NSW Nurses and Midwives Association (NSWNMA) members at Dubbo Hospital voted on Tuesday October 1 to suspend for two weeks the planned closure of the hospital’s Emergency Medical Unit’s (EMU) six beds after hospital management agreed to try and fill, as quickly as possible, the large number of nursing vacancies in the emergency department.
Late last week the nurses voted to close the six beds from Monday, 30 September, and ban unreasonable overtime in the emergency department (ED) from next Friday, 4 October, in response to unsafe nursing levels in the ED.
However, hospital management has now put forward a plan to deal with the high number of vacancies and the nurses are prepared to give management two weeks to implement it. The ED nurses will still refuse to do unreasonable overtime to cover the vacant positions.
During the two-week suspension of bed closures, the nurses will closely monitor the implementation of the management plan and will not hesitate to act quickly, if required, to protect safe nursing levels. A full assessment of the situation will be conducted by the NSWNMA Dubbo Base branch at the end of the two weeks.
Dubbo Base ED has 20 beds, including the six EMU beds, two resuscitation beds, three consultation rooms and a patient chair. The NSWNMA believes there are currently nearly nine fulltime-equivalent nursing vacancies in the ED, including three on maternity leave who have not been replaced. As a result, about 60 ED shifts still have to be filled during the next two weeks.
NSWNMA assistant secretary Judith Kiejda welcomed Dubbo Base management’s belated acceptance of the seriousness of the nursing shortage, but said the issue continues to highlight the need for mandated minimum nurse-to-patient ratios in all hospital clinical areas, including EDs.
“The failure of the Western NSW LHD to fill these positions until things got to this dramatic stage, even with agency nurses while they recruit permanent nurses to the vacancies, proves why local managers cannot be left to handle these things without such compulsory minimum staffing levels.
“The overemphasis on budgets at the expense of patient care and safety is unacceptable in a country like Australia. After all Australia runs one of the cheapest health systems in the world, at less than nine percent of gross domestic product.
“The people of Dubbo and surrounding regions who depend on Dubbo Base deserve better than this from the state Government. It is unsafe for patients and staff not to have these vacancies filled and the ED nurses were right to act decisively. All nurses and midwives have a professional obligation to ensure safe patient care and no employer can ask or expect a nurse or midwife to work unsafely.
“The Dubbo ED is a very busy place and a vital part of the healthcare system for people throughout western NSW. There were 28,061 presentations for the year 2012-13, which has mostly remained the same for the past four years. However, over that time Triage 1 presentations, or life threatening presentations, have increased by 134 per year, Triage 2 have increased by 320 and Triage 3 by 936. Triage 4 and 5 presentations, the less serious cases, have actually decreased over the past four years.
“In recent years there was also a big increase in the length of time many patients stay in the Dubbo ED. In 2008-09, 162 patients were in the ED more than 24 hours. This blew out to 546 last year. So it is absolutely essential that this ED has safe nursing levels at all times,” Ms Kiejda said.
The first round of enforceable, minimum nurse-to-patient ratios was introduced into general medical and surgical wards in most NSW hospitals as part of the 2010-11 award negotiated between the NSWNMA and former Labor government.
The NSWNMA wants the O’Farrell Government to build on this landmark staffing reform by extending the ratios or guaranteed minimum staffing to more clinical units, including emergency departments, children’s wards, intensive care units, community health services and smaller hospitals. It also wants all hospitals to be treated equally, so that the nurse-to-patient ratios are the same in each hospital around the state.
That means, in summary, minimum legally-enforceable nurse-to-patient ratios such as:
• one nurse to four patients or a minimum average of six nursing hours per patient per day in all general medical, surgical and acute inpatient mental health wards in every hospital throughout the state, including all country hospitals
• one nurse per three children in general children’s wards – about 8.5 hours per child per day
• one nurse to three patients in emergency departments
• one nurse per patient in intensive care units, including neo-natal ICUs, and
• a maximum of four hours patient contact time per nurse/midwife eight-hour shift in community health services, including most community mental health services.
In March this year the NSWNMA launched its Ratios put patient safety first campaign to achieve this outcome. Thousands of nurses and midwives around the state, including many working at Dubbo Base Hospital and other Western NSW LHD facilities, held a statewide strike on July 24 as part of the campaign and in response to the O’Farrell Government’s failure to implement this vital patient safety reform.
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