Public Health

Closing beds on a severely understaffed ward is an option open to members when management fails to act in the interests of patient and staff safety.

If managers insist on filling more beds regardless of the staff available, a hospital’s NSWNMA branch may consider closing beds.

The aim would be to align bed numbers with the number and qualifications of the available nursing workforce.

The branch is more likely to decide to close beds if nurses have already put a case to management through all available channels with no relief.

Members can expect to come under pressure from management not to close beds.

However, as Bathurst Base Hospital branch has shown, management pressure can be resisted if branches have done the necessary networking to get members on board and members stay united.

Closing beds to protect patients and staff

A Bathurst Hospital branch decision to close beds led management to abandon hardline positions, take a fresh look at staffing solutions and implement bed closures themselves.

“It is still a work in progress, but so far we have pretty much got the outcome that we wanted,” said branch secretary James Adams.

The branch met last October to discuss concerns raised by members in the surgical ward.

The ward had failed to meet its required nursing hours per patient per day (NHPPD) for 40 weeks of 2024.

“There was constant use of unfunded beds despite members raising the issue through reasonable workloads meetings,” James said.

“There was excessive overtime, and the surgical ward basically absorbed the hospital’s entire casual pool which impacted every other department.

“For instance, our clinical nurse educators were being redeployed to the floor most of the time – despite an Award provision that they are only to be allocated to direct patient care in an emergency.

“At the same time, the CNEs were held accountable as to why their education workload wasn’t being met, which was a ridiculous situation.”

Work Health and Safety Act gives protection

James said the branch voted unanimously to immediately close non-funded beds to improve NHPPD and protect patient and staff safety.

“We have the right under the Work Health and Safety Act to refuse an unsafe workload.

“Our branch resolution included a proviso that we were willing to negotiate beds being opened when we had a Step Level Black situation.

“We closed beds for about half a week. One bed-closure day had a real impact, which prompted management to come to us for a meeting.”

James said bed closures are one of the hardest things a branch can do.

“There was pressure from management on individual members to ignore the branch resolution.

“Some members initially didn’t understand their rights and backed away a bit, but other members really stood their ground.

“We had to be unified in our approach, and we did a lot of networking to coordinate everybody at the ward level.

“Our team leaders were the key because they were the ones who interacted with management. They had to be able to stand strong and say no, that bed is closed.”

The branch advised members to communicate with management about bed closures by email with copies to branch officials.

“This gave us an evidence base that helped us in our subsequent meetings with management,” James said.

Following the bed closures, branch officials and NSWNMA staff held four meetings with management.

Operating without models of care

“Management let us lead the first meeting and they actually listened to everything we had to say. I think we showed them that we had a whole evidence base behind our decision [to close beds],” James said.

“We argued that key areas of the hospital including surgical, medical and rehab were operating without models of care.

“For example, the rehab ward had a mixed patient cohort with medical patients sometimes outnumbering rehab patients. However, it was staffed as if all patients were rehab.

“Management are now committed to dividing the ward with medical patients staffed with the appropriate NHPPD ratio and no nurse to be given a mixed patient load.”

James said management also agreed to cap surgical ward beds at the funded 20 beds and not surge unless appropriately staffed.

“This was the cap we sought when we decided to close beds,” he said.

“The hospital is developing a model of care as well for rehab, surgical and medical wards which will be finalised through the Staff Consultative Committee. The aim is to make patients safer and reduce staff workload.”

And the branch and management have agreed that CNEs are only to be deployed to the floor in an emergency, which must be clearly documented.

Meanwhile, the casual pool has increased and “management are looking at new approaches to recruitment.”

James said branch stewards and key members were monitoring the implementation of agreed staffing improvements.

“We have a good group of stewards and key members who are doing great work on the ground.

“They collect a lot of data, which they put in the IMS (incident management system) for the workload committees to review.

“They also email suggestions to the staff consultative meeting and email the branch regularly to keep us up to date with their actions.”

James said some branch stewards had benefited by attending NSWNMA training sessions.

“We encourage as many stewards as possible to attend union training courses and workshops.”