Propping up a system in crisis

Research by the NSWNA reveals conditions leading to breakdowns in the health system are widespread in public hospitals.

The NSWNA has just conducted research into members’ views in preparation for our public hospital pay campaign for 2008 and the feedback from nurses on the frontline is if it’s alarming then it’s sobering.

Discussion groups were conducted throughout NSW with a cross section of nurses and midwives working in the public health system. Most of the groups met before the recent blow-up at Royal North Shore Hospital.

The clear message from the groups is conditions that can lead to breakdowns in the system – like those at Royal North Shore – are widespread in our public hospitals.

‘Our workload in emergency is quite unrealistic. We are seeing between 150-170 patients a day. We’ve got ambulances loaded, five to six patients in corridors at all times. We’ve got pressure from the media, the patients and the executives who are taking calls from the ambos wanting to get back on the road. It’s chaotic,’ said an RN at Royal North Shore a week before the incident involving Jana Horska.

The possibility of this type of scenario occurring elsewhere was brought up in all of the groups. Some described the working environment as a ‘war zone’, while others said it was like being ‘in the trenches’.

As one nurse said: ‘When people become nurses they know it is hard work; that they have to clean up piss and vomit and that the pay is not great. But they don’t know it is unsafe; that you don’t get a break and you are not supported. Some shifts feel out of control.’

Participants in the groups were also very clear about what needed to be done to improve the working environment and the level of care in the public system: better funding, more staff and a better skill mix.

Improving pay, the image of nursing and workloads is seen as critical to attracting others into our profession.

‘If you want to keep nurses and midwives you have to increase the number of nurses and midwives,’ said one nurse.

‘The more desirable you make the job – the more they will come,’ another young nurse from Parramatta said. Improving pay was seen as crucial to making the job more attractive and indicating that nurses and midwives are valued.

‘You go to university and get a degree and then come out and get lousy pay and have to do shift work,’ was a typical comment.

‘My friends have jobs in cafes … and get paid more making sandwiches or coffee than I get working as an RN. That kind of pisses you off,’ said another.

The need for financial incentives to recognise and reward loyalty, experience, higher qualifications and responsibilities is seen as essential to retain nurses in the system.

‘Without penalties no one will do nights or weekends.’

The majority of nurses in the groups rated themselves as having high to excessive workloads.

‘It’s like the frog in the pot that doesn’t notice the temperature is slowly rising – you get accustomed to it. You come home, you’re exhausted, you have nothing left to give to your family.’

Hospitals in critical condition

What NSWNA members say about the trends in our public hospital system:

  • increased workloads;
  • higher patient acuity not taken into account in nurse/patient ratios;
  • Fewer support staff – ward clerks, cleaners, porters and administrative support – forces nurses and midwives to pick up the slack;
  • not enough permanent staff on wards;
  • increased use of ENs and AiNs as ‘replacements’ for RNs;
  • more overseas-trained staff;
  • fewer experienced/trained staff per patient;
  • politicisation of the public health system;
  • a more budget-conscious system where more things are measured;
  • increase in aggression from patients and their families;
  • changes in the role of management caused largely by the increased focus on budgets;
  • a move away from nursing ‘care’ to nursing as a process.