The hospital in the Murray River town of Corowa illustrates staffing and safety problems that plague health facilities in rural NSW.
Corowa District Hospital’s emergency department (ED) is staffed by a single nurse working in isolation overnight after 8 pm. The hospital has no security guard, and the local police knock off at midnight.
Two locked doors separate the ED from the acute ward, where understaffed nurses rarely have time to monitor the CCTV link to the ED.
Just one nurse was rostered to the ED across all shifts until December, when the hospital’s NSWNMA branch won funding for a second ED nurse from 11 am–8 pm, usually the busiest period.
Murrumbidgee Local Health District agreed to fund the second ED nurse for three months while the hospital’s Reasonable Work-loads Committee (RWC) worked out a permanent arrangement for safer staffing.
NSWNMA Assistant General Secretary Judith Kiejda said it was an important breakthrough for the branch, which spent 18 months collecting data and building a case for safer staffing.
“The branch’s hard work and persistence has paid off and we will continue to support their efforts to get a lasting solution,” Judith said.
Corowa Hospital has 18 acute beds including cardiac monitor beds, four ED beds and 31 residential aged care beds.
As a ‘D’-rated hospital there is no mandatory minimum staffing ratio. However, the nursing allocation for the acute ward is less than five nursing hours per patient day (NHPPD).
Though the branch worked through the RWC to prove the need for a second ED nurse, the Local Health District (LHD) did not approve a staff increase until after NSWNMA branch members voted to lodge a dispute with the LHD.
“We had a great turnout at the branch meeting and the decision to go into dispute restored people’s faith in the process,” said branch president, Erin McMahon. “We knew we were potentially going to get somewhere instead of going around in circles.”
Erin said to operate safely, the ED must permanently retain the second nurse from 11 am–8 pm and roster a second nurse on night shift to “float” between the ED and the acute ward.
“It’s an incredibly risky thing to be working in the ED in isolation, especially overnight, which is potentially the most dangerous shift,” she said.
“We can call a security contractor who can supply someone within the hour. It’s a long time to wait if you’ve got a dangerous situation.
“Corowa police service a huge area and are generally not on duty after midnight. After that time, we have to call the area police station, which is about 45 minutes’ drive away.
“At times, the ED nurse is actually in charge of the hospital. So, when a patient is deteriorating, the ward nurses might have to consult the ED nurse. That means she has to leave the ED unstaffed.”
Getting a second ED nurse from 11 am–8 pm is a welcome improvement but it has unintentionally created a staffing problem in the acute ward.
The hospital has been forced to fill the ED position by taking nurses off the acute ward because agency nurses have been unobtainable for several months.