Action pledged on nurse shortage

Sharney Fleming, Jane Cotter and Lorraine Emerton are determined to get results for the Goulburn community.
Sharney Fleming, Jane Cotter and Lorraine Emerton are determined to get results for the Goulburn community.

Management of Goulburn Base Hospital offers to bring forward nurse-to-patient ratios.A decision by Goulburn Base Hospital nurses to close beds in the interests of patient safety has wrung concessions from management, aimed at addressing nurse shortages.

The hospital’s NSWNA branch agreed not to close any beds for three weeks in order to test management’s proposals.

Goulburn Hospital has been plagued by nurse shortages for many years and local nurses were ready to defy management and reduce bed numbers to more safely align them with nurse numbers.

The NSW Nurses’ Association branch at the hospital had resolved to close beds from 7 November unless management took steps to recruit more nurses and, where necessary, restrict admissions to ensure patient safety.

Hospital and Southern NSW Local Health District management offered eight initiatives in response.

These include bringing forward the implementation of nurse-to-patient ratios /Nursing Hours Per Patient Day and 10-hour night shifts in the medical and surgical wards, and postponing elective surgery where necessary (see box).

The government agreed to the ratios earlier this year following statewide industrial action, which began late last year. The ratios were not due to be implemented in Goulburn until March 2012.

Management also offered to close two intensive care unit beds for one month until a nurse is recruited.

NSWNA general secretary, Brett Holmes, said the nurses and midwives at Goulburn had achieved a significant breakthrough.

‘The Goulburn community is entitled to safe patient care and the determination of the nurses and midwives has finally got some sensible action on the heavy workloads at the hospital, which were putting safe patient care at risk,’ Brett said.

NSWNA Branch Secretary Lorraine Emerton said bed closures would be ‘back on the table’ if management’s proposals did not work.

‘There will be no third chance. Some nurses wanted to go ahead with the bed closures as planned, but the majority decided to accept a three-week trial as a gesture of good faith,’ she said.

‘Over the past 10 years we have been working in very stressful and tiring situations with enormous expectations to do overtime. There is no casual pool so no one to cover for absences due to sickness and the like.

‘Staff are simply unable to keep up with current workloads, overtime is through the roof and simply not sustainable.

‘Meanwhile, non-urgent elective surgery goes ahead despite having insufficient staff.

‘We put forward a number of proposals to address the issues but management’s initial response gave us no choice but to develop a plan for closing beds to ensure safe patient care for our community.

‘Regional communities such as Goulburn deserve the best of care, just like city people.

‘We love our hospital, it’s a fundamental part of our community, but things got to the stage where we could no longer carry on. It’s been bubbling away like a volcano and now its finally erupted.’

Lorraine said it could often take months to authorise the recruitment of nurses to rural hospitals.

‘How many nurses can afford to hang around for months waiting for a decision?

‘We employ 14 agency nurses but we don’t have an agency in Goulburn. They have to come from Sydney or elsewhere on short-term contracts, so it’s costing an absolute fortune.’

Lorraine said the branch welcomed management’s offer to look at staff and bed availability daily and cancel elective surgery when necessary as a short-term solution.

‘We don’t want to affect local people and local doctors but we have to do something. It’s very hard to see your workmates so tired that they’re distressed and in tears – that’s not patient safety as far as we are concerned.

‘And driving home after a 17-hour shift – how safe is that?

‘What happens if someone dies as a result of the understaffing? We would all have to live with that, and that’s not fair.’

Lorraine said ED nurses would welcome the offer to undertake a clinical redesign of the emergency department.

‘The ED has been renovated and two beds added but with no extra staff. The throughput there is such that they are on code red most of the time. The people in there have my greatest admiration because they work so goddamn hard.’

Management’s 8-point offer to Goulburn nurses

  1. Assess staff and bed availability daily and, if necessary, postpone elective surgery.
  2. Investigate the way operating theatre cases are managed.
  3. Undertake a clinical redesign of the emergency department, to start at the end of November, with an outcome to be provided to the NSWNA branch in December 2011.
  4. Bring forward, to 30 November 2011, the implementation of nurse-to-patient ratios (based on mandated nursing hours) in the medical and surgical wards, along with 10-hour night shifts for these two wards. Management will also consider implementation of 10-hour night shifts for the rest of the hospital.
  5. Provide dedicated clinical nurse educator support for the emergency department.
  6. Two intensive care unit beds to be closed for one month until a nurse is recruited, and they are not to be reopened in a surge situation without staffing being provided.
  7. Discussions to occur between the Director of Nursing and Midwifery and the After Hours Nurse Managers, regarding management of the intensive care unit workload, and cancelling of operating theatre cases if no beds are available.
  8. Separate Nurse Unit Managers for the emergency department and intensive care unit.