Closing Beds Wins More Staff

Sue Kendall, President of NSWNA Coffs harbour Mental Health Branch and Jack Schwartz, Vice President
Sue Kendall, President of NSWNA Coffs harbour Mental Health Branch and Jack Schwartz, Vice President

Breakthrough for mental health nurses. A campaign of bed closures has delivered a major breakthrough for safer staffing levels in the Coffs Harbour Mental Health Services.During a hearing in the NSW Industrial Commission, management guaranteed to roster eight nurses on morning and afternoon shifts and four on the night shift at the 30-bed acute mental health unit.

In return the NSW Nurses’ Association mental health branch reopened six beds it shut during the campaign of bed closures.

The 8:8:4 roster was a key demand of the branch, which had been battling for more staff for at least two years. Previously the unit had seven nurses on mornings and afternoons and four at night.

NSWNA General Secretary, Brett Holmes, said management of the Mid North Coast Local Health District also agreed to fast-track the implementation of nurse-to-patient ratios according to the Nursing Hours Per Patient Day (NHPPD) model.

The NSWNA secured these ratios for most NSW hospitals following a public campaign in 2010. They are due to come into effect in June next year.

Brett said the Coffs Harbour nurses correctly decided they could not safely continue their high levels of overtime and double shifts.

‘They were burning out and many were considering leaving, which would have made the vacancy situation worse,’ he said. ‘The safest thing to do, for all concerned, was to take this action (bed closures) while recruitment efforts were beefed up.

President of the union’s mental health branch at Coffs Harbour, Sue Kendall, said the branch voted unanimously to close beds after more than two years of fruitless negotiations.

Sue said nurses were concerned about working in an environment that was unsafe for both patients and staff. The branch had raised the issue at the Reasonable Workloads Committee as far back as November 2009.

She said two high dependency beds and four acute/sub acute beds were closed in the 30-bed unit. This meant only those beds that could be safely staffed remained open, after existing patients were discharged.

‘It wasn’t difficult to get nurses to agree (to close beds) because they have had to work in an unsafe environment under great stress for so long. Nurses were worried about what might happen to a patient as a result of the pressure,’ Sue said.

She said management had agreed to re-establish an active Reasonable Workload Committee, where nurse and management representatives would meet fortnightly, to discuss issues such as rosters, recruitment and the skill mix.

‘We need to follow up the 8:8:4 agreement and make sure recruitment happens as quickly as possible.’

How the dispute unfolded: a timeline

INTRO: 2 September 2011 The Coffs Harbour NSWNA Mental Health branch resolved to impose work bans, including closing beds, from September 26 ‘unless management satisfactorily addresses the problem’ of insufficient staffing.

14 September

A further branch meeting reaffirms the motion and decides to seek union head office help in applying work bans.

22 September

The branch gives management yet another chance to provide safe staffing before bed closures take effect. The branch asks for a list of all vacancies and requests a meeting with Local Health District (LHD) management and a NSWNA organiser, to discuss immediate recruitment.

The branch resolves that from 26 September, members will ban non-essential paperwork (i.e. MHOAT, seclusion review, medication chart reviews, etc.) and gives the LHD until 17 October to find enough staff before beds are closed.

29 September

The meeting with LHD management makes insufficient progress. The branch meets and decides to escalate the campaign by closing beds from October 3.

1 October

Management offers to supplement staffing with another security officer on two shifts until they can find more casual and agency nurses. The branch meeting decides this is unacceptable because:

  • patients’ greatest need is adequate therapeutic treatment with sufficient numbers of nurses
  • filling nursing positions with a security guard does not lessen the workload on nurses and would still require the NUM to take a patient load
  • using security staff without mental health experience would simply add to the nurses’ workload.

The branch reaffirms its intention to start closing beds from 3 October, unless the unit can be staffed by nurses according to the 8:8:4 shift profile.

5 October

With bed closures underway, the branch meets to consider a management letter outlining efforts to fill vacancies, including a pledge to meet 7:7:4 staffing by 10 October without overtime. …continued overleaf

The branch unanimously adopts a resolution pointing out that, ‘This has been an ongoing, long term issue and promises have been made in the past that have not come to fruition. The branch will not consider reopening closed beds without a written commitment from management of their intention to staff to 8:8:4 and a timeframe for implementation. The branch says this would be an interim measure until NHPPD can be implemented earlier than scheduled.

The six beds will remain closed until the eighth staff member is rostered.’

6 October

Union officials hold a teleconference with Area mental health management who agree to an 8:8:4 roster ‘as soon as staffing becomes available’ and other concessions. Management proposes that some beds remain closed while others reopen.

A branch meeting welcomes the acceptance of 8:8:4 but says management’s proposal on bed closures does not address the issue of patient and staff safety. The branch puts forward an alternative bed plan with other measures, including weekly staff recruitment updates from management.

LHD management notifies the Industrial Relations Commission of an urgent dispute.

7 October

The Commission recommends management immediately roster 8:8:4 pending recruitment to make the new rosters permanent, bans be lifted on the six mental health beds while three ED beds be closed.

Branch members considered the recommendation and decided to keep the six beds closed but as a gesture of good faith, accept three patients from the ED. Meanwhile the branch would monitor management’s ability to roster 8:8:4 over the weekend until a further Commission hearing on 10 October.

10 October

The NSWNA confirms that the 8:8:4 roster is operating and management pledges to continue it, with agency and casual nurses as an interim measure until positions can be permanently filled. The beds are now open while the agreed staffing arrangements remain in place.