Wednesday 25th July 2012
Nurse-to-patient ratios have improved clinical care and work satisfaction for nurses at the Royal Prince Alfred Hospital.
On a good day, in the bad days, only seven nurses could be there to care for patients in Ward 7 East 2 at the Royal Prince Alfred Hospital (RPA). The Ward 7 East 2 surgical unit has a high patient turnover rate and is a multi-disciplinary ward specialising in, among others, urology, melanoma, gynaecology, gynae-oncology, radiation oncology and dermatology.
Aaron Jones, Nursing Unit Manager of this ward, remembers just how difficult it was before nurse-to-patient ratios were put in place.
“The staff were very stressed,” Aaron said. “They would often get so busy that they wouldn’t have time to just stop for a minute and regroup, and that would build up the stress.”
Only 30 beds are available to patients in the ward, with at least 12 discharges and admissions being made every day.
“Nurses would always say at the end of their shift that they felt that they didn’t have enough time to finish their work properly, or they didn’t get enough time to sit down and talk to the patients, or they felt that they were rushed,” Aaron told The Lamp. “On weekends, the nurses would report that they were very busy because there were only six of them on the ward and they felt that the workload was quite heavy.”
After ratios were implemented in August last year, the NUM noticed significant improvements in staff morale and the quality of clinical care.
“On a workplace satisfaction survey that we did late last year, after the new award provisions came in, we saw a significant improvement on the previous staff satisfaction survey results.
“What I’ve seen as a manager is staff who were really stressed and not particularly happy at times, to staff that are less stressed. There will always be stress in this job, but now staff report to me that they have a lot more workplace satisfaction.”
New ratios have also allowed the ward to change its model of care, through the new staff they have taken on board. To add a much needed boost to the provision of care in the RPA ward, once the award provisions were put in place, Aaron spent a couple of months recruiting graduates, a flow nurse, supernumerary and extra night shift staff.
“The extra numbers meant I was able to implement a new model of care that saw the introduction of a flow nurse who helped with the admissions and discharges on the ward.
“We’ve taken on a lot of graduate nurses, which has been fantastic,” Aaron said. “We’re in a position where we’ve got quite a few graduate nurses coming through and in 12 months time, when we retain them, we’re going to have quite a nice, healthy robust nursing workforce.”
The hospital’s quality improvement program has also shown positive results. The Hand Hygiene Australia rating has risen from a 3.5 to a 5–star rating.
“RPA also has a clinical audit program. Since August last year not only are the audits being completed by clinical staff, which is how it was designed, but our audit results are improving,” Aaron told The Lamp.
“Also what I’ve noticed is that staff are taking more interest in looking at extra stuff that they can do on the ward.
“It has been positive and I think it can only get better.”
Lisa Bullock, RN
Lisa Bullock has worked continuously in Ward 7E2 for 18 months, first with the old nurse numbers, through the implementation and now, for six months, with settled nurse-to-patient ratios.
She says an important benefit of ratios is the presence of a nurse who gives priority to discharges.
“We are a surgical ward with about 10 admissions and discharges every day. We have acute post-operative patients with acute surgeries such as cystoprostatectomies. They are complex surgeries. The patients come back in acute condition with a lot of things going on and at the same time you have others you are trying to discharge before 10 o’clock.
“Before, you wouldn’t have time to give the discharges information that they would benefit from. There is only so much you can do in one shift.
“Since we’ve had the ratios we have a supernumerary nurse who concentrates on discharges. They make sure they have their information, that they have a lift home, that they get their medications. So the patients are not waiting for hours and hours. The patients get out of here quicker.”
Lisa says she used to find it scary when there weren’t enough nurses on the ward but thankfully things have changed.
“You’d have this black cloud hanging over you that something serious could happen – especially when you are a new grad. You also suffered at home. You were so tired when you left. Often you didn’t get meal breaks.
“Yesterday a nurse said to me that she has more time and it is calmer with eight patients between two, rather than 10. She was able to give them a bed bathing. It was more satisfying.”
Emma Warren, RN
RN Emma Warren has had two stints in RPA’s Ward 7E2, giving her an objective view on the value of nurse-to-patient ratios.
She did her new grad rotation in the ward before it had ratios, worked in another ward without ratios and then returned to 7E2 after ratios had been implemented.
“You can definitely see the difference it has made. Even having one less patient to look after makes a massive difference. The ward is a lot more relaxed.
“You are able to focus on one particular room with, say, four patients. You are not going in and out all the time. It’s better for patients – they always see a nurse within view so they are calmer. Nurses have a chance to be thorough. You don’t have to rush through everything, which gives more job satisfaction.”
Emma says a big plus of having more nurses on the ward is the increased opportunity for nurses to develop their skills.
“It encourages the senior staff to improve leadership. Ratios have brought in more graduate nurses. Now senior nurses have more time to help them. If you haven’t got the staff it can be a burden for senior staff, showing the younger ones.
“I’ve changed from being a new grad to having a leadership role. I can’t imagine being able to do it with the previous workload. With more time you can provide that leadership to new grads.”
Emma says she was inspired to join the NSWNA campaign to implement ratios and hasn’t been disappointed.
“When I was a new grad I got involved in the rallies for ratios because I found the wards were very stressful. I was up for the ratios. I get satisfaction out of the fact that we won them. You know you can make a difference if you get involved.”