Workplace actions have led to a staff increase for Blacktown Hospital’s ICU despite ‘corporate negligence’.
Management of Western Sydney Local Health District has agreed to give Blacktown Hospital’s 18-bed intensive care unit an extra 15.8 FTE (full-time equivalent) nursing positions.
In return, the hospital’s NSWNMA branch agreed to lift bans on overtime and cooperation in moving to a new facility.
The bans were imposed by unanimous votes of branch members.
Branch member Paul Topalovic said all additional positions would be mostly supernumerary, as requested by ICU nurses and the branch.
Positions will include ACCESS nurses (providing on-floor Assistance, Coordination, Contingency, Education, Super-vision and Support), additional team leaders, a clinical Nurse Educator (CNE) and nurses to backfill core staffing deficiencies.
“We badly need more support for nurses who are allocated a patient load, but management always insisted there was no budget for unencumbered positions,” Paul said.
“Action to achieve these new positions really united the unit; everyone was invigorated and determined to carry on the industrial campaign until we succeeded.”
Staffing of Blacktown ICU has failed to keep pace with a growth in bed numbers.
ICU members said the unit needed supernumerary ACCESS nurses, team leaders and extra CNEs to ensure patient safety and quality of care, and reduce excessive overtime.
Extra 15.8 FTE won
In July 2019, a new ICU was built as part of the Stage 2 Blacktown Hospital development.
Paul said local hospital executives acknowledged the need for the proposed ICU staff profile enhancements but could only offer sympathy after negotiations lasting more than a year failed to secure the necessary funding.
In August, the Blacktown Branch voted to not cooperate with the move to the new building until the ICU received supernumerary staff.
In their first action, ICU members refused to take part in an education program relating to the move. They took leave without pay or worked on the floor instead.
When further meetings with management failed to win extra staff, ICU members, backed by the branch, initiated a ban on overtime.
They refused to work over-time from 26–28 August when the dispute went to the Industrial Relations Commission (IRC).
At the IRC, management and the union agreed that negotiations should be given one last chance.
In September, a deal was struck to employ 15.8 FTE of staff in three phases, with recruitment to be completed before moving into the new facility.
Paul said members were very pleased with the outcome, adding: “We are still waiting for the general manager to unambiguously formalise in writing the time-line associated with the phases of recruitment.”
“We have endured working in an understaffed environment for such a long time,” he said.
“The unit has relied heavily on overtime and there is a high level of sick leave, partly due to constantly being overworked.
“If the overtime ban had stayed it would have affected surgery, admissions from emergency and overall patient flow.”
Management responsible for unsafe staffing
A position statement adopted by Blacktown ICU nurses said the Level 5 ICU was badly understaffed by the standards of the Australian College of Critical Care Nurses (ACCCN) and the College of Intensive Care Medicine.
More than 55 per cent of Blacktown ICU nurses do not hold postgraduate qualifications, meaning the unit should have minimum staffing of one team leader and at least 2.5 ACCESS nurses per pod.
“Presently, the unit is dysfunctional with one team leader covering two pods and one ACCESS nurse, if available, permitted only in the after-hours,” the statement said.
“What we have presently been staffed for could equate, in our opinion, as being adequate only for a close observation unit.”
The statement said the unit had only one FTE CNE to service about 100 nurses. The ACCCN recommends one CNE per 50 staff.
“We are continually faced with the challenges of justifying our demands for adequate staffing and manageable workloads on a shift-to-shift basis every day,” it said.
“The organisation habitually fails to provide the necessary support and lacks the capacity to influence the allocation of resources to improve what is affecting the safety and quality of care delivered.
“All employers must be held accountable for their actions when, through unsafe systems of work and unrealistic work expectations of nurses, they put not only patients at risk but also risk their licence to practice and the livelihood of nurses.
“Since providing a safe environment for patient care is a corporate responsibility, understaffing is corporate negligence.
“Nursing and medical professional bodies, hospital administrators and govern-ments all have a role in understanding and addressing this inadequacy in staffing, with a particular focus on requested additional supports and resources.”
Good nursing ‘not appreciated’
Hospital and health care administrators and the state government view nurses as a cost and fail to appreciate the benefits that result from good nursing practices, a statement by Blacktown ICU nurses said.
The statement said evidence showed that:
- risks to mortality, morbidity and the occurrence of adverse events are all greatly increased when too few nurses are available for the delivery of safe, quality care
- patient outcomes are significantly affected by nurse education levels, staffing, workloads, work environment and skill mix
- adequate nursing care can avoid many preventable adverse patient outcomes
here is a significant relationship between nurse staffing, workload, and work environment and the well-being of nurses themselves.