Wednesday 1st September 2010
Feedback from Roadshow
This month the NSWNA visited members at 55 workplaces across NSW to consult and validate the nurse ratios claim. Ratios is the better way to go was the resounding feedback from NSWNA members.
NSWNA General Secretary Brett Holmes, Assistant General Secretary Judith Kiejda and NSWNA officers hit the road this month to visit members at public hospitals right across NSW and answer questions and gather feedback on the nurse ratios claim.
The claim for nurse-to-patient ratios and skill mix is part of the 2010 Claim for a new Award for public health system members. The ratios claim describes models developed by the NSWNA for nurse-to-patient ratios and tools for the following specialties: medical, surgical, emergency, palliative care, rehabilitation, inpatient mental health, community health, community mental health and operating theatres.
Brett Holmes said, ‘We met with members from the different nursing specialties at a representative range of public hospitals from large metropolitan hospitals in Sydney to rural and regional hospitals as far afield as Albury and Armidale to Tweed Heads and Wagga Wagga.’
There was a strong turn out to the NSWNA meetings, with resounding feedback that members agree nurse ratios is the best solution to the staffing pressure in NSW public hospitals.
Judith Kiejda told members that nurses should not have to cope with staffing issues that are out of their control and impacting on the delivery of safe patient care. ‘The nurse-to-patient ratios models in the claim would ensure a mandated base number of RNs and the right skill mix on a shift.
‘For too long members have struggled to cope with ever-increasing staffing pressures. We just keep going because we care about our patients. But we need to fight for ratios because currently staffing issues are putting our patients at risk.’
Judith stressed to members the importance of being an active part of the campaign to win nurse ratios. ‘You need to start preparing to take some action,’ she said.
We need to report risks and near misses
Nurses need to report near-miss incidents as a result of short staffing using the NSW Health Incident Information Management System (IIMS), according to NSWNA Assistant General Secretary Judith Kiejda.
‘I hear numerous stories every week when I visit workplaces about things going wrong and near misses and the reason comes down to lack of staff and appropriate skill mix.
‘Nurses are a caring profession and we put up with staffing pressure because we don’t want to let our patients down. We work under strain, work without enough staff, we don’t make a fuss, we don’t complain, we don’t report near misses and risks because we are so busy caring for our patients.
‘But because we don’t complain and don’t report incidents there’s an inadequate record of the real picture. And because the picture looks ok, nothing is done.
‘Inadvertently, we might be neglecting our professional responsibility as advocates for our patients by not reporting all risks and near misses because of staffing issues. As patient advocates we have a responsibility not to accept insufficient staff and the consequences.
‘Nurses don’t have to accept personal responsibility for circumstances beyond your control.
‘I encourage all nurses to follow NSW Health’s own guidelines and report all incidents and risk of incidents – and that includes when inadequate staffing means patients are at risk,’ said Judith.
NSWNA members are asked to also email the NSWNA details of risks and near misses that occur as a result of staffing issues: firstname.lastname@example.org
‘A lot less would be missed’
‘If we had the right numbers of staff with the right skill mix, it would take a lot of pressure off the RNs. Often we only have two RNs on the floor for 28 patients and we have to supervise and be accountable for EENs’ and AiNs’ work, which is a huge extra responsibility. If we had more RNs or experienced nurses with the correct skills and knowledge, a lot less would be missed in terms of error detection, accurate documentation and early recognition of deteriorating patients.
‘This is a common problem when your allocation for the shift is predominantly junior and agency staff, with an inappropriate staff ratio.
‘If we have RNs call in sick we often get them replaced with agency first-year RNs, some of whom have only done one or two shifts outside university or with an agency AiN, so they are not replacing the skill mix, which is very frustrating and potentially dangerous on an acute ward. It’s a huge problem as it puts more pressure on existing staff and often a lot more gets missed.
‘It’s very difficult for me to fulfill my full role as a CNS, especially when I come on duty and I’m given 10-14 patients and an EEN, which seems to be the norm. It’s the same case for my educator, who is actually supposed to be indirect with patient care but is surged as a nurse on the floor when we are short staffed, so we miss out on in-services.
‘Occasionally we get a lucky shift and have three or four RNs and the difference in the dynamics of the whole shift is remarkable in terms of holistic patient care, documentation, staff morale and making sure you’ve done everything you can for your patient. The job satisfaction is so much better. Everyone comments on it when we have a lucky shift like that. I only wish there was more of them.’
Tanya Bronn, CNS in surgical ward, Hornsby Hospital
‘The right numbers of staff with the right skill mix is essential’
‘Proper nurse-to-patient ratios would mean patients get the level of care they require. For people on our ward it’s the more basic things that get missed. Nurses prioritise so they will do anything that needs to be done if the patient is deteriorating, but things like making sure patients’ teeth are brushed, making sure they get a proper shower, not a five-second bird bath, making sure their hair is brushed are missed.
‘If we had the right numbers of staff and skill mix, we’d get more time to spend on actually talking to patients, interacting with them, building up a better relationship. We’d also be able to spend more time to assess them, whether it be for their cognition or physical limitations.
‘We’ve had multiple near misses. It’s quite scary. On our ward the majority of patients are confused and don’t know what they are doing from one day to the next. Some of them are in danger if they fall; it’s a huge safety issue. They need a high level of care so having the right numbers of staff with the right skill mix is essential.
‘If nurses had more time to spend with patients and give them more support, they’d be able to deliver the standard of care they’d like to. They’d feel like they had met the patients’ needs so it would be more satisfying. It would also mean less burn-out for nurses.’
Alicia Agius, Acting NUM, neuro-surgical ward, Royal North Shore Hospital
‘Time for basic nursing’
‘On our ward, which is rehab, we have a lot of aged care and geriatric rehab patients. Because of understaffing on the afternoon shift, the nurses are too busy doing routine stuff so that basic things like changing wet beds get missed. We do it when we come on night shift and that puts us an hour and a half behind on our own work.
‘If you’re understaffed, pills and observation comes first and basic nursing gets missed. There shouldn’t be a differentiation between these types of nursing in aged care but let’s face it, you don’t go to the Coroner’s court for a wet bed. The right staff mix would mean patients’ basic nursing needs would be met.’
Peter Buckney, night shift RN, rehab ward, Blue Mountains Hospital
‘Time to do my CNS role’
‘Having the right numbers of staff with the right skill mix would make a huge difference for us. The skill mix is the biggest problem for my ward. There are a few of us who have been there a long time like myself but they’re getting fewer as we get older and the physical load is getting heavier and heavier. The patients are getting sicker and sicker.
‘Normally they would go to HDU but now they come to us. We have non-invasive ventilation on our ward so anybody who doesn’t need to be intubated comes to our ward and it’s really hard because you might have two senior staff on a shift and four junior staff such as ENs. We are now using AiNs on our ward and we have really complex sick people. When you have ENs and AiNs the RN then has to take on a greater responsibility for things like medication and IV medications, which is something we use a lot of.
‘All ENs and AiNs can do is observation. We have some EENs who can do medications but in small amounts and they have to come to you for assistance all the time. We have never had a situation on our ward where the team leader could be free to be there to assist everyone else – you have to take your own patients and also help everyone else.
‘I’m never able to do my role as CNS properly. If you’ve got an EN in the group you can’t give the EN the sick patients because if you do, you are making twice as much work for yourself. You get asked 1000 questions a day. I know that’s why you’re there as a CNS and I have no problem with that but if we had more staff it would make it so much better – you could concentrate on educating your staff, educating your patients better and looking after them better.
‘I trained in the hospital system many years ago and the little things you used to do for patients you can’t do anymore. It used to be team nursing: you’d be given a job, you’d do it and it was much easier – you weren’t rushing around like a mad dog all the time. Now you are allocated a number of patients and some of them are so sick that everyone else who is not so sick gets neglected. You’d love to be able to spend time with the poor man who’s just been told he’s got cancer but you can’t because you’ve someone who’s on non-invasive ventilation who needs constant monitoring.
‘Ratios that include more experienced staff would make a huge difference to both patient care and nurses’ job satisfaction.’
Julie Chapman, CNS, respiratory unit, RPA
‘Our care would be better’
‘Patient to Nurse ratios will greatly improve patient outcomes. It would enable nurses not to miss vital clinical indicators for patients because the workload will ensure less mistakes and greater results. As a result of greater attention and care a patient is less likely to deteriorate. There was a recent situation where we were short staffed and a patient deteriorated, but it worked out well due to the strong teamwork of all clinicians within the ED. With ideal numbers of nurses and appropriate skill mix nurses would not be stressed and have to work under pressure, creating a much better environment for patients.’
Bree Graham, RN in ED at RPA
‘Time to give patients the care they deserve’
‘With ratios, nurses wouldn’t be stressed and run off their feet. We’d have the appropriate amount of time to be able to give the care that patients deserve. Near misses can happen because you’re rushed, and extra hands on the ward would give people more time and care.’
Brenda Clarke, EEN, Holbrook Hospital
We all need to get active to win our ratios campaign. During September we want to reach out to the community and to our State politicians for their support in our campaign to achieve mandated nurse-to-patient ratios. There are two activities in particular you can help with:
If you want to get involved in these activities, contact your NSWNA branch or email your contact details to email@example.com or phone Rita Martin on 8595 1234.