NUMs support safe staffing

Lamp-March-2010

The NSWNA hosted forums on safe patient staffing for N/MUMs and Nurse Managers.

When it comes to staffing and workloads, N/MUMs are ‘stuck between a rock and a hard place’, said NSWNA Assistant General Secretary Judith Kiejda at a N/MUM Society forum hosted at the NSWNA.

‘N/MUMs have an impossible struggle to develop rosters that ensure safe patient care with decreasing numbers of RNs; they are concerned about low morale on their wards and responsible for staff who are stressed and thinking about leaving because of the ongoing strain of excessive workloads; and they are pressed from managers above to cut budgets and fulfill their roles with fewer and fewer resources.’

The NSWNA hosted forums for the N/MUMs Society and Nurse Managers to explore issues around safe patient care and the nurse ratios model as a more effective staffing solution in NSW.

Safe patient staffing top priority in pay campaign

General Secretary Brett Holmes told N/MUMs and Nurse Managers at the forums that safe patient staffing was a top priority for the NSWNA in its negotiations with the NSW Government for the new Public Health system Award.

‘As part of our preparations for the pay campaign we’ve consulted with members in forums and carried out a survey about their concerns and priorities. Yes, they want better financial outcomes but they also want the Government to improve their workloads. As one member put it: “If we don’t get more staff, $100 hour won’t be enough”,’ Brett said.

‘The support and input of N/MUMs and Nurse Managers is crucial to addressing the staffing crisis that is crippling NSW public hospitals and putting patient safety at risk.’

Brett acknowledged it will be very challenging bargaining for a new staffing model with a State election looming and financial pressure due to the Global Financial Crisis.

Reasonable Workloads Tool has not worked

Brett told forum participant, ‘Previously, we campaigned for the Reasonable Workloads Clause – Clause 53 – in the Award, with a Reasonable Workloads Tool to measure workloads,’ he said.

‘The Reasonable Workloads Clause was an important industrial win that legally enshrined nurses’ right to a reasonable workload.

‘However, in practice the Reasonable Workloads Tool has not worked well enough. Monitoring was not mandated in the Award and it hasn’t resulted in the expected outcomes. N/MUMs are so overloaded they don’t have time to continuously collect and collate the required data, and there have been problems accessing data from management.

‘Clinical settings have become more complex and acuity has increased so the general tool can’t be used in most wards in NSW. No one has come up with a magic tool that fits all.

‘Rather than addressing workload problems, staffing problems are getting worse.

‘The time is right to consider mandated nursing numbers for key specialties,’ said Brett Holmes.

Nurse ratios will ease N/MUM workload

Judith Kiejda told N/MUMS at the forum, ‘Nurse ratios is a blunt model but it makes your jobs easier. You’ll have the budget to roster a safe staffing mix. Staff morale will be lifted and a sense of pride in the nursing profession will be restored.’

Karen Draddy, Vice President of the N/MUMs Society, agreed that staffing and safe patient care should be a high priority in the NSWNA’s pay campaign. ‘Nurse ratios is the way to go. I think you’re on the money,’ she told the forum.

Nursing Professor backs nurse ratios

Also on the side of the nurse ratios model is Professor Christine Duffield from the Faculty of Nursing, Midwifery and Health at University of Technology, Sydney.

Professor Duffield said, ‘It was a difficult decision to back the push for nurse ratios but I’m here because I’m concerned about patient care.

‘I had long believed that decisions about staffing should be made by the person in charge of the ward. But it hasn’t worked,’ she said. ‘Staffing is getting worse to the point where safe patient care is at risk. We have to do something. In my opinion, nurse ratios is the best solution.’

Professor Duffield said the critical factor to keeping staff and patients safe is skill mix. ‘Skill mix should be measured by the percentage of RNs rostered. As the percentage of RNs increases, the percentage of adverse patient outcomes decreases.’

It’s a conclusion reached after two major research projects on nurse workloads and staffing and the impact on patient care.

Professor Duffield’s extensive study of staffing in NSW hospitals, Glueing it together – nurses, their work environment and patient safety, shows that skill mix and nurse workloads are getting worse and the hours of care received by patients is decreasing.

The study showed a direct link between the percentage of RNs or skill mix and nursing-sensitive outcomes. A higher proportion of RNs resulted in decreased rates of:

  • Decubitus ulcers, gastrointestinal bleeding, sepsis, shock, physiologic/metabolic derangement, pulmonary failure as well as failure to rescue;
  • Fewer falls;
  • Fewer medication errors.

Professor Duffield said nurse ratios are essential to halt the decline of our health system. ‘As well as ensuring safe patient care, nurse ratios will give nurses pride in their profession and defend the RN role. It offers nurses leadership and hope.’

Dr John Buchanan from the Workplace Research Centre, University of Sydney, also addressed the forums on the ANF Victoria’s path to adopting nurse ratios (see story page 21).

We need creative staffing solutions

President of the Nursing and Midwifery Unit Managers Society, Samantha Faithfull, said rostering and skill mix issues are a major concern among N/MUM Society members.

‘N/MUMs are concerned about the effects on patient care and safety of a staffing mix that contains less experienced RN/Ms and an increased number of lesser-trained or experienced staff.

‘Many N/MUMs think that safety is already being compromised and will deteriorate in the coming years with the expected accelerated loss of experienced RNs/Ms from the workforce,’ she said.

‘With less experienced RNs/Ms and an increased number of lesser-trained or less experienced staff, there is increased difficulty rostering a safe skill mix. It is difficult building rosters to ensure there is an appropriate skill mix without taking into account day-to-day fluctuations such as leave,’ said Samantha.

‘One minute a roster can look great with minimal requirement for agency staff, but then someone is sick or needs leave and a reasonable roster is turned on its end. The N/MUM or RN/RM in charge then needs to look for someone to swap a shift, do overtime or engage agency staff.

‘Having an agency nurse is “a valuable pair of hands”, but one cannot rely on agency staff  to take responsibility for the more acute or critical patients as their skills are unknown to the N/MUM,’ said Samantha.

‘We need to be creative in finding a solution to staffing problems. Nurse ratios should be explored as a possible solution. The N/NUMs Society of NSW is keen to work collaboratively with the NSWNA in pursuing this.

‘N/MUMs should be leading the change and be part of finding effective staffing solutions. I strongly recommend that all N/MUMs join the N/MUMs Society of NSW so you can have input and be part of discussions at this critical time,’ said Samantha.

To join the N/MUMs Society of NSW, go to www.numsociety.org.au or email the Admin Assistant on lsaunders@numsexecadmin.optusnet.com.au

Nurse ratios staffing remedy

Karen Draddy, Vice President, N&MUMs Society of NSW, said nurses at Mona Vale Hospital are very concerned about workloads and staffing. ‘We’ve had some difficulties accessing the Reasonable Workloads Committee to address these concerns and we’re hoping to re-ignite the committee with some new representatives and passion.’

Karen agrees that staffing and safe patient care should be a high priority in the NSWNA’s Award negotiations. ‘We urgently need a more effective staffing solution. I believe nurse ratios is the way to go, especially if they have built-in skill mix, acuity and environmental considerations.’