Friday 22nd February 2008
Swamped by routine administrative tasks, NUMs have little time for crucial responsibilities.
Nurse and midwifery unit managers in NSW are at ‘breaking point’ and are unable to cope with increased non-clinical duties forced on them by successive restructuring of the public health system.
Responsibility for management and administration has increasingly been dumped on M/NUMs who lack adequate clerical, IT and other administrative support.
Patients and nurses are disadvantaged because M/NUMs are unable to spend enough time exercising their high-level clinical skills, supervising and mentoring other nurses and midwives, and implementing best practice.
This is a key trend reported by M/NUMs surveyed as part of research by the NSW Nurses’ Association into state public sector nurses’ attitudes to working conditions.
The union has conducted discussion groups involving M/NUMs and maternity unit managers from Sydney and regional and rural NSW.
All M/NUMs said they were obliged to put in many hours of unpaid overtime each week to try to keep up with the administrative workload.
Most M/NUMs surveyed said they spent more than half their time on non-clinical related tasks. For some it was 80% or more.
The three biggest non-clinical tasks forced on to M/NUMs in the last two years have been human resource functions, new IT systems and data entry, and ordering of stores.
M/NUMs said the solutions to their own and their staff’s excessive workloads were more staff, increased budgets, proper skill mix and more administrative support.
They said nurses were increasingly reluctant to work nights and M/NUMs found it harder to fill night shifts. Improved penalty rates were the only solution, they believed.
Rostering, always a difficult and thank-less task, has become more time-consuming as M/NUMs try to offer staff greater flexibility in order to attract and keep them.
A shortage of clinical nurse and midwife specialists and clinical nurse and midwife educators means reduced supervision and monitoring especially on general wards. Student nurses do not always get the supervision they require and deserve.
Mental health in particular has huge problems with a lack of skills and lack of CNEs to support nurses.
Midwifery unit managers said they had received no additional staff and resources to cope with an increased birth rate.
NUMs agreed that better administrative support was critical to reduce their non-clinical workloads and risk of burnout and to keep them in the system.
NSWNA calls for more support
NSWNA General Secretary Brett Holmes is calling on the Health Department and the NSW Government in general to put more funding into positions like ward clerks so NUMs can focus on developing their team in order to deliver the highest possible quality of care.
’Better nurse recruitment and retention cannot be delivered unless NUMs have this support reinstated,’ Brett said.
Two millstones around the neck of the M/NUM
M/NUMs are now responsible for recruitment, annual leave planning, rostering, pay and incident reports.
Organising recruitment is plagued by illogical, cumbersome process and management delays.
The lengthy process of obtaining permission to fill a position is just the start. M/NUMs are then required to organise the advertisement, the interview panel, the interviews, referral checks, immunisation checks and all associated administrative tasks.
‘We need eight people sign off on staff recruitment and it takes about three months to go through the system,’ one Western Suburbs NUM said. ‘If there is any little change then it has to go back through the system and that is another three months and the person has taken another job!’
Computers and data entry
Computer systems are introduced with inadequate training and little or no ongoing IT support.
Inadequately trained M/NUMs are often required to train their own staff in new systems.
When the system fails or M/NUMs encounter other technical difficulties they have trouble finding technical support.
Some M/NUMs report they personally have to enter all patient details into the data system before the patient can be cared for. This means it is always an urgent job which takes priority over other important tasks.
Area health service managements generate excessive numbers of emails which the M/NUM has to read and respond to.
M/NUMs are doing a lot of data entry. As one NUM put it, ‘we have become expensive ward clerks.’