Members act on chronic understaffing

Adrian King
Adrian King

Bed closure plan gets results at MuswellbrookMuswellbrook District Hospital has secured an extra nurse and an urgent review of staff levels thanks to a move by nurses to shut beds due to chronic understaffing.

The hospital’s NSW Nurses’ Association branch decided to close 10 beds – about one third of the general ward – so they could more safely care for patients in the emergency department (ED) and high dependency unit (HDU).

The decision brought swift concessions from Hunter New England Local Health District management after eight months of fruitless requests and talks.

Following a hearing before an Industrial Relations Commissioner in Newcastle, management agreed to roster an extra nurse on the ED for four hours on weekday evenings as a six-month trial.

Management also began an urgent two-week review of night shift staff levels and workloads.

In reply the NSWNA branch voted to withdraw their industrial action but also launched a campaign to enlist community support for improvements to the hospital, the largest in the Upper Hunter. A group of seven nurses has volunteered to get flyers and a petition to the community.

Branch secretary Adrian King RN said the hospital urgently needed an extra RN on both evening and night shifts.

‘At first management said no to any more staff, but later offered an enrolled nurse or registered nurse Year 1 or 2,’ Adrian said.

‘Members were concerned that nurses working in ED needed to be able to triage and work independently and not be thrown in to learn at the deep end. The extra staff rostered should be an RN.

‘The branch decided to stop discharging people from the computer, which got negotiations going, but it wasn’t until we decided to close beds that management made some serious offers.

‘Members were angry that their concerns were being ignored and were ready to act. Nurses were discussing closing beds in a way that would not compromise patient care.

‘We needed to close 10 beds to bring us into line with the nursing hours per patient day (NHPPD) ratio we are supposed to be working towards.’

The 33-bed general ward currently has four nurses on the evening shift and two on the night shift.

But an RN is often forced to leave the ward area to assist the lone RN in ED/ HDU – which then leaves the ward unsafely staffed.

‘On night shift, an endorsed enrolled nurse is often left to care for 10-20 patients on the ward by themselves,’ Adrian said.

He said the escalation plan also needed an urgent review.

‘The person we call in is usually a full time staff member, which means we start taking staff away from the next shift.

‘And if we need help in the ED we need someone there now, not in half an hour after someone gets out of bed and drives into work.’

Adrian said the hospital’s antiquated layout made working conditions even more difficult.

‘Every single member of the public we speak to agrees we need a better hospital with more staff. Now we are engaging with the community and asking our local MP for support.

Management’s record of inaction

Only one registered nurse is rostered on to Muswellbrook’s emergency department and high dependency unit, which are separated by a corridor.

Between April and June this year 2005 people attended the ED – an average of more than 20 a day or nearly one every hour. Of these more than 500 presentations involved conditions that were imminently, or potentially, life threatening. More than 200 had to be admitted to hospital.

‘It is hard to see how one very busy ED nurse can also be responsible for patients in the HDU,’ said NSWNA General Secretary Brett Holmes.

‘The ED would be demanding constant attention and clearly requires a full-time nurse.

‘The nurses, on all shifts, have been forced to juggle their patient responsibilities to cope with an ever changing and unpredictable patient environment. That is not safe for the patients or the nurses and midwives.

‘Nurses and hospital management are also trying to cope with more than

3.5 full-time nursing vacancies at the moment, which adds to stress levels.’

Brett said hospital management had been regularly warned about under-staffing.

‘As far back as 2005 a staffing review at Muswellbrook recommended an extra nurse on the evening and night shifts. Management did not act on that recommendation.’