staff-to-patient ratios

The NSWNMA’s award claims aim to give NUMs in the public health system more control over unit staffing.

The NSWNMA claim for improved ratios would help nurse unit managers to staff their units with the nursing numbers and skills they need, says Nepean Hospital NUM Kerry Rodgers.

Kerry, who is NUM of the Operating Suite (Clinical) and a NSWNMA councillor, says if successful, the union claim would give NUMs “more autonomy and greater capacity to staff units the way they should be staffed, with the right skill mix depending on patients’ acuity.”

She says recent Industrial Commission cases brought by the NSWNMA have revealed how upper management in some local health districts have manipulated the existing nursing hours per patient day (NHPPD) system.

“The current Award says NHPPD should be considered as the minimum standard but NUMs find it difficult to make that argument.

“At a lot of hospitals, including Nepean, NUMs have been hamstrung in their efforts to advocate for their wards and obtain the correct NHPPD, including like for like replacement of absent staff.

“For some senior management, as long as you’ve got a beating heart you are an adequate replacement for any staff member regardless of your qualifications and skills.

“Wards have also been short-changed via the use of shorter shifts for replacement staff and the direction to manage ‘specialling’ patients within staffing numbers.

“The 2018 award claim will strengthen the capacity of NUMs to say they need extra appropriately qualified staff due to the high acuity of their patients.”

Equal ratios for all NSW hospitals

The union’s award claim includes equal ratios for all adult medical/surgical wards in all NSW hospitals.

“It is unfair that a ward in a country hospital has to work with fewer NHPPD than a ward caring for the same type of patients in a tertiary hospital,” Kerry says.

“People should receive the same level of nursing care regardless of which hospital they attend.”

The current award says operating theatres should be staffed according to ‘ACORN’ 2008 standards and the NSWNMA 2018 claim seeks to have staffing levels continually updated in line with the release of ACORN standards.

Kerry says applying current ACORN standards would boost staffing of indirect roles such as NUMs and clinical nurse educators.

It would also help non-theatre procedural areas undertaking procedures requiring sedation such as endoscopy units and imaging departments, to gain safe staffing levels.

Our public hospitals need a simpler, more accountable ratios system.

Public hospital staffing based on nursing hours per patient day (NHPPD), must be improved to account for skill mix and daily fluctuations in patient numbers, says nurse unit manager Darryl Petersen.

Darryl, the NUM of Blacktown Hospital’s aged care ward, believes the NHPPD system is “open to wide interpretation” and can be manipulated to reduce effective staff numbers.

He supports the NSWNMA’s 2018 award claim for a simpler, more accountable ratios system.

“We need ratios that ensure we have enough staff with the required skills to care for our patients. The current system gives us staff numbers only,” he says.

Blacktown’s aged care ward has 12 patients plus one flex bed and is staffed by three nurses plus the NUM on morning shift.

“Our staffing is often one RN, one EN and one AiN – the lowest skill mix we can possibly have,” Darryl says.

“This morning I had two RNs and an EN on the roster, but one RN was moved to another ward and replaced with an AiN.

“Replacing RNs with AiNs reduces the level of care available to my patients without a doubt. It means we can’t always attend to their clinical needs in a timely manner.

“Recovery care is sometimes delayed because there are not enough skilled nurses available.”

Darryl says the practice of counting patients at midnight understates the true number to be cared for.

“We quite often use the 13th bed during the day with the number of occupied beds dropping to 12 by midnight.”

He supports the union’s award claim for the in-charge nurse not to be allocated a patient load.

“On mornings I am the team leader for three other staff who carry patient loads. As team leader I manage ward activity such as admissions and discharges.

“However, on afternoon shift, the senior nurse acts as team leader and also has a patient load. That significantly reduces the level of care that can be provided compared to morning shift.

“The same problem applies on nights and weekends to varying extents.

“In order to maintain an equal standard of care for our patients 24/7 we need a dedicated in-charge nurse without a patient load for every shift.

“I would be open to some flexibility about the NUM being the team leader in the morning. But I would definitely advocate a team leader without a patient load for afternoon and night shifts.”

Darryl says inadequate staffing often causes delays in non-clinical care and management of patients.

“In the aged care ward we are very involved with patients’ families. We may be trying to maintain a person’s ability to continue to live safely at home. Or, we are working with a family to make plans for their relative to go into some level of care or service provision at home.

“These decisions require intensive interaction between patient, family and staff and it’s very difficult to do that when we are spread so thin.”

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