Extra nurse breathes life into Hornsby ED

Gosia Nizik, Anthony Baker, Rosalyn Ferguson
Gosia Nizik, Anthony Baker, Rosalyn Ferguson

There was a hard fight to win them but now newly implemented nurse-to-patient ratios are enabling Hornsby Ku-ring-gai Hospital emergency department to deliver better patient resuscitation care and student training.The emergency department (ED) at Hornsby Ku-ring-gai Hospital on Sydney’s upper North Shore treats more than 30,000 patients a year, many arriving acutely ill and needing resuscitation.

With 52 permanent nursing staff in the ED, equivalent to 40 full time nurses, the nurse-to-patient ratio has enabled new rosters to swing into action for the fast-paced needs of a busy emergency department, with more staffing for peak patient arrivals.

“The nursing staff are very happy with the enhancement; it provides an improved career pathway in acute nursing. It also recognises the demanding and complex work a resuscitation nurse does in the co-ordination (of patient care and treatment),” said Hornsby ED’s Nursing Unit Manager (NUM), Rosalyn Ferguson.

Rosalyn was one of several NUMs that helped the NSWNA explain the operational needs of emergency departments to NSW Health, during our ratios campaign. These NUMs represented country hospitals, city teaching hospitals and major metropolitan hospitals, such as Hornsby.

“It’s very difficult to work ratios out in a clinical area like an emergency department,” Rosalyn said. But the result, she added, “is the biggest enhancement I’ve seen in 20 years of emergency nursing.”

The gains include one-on-one nursing time for patients in the resuscitation room, which is critical, as these patients require intensive nursing care immediately on arrival.

“As soon as we had the funds allocated by the NSW Ministry of Health, the Director of Nursing discussed how to implement the ratios,” Rosalyn said. “At Hornsby we have very good recruitment and retention. People like to work here.

“We need a dedicated resuscitation nurse for facilities like Hornsby, one every shift. The history [at Hornsby] was that the resuscitation nurse was also required to help with the rest of the patient workload,” Rosalyn said.

“It’s exciting that NSW Health adopted this proposal for a dedicated resuscitation nurse. We looked at our patient acuity, analysed the data for the main time frames resuscitation patients presented, and then rostered the first dedicated resuscitation nurse according to patient activity and workload. Staff members were very happy to see this change, and look forward to the next step in the implementation.”

The emergency department team,includes a Clinical Nurse Educator, two full time equivalent clinical NUMs, a Nurse Practitioner, six Clinical Nurse Specialists, Registered Nurses, Endorsed Enrolled Nurses and an undergraduate Assistant in Nursing.

“This enhancement has given us the scope to take a transitional Registered Nurse (new graduate) for 2012. We also have a second year Registered Nurse critical care program. The Hornsby emergency department has a dedicated senior group of Registered Nurses who are looking forward to training resuscitation nurses for the succession planning for our district.”