Friday 4th November 2011
Management has backed away from staff cuts at Cobar Hospital in the face of nurses’ determination to enforce safe staffing levels by capping beds.District has agreed to partially restore nursing hours and give nurses the authority to call in relief staff under an agreed escalation plan.
The arrangement will be trialled for three months and reviewed in December. RN Genie McMullen called it a win for the NSWNA branch and the people of Cobar who strongly backed the nurses.
‘Our decision to cap beds was pivotal. It pushed management to the point where they needed to make a concession,’ she said.
‘Capping beds would have caused uproar in the community.’
‘People are still nervous about the situation but at least we have something we can work with.
‘There is a sense of celebration but we know it’s not over. We expect to have to be putting our case again in a few months when the review finishes.’
Until last July the hospital had two eight-hour nursing shifts and one six-hour nursing shift for both day and evening shifts – 2.75 FTE staff to cover the 21-bed acute ward and emergency department.
Then, district management scrapped the two six-hour shifts claiming they could not be justified by admissions data.
But nurses compiled their own data, which painted a different picture. ‘Management didn’t look at the acuity of the patient load or take other factors into consideration,’ Genie said. These included time spent with critical patients waiting to be transferred to bigger hospitals, the lack of any occupational or physical therapists and social workers, and nurses having to do their own pathology and most of the administrative work.
The NSWNA branch took their case to the Cobar community with a petition and public rally in the main street.
‘We had huge local support. Everyone was cheering and beeping their horns, it was quite a buzz,’ Genie said.
‘Around 200 people came to support us, including 20 teachers who turned up with banners in their lunch break.
‘We had immense support from the mayor of Cobar, Lilliane Brady, who calls us at least weekly to find out how we are going and see if there’s anything more she can do for us.
‘Lilliane and the local mine managers were prepared to argue the case for more hospital resources. We service four large mines with another starting up. The mines know it will be harder to attract workers if services such as health are cut.’
Public support for the nurses helped push management to make a first offer to restore 32 nursing hours a fortnight.
Nurses rejected this as inadequate and decided to impose a cap of eight inpatients, stop treatment of triage 4 and 5 patients in ED and ban clerical duties.
‘Management came back with a second offer to restore 60 nursing hours a fortnight. We said we would only accept this if we also got an on-call roster with a clear escalation plan.’
Management agreed to the nurses’ counter-proposal just before their bans were due to come into affect.
Genie said capping beds and restricting triage in ED was a tough decision.
‘We talked about it months ago and asked how far are we going to take it and where’s it going to end,’ she said.
‘The staff didn’t want to go down that road. It’s our job to care for people who walk through the door, so to have to tell them, ‘I’m sorry the doctor will treat minor injuries himself, we can’t help you’, was going to put us in a difficult situation.
‘But eventually we realised we had no alternative. We were just exhausted and exasperated from working such long hours under such stress. People were calling in sick because they were too exhausted to turn up for work. Plus we were getting more injuries from increased manual handling.
‘The union advised us we had no options left, other than to keep talking in circles.’
NSWNA General Secretary Brett Holmes says the agreement provides for an extra nurse rostered for six hours on Saturday and Sunday AM and PM shifts and the Monday PM shift. Public holidays will be staffed the same as weekends, with the next working day treated as the first business day with an extra six-hour PM shift.
Brett says the escalation plan, worked out in consultation with the NSWNA Cobar branch, includes an on-call roster to be invoked by the in-charge nurse when the hospital gets to 10 in-patients or the in-charge nurse decides the acuity is too high for two nurses.
‘Then a registered nurse or medication-endorsed enrolled nurse will be called in. The important thing here is that it is the clinician who makes the decision,’ he said.
Genie said the nurses insisted on a rapid escalation plan partly because most presentations arrive at Cobar by private transport with no notice.
‘Most people don’t arrive by ambulance, but in the back of a car or ute, or they are carried in or stumble in.
‘The escalation plan is very clear. If we need to call a nurse we can – we don’t have to check with three or four people first. And there will be a nurse on call so we can make one phone call and get someone.’
Photo courtesy The Cobar Weekly.