Danger signs at understaffed ED

"We have spent two years raising the issues at the reasonable workloads committee with no result."
“We have spent two years raising the issues at the reasonable workloads committee with no result.”

Bathurst Hospital board deaf to nurses’ plea for help.

Bathurst Hospital nurses have asked New South Wales health minister Jillian Skinner to visit their emergency department to witness a dangerous staff shortage.

The hospital’s NSWNMA branch wrote to Mrs Skinner and Member for Bathurst, Paul Toole, asking them to visit the ED urgently, following the Western Local Health District board’s rejection of the nurses’ appeal for extra staffing.

“We have asked Mrs Skinner to come and see for herself the unsafe situations that arise in the ED because of short-staffing,” branch president Tatiana Muller said.

Bathurst nurses have also begun a community campaign, holding roadside rallies and calling on motorists to honk their support for more staff.

The nurses have also prepared letters to hand to non-urgent ED patients explaining that they may experience delays because of inadequate staff numbers.

Tatiana said branch members were frustrated after unsuccessfully seeking an extra ED nurse on each shift, for two years.

“We have spent two years raising the issues and presenting data to the reasonable workloads committee with no result.”

Escalation plan ignored

Tatiana says the ED has an escalation plan starting at green through amber to red, but extra nurses have never been provided even when the situation reaches red.

“Red usually means the situation in ED is reaching a dangerous level because you are on bed block and can’t offload ambulances. We are supposed to get extra help in those circumstances but we never do.”

She said the failure of the reasonable workloads process forced the branch to appeal to the board of Western LHD, at a public meeting called by the board, to tell the community how the LHD had performed during the past year.

When the floor was opened for questions nurses handed the board a letter calling for an extra ED nurse on each shift, to cope with greater workloads brought about by increased patient acuity, especially in resuscitation, emergency and urgent cases.

However the board’s chair, Dr Robin Williams, later wrote to the branch effectively rejecting the request. He claimed the number of presentations had decreased and the ED was meeting the required key performance indicators set by the Ministry of Health for the five triage codes.

Patient care compromised

The NSWNMA branch met to consider Dr Williams’ letter and carried a resolution “absolutely rejecting” the response.

“Not one of the issues has been addressed and we remain extremely concerned that patient care continues to be compromised,” the resolution said.   “The board completely ignored the issue of increased acuity, saying everything is okay because we meet our benchmarks each month,” Tatiana said. “Nurses manage to meet their targets through hard work and dedication, but that doesn’t mean it is always done safely or is sustainable.”

Patient numbers at Bathurst ED have grown steadily in recent years, from 22,233 in 2008-09 to 23,870 in 2010-11. While non-urgent presentations dropped from 3696 in 2008-09 to 2558 in 2010-11, emergency presentations rose from 1109 to 1472 in the same period. Urgent presentations went up from 4789 to 6117.

In 2010, the ED averaged 65 patients a day, with an average of more than 21 being emergencies or requiring urgent attention.

To handle all this there are:

  • 3.5 nurses plus a nurse unit manager on the morning shift.
  • Five nurses on the evening shift, including the clinical initiatives nurse who is dedicated to non-urgent cases.
  • Three nurses on night shift.

NSWNMA General Secretary Brett Holmes says these figures show the Bathurst ED is being staffed at the bare minimum, with emergencies and urgent cases averaging nearly one an hour.

He said that until safer nurse numbers are provided non-urgent patients may face extra delays, as nurses focus on emergencies and urgent cases.

“Until now they have been trying their best to juggle both. However, I am advised that has led to a number of near misses and they must now take action to protect patient safety,” he said.