A Local Health District’s refusal to spend $40 a day to re-establish an on-call roster at a small but busy rural hospital, has forced nurses to limit bed numbers.Management penny-pinching has forced Cobar Hospital nurses to limit bed numbers in support of an on-call roster.
Cobar Hospital nurses capped in- patient numbers at five, plus two emergency admission beds, in October, after the Western New South Wales LHD refused to act on low nursing numbers, despite 14 months of trials and negotiations.
Cobar nurses have gathered statistics to show that an on-call roster, at an annual cost of less than $15,000, would actually save the LHD money by reducing its overtime bill. The decision to close beds won strong support from local doctors and the general public.
Cobar hospital has 21 in-patient beds and an emergency department and averages about 10 in-patients a day. It services a town of 5000 as well as outlying farms and a substantial mining industry. Both sectors have significant workplace injury risks.
NSWNMA General Secretary Brett Holmes said the LHD has been staffing the hospital with 52 nursing hours per day. This provides the basic 4.8 hours per patient for an average of 10 in-patients, with only four hours nursing work left for the emergency department.
“Cobar nurses have been arguing for more than a year that this is unsafe – especially without an on-call roster – and a number of recent clinical incidents and near misses confirm their concerns,” Brett said. “Based on the current award rates, we estimate that one on-call nurse, between 11am and 11pm each day, will cost the government just under $15,000 a year or about $40 a day.
“We don’t understand why such an isolated but busy place like Cobar is being denied the protection of a basic level of safe hospital services.”
The hospital previously had two, eight-hour nursing shifts and one six-hour nursing shift for both day and evening shifts – 2.75 FTE staff – until district management scrapped the two six-hour shifts in July 2011.
Management claimed admissions data did not justify 2.75 FTE staff, but nurses said the numbers did not reflect the acuity of the patient load and other factors. Concessions were made after nurses threatened to cap bed numbers and ban some duties. Nurses accepted a three-month trial of new arrangements, including partial restoration of nursing hours, with an escalation plan and on-call roster.
Cobar Hospital RN Genie McMullen said the trial worked well but management insisted on a second trial. This included an escalation plan and on-call roster but no six-hour shifts.
After the second trial management decided to abolish six-hour shifts and the on-call roster, though the escalation plan would stay.
“Losing the on-call roster was a huge blow and we were very disappointed. We lost the security of knowing that there was a particular person available to come in to work in an emergency,” Genie said. “We reluctantly accepted because the trials and discussions had been dragging on for 14 months and we were sick of it, so we thought we would give it a go.
“But it is just not working. There have been emergency situations where it has taken us 40 to 50 minutes to find someone to come in.
“That is unsafe and staff are no longer prepared to continue working without an on-call roster.”
She said it was a difficult decision to close beds. “When bed closures were first brought up there was silence in the room. Nobody wanted to close beds. But when we discussed it we realised it was the only option left.”
Genie said an escalation plan without an on-call roster meant that when patient numbers unexpectedly increased, nurses had to waste time on the phone, searching for colleagues who were available and willing to come in on their day off.
“The nurses on duty should be able to get help immediately, but now we can’t,” she said.
“Management are banking on the fact that in a small community people will come in to work at a moment’s notice, on their days off, because of dedication to their community and colleagues.
“The expectation is you will come in at any time for as long as is needed. That is an abuse of the relationship that nurses have with their employer and with each other.
“There are 19 nurses on staff, with six rostered on every 24-hour period. Some have jobs outside the hospital or have young children so they are not available.
“This means the pool of nurses who can potentially come in to work in an emergency is tiny, and the same few people are being asked to come back in to work. And because nursing hours are so low we have to escalate more than 50% of the time.
“If you are on your day off and still in town, you feel guilty if you say you can’t come in.
“I have had to turn the oven off, with the dinner half cooked, drive my children with me into the hospital and leave them in the tea room waiting for my husband to pick them up when he finishes work.”
Genie said an on-call roster, made up mostly of casuals and permanent part-timers, would actually save money through reduced overtime payments.
“A full timer is not put on the on-call roster unless it is absolutely unavoidable. But with no on-call roster, during an emergency, you don’t look at who is the cheapest option to bring in; you just get the first person you can find.
“We have told the district, if you give us the on-call we can give you savings and we have the stats to prove it, but for whatever reason they are not listening.
“They are wasting taxpayers’ money for reasons we can only guess at.”
Small improvement but big issues remain
As The Lamp goes to press the NSW IR Commission has ruled that:
NSWNMA General Secretary Brett Holmes says that is a small improvement but nurses and patients in the Cobar ED or hospital, still need the professional skills of that additional nurse – who should be on-call.
“Our members are considering their response but remain committed to continuing the fight for safe patient care for the people of Cobar,” he said.
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