Staffing win for RPA maternity unit

Midwives’ determination delivers results

Overworked midwives at Royal Prince Alfred Hospital, under intense pressure from a huge increase in births, are celebrating victory after a two-year campaign for more staff.

The Camperdown Women and Babies Service is getting an extra 8.42 full-time-equivalent midwives for the delivery ward and postnatal ward, in the first significant staffing increase since the unit was reorganised and rehoused in 2000.

Initially staffed for a projected 3,500-4,200 births per year, the service managed 5,043 births in 2006.

Staff have been hit by high rates of burnout and stress from severe workloads, and have expressed concerns about their capacity to provide a high standard of care and ensure patient safety.

Sydney South West Area Health Service rejected calls for more staff until the NSW Nurses’ Association lodged a dispute last month. The breakthrough came a week later, at a meeting of the Area Reasonable Workload Dispute Committee where NSWNA officials and representatives of the midwives sat down with senior management.

Staff were ‘absolutely thrilled’ when Area management agreed to fund additional midwives, said Nanette Stacey, a Clinical Midwifery Specialist and acting NUM in the postnatal ward.

‘We are very pleased and impressed with the support we received from our union – both the local branch officials and organiser and industrial officer from head office. They all did a brilliant job and without them we wouldn’t have got anything through,’ Nanette said.

Staff levels fixed in 2000 were based on predictions that the number of births would remain static or even decrease as a result of area demographics.

The reality was the opposite: a steady increase to 5,043 births last year – almost 20% more than the predicted maximum of 4,200.

The postnatal ward has 60 full beds yet night shift has been staffed by just eight midwives – one third of the day shift number.

RPA Women and Babies provides services for a relatively high-risk population – women are transferred from other hospitals to RPA’s level 3 tertiary referral maternity unit, and patients from around the State are brought to the neonatal intensive care unit.

‘We are also getting younger babies of 35-37 weeks in the ward,’ Nanette said. ‘They need more observation, more blood sugars, have a greater need to be kept warm and often don’t feed very well. We also offer services to families affected by drugs and alcohol.

‘The workload is also increased by the rising caesarean rate. In the first three months of this year we had 94 caesars more than in the same period last year.

‘So at any one time the ward has eight midwives caring for 120-plus mothers and babies, with possibly 40-50% of them having had caesars. And at the moment we’ve got three sets of twins.

‘Many staff have to do regular overtime to cover staff shortages – the burnout rate is huge and the stress levels high.

‘Some staff also need stress leave because they have been abused or threatened by a visitor or patient. Some staff have left because they can’t deal with it anymore.

‘The ones who stayed are getting exhausted to the point where they can’t keep working much longer.’

Midwives sought help from the NSWNA branch at the hospital in mid 2005.

The branch went into bat for the midwives’ representatives on the hospital Reasonable Workload Committee – Nada Carroll, Robyn McGuire and Nanette. The RWC sought more staff for maternity based on recommendations from an independent review of postnatal services conducted in 2005.

Branch secretary Eleanor Romney said management took initiatives such as capping patient numbers by excluding patients from outside Sydney South West Area Health Service, removing trainee enrolled nurses from the postnatal ward, trialling a NUM1 position, improving security and reorganising the antenatal clinic.

‘Management did not address the core issue of inadequate staffing, claiming their hands were tied by a lack of funds,’ Eleanor said.

‘The full bench of the NSW Industrial Relations Comission made the point that a lack of funds cannot be an excuse for an unreasonable workload.

‘The bottom line is that it is not the employee’s responsibility to sort out funding problems. There is a clause in our award that says all employees should have a reasonable workload.’

Dissatisfied with management’s response, the branch sought an extraordinary meeting of the Reasonable Workloads Committee where it presented a list of recommendations – including a call for increased staffing.

The RWC endorsed the union’s claim but area management again disagreed, prompting the NSWNA to lodge a dispute at the area level.

Management has now agreed to fund the equivalent of two full-time extra staff in the postnatal ward for night duty, raising staff numbers from 8 to 10. The delivery ward will get extra staffing on the morning shift, lifting FTE numbers from five to six, and the antenatal clinic will also get a staffing boost. Extra hours for ward clerks and ward assistants have also been funded.

Discussions are continuing over the union’s claim for an additional Clinical Midwifery Educator and an expanded role for  the Clinical Midwifery Consultant who is shared with another hospital.

Eleanor said the branch was impressed with the midwives’ determination and patience in pursuing their claim.

‘They’ve been working under difficult conditions for a very long time, yet remained committed to achieving a better workload, good patient safety and quality care,’ she said.