Compromise cascades through wards

A key objective of a recent research project was to assess the range of staff, clinical and infrastructure resources in New South Wales’ public hospitals and compare them across different peer groups.

Administrative and clinical support

For nurses and midwives in F3 facilities (multi purpose services) there is virtually no administrative support outside of weekday mornings.

Nurses and midwives working outside of Peer Group A (principal referral and specialist hospitals) and B facilities (major metro and non-metro hospitals) are more likely to have no admin support at all. 46.5% of respondents in D1a (community acute with surgery) reported this.

It is not just RNs and RMs who lack administrative support. It is also true for unit managers.

“Administrative support for NUMs is still not provided routinely despite the recommendations of the Garling Report,” said a NUM from a metro hospital.

Similarly, nurses and midwives in the smaller, rural and regional facilities are less likely to have a team member without a patient load who is able to provide support when needed.

  • 84.8% of respondents in F3 facilities reported no “in charge without a patient load”.
  • 74.1% of nurses and midwives in D1b facilities reported no “in charge without a patient load”.
  • The level of clinical support from a CNE/CME in these facilities is minimal or non-existent. In some D1b facilities a CNE/CME is available on some weekday mornings although 56.6% of respondents in this group reported no availability of a CNE/CME. A respondent from a country Hospital said “the CNE is shared with three other hospitals, thus only see her once to twice a week”.
  • 92.3% of respondents in Peer Group D2 have no access to a CNE/CME on site.

Ancillary staff

Participants in the study were questioned about the availability of ancillary staff such as a wards person, cleaners, security personnel, blood collectors and ECG technicians.

An ECG technician is rarely reported outside the metropolitan hospitals and is not found at all in D1a and D1b facilities.

One would expect to find a cleaner in all facilities but this was not so. One respondent from a metro hospital said “cleaners only work half days on weekends – patient care activities and waiting rooms have the same traffic. The place is just grubby and dirty”.

Wards people/porters were also not found across all facilities.

There were concerns about the availability of security personnel across all the peer groups.

“Security for our hospital is provided by the campus and it sometimes takes a long while for them to show up as they could be with an aggressive patient (on another part of the campus),” said a respondent from a metro hospital.

In the absence of ancillary staff, nurses and midwives are required to multitask and incorporate non-nursing duties or indirect patient care into their workloads.

“The worst thing is having to clean and make our own beds, including the birth suites following a birth. It takes a lot of time and is not a clinical task,” said a country midwife.

Allied Health personnel

Participants were also questioned about the availability of allied health personnel such as radiographers, physiotherapists, occupational therapists, social workers and pharmacists.

The overall trend of these roles is to be less frequently found outside of weekday mornings and less frequently found at all time periods, or not available at all, in peer group D and F3 facilities.

The lack of allied health staff has implications for patient outcomes and for the workloads of nurses and midwives.

“Our occupational therapist is in another town and comes after a referral is sent – maybe in the next week. The physio is also on an arrangement and comes twice a week, so rehab is essentially up to the nursing staff,” commented a respondent from a country hospital (D1a).

Medical staff

D1b, D2, and F3 facilities have little access to medical specialists, registrars or residents. The medical support at such facilities is provided by a VMO/GP.

“I cannot stress how understaffed the medical department is here. There is no doctor on site after 6pm weekly and difficulties arise as to who will make medical decisions on these patients out of hours,” wrote a nurse from a country hospital.

What nurses and midwives had to say:

On failing their patients

“You do not get time to spend on patients’ emotional and psychological needs or [to] just be with them. All our time is spent on reports and the patients’ physical needs, stocking up, tidying rooms …” — Country MPS (F3)

On ancillary staff

“Ancillary staff, such as equipment officers, are not replaced for annual leave thereby the responsibilities are left to the nursing staff on top of their existing workload and the stores ordering is sent into chaos. Restocking and unpacking of stores falls to senior staff with no patient load, such as NUM3 and CNC – not very cost effective.” — Metro

On Allied Health workers

“No speech pathologist to assist with swallowing problems in patients … especially post-stroke. No social worker or local mental health provider means that psychosocial issues also have to be managed by clinical staff (often on the run). — Country (D1b)