Regional hospitals don’t receive the higher staffing levels that apply to metropolitan hospitals and it’s usually harder to attract nurses to work in smaller towns.

Located in the town of Bega, South East Regional Hospital services a 300-kilometre stretch of coastline from Mallacoota to Batemans Bay.

South East Regional has an emergency department, medical and surgical beds, a maternity unit, paediatric unit, critical care unit, operating theatres including day surgery, renal dialysis chairs, an oncology area, a mental health unit, a sub-acute rehabilitation unit and hospital in the home.

It opened in 2016 and will provide 135 beds when at full capacity.

As a Group C1 hospital, its staffing ratio is set at five nursing hours per patient day (NHPPD) as compared to six NHPPD for most metropolitan general surgical wards.

That means nurses at Bega and other regional hospitals are expected to care for five patients – one more than nurses in many bigger hospitals.

The disparity goes beyond mere numbers.

“Compared to a metro hospital, we don’t have auxiliary nurses dedicated to ECGs, wound dressings and pathology, for example,” says Diane Lang, president of the NSWNMA’s South East Regional branch.

“Our nurses on the wards have to do the ECGs, the complex dressings, cannulation and bloods.

“We don’t have an X-ray nurse, which means the ward is short-staffed when someone takes a patient to radiology.

“We don’t have 24-hour cleaning, so nurses have to clean beds in the middle of the night, and there’s no after-hours clerical support aside from one person in ED to do admissions and discharges.

“Our after-hours managers on afternoon and night shifts run the whole hospital and are also required to support the met calls, the code blacks, and the ED when it gets busy.

“These factors add to the staff workload and disadvantage our patients compared to patients in metro hospitals.”

Inadequate medical coverage

Medical coverage is also inferior, Diane points out.

“Most metro hospitals have a ward doctor, but we have one junior medical officer covering three wards on weekends and no medical support after 8 pm aside from ED or ICU.

“That makes it difficult for our nurses if, for example, they want to get a fluid order or they are chasing a review of a patient.

“Like most non-metropolitan hospitals, we rely on VMOs. They are usually short stays, which makes continuity difficult and adds to the workload of nurses who have to provide extra support.

“That also adds to the workload of the clerical staff, who have to organise doctors’ accommodation. The accommodation itself is very costly and eats into our budget.”

Inadequate staffing means work is often exhausting.

“You walk out feeling like you haven’t accomplished what you needed to do,” Diane says. “You’re not getting job satisfaction because you’re rushing, and not actually spending time with the patient.”

“A lot of nurses get burnt out and leave the profession, or transfer to something different.”

Diane says improved staffing ratios would make a “huge difference” to patient care 
and safety.

The ED, for example, would be funded for 1:3 plus a triage nurse. At South East Regional, the triage nurse also cares for ED patients.

South East Regional’s NSWNMA branch has been working to get better staffing in the ICU for about two years.

Hard work pays off

The hard work recently paid off when the ICU secured an extra nurse on afternoon and night shift, in the form of a supernumerary, or nurse in charge without a patient load.

“We put in a lot of proposals to get that extra nurse. It really helps because the ICU lost a nurse when they had to respond to met calls, which meant someone else had to cover the shift.”

The branch is now trying to get additional funded staff in ED.

“You never know what is going to come through the emergency door – you could have a quiet evening, or all hell could break loose. Management doesn’t plan for all hell breaking loose.”

There is no agency service nearby, so the hospital relies on casuals or overtime when wards are suddenly short-staffed.

The hospital has improved its casual pool by setting up a bank nurse group, who are not assigned to a specific ward and can be deployed where needed for a month or two.

“It’s getting harder to attract and retain nurses in the area, and adequate staffing would make the job more attractive.”

Diane says incentives are needed to attract more nurses and doctors to regional areas.

“We are a beautiful town of about 6000 people on the coast, but there are disadvantages for nurses looking to come here.

“We are three hours from Canberra and five to six hours from Sydney or Melbourne, and you have to travel to metro areas to get extended education.

“Rental accommodation is in short supply and getting expensive and employment opportunities are limited: you can miss out on a good nurse moving here because there are limited job opportunities for family members.”