Emergency
EDs in desperate need of 1:3 nursing ratios
Pressure is mounting inside the state’s emergency departments, with the latest hospital data revealing the time patients spend waiting to be admitted has blown-out to more than five and a half hours, the longest median time recorded in the past five years.
The Bureau of Health Information’s latest quarterly report has reinforced concerns raised by the NSW Nurses and Midwives’ Association (NSWNMA) that patients were increasingly presenting in dire need of urgent medical help.
The January to March 2021 figures showed the volume of ‘emergency’ (triage category 2) and ‘urgent’ (triage category 3) presentations were the highest recorded over the five-year period for that quarter.
NSWNMA General Secretary, Brett Holmes, reiterated the NSW government must implement ratios of one nurse to three patients (1:3) in ED and ensure patient safety was prioritised across the system.
“The amount of time critically ill patients are waiting for admission to a ward bed reinforces the absolute need to ensure our EDs have at least one nurse for every three patients at all times,” said Mr Holmes.
“We need shift-by-shift ratios in EDs to ensure patients, who are presenting acutely unwell, can get the right care when they need it.
“These figures confirm it’s taking longer for patients to be seen and leave on time, which is a recipe for heightened aggression and abuse towards frontline nurses just trying to do their jobs.
“Not to mention, the highest number of ambulance responses for any January to March quarter over the past five years, which impacted on the time it took to transfer patients from paramedics to ED staff.
“The volume of elective surgeries carried out, up 13.9% (or 7,065), was also highest for that quarter since 2017.
“Our members know that what happens inside an ED has a ripple effect across their hospital. Safe staffing must be prioritised to help address these concerns.
“Many of our nurses are at breaking point because if they’re not run off their feet in the ED, they’re flat out raising workload issues with hospital management to little or no avail.
We need mandated nurse-to-patient ratios in our hospitals, just like they have in Queensland and Victoria. The NSW government’s preferred staffing model is outdated, unsafe and frequently fails to deliver the right number of nurses needed on every shift.”
The NSW government has refused to negotiate with the NSWNMA on introducing nurse-to-patient ratios, despite widespread industrial actions in metropolitan and regional areas.
Howard Weir says
I worked in ED for 15 years .. In the end I turned my back on ED and walked away.. I now work in the Community..
I left ED because of the continual under staffing, continual unrelenting pressure, the increasing violence … and simply because the Government just doesn’t care.. and that is proven by wage freezes and not mandating staffing levels
Bernhard Deszo RACZ says
I’ve worked in ICUs and ED for over 40 years. From 2000 to 2017 i worked at one of Sydney’s biggest and busiest hospitals (It’s not you, Liverpool!, no matter what you say… though you are excellent).
In ED I would get a 4 – 5 patient load, but at times would look after 8 beds. As long as you didn’t go on a break, you had a chance with the turn-over. take a break, and you had 6 new patients, and were ‘behind the 8-ball’. If you were quick, you had a chance: welcome them to the unit, ask their symptoms; get them comfortable while doing their obs; cannulate if needed, start IV fluids, take bloods, give them a yellow jar (and tell the young men that we had ways to tell if the urine was theirs and not their girlfriend’s); then get a doctor to prescribe pain relief asap/immediately (never let the system tell you the patient ‘hadn’t been taken up by a doctor yet’). More importantly ask if they wanted a pillow (and ask the wife if she wanted the pillow under or over his face); offer a blanket; and extremely important= ask the family member/friend if THEY would like a seat, blanket, cuppa, and show them where the toilet was. That was when we used REAL charts!
Then came eMR, and all of a sudden we had computer crashes/ downtime; and massive delays in getting any idea of status. Without a paper chart there were no immediately visible trends (such as crashing BGLs), and now you were lucky to see half the number of patients and treat them effectively in the fastest time.
Every delay meant increased risk of complications, errors, and adverse events.
RATIOS are essential, in ED, as EVERYWHERE.
I still work those areas, with less staffing, and a greater workload, and less time. On nights, no-one has a break through 10-hour shifts. I frequently come on to find sick patients who haven’t had obs done for 6-8 hours. Frequent Clinical Review Calls and Rapid Response calls are becoming almost a daily event.
Not having safe RATIOS is killing people, and this means that THE GOVERNMENT is killing people through incompetence, negligence, apathy, and inaction.
But don’t worry – ” it’s only 1 in 350,000 ” that are dying seems to be the common phrase these days, and no longer “sadly a 45-yr old woman (with small children, a husband, a family; a job) has died tragically!
Karen Goodland says
Very well said Bernhard. I hope you’ve also sent this to Scot Morrison and Gladys Berejiklian. This government are an utter disgrace, they think if they ignore nurses we will all go away.