Country hospital flouts NSW Health policy despite safety risk.

Leeton District Hospital is breaching NSW Health policy by rostering nurses to work alone, a NSWNMA inspection has found.

The current staffing level makes it impossible to provide a safe environment for nurses and patients in the ground floor emergency department and upstairs medical ward at the same time, the inspection report says.

NSWNMA officers inspected the hospital after a patient assaulted a nurse and another patient. Later, another patient threatened a nurse with physical harm.

A single nurse is rostered to work in the ED on day and afternoon shifts and three nurses cover the ward and ED at night.

“Rostering a sole nurse to work in isolation is in breach of NSW Health policy as set out in chapter 26 of the Protecting People and Property manual,” the report says.

It says nurses often have to answer the ED door on their own and retrieve medical records after hours and on weekends on their own.

“There is clear potential for a serious injury to staff or patients to occur,” the report warns.

The 76-bed hospital has poor perimeter security and only one security guard employed for five 8-hour days. The guard is not replaced when on leave and Leeton does not have a 24-hour police presence.

The report calls for an add-itional nurse and a security guard to be rostered on afternoon and night shifts.

It says safety risks are aggravated by a lack of appropriate location finding duress alarms with person-down capability.

The current duress alarm system fails to meet minimum standards in place since 1998.

The alarm alerts a distant security company which then telephones the ward. Ward staff then have to investigate – including finding the source of the alarm – and call the security company for help if needed.

Since the 1998 standards were introduced, new systems have become available that provide “all-in-one functionality including connectivity to telephone, duress alarm, pager, nurse call, fire alarm and door alarm systems.”

These all-in-one systems enhance safety, productivity and communication and are particularly suited to smaller facilities, the report adds.

The NSWNMA’s Leeton Hospital branch president, Robyn Whittaker, said management representatives declined to attend the past two workloads committee meetings. As a result, they could not be held due to the lack of a quorum.

However, Robyn, and ED nurse Kerrie Maguire, met management representatives in October to discuss security issues raised in the NSWNMA report.

Robyn said management reps talked about possible “structural and physical” improvements to security but said they had no authority to discuss nurse staffing levels or employment of a security guard.

“The meeting was the first sign of progress but we’d really like to see progress on our staffing levels,” she said.

“Design changes will help but won’t resolve the issue of nurses working in isolation when the hospital is on two levels.

“On a night shift, the ward can have anywhere from three to 24 patients. When one nurse is working in ED the other two nurses can’t be watching the monitor all the time to check on her welfare.”

In a letter to NSWNMA General Secretary Brett Holmes, the acting Chief Executive of Murrumbidgee Local Health District, Maurice Ahern, said the LHD had taken steps to improve security following the union’s inspection.

They included an upgrade of CCTV cameras, advertising a casual security position to backfill planned leave and installation of swipe card access in the ED and other clinical areas.