‘Every patient deserves the right to excellent, timely and safe nursing care.’
‘Specials put a huge load on what is already a very busy, high-stress department.’
“Every patient deserves the right to excellent, timely and safe nursing care. As a senior nurse I sometimes feel we are letting people down due to staffing constraints,” says Sabrina Sharp, NSWNMA delegate at Royal Prince Alfred Hospital.
An emergency nurse, currently on secondment to another department, Sabrina strongly supports the union’s push to introduce nurse-to-patient ratios in hospital emergency departments.
“The union’s claim is for a 1:3 ratio in EDs, plus a triage nurse and an in-charge nurse. We feel our patients are entitled to that level of care,” she says.
“Currently the ED can have two nurses looking after over 30 people in the waiting room. Some of them should be in beds on monitors but because of bed block there is nowhere to take them.
“The ED never closes its doors. When we are full we are still taking ambulances and attending to increasing numbers of walk-ins. Inadequate staff numbers force us to prioritise people who are in pain, distressed, and need timely treatment and other interventions. It seems like we’re juggling a lot of the time.
“Elderly people could be sitting in the waiting room for hours because of the acuity of other patients who don’t stop coming through the door. And if we don’t have appropriate staff numbers those patients can face lengthy delays to treatment.”
Sabrina says ratios would help to protect the ED skill mix by reducing high staff turnover partly due to some staff leaving in search of less stressful roles.
“The ED gives nurses great opportunities for education and our senior nurses are highly trained.
“The nurses in ED are very passionate about their work and are motivated by their desire to help people.
“Losing them is so wasteful because it’s a huge cost training people to a high level.
“And our junior nurses can’t properly learn if there are too few senior nurses to guide them.”
Sabrina says ED nurses now perform certain tasks previously attended only by medical staff. This was aimed at improving both the flow of ED and outcomes for patients.
“We enjoy working at a high level and it benefits the whole department, but if we’re getting bogged down by sheer numbers we’re not able to do that.”
The NSWNMA claim calls for additional nursing hours to be allocated when a department provides ‘specials’ for patients who require one-on-one care.
“Specials are needed every day and if we have 20 nurses at the start of a shift and three end up assigned to specials, it puts a huge load on what is already a very busy, high-stress department.
“Our staffing claim is based on achieving positive nursing environments where nurses feel they can always deliver the safe and timely care our patients deserve.”
‘It’s not right that smaller country hospitals are still fighting to get what we have.’
Westmead Hospital’s midwifery service benefited from staffing increases achieved through Birthrate Plus, a staffing tool for maternity services won for major hospitals in the union’s 2011 award negotiations.
In 2014, Birthrate Plus achieved a 29 per cent staff increase across the birthing unit, maternity ward, antenatal clinic, and home visits service of Westmead, the state’s second biggest maternity hospital.
Westmead midwife Joanne Robertson, the hospital’s branch secretary and delegate, says it is now time to support the union’s current award claim for guaranteed staffing arrangements at non-Birthrate Plus maternity services.
“The state government must fund smaller hospitals and services to employ adequate staff so that all women and babies across NSW get the care and education they need,” she says.
After 2014 Westmead’s staff ratios and skill-mix gradually eroded until the gaps were filled by recent recruitments based on Birthrate Plus calculations.
“Before the recent intake it wasn’t uncommon to find three or four assistants in midwifery under the supervision of one midwife looking after 41 women and babies.
“Due to the shortage of midwives we had to get assistants in nursing, endorsed nurses and registered nurses from the casual pool to replace people on sick leave.
“A lot of our recent recruits are new midwives and 3rd year bachelor of midwifery students employed as AiMs.
“So it’s quite common to be the only senior midwife on afternoon shift in a full ward.
“Fortunately, the hospital has just employed an after-hours educator to cover the maternity and antenatal wards on afternoon shifts, which will help take a bit of pressure off the staff.”
“The increasing acuity of patients makes it more important to guarantee safe staffing of all hospitals across the state. It’s not right that smaller country hospitals are still fighting to get what we have.”
Government neglecting the bush
“Our patients should be entitled to the same level of care as patients in the big city hospitals, but the state government doesn’t seem to care about the bush,” says Gunnedah District Hospital registered nurse Heather Franke.
Heather, acting secretary of the hospital’s NSWNMA branch, says the government’s refusal to extend nurse-to-patient ratios to small regional hospitals disadvantages her patients.
“Extended ratios would help to overcome the serious, long-term under-staffing that puts the safety of both patients and nurses at risk.”
The hospital serves Gunnedah’s 10,000 residents plus workers at area mine sites. Heather works in the emergency department and 25-bed general ward.
“In ED we only ever have one RN on each shift and at night that person has to cover both the ED and general ward. And sometimes you’re designated in charge of the hospital as well.
“When you’re working in ED at night you might not get down to the ward until 3am. Usually that leaves just two endorsed enrolled nurses unsupervised on the general ward.”
“When we ask for another RN for night shift, management offers to reassign someone from elsewhere, which is not what we want. We want to gain a staff member, not lose one from some other part of the hospital, which is also understaffed.
“Morale here is pretty low but the situation is not well known in the community. We are about to start a campaign to tell local people what’s going on. It’s important to get them onside.”