Emergency nurses under pressure

"We are really worried that something?s going to happen to our patients in these circumstances."
“We are really worried that something?s going to happen to our patients in these circumstances.”

Minimum nurse-treatment space ratios essential for safe functioning of EDs.

Achieving a 1:3 staff-to-treatment space ratio is the biggest issue facing emergency department nurses in the Hunter district, says Jillian Thurlow NSW Nurses and Midwives’ Association delegate at Maitland Hospital.

A council member of both the NSWNMA and Australian Nursing Federation (NSW Branch), Jillian has worked in the emergency departments of two Hunter region hospitals in the past four years.

Latest figures from the Bureau of Health Information show Maitland Hospital now has the Hunter’s longest waiting times in emergency in all triage categories.

The hospital’s general manager said there had been a 32% increase in ED patients in 2012 compared with 2011, according to media reports.

Jillian says this is no surprise given that Maitland is one of Australia’s fastest growing inland cities.

“In some emergency departments you could be looking after as many as six patients with the added pressure of a waiting room full of people,” she told The Lamp. “At Maitland Hospital ED the ratio is usually 1:4, which is a lot better than some places but still a challenge.

“A 1:4 ratio gives us only one nurse for two resuscitation beds. If one of those patients needs to be transferred to John Hunter Hospital a nurse usually goes with them. Those left in the department have to do that nurse’s work while looking after their own patients and attending to new patients coming in.”

Jillian says securing a 1:3 ratio for emergency departments is key to the Association’s campaign for a new public health system award, because it will guarantee safer patient care.

“Getting a 1:3 ratio would also give us a 1:1 ratio for resuscitation beds, meaning we would no longer have to prioritise who is sicker and who will get care first.”

She said Maitland Hospital did not have enough staff to assign a triage nurse or clinical initiative nurse to the ED waiting room at night.

“There is only an administration officer present with people in the waiting room from 11pm to 7am. The administration officer calls the nurses within the main department when a new patient arrives or asks for pain relief and either the nurse in charge, or a nurse with a patient load, attends the waiting room.

“A patient’s condition can deteriorate in that situation with a greater risk of infection and even sepsis mortality.

“I was looking after a new patient the other day when I was asked to go out the front to start triaging and seeing to another patient. It was a real struggle to decide which patient would get my attention.

“We are really worried that something’s going to happen to our patients in these circumstances – whether it is a new patient who can’t be assessed or treatment-commenced in a timely fashion or whether it’s our own patient we have left back in the department.

“Often it’s the nurse in charge who goes out front and during that time they have to juggle running the department, triaging and initiating treatment for the new patient, all at the same time.”

Jillian said a 1: 3 ratio in ED would allow nurses to triage and commence treatment in the waiting room as soon as patients arrive during the night – without being at the expense of patients already in the department. She described waiting times at Maitland Emergency as “challenging” due partly to nearby rural hospitals that frequently refer acutely unwell patients, as well as the limited number of other health providers and medical clinics in the area.

Jillian was one of several Maitland nurses who attended the NSWNMA’s recent rally in Sydney to push for a new public health system agreement.

“It’s a real honour to be part of a collective group of nurses advocating for their patients,” she said. “We just want to provide every patient with the same high standard of care we would provide for our own loved ones.

“With the 1:3 ratio nurses would recognise deteriorating patients earlier in their emergency presentation, when adverse outcomes can be reversed or even prevented.

“Studies show this reduces the length of stay for hospitalised patients as they receive optimal and timely treatment, such as the golden hour for antibiotics with patients suffering from sepsis.

“This reduces the chance of requiring aggressive fluid resuscitation, vasopressors and admission to intensive care.

“Decreased treatment costs and shorter hospital stays (and type of stay), save money by freeing up inpatient beds, which in turn reduces the pressures on over-burdened emergency departments.

“I don’t understand why the Ministry of Health has failed to support minimum ratios in EDs. They would deliver additional cost savings in the form of reduced staff turnover and burnout, reduced sick leave and overtime and lower recruitment costs, for example.”