Recruitment woes for regional maternity unit
Difficulty in recruiting experienced midwives and a dwindling casual pool are serious challenges for Shoalhaven Hospital on the NSW South Coast.
RN/RM and NSWNMA delegate at Shoalhaven Hospital, Jennifer Greed, says it is especially hard to recruit midwives to regional areas like the South Coast.
Shoalhaven maternity unit is forced to rely on non-midwifery staff including registered nurses and enrolled nurses to fill its roster.
“A dwindling group of senior midwives is feeling the strain of excessive workloads, lack of support, high levels of stress and increasing sick leave, Jennifer says.
“Less experienced midwives feel stressed and frustrated when they are expected to ‘Step Up’ before they are ready without the support, education and experience they need.”
Birthing an average of 850 babies each year, the maternity service includes a 4-bed birthing unit, 13 postnatal/antenatal beds and an assessment bed; a freestanding antenatal care area with midwives’ clinics and a high-risk clinic.
The service also provides in-home postnatal care via a midwifery support program and the birthing unit provides 24/7 outpatient care to pregnant women.
With no registrar cover, the service has a resident on weekdays, one staff specialist and a number of locum obstetricians on call.
Normal staffing levels on the Monday to Friday morning shift is six staff plus the midwifery unit manager and midwifery educator.
Poor skill mix a pressing concern
Jennifer says workloads can be even higher on afternoons and nights when fewer support services are available.
“There is no clerical support after 1530 hours, so midwives are required to answer all incoming calls, and there is no cleaning support after 1430 hours.
“A wardsman has to be called to clean bathrooms and floors in the birth units and they are unavailable for the postnatal area.
“As a result of increasing pressures on other areas of the hospital, the maternity unit is regularly expected to accept ‘outliers’ who would normally be accommodated in medical or surgical areas.
“Maternity patients are shuffled to empty beds in the children’s ward to accommodate surgical or medical patients.
“The in-charge midwife who regularly has a full patient load and may well be the only senior on shift is expected to decide the most suitable patient to send to children’s ward, which is behind a locked security door.
“Children’s ward buzzers do not appear on our board so we rely on children’s ward staff to notify us of our patients’ needs.
“The increasing number of Bachelor of Midwifery midwives who do not have general registration puts more responsibility on those with general registration to care for general patients.”
Poor skill mix is one of the most pressing concerns raised by Shoalhaven members.
They say the problem is worst on afternoon and night shifts when the ratio of senior staff to junior/ inexperienced staff deteriorates and shifts can be a combination of RN/RM, RM, RN and EEN.
Student midwives are counted in staffing numbers even though these shifts lack experienced staff to support them.
Broad support to have babies counted
Like for like replacement for staff on sick leave is not always available and the in-charge is usually carrying a full patient load and may be the only one able to work unsupervised on the shift.
“Birth unit staff can be responsible for four or more women in labour as well as outpatient presentations at any time – very much like an emergency department,” Jennifer says.
“Many outpatients can take at least an hour of care especially if they need monitoring, tests and review by an obstetrician and potentially transfer to a higher level of care.”
There is broad staff support for the NSWNMA campaign to change the maternity staffing system to ensure babies are counted in patient numbers in postnatal wards.
“In the postnatal area there will often be patients who have had difficult births, complications or caesarean sections and are unable to care for their own babies. “We perform major abdominal surgery on these ladies, their movement is restricted, they are often on medication for pain and then we hand them a newborn baby and expect them to care for the baby independently.
“Of course, they can’t but the system pretends they do. This failure to acknowledge complicated postnatal care puts an additional workload on the midwife.”
Shoalhaven staff say it is hard to access education and training because the educator is often given a patient load to fill staffing shortfalls.
Staff report high rates of sick leave as midwives succumb to stress due to overwork. Meal breaks are seen as a luxury on many shifts and overtime is normal.
“Many are feeling overwhelmed and becoming despondent. People speak of moving on or already have,” Jennifer says.
“Despite low morale the maternity service has a strong team spirit.
“Everyone is trying their hardest including our manager and educator who have their own pressures.
“We are looking at structures we can put in place to lift morale and offer support and education.
“The bottom line is safe and excellent patient care – that is what our amazing team strive for always.”