Public Hospitals

The people of NSW go to the polls on Saturday 25 March. NSWNMA local leaders tell The Lamp why the public health system is a vital election issue.

The ALP has promised to introduce maternity ratios of one midwife to three mothers and to review Birthrate Plus to ensure babies count.

“The poor state of public health services will be a big issue at the election”

Midwife Elise Spanner and fellow NSWNMA members in Wollongong plan to hold a public forum and community picnic to focus attention on health care, including maternity services, in the lead up to the state election.

“I think the poor state of public health services will be a big issue at the election, especially given what we’ve been through during the pandemic,” says Elise, Delegate, NSWNMA Wollongong Hospital Branch.

“At some level everyone has felt the impact of the system’s weaknesses – the care deficit is definitely on people’s radar.”

Achieving mandatory staff-to-patient ratios is the most important issue for midwives, she believes.

“Heavy workloads are causing a great deal of mental frustration and a lot of burnout for me, my colleagues and among midwives across the state.

“The pressure is so intense that a lot of staff are leaving. Retaining staff is now a real challenge.”

The ALP has promised to introduce maternity ratios of one midwife to three mothers and to review Birthrate Plus to ensure babies count.

“Under the current system, maternity doesn’t have any staffing safeguards – not even the minimal protection of nursing hours per patient day” Elise says.

“We do have Birthrate Plus but each LHD gets to decide how they use the allocated hours. Hospitals can allocate a lot of that time to educator or policymaker roles, for example, rather than putting sufficient people on the floor.

“I might have eight mothers on an average shift, but because babies aren’t counted, that means writing 16 sets of notes, a minimum of 16 obs, and everything else.

“That workload is not reflected in the current staffing system.”

As a NSWNMA local leader Elise has met politicians from different parties over the last few years.

“It’s been very obvious the Liberal Party has no intention of even speaking with us or trying to understand where we are coming from.

“Other parties have at least been willing to have a conversation with us.”

 

‘The public needs to know the health system has a smart and dedicated workforce that is being undermined by government inaction.’

— Michelle Rosentreter, Delegate NSWNMA Hornsby and Ku-ring-gai Hospital Branch

 

“The current government has shown a complete disregard and disrespect for healthcare professionals”

Whoever wins this month’s state election needs to think differently about public health services and funding, says Michelle Rosentreter, a senior intensive care nurse and Delegate, NSWNMA Hornsby and Ku-ring-gai Hospital Branch.

“Governments will always face budget constraints, but now they need to ask themselves whether they can afford to maintain the current approach and do nothing,” she says.

“By tolerating constant short staffing and the ridiculous workload demands placed on clinicians, the current government has shown a complete disregard and disrespect for healthcare professionals.

“I don’t know why they feel it’s okay to be as inactive as they have been.”

Michelle says the election is a great opportunity for the next government to step up and invest in public health and the workforce.

She says this can be achieved via a payrise to make nursing a more attractive career and “a staffing footprint that must be recruited to above what we currently have”.

“The next government has got to understand there needs to be incentives and empowerment of the existing workforce.”

Labor has promised to adhere to the latest professional standards laid down by the Australian College of Critical Care Nurses, including access nurses.

Michelle believes the pandemic has helped bring about greater community awareness of public health issues and the system’s limitations.

She says members of the public she speaks to can’t believe that some politicians deny or make light of the system’s failings.

“People can see how busy nurses are when they go to visit their relatives in hospital. Patients don’t want to ring the bell because they can see the nurses are understaffed and overworked.

“And because nurses and midwives took a united stand in support of four massive rallies and lots of independent stopwork actions, they showed the public that short staffing and unsafe workloads are a problem in every community.”

Nurses and midwives should take every opportunity to speak to anyone regarding the system’s challenges and solutions, such as staffing ratios and a pay rise to retain and incentivise the highly trained workforce.

“The public needs to know the health system has a smart and dedicated workforce that is being undermined by government inaction.

“We need everyone to understand that investment is the key – and we need a government that will start to fix things, not just talk.”

 

‘If you don’t have time to engage with patients and observe them, they will suffer and the health system will suffer.’

— Nick Howson, Delegate, NSWNMA Cumberland Hospital Branch

 

Healthcare should not be about political parties, it should be about the safety of patients

“Mental health nursing is built around engagement with, and observation of patients,” says Nick Howson, a mental health nurse and NSWNMA Delegate, Cumberland Hospital Branch.

“If you don’t have time to engage with patients and observe them, they will suffer and the health system will suffer.”

Nick says that over the past six years, documentation requirements for mental health nurses in NSW have dramatically changed from short, narrative, handwritten entries and rounding checklists to continuous observational documentation.

“These changes have far outstripped the staffing calculations developed a decade prior and still in use today.”

To ensure acute mental health wards are adequately staffed, the NSWNMA is seeking ratios of 1:3 on morning and afternoon shifts and 1:5 on night shifts.

However, the Liberal government will not even discuss ratios, Nick says.

“The Liberals keep making false and empty promises that something is coming to alleviate the staffing crisis, but have yet to actually announce anything,” he adds.

The ALP has promised to convert all NHPPD wards to shift-by-shift staffing, which Nick agrees is a better system.

However, Labor’s promised ratio of 1:4 would leave mental health acute wards slightly worse off, he says.*

“Currently under the NHPPD the ratio is about 1 to 3.3, though we are rarely staffed to it.

“As a branch and an interest group we have spoken with Labor’s shadow health minister Ryan Park, but we haven’t had much movement on that unfortunately. I don’t believe Labor understands the situation and I think they really need to.

“It wouldn’t cost a great deal more to slightly increase the ratio in mental health and the benefits of that additional bit of time would outweigh the cost.

“In mental health an extra 15 minutes or half an hour with an individual is a huge benefit to them.

“Our patients require significant resources and take up the most time in EDs as repeat presentations and sitting around waiting for beds in mental health units.

“Properly staffing mental health units would have a flow-on effect in making sure there is less stress on EDs.

“Discussions about health care should not be about political parties – they should be about safety of patients and nurses and the benefits to the state.”

*Editor’s note: Labor is promising no unit or ward will be worse off following the implementation.

 

‘As nurses we need to use our votes far more carefully.’

— Colette Duff, Delegate, NSWNMA Sutherland Hospital Branch

 

We have some clout and we need to use it

This state election may be the last opportunity to rescue the NSW public health system from its understaffing crisis, says ED nurse Colette Duff, Delegate, NSWNMA Sutherland Hospital Branch.

“I think we have a very small window to make some progress,” she says. “If we don’t get some significant change and some hope into this environment very soon, the resignations will keep mounting up.

“Almost every day, our nurses are leaving or saying they are looking for other jobs. I’m looking elsewhere too. I need some hope and at the moment the current government offers me no hope that anything is going to be fixed.

“We are really overworked and the staff is extremely junior. We don’t have enough senior nurses to support the new grads and look after our own patients.

“I want the juniors to be supported like I was supported when I started my career 27 years ago.

“I remember all these fantastic nurses who mentored me, answered my questions, gave me a hug when I needed it, and I feel bad because I just don’t have the time to give today’s new grads the same support.”

Colette says nurses who raise staffing problems are usually told to “make do” or “reprioritise”.

“That’s insulting – I have a master’s degree in critical care nursing and many years’ experience, and if I say I don’t have enough staff to do the job, then the government should be listening to me and other nurses.

“I can prioritise everyone over the person with the broken leg, but that person is still sitting in the corner with a broken leg and they are a human being who deserves better.”

The ALP has pledged to introduce nurse-to-patient ratios of 1 to 3 in all EDs if it wins government.

Sutherland Shire is regarded as a Liberal Party stronghold, but Colette says locals are increasingly aware the hospital staffing crisis needs to be fixed.

“As nurses we need to use our votes far more carefully. We are a fairly big and influential group of people; we have some clout and we need to use it.

“We need to remind our MPs they are accountable to us, the electorate, and not to the premier or the Liberal Party, who are not listening to us.

“We have to show our MPs that if they don’t look after our interests, we will vote them out.”

The state election on 25 March will be a critical moment in our campaign for ratios.

The NSWNMA wants the NSW state election to be a referendum on shift-by-shift ratios, says General Secretary Shaye Candish.

“The election is both a moment for accountability and an opportunity to progress our campaign for ratios,” she said.

“When nurses and midwives cast their ballot on 25 March, we would like you to remember what your lived experience has been like in the workplace over recent years and to vote for candidates who support ratios so we can make things better.

“There is a clear choice between parties that support safe staffing and an incumbent government that clearly does not.

“The Perrottet government does not even listen to nurses and midwives – witness the conspicuous silence after four massive statewide strikes over the last 12 months – and this must change. Without a government that is prepared to listen and to respond to nurses’ and midwives’ warnings, the public health system has a grim future.”

What Labor has committed to

The ALP hasn’t committed to the NSWNMA’s full ratios claim but they have signed up to five key areas, starting with emergency departments. Under a Labor Minns government:

• All existing NHPPD wards will convert to a shift-by-shift system. For those currently at 6 NHPPD, a minimum of 1:4, 1:4, 1:7 enforceable on every shift will apply – with an additional nurse designated as “in charge of shift”/“clinical coordinator” on at least two shifts. Assistants in nursing will be additional to the minimum
• In EDs there will be a move to a shift-by-shift minimum of 1:3 + triage; 1:1 in resus; 1:3 in EMUs and 1:4 in MAUs. A clinical initiative nurse and assistants in nursing are to be additional to the minimum
• In Maternity there will be a full review of Birthrate Plus® in consultation with NSWNMA; shift-by-shift minimum of 1:3 in postnatal wards. Midwifery group practice/midwifery-led models of care will continue
• ICUs will be staffed to the latest Professional Standards outlined by the Australian College of Critical Care Nurses, as relevant to the department
• Multi-Purpose Services with Level 2 ED open 24/7 will get a shift-by-shift minimum of three nurses, two of whom must be registered nurses and two must be FLECC or ENECC trained.

The Perrottet government’s position

As The Lamp went to print, the NSW Government hasn’t moved beyond its announcement from last year’s June state budget when it claimed it would enhance the public health system with 10,148 additional full-time-equivalent staff.

NSWNMA Assistant General Secretary Michael Whaites says there has never been any clarity about how many new nurses and midwives are within this figure, where they will be allocated, or when they will be recruited, and there still isn’t.

“These numbers include a rehash of previous announcements and include the NSW Ambulance service as well as at least 1600 nurses and midwives from a 2019 announcement.

“There’s no guarantee how many will actually be recruited because the government said it would allocate funds to Local Health Districts to use at their own discretion.

“What we do know is ratios are completely off the table as far as the Perrottet government is concerned.”

Other parties

Both the Greens, and the Shooters, Fishers and Farmers Party have committed to support mandated safe staffing ratios.

When nurses and midwives cast their ballot on 25 March, we would like you to remember what your lived experience has been like in the workplace over recent years.

– NSW General Secretary, Shaye Candish

 

‘The result of this election will probably either make or break the health system’ — Shane Slade, RN

“Ahead of the state election, we are raising awareness of our ratios campaign in the area around St George Hospital, where I am NSWNMA Branch President. Understaffing is the number one issue for members, along with excessive workloads. People are being pushed over the edge and doing jobs in excess of nursing. There is an incredible incidence of overtime in the ICU, and it is really hard to fill the gaps because you need someone trained.

“There are some critical seats in and near the hospital, such as Kogarah, held by the Labor leader Chris Minns, and the seats of Rockdale and Oatley, and we are trying to speak with as many candidates and sitting MPs as possible about ratios. We are hitting the ground with letterbox drops and going to train stations and handing out flyers there, and having a chat with anyone who has a minute to stop. We are also using social media: our members at St George are putting messages on Facebook, Instagram and Twitter to share with their families and friends.

“We’ve spoken to all the Greens candidates in the area, and they are very committed to supporting ratios if they win. The Labor candidates have committed to five areas, and they call for ‘safe staffing’, so it is a good start, but there is a long way to go. We’re advising people to ask their local candidates and MPs to support ratios fully, and then ask which candidates best support those.

“It is critically important to set up the public system for the next decade. The result of this election will probably either make or break the health system.

“We are generally receiving quite a positive reaction, and there is a lot of public support for nurses and midwives.”