No compromise on safe community care

Community nurses are planning to take greater control over staffing to ensure adequate patient care.

Working too much overtime, too busy to take meal breaks, then a staff member goes on annual leave and is not replaced – leaving you to carry the extra load with even less time for your patients.

That scenario is increasingly familiar to community health nurses not covered by the nurse-to-patient ratios won by the NSW Nurses’ Association in 2011.

With patient numbers, age and acuity on the increase, understaffed nurses fear that safe patient care in the community setting is being compromised.

A NSWNA team, led by Assistant General Secretary Judith Kiejda, has been meeting with community and community mental health members around the state as part of a campaign called Take Control of Your Day: There’s No Reason to Wait.

“For too long community health has been the silent health service, with members feeling they are the poor cousin of hospitals. The time has come to get community health on the agenda and work together to redress this,” Judith said.

During their regional visits the NSWNA team gave a presentation on Award entitlements, the process of raising staffing concerns locally, and ways of developing plans to achieve safe and competent community care. They also distributed a handbook – Nurses and Midwives: Organising for Safe Patient Care – a guide to take community nurses through the process and empower them to take control of their day.

Judith says all nurses have a professional obligation to provide safe and competent patient care and to ensure that such care is not compromised by any circumstance, including unsafe staff levels.

She added that the Public Health Nurses and Midwives’ Award clearly gave nurses and midwives an entitlement to a reasonable workload, but more importantly, our communities are entitled to safe patient care.

The NSWNA handbook advises community nurses to initially raise staffing concerns with their Nurse Unit Manager or team leader and to suggest solutions where possible. If problems cannot be solved at the local level they should be referred to the next line manager.

If management still cannot resolve the issues they should be referred to a Reasonable Workload Committee (RWC), where one exists. If the committee cannot find a solution within a reasonable time then the problem becomes a grievance and there are processes within the Award to escalate unresolved staffing issues. If there is no RWC, or management can’t resolve the issue, that’s not the end of the story.

“If nurses are too short-staffed to safely and adequately meet patient care demands, then one solution is to reduce activity to meet staffing levels, such as cancelling non-urgent home visits and clinical appointments,” Judith said. “Taking the decision to reduce services away from management reinforces your commitment to safe patient care and lets them know you take your professional obligations seriously.

“Nurses should involve their local branch and NSWNA head office before commencing any action. The union will work with nurses to plan and organise a local campaign for safe patient care.

“What may work for one service may not work for others. It is imperative that strategies do not put clients or staff at risk.”


Get the handbook

Nurses and Midwives: Organising for Safe Patient Care is a handbook that guides community nurses through the process of securing safe and reasonable staff levels.

To obtain a copy, email

Phone (02) 8595 1234 or 1300 367 962 from outside Sydney


How to get safe staffing

What can union branches at community health services do to guarantee safe staffing? Here are some examples:

Public campaign

A community palliative care service starts a weekend on-call service for end of life care clients. As client numbers increase so does the frequency of call outs, leaving weekday nurse numbers depleted. Members decide to form a coalition with key stakeholders (clients, carers, family and a local Palliative Care Support Group) to publicly campaign for increased staffing for safe patient care.

Limit client numbers

A child and family health service has not met NSW Health home visit program benchmarks. Child and family health nurses are working hard to meet key performance indicators, however increasing birth rates and vacant positions are proving problematic. The branch agrees to see a maximum of four clients per day to ensure safe, appropriate levels of care can be provided. The branch also agrees that their community should be told why the number of visits are being reduced and ask the community for their support and understanding.

Refuse non-urgent referrals

A generalist community health service experiences increasing referrals with no additional resources. Community nurses get speeding fines while trying to visit all allocated clients and are concerned that the quality of care provided is unsatisfactory. There is no locally agreed face-to-face time ratio. Members agree that non-urgent referrals will not be accepted until a local face-to-face time ratio is developed and additional resources are provided so that a reasonable workload and safe patient care can be delivered.

Ask management to prioritise

The Department of Health reviews the use of health service vehicles. A community health service loses one car that the department decides is being under-used. With reduced access to vehicles, nurses must start earlier and finish later, working unpaid overtime to meet client care needs. The local NSWNA branch unanimously resolves that unpaid overtime will be claimed and that if management declines to pay overtime rates, nurses will no longer start early or finish late. Management would then need to prioritise which clients receive a visit and which do not.


Sydney community health meeting

Metropolitan community and community mental health members are invited to attend the Take Control of Your Day: There’s No Reason to Wait presentation on Tuesday 15 May from 5.00–6.30pm at the NSWNA office, 50 O’Dea Ave Waterloo. This will be followed by a barbecue and Committee of Delegates meeting from 7.15pm. Members are welcome to stay for the meeting as observers. Please RSVP by email to for catering purposes.

If you would like a visit from the Association to hear about this important campaign, please email