More nurses ease ED overload


More staff, more reasonable workloads in POW emergency department.

A determined workloads campaign by the NSWNA Branch at Prince of Wales Hospital (POW) has won 248 RN hours per week for the hospital’s busy emergency department (ED).

The boost to nursing staff brings welcome relief to exhausted members who have been struggling with increasingly unmanageable workloads for years.

Liz Ryan, NUM, said there are a number of factors contributing to increased workloads in ED. Presentations have been increasing 7-8% per year, levels of acuity and admission rates have risen and there are more presentations by mental health patients.

‘Patients are sicker than before and they are here longer because beds are not available in wards to move patients out of ED.

‘Workloads used to fluctuate seasonally. For example, there were busy times during winter. Now it’s busy all the time. You can have five or six patients sitting in the ambulance bay,’ said Liz.

‘ED is a very unstable environment. You don’t know what’s going to come through the door.

‘Our workloads are incredibly stressful. People are going home shattered after a shift. They finish physically and emotionally exhausted and are getting burnt out. It’s just getting busier and busier – you’re constantly juggling. We desperately needed an increase in nursing staff, particularly on night shift.’

Liz said excessive workloads pressure puts at risk the safety of nurses and patients. ‘We are very concerned about patient safety,’ she said.

NSWNA Assistant General Secretary Judith Kiejda said pursuing nurses’ right to a reasonable workload is a priority of the Association and is an enforceable provision under the Public Health System Nurses’ & Midwives’ (State) Award.

‘The Award includes a Reasonable Workloads Clause that details procedures to address excessive nurse workloads by working through the local Reasonable Workloads Committee,’ she said.

Members in ED raised the issue with the NSWNA Branch at POW, which took the issue to the local RWC.

Senior Nurse Manager Barbara Daly collected data and prepared a submission for the RWC, demonstrating a strong case that additional nursing staff were required to cover ED workloads. The data included rates of ED presentations, admissions, mental health presentations and discharges. The committee was also provided with a snapshot of workflow across the week.

‘This submission was crucial to the process,’ said Judith

Unfortunately, issues were not resolved at a local level after 12 months of discussion.

In September, Judith Kiejda was visiting nurses on the wards at POW when she was shown the submission. ‘The submission was very thorough and clearly demonstrated there was a serious workloads problem in ED,’ Judith said.

The NSWNA immediately requested an urgent Area Health Service Reasonable Workloads Committee meeting.

The ensuing process resulted in a significant staffing increase. The offer included an extra registered nurse during the day, and three additional RNs on night duty. This means an extra 210 nurse hours for night shifts each week.

Liz said the extra positions were already making a big difference to workloads and nurse morale in ED.

The campaign by the POW members also resulted in a boost to union membership, with at least five nurses from ED becoming part of the NSWNA team after seeing the benefits of sticking together and having the union behind them.