Monday 3rd October 2011
Orange Base Hospital Branch closed beds and enforced a bed cap in defence of patient safety, and won a commitment from the Local Health District (LHD) to introduce some wards to the staffing ratios set out in the Public Sector Award.
On 1 September, Orange Base Hospital Branch voted to enforce safe staffing in the medical, surgical and rehabilitation wards, in line with the staffing ratios set out in the Public Sector Award, and staffing in the maternity unit according to Birthrate Plus.
Based on existing staffing levels, this meant beds were immediately closed in a number wards to reach the safer ratios. Six beds were closed in the maternity unit and the remaining 12 beds were only to be used for obstetrics patients. Five beds were closed in the surgical ward, with a cap of 24 surgical beds remaining open, with four surge beds to help relieve bed block in the Emergency Department. Bed numbers were also capped in other wards across the hospital.
Nurses also demanded the cancellation of elective surgery to allow all emergency surgery to be completed.
The Branch also demanded that hospital management abides by the ‘like-for-like’ provision in the award and replace nursing sick leave and absences with nurses of the same classification, which means replacing Registered Nurses with Registered Nurses.
On 1 September, Orange Base Hospital Branch also held a rally, which was attended by more than 30 nurses and midwives, to inform the local community of the staffing shortages and nurses’ concern for patient safety.
A day after the rally and bed closures commenced, the LHD agreed to provide extra funding to introduce the surgical ward to the new nurse-to-patient ratios system from 9 September – meaning an extra 4.58 FTE positions.
An additional new resuscitation nurse for the Emergency Department will also be funded and provided for the afternoon shift, and the LHD has committed to a review of maternity services because it can identify a large increase in birthing at the new hospital. The original calculations for additional midwife positions did not accurately reflect this increase in births.
‘This is a huge win by nurses and midwives at Orange Base Hospital,’ said NSWNA General Secretary Brett Holmes.
‘By sticking together and taking action, Orange Base Hospital Branch won significant staffing improvements. They closed beds to achieve this. These nurses and midwives fought back.
‘It’s never an easy decision for nurses and midwives to take action but Orange Base Hospital Branch was forced cut back services because there were not enough nurses to provide safe patient care,’ said Brett.
Vice President of Orange Base Hospital Branch, Katrina Lee, CNS, said there have been chronic staffing problems at Orange Base Hospital since the move to the new facility in March. ‘There has been increased acuity, referrals, presentations and activity. We’re the major referral hospital in the Central West.
‘There is increased pressure on maternity services as more complicated cases are bypassing the smaller facilities. There has also been an increase in births since the pilot project.
‘In the surgical ward, one nurse is often required to care for up to eight acute patients during the day, and that is far too many to be safe. The skill mix is also inadequate, with Registered Nurses often being replaced by AiNs.
‘We’re at 98% capacity most of the time but staffing levels haven’t adjusted. Vacancies haven’t been filled. There are problems recruiting staff; people just aren’t available to recruit.
‘A lot of nurses and midwives are exhausted. We all have to do massive overtime. Vacancies are not backfilled because there is no casual pool.
‘Workloads are untenable and unsafe. Every day, every shift, nurses and midwives are expected to do their jobs without enough nurses.
‘We have a professional obligation to ensure patient care is delivered in a safe way. That’s why the Branch decided we just couldn’t continue. We’d had enough and we voted to take industrial action to get the government to listen. We closed beds because we do not have enough nurses,’ said Katrina.
Matt McGrath, Branch Secretary and CNS in the hospital’s busy intensive care unit, said: ‘We’ve been understaffed in intensive care for a long time. Management has not been able to fill vacancies. There are not enough nurses available with the adequate skill mix and experience,’ he said.
‘Inadequate skill mix is a serious problem at Orange Base. At the moment, AiNs, ENs, and new grads are replacing RNs – some with 10-15 years’ experience. Not having the right skill mix and experience puts patients at risk.
‘Staff are put in a position where they have responsibility beyond their scope of practice and skill level. This puts them in a position where they risk their registration,’ said Matt.
Brett Holmes said Orange Base Hospital nurses and midwives are to be commended for standing up for patient safety. ‘At a time when the NSW Government is attacking public services, the action by Orange Base Hospital Branch is a brave example of what we may all need to do to defend our services. By sticking together and taking action we can win the fight to defend our public services and the rights of public sector workers.
‘During the campaign for nurse-to-patient ratios, NSWNA Branches learned tools such as closing beds to enforce safe staffing. We let the Government know we were prepared to take action to defend our patients and services. And we will close beds again if services and safe patient care are at risk,’ said Brett.