December 11, 2024

midwives in nsw

Knife attack reveals safety failures 

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Association inspects Blacktown Hospital as staff demand better security and ratios.

A 35-year-old Blacktown Hospital nurse suffered knife wounds to her wrists and arms when attacked by a patient.

The assault happened in an unlocked staff tearoom in a medical ward.

Just a week before the attack, Blacktown nurses and midwives had rallied in support of the NSWNMA’s campaign for a new nurse-to-patient ratios system.

The campaign aims to address safety, workload and other issues linked to inadequate staffing.

At the time of the incident, three nurses were working in the ward. Under the safe staffing system sought by the NSWNMA, five nurses would have been rostered on.

Staffing levels at the hospital have been an ongoing concern. From January to June this year, the NSWNMA uncovered around 1250 hours of missed nursing shifts in breach of the award minimum.

Speaking to the media following the knife attack, NSWNMA Assistant General Secretary, Judith Kiejda, said violence in the public health system is spreading from high-risk areas, such as emergency departments and mental health units, to all hospital areas.

“Nurses are fed up with the current staffing system because there is no mandated ratio for every shift on every day. When incidents like this occur, nurses need all the support they can get,” she said.

“There must be more measures in place to protect nurses and midwives when they’re on the job, so their focus is on caring for patients, not the possibility of being violently assaulted.”

A meeting of Blacktown’s NSWNMA branch called for changes to hospital security, including swipe-access locks on doors to staff-only areas.

Members also resolved to wear grey armbands for two days to highlight violence in the workplace.

Branch president Christine Boxsell said members earlier wore red armbands in support of ratios.

“This time we chose grey because black is worn for a death and we never want to have to wear that,“ she said.

“Grey armbands were worn by all staff classifications throughout the hospital – nurses, doctors, allied health, cleaners, everyone.”

Access exists to items usable as weapons

Christine joined NSWNMA officers in a safety inspection following the attack.

The inspection identified improvements needed in access to staff-only areas, duress alarms, ward design, access to the emergency department and after-hours access to the whole hospital.

General Secretary Brett Holmes conveyed the inspection team’s findings in a letter to Western Sydney Local Health District.

Brett said it was good to see that electronic swipe access was being installed on the staff tearoom door at the time of the inspection.

However, he wrote, patients could access other areas of the hospital without lockable doors to obtain items such as knives, scissors and needles that could be used as weapons.

Also, doors with appropriate locks were propped open and staff toilets did not have measures to ensure staff-only access.

At the time of the inspection, ward B35 had two fixed-point duress alarms at the nurses’ station and medication room and one personal duress alarm.

“There was no clear understanding from staff in the ward about the circumstances in which the personal duress device would be worn or who should wear it, with the result being that it appears to sit in a drawer.”

Brett said the assaulted nurse was unable to access a duress alarm and it was fortunate that another nurse was able to use the duress alarm in the nurses’ station in order to call for help.

In addition, there was no indication to the person operating the alarm that it worked when they pressed it.

Anyone can enter most wards at any time

These and other failings fell short of standards set out in mandatory NSW Health policy.

Christine Boxsell told The Lamp that swipe access had since been installed on the B35 staff room and main hospital dining room.

However, the fire exit door was able to be accessed from outside and, due to renovations, access to the ED was now through the main hospital entry, which is unlocked 24 hours per day. That means anyone could access most of the wards at any time.

Christine said all nurses in B35 had been issued duress alarms following the union safety inspection.

“We had another episode in B35 the other day when a patient pulled a nurse by the hair.

“She immediately activated her duress alarm and security came straight away.

“That’s an improvement, but we don’t know if and when nurses in other wards will be given personal alarms.”

The inspection team recommended the hospital investigate options to remove “entrapment points” in the ward such as the nurses’ station, which has only one entry/exit point. The inspection noted serious problems in the ED including the inability to remotely lock it down, lack of secure staff areas, patient access to items that could be used as weapons and staff not wearing duress alarms.

Lockers provided for ED staff were too small, resulting in bags being kept on the floor, which posed a trip hazard.

This was a breach of the Nurses and Midwives’ State Award, which provides for “a full-length locker fitted with lock and key or other suitable place for the safekeeping of clothing and personal effects”.

Christine said Blacktown Hospital’s director of nursing and midwifery told the branch that management were working on an “action plan” in response to the safety inspection recommendations and would communicate the results to the branch.

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au

The everyday violence of health

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The power of NSWNMA members will be crucial to force the systemic change needed to deal with violence in our hospitals, says expert.

Nurses are more likely to suffer violence at work than police and prison officers, a researcher at the University of Technology Sydney has found. Dr Jacqui Pich, who recently presented her research to an international conference in Toronto on violence in the health sector, told The Lamp we need to ask “why is it safer to work in a prison or be a police officer?”

Dr Pich’s findings come from more than 3500 NSWNMA member responses to a survey about workplace violence. The results found that younger nurses are more at risk than older nurses, and that the private sector is only slightly better than public (see story on pages 12–13 for all the survey results). There was no difference, however, in the types of violence nurses experienced across sectors.

“Emergency departments and mental health and drug and alcohol nursing have been places where we think about violence. But the findings are telling us it doesn’t really matter where you work; 
you can be in a public hospital in a big city or you can be in a small country hospital, you are still exposed to risks.”

The high response rate Dr Pich received from nurses and midwives to her survey shows that violence is an “issue close to their heart: they take it very seriously and we have 
an obligation to do something with the results”.

Dr Pich said she was surprised both by the degree that violence extended outside of the workplace, and how long lasting the impact of violence can be: “We tend to think when we call it ‘workplace violence’ that it happens in your workplace. But it happens outside of work, and it happens in cyberspace.

“The use of social media has taken off and we haven’t managed to deal with it effectively. People are using social media to take photos, to threaten and to stalk people in ways that extend well beyond the workplace.”

Impact of violence is long lasting

Workplace-related violence is having long-term personal and professional impacts on nurses and midwives too. More than three quarters of those surveyed reported verbal and non-physical forms of abuse, and these experiences can “cause a lot of symptoms like you would have with PTSD, such as trouble sleeping and flashbacks”, said Dr Pich.

“People are leaving the profession, withdrawing from certain types of patients, and experiencing feelings of professional incompetence or self-doubt.”

The responses to the survey included “really desperate comments that people are so unhappy that they are scared to 
go to work, and that they attempted self-harm”.

The result is a decline in the quality of care and a climate where errors are more likely to occur. “The bottom line is it is going to have an impact on patients’ safety.”

Dr Pich said while reaction in Canada to her findings was shock, researchers also recognise that it is an international trend.

“It is a similar experience with nurses overseas, so it is not just isolated to Australia.”

Reporting system broken

One of the major hurdles to addressing workplace-related violence is that it is hugely under-reported, said Dr Pich.

“Often management will say ‘I haven’t got any reports and this is not a big problem’. But we know that it is happening and nurses aren’t reporting it for a multitude of reasons.

“Often the system is designed so that they won’t report it because it is going to take time, or it is a difficult system, or because the violence is so common, or they know if they report it nothing will happen. There is a big gap between what happens out there and the policies to protect people.”

Dr Pich says what is needed is systemic change driven by the power of the NSWNMA.

“Nurses are the most vulnerable and experience the most violence of all the healthcare professions. The NSWNMA is in a good position to drive this push for change.”

Dr Pich says this research provides a solid basis for the union to take evidence to the NSW health minister and say “this is not good enough” and use it to drive change.

“We need to have a series of recommendations for change, and it needs to include ways to evaluate those changes and it needs to be an ongoing process.”

“And we need to really keep it out there. Because if something really bad happens it hits the media and everyone is really interested, but things like this are happening every day.”

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au

Aggression is widespread – and on the increase

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Survey exposes alarming levels of violence against nurses.

Eighty per cent of nurses and midwives experienced at least one episode of verbal and/or physical violence in the six months before answering a survey of NSWNMA members.

Forty-seven per cent of nurses and midwives reported an episode of violence in the week prior to completing the survey.

A total of 3416 members took part in the survey, which was sent to all members.

The survey asked about violence from patients and family/friends/visitors of patients.

Of those who responded to her survey, 77 per cent were RNs and 87 per cent were women.

Almost one quarter (24 per cent) had suffered physical violence with 76 per cent receiving verbal/non-physical abuse.

Among members who reported physical abuse, 35 per cent of cases involved use of a “traditional or opportunistic” weapon. Inappropriate physical or sexual contact occurred in 41 per cent of cases and sexual assault occurred in two per cent.

Among members who reported verbal abuse, 14 per cent involved use of social media and taking of photos and 25 per cent involved “sexually inappropriate” behaviour.

More violence in public sector

Emergency department, drug and alcohol and mental health services were the clinical areas most likely to be subjected to violence.

Public sector workers were more likely to experience violence (82 per cent compared to 69 per cent for the private sector) and there was slightly more physical violence in regional areas compared to metropolitan.

The number of reported violent episodes ranged from 1 to 100 with the majority (80 per cent) reporting between one to 20 episodes.

Older and more experienced nurses were less likely to be subjected to violence and men were more likely to experience it.

The survey indicates the workplace is becoming more violent. Of those who responded to the survey, 76 per cent believed the frequency of violent episodes was increasing.

Members were asked about signs and symptoms exhibited by people who inflicted violence. Members said mental health issues were apparent in 78 per cent of cases. Substance abuse (57 per cent) and alcohol intoxication (46 per cent) were also common.

 

Psychological injuries are consequences of violence

The survey also examined the impact violence is having.

Twenty-eight per cent of respondents reported that they had suffered a physical or psychological injury/illness as a consequence of violence. In this group, psychological injury was the most common (71 per cent).

Almost 52 per cent of those who reported violence said it had an impact on their professional practice.

Impacts included lack of empathy towards patients, decline in quality of care, avoidance of patients, feeling of professional incompetence and self-doubt.

Members were asked about employer responses to violence and any risk-prevention strategies in place.

Only 12 per cent thought their organisation’s policies and procedures related to prevention and management of violence were effective.

Almost half (48 per cent) of survey participants were not satisfied with their employer’s immediate response to the most significant episode of violence in the preceding six months. In this group, just over 10 per cent said the employer blamed them for the violence.

Sixty-seven per cent said they were not provided 
with adequate information, support and follow-up after the episode.

The survey indicates that incidents of violence are greatly under-reported. Only 33.45 per cent of staff subject to physical abuse said they reported all episodes.

When asked why they did not report these episodes, almost 41 per cent said they were “an accepted/expected part of the job”. A higher percentage – 56 per cent – said they did not make a report because they did not expect anything to change in the long term as a result.

This research was conducted with Prof Jacqui Pich and UTS Health. 

 

Letters to the Editor Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor. Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au

Understaffed rural EDs face security risks

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Narrandera nurses seek better staffing and improved security.

The NSWNMA has warned of security risks facing small country hospitals that have emergency departments gazetted as mental health assessment centres.

These hospitals do not have mental health beds or trained mental health nurses.

They must care for patients at least until a telehealth assessment can determine the next step in the treatment process.

The 34-bed Narrandera Hospital in the Riverina region is one of about 12 NSW facilities in this category.

Following an NSWNMA safety inspection of the hospital, General Secretary Brett Holmes wrote to Murrumbidgee Local Health District warning that Narrandera nurses are at serious risk from violence and aggression.

This was due to inadequate nurse-to-patient staffing ratios, inadequate security coverage and poor facility design.

“Add to this that Narrandera is a declared mental health emergency assessment centre and it is only a matter of time before a major incident occurs,” Brett said.

Overnight, the hospital is staffed by three nurses with no security guard working across the ED and 20-bed ward. The nearest full-time police service is 90km away at Griffith.

Nurses must often work in isolation in the ED or ward, which does not allow for an effective duress response in an emergency.

This is in breach of NSW Health’s “Protecting People and Property” policy and Australasian health facility guidelines, which say no nurse should work alone or in isolation, Brett pointed out.

“Staffing numbers must not only take into account patient numbers, but also the safety of staff,” he said.

He recommended a minimum of four nurses be rostered to work at night to ensure that none were forced to work in isolation and an additional security guard be employed.

Vulnerable in the ED

NSWNMA delegate and branch secretary Linda Sommerfield told The Lamp the hospital employs just one security guard from 2pm to 11pm Wednesday to Sunday. The guard is not replaced when sick or on leave.

She said the branch had asked for better staffing and improved security for several years.

“The LHD gave us a new duress alarm system in 2016 but they are the most cumbersome devices ever invented. They have a button at each end and you must be sure to press the correct button twice. That’s not always easy when you are being assaulted.

“The duress rings through to a security company in a remote location, which then calls the hospital to find out if there is a problem. If there is, security calls the police who could be 100km away as the local station is not staffed 24 hours.

“The police always arrive in pairs, yet we are expected to deal with these patients in isolation. In the last 6–12 months ED has been very busy with at least one nurse working down there for a whole eight-hour shift.

“We don’t have a safety lockdown area or triage area in the ED. We open the door to the public and they can walk straight in to access the whole department and go through to the ward.

“We have no cameras in ED and, if a nurse working in isolation can’t get to their personal duress or the duress emergency button behind the nurses’ station, that nurse could be unconscious or dead on the floor and we in the ward would be none the wiser.

“If a nurse is concerned about someone’s behaviour in ED they have to ring the ward for assistance, which leaves one ward nurse alone with up to 20 patients on a night shift. That includes patients with dementia and at high risk of falls and three close-observation patients.”

Multiple issues with mental health patients

Linda said despite the hospital being listed as a mental health emergency assessment centre, none of the nurses are mental health-trained apart from doing a 30-minute online course.

“Given our staffing situation, how are we supposed to give mental health patients the best-possible care while ensuring our own safety and that of our other patients?

“Quite often, mental health patients have to be sedated before being admitted to our facility. ED presentation is only supposed to be for four hours, but they are sometimes here for up to eight hours waiting for a telehealth linkup or transport. That’s not fair on the patient, their loved ones or staff.”

There have been several violent incidents at Narrandera hospital in the past 2–3 years.

A patient held a doctor and two nurses hostage for several hours; a handcuffed patient in police custody tried to strangle a nurse, dragging her to the ground; a security guard was badly bitten and permanently scarred; and a nurse was forced to change work patterns following threats and verbal abuse.

Linda said the LHD has made some improvements including: more swipe card access; installation of an internal door to prevent free access to wards and to isolate aggressive ED patients from wards once the door is closed; and enhanced safety in the doctors’ consulting room.

In a letter to Brett Holmes, the acting Chief Executive of Murrumbidgee LHD said an “action plan” to improve security had been developed.

Narrandera Shire councillor Barbara Bryon told the Narrandera Argus newspaper that violence towards nurses was on the increase and security must be improved.

“John Barilaro, Minister for Regional Development, talks about money into the regions and 
the regional funds and grants available. But at the same time, the state government is pulling services out of the regions,” councillor Bryon said.

“If there is a violent incident, who do you phone? We don’t have 24-hour police services, because that’s another arm of government that they’re pulling out of the regional centres.”

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au

Grave concerns’ over forensic hospital assaults

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NSWNMA urges Safework to act on “imminent danger” to mental health nurses.

 Nurses at Sydney’s Long Bay forensic hospital are at “imminent risk” of serious injury or death as a result of management’s failure to reduce exposure to violence from patients, the NSWNMA has warned.

The warning follows another serious assault in September in which six nurses were injured and two needed hospital treatment.

In March 2017, a nurse suffered a broken jaw, broken nose and two fractured eye sockets when assaulted by 
a patient.

The high-security forensic hospital cares for patients deemed unfit to stand trial or not criminally responsible due to mental illness.

In a letter to the workplace health and safety regulator, Safework NSW, NSWNMA General Secretary Brett Holmes said the union had “grave concerns” for members’ safety “arising from a failure of the Justice and Forensic Mental Health Network to eliminate or minimise” nurses’ exposure to high levels of violence.

“We strongly believe there is an imminent risk of serious injury or fatality to our members at the site,” Brett wrote to Safework’s executive director, operations, Anthony Williams.

Brett said Safework inspectors had been “engaging with the hospital” since March 2017 and issued improvement notices with no consequent reduction in risk to nurses.

He asked Mr Williams to outline what Safework now intended to do to minimise risk.

The hospital’s NSWNMA branch secretary and delegate, Michael Sparks, said staff called in Safework last year after five nurses were injured in two separate attacks.

“Safework asked the hospital to improve staff numbers, install security cameras, implement safety procedures and provide appropriate training.

“They only thing they have done is install CCTV cameras. These are not monitored by security or clinical staff and are there only for post-incident investigation. They will not stop assaults from happening.”

Many staff left after 12-hour shifts abolished

He said the hospital had been “chronically short staffed” since management switched from 12-hour shifts to eight-hour shifts.

“About one-third of staff resigned soon after 12-hour shifts were abolished and we now have vacancy rates in excess of 25 per cent.

“Those who resigned were experienced mental health nurses. A large number of current staff 
are agency nurses and new graduates who do not have the necessary experience and training to manage the level of violence exhibited by patients.

“Staff fatigue is a big factor given the high-stress nature of the job combined with excessive overtime.”

Michael said the hospital has no security guards except a private contractor who manages the front gate. “It is the nurses who provide security within the hospital and consequently get assaulted.”

“The branch has called for security guards but if we can’t get them we at least need to be fully staffed with a trained response team.

“The police hate coming here because it is such a dangerous situation. Often the local police will call the police Public Order and Riot Squad.”

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au

Mandated ratios will bring midwives back

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Public sector midwives working part-time or casual would work more hours if there were mandated minimum staffing requirements in maternity, new research finds.

Over the last year The Lamp has reported on the chronic shortage of midwives in hospitals across NSW yet a new survey has found that large numbers of midwives would work more hours in our maternity suites and post-natal wards if ratios were introduced.

The survey of over 1000 NSW midwives found that 62 per cent work part time or as a casual and 93 per cent of these say they would increase the number of hours they would work if there were mandated minimum staffing requirements in maternity.

All had thought about leaving the profession with 80 per cent highlighting understaffing as the main reason they would act.

Currently there are no ratios of midwives to mothers in post-natal units in NSW hospitals.

The survey comes on the heels of the annual statistical report on births in NSW, released last month by the Centre for Epidemiology and Evidence, which found that the proportion of babies fully breastfed has dropped by 8.4 per cent to 73.7 per cent since 2012. Other studies have found that babies discharged quickly from hospital are less likely to breastfeed.

A part of the problem, says NSWNMA Assistant General Secretary Judith Kiejda, is the lack of time to give mothers the level of support they need before they discharge.

“Midwives are responsible for educating mothers and providing physical and emotional support to both women and their babies,” she said.

your postcode counts in post-natal care

“Under the current system there is not enough time for midwives to provide the level of support and education mothers need during these vital days.”

This is particularly so in Sydney’s west where, on average, mothers and babies are sent home a day earlier than those from hospitals in the east and north, the statistics reveal.

“I feel that the women of western Sydney are being ripped off. They don’t get the one-on-one care, they don’t get the education that they need because we just don’t have the time to spend with them, We’re putting women out the door when they want to stay and be cared for in hospital,” Renalla Fairley from the NSWNMA Nepean Branch told a recent rally outside the hospital.

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au

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