Plan to close beds gets results

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Staff shortages eased at Dubbo Base Hospital emergency department after nurses voted to close beds and ban excessive overtime.

Micheal Harper and collleagues, Dubbo Base Hospital.

Micheal Harper and collleagues, Dubbo Base Hospital.

Dubbo hospital branch of the NSWNMA voted to close the six-bed emergency medical unit (EMU) and refuse to work unreasonable overtime in the emergency department (ED), unless management put an end to unsafe staffing arrangements.

Management moved quickly to fill gaps in the roster following the vote.

A fortnight later nurses reported that both staff numbers and the skill mix in the ED were improving.

“Members are pleased that management has acted on our concerns,” branch secretary Micheal Harper said. He said the issue had been building for months.

“Branch members were pretty determined to do whatever it took to improve safety. They believed closing beds was the only action left open to them,” he said.

“Management said they were the only ones who had the right to close beds. However we told management that under work health and safety law they had an obligation to provide a safe working environment.

“There were too many junior nurses and people were working short all the time.

“ED nurses believed they could no longer provide the community with the safe level of care they were entitled to. Patients come here expecting to be in a safe environment and we need to be able to provide the appropriate skill mix and staffing levels.”

In mid-September, ED nurses reported that the 20-bed ED had 7.2 FTE (full time equivalent) vacancies including nurses on leave. In the period 16 September to 13 October there were 127 gaps in the roster including 71 shifts with shortages of experienced nurses: 26 in the resuscitation area; 16 in triage; 13 in the clinical initiative role; and 16 in the nurse in charge position.

ED nurses told the Association that overtime was out of control and new graduates were replacing experienced nurses.

A NSWNMA branch meeting on September 26, called on the administration to advertise and backfill all vacancies, including those on leave or seconded to other positions.

The meeting called for all PPT (permanent part time) and casual nurses to be asked in writing to increase their hours permanently, and for casuals to be employed for the duration of the shift they were covering.

The meeting voted unanimously to close six beds in the EMU as of Monday 30 September until all vacancies were recruited, and for ED nurses to refuse to perform unreasonable amounts of overtime starting 4 October.

Hospital and Local Health District management met branch members on 30 September and hammered out a short-term agreement.

The main points were:

  1. Management would not put ward patients in the EMU and they would remain in ED until a ward bed became available.
  2. Patients would not go into EMU unless staff members were available.
  3. Nurses on annual leave would be asked to return to work voluntarily to fill gaps in the roster.
  4. Management would improve the skill mix in the ED and closely monitor rosters weekly.
  5. Agency nurses would be employed to backfill gaps.
  6. The branch reserved their right to close beds if they felt the staffing level was unsafe.

Two weeks after reaching this agreement the EMU remained closed by decision of the management because of a combination of factors.

“There were not enough suitable patients, no ward patients were being admitted to EMU and the staff member who would previously have been on duty in EMU has been used in ED to fill the roster gaps,” Micheal Harper said.

Gaps in the ED allocation sheet had been reduced to 31 and overtime had been reduced, though some nurses still had to work double shifts and 12-hour shifts due to unplanned sick leave.

The skill mix had improved but there were still not enough experienced staff members to cover all shifts.

Micheal said he believed the administration was genuinely trying to find a solution.

“I don’t think management like the fact their staff are overworked and unhappy and stressed out. They seem quite willing to work with the branch to try to find a solution.”

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Dubbo proves case for ratios

The staff shortage at Dubbo Base Hospital was further evidence of the need for mandated, minimum nurse-to-patient ratios in all clinical areas, including EDs, in all hospitals, NSWNMA general secretary Brett Holmes said.

“The failure of Western NSW Local Health District to fill the Dubbo positions, even with agency nurses while they recruit permanent nurses, proves why local managers cannot be left to handle these things without compulsory minimum staffing levels,” Brett said.

Brett said the ED needed 41.05 FTE staff to cover all shifts at the end of September but was only operating at 32.21 with three nurses on maternity leave.

“This is completely unacceptable, especially in a key regional emergency department,” he said. “The people of Dubbo and surrounding regions that depend on Dubbo Base deserve better than this from the state government. It is unsafe for patients and staff and the ED nurses were right to act decisively.

“All nurses and midwives have a professional obligation to ensure safe patient care and no employer can ask or expect a nurse or midwife to work unsafely.”

The first round of enforceable, minimum nurse-to-patient ratios was introduced into general medical and surgical wards in most New South Wales hospitals as part of the 2010-11 award, negotiated between the NSWNMA and the former Labor government.

In March this year, the NSWNMA launched its Ratios put patient safety first campaign to have ratios extended to more clinical units, including emergency departments, children’s wards, intensive care units, community health services and smaller hospitals.