occupancy rates over the same period increased from around 50 per cent to about 62 per cent.

In 2018, new clinical handover arrangements took an additional 20 nursing hours off the ED floor in any 24-hour period.

No extra staff were provided other than a “navigator” nurse position for a trial period to assist with patient flow. This position was later removed.

As a result, nurses were often left alone with several patients while the second nurse transferred a patient to the ward.