The fifth nurse

Cover story - the fifth nurse - sweenys1

Nurses at two South Coast hospitals worked together to successfully prevent dangerous staff cuts at Bega Hospital.

Confirmation of a dangerous cut to nurse numbers on the medical ward of Bega District Hospital came via a new roster posted on the ward noticeboard one Monday morning.

Nurses arriving at work were stunned to read that the busy morning shift would lose one of its five nurses. The decision had been made without any negotiation with the NSWNMA.

The Bega branch of the Association called an urgent meeting where members condemned management for “the appalling lack of consultation”. They unanimously decided to start closing beds within a fortnight, unless the published roster was withdrawn and nursing hours reinstated.

“It’s hard enough to adequately care for patients on morning shift with five nurses. Having only four nurses would clearly be unsafe and left us no choice but to close beds,” branch secretary Amanda Gillies, a clinical nurse specialist on the medical ward said.

The branch also condemned the introduction of Assistants in Nursing without consultation, called for talks on a planned restructure of nursing management and endorsed a community campaign to oppose the cut in nursing hours.

Bega nurses rallied outside the hospital during their lunch break, carrying placards alerting the public to the safety risks posed by staff reductions. “Less Nurses = Money Saved and Lives Lost” warned one sign. “Cuts to Nurses Don’t Heal” said another. Meanwhile, nurses at Pambula Hospital, 35 kilometres away but part of the same Local Health District (LHD), were also staging a public protest in support of their Bega colleagues.

“Pambula wanted to show their support for us because the two hospitals are closely connected. For example, we get patients from them after hours because they don’t have doctors overnight,” Amanda said. “Pambula have their own staffing issues and hopefully we will be able to support them when they need it.”

District management claimed the reduction in nursing hours was justified because the morning shift was overstaffed according to award staff ratios.

However, the award provisions they referred to were a minimum requirement that should be adjusted upwards, if necessary, to ensure safe patient care and staff welfare, NSWNMA Assistant Secretary Judith Kiejda said.

“A whole range of issues needs to be taken into account at the local level when determining nurse numbers, including the level of support and back-up available to the nurses,” Judith said. “Management had not accounted for extra work performed by nurses, and types of patients at Bega, outside the medical ward parameters for the nursing-hours-per-patient-day ratio.

“There aren’t enough nurses on this ward to do everything that needs to be done now, with current staffing levels,” she said. “Back-up support for the Bega nurses, such as cleaning and administration, is inadequate. At the moment there is only one wards person, on each shift, for the entire 77-bed hospital.”

Amanda Gillies explained that Bega nurses regularly have to escort patients for tests, including MRIs, outside of the hospital; they routinely clean beds, including terminal bed cleans; they help out in the children’s ward; empty garbage bins and linen skips after hours; and order and unpack stock.

“Morning shift is usually the busiest time of the day, with doctors doing their rounds and ordering tests and people being discharged and admitted. Most of our patients are elderly, and they need to be showered in the morning. Plus we have to make our own beds.”

Amanda said the wide range of patients in the medical ward added to the workload.

“There are always one or two in palliative care, plus morbidly obese patients, sometimes psychiatric patients and drug and alcohol patients. There are always two or three in isolation who are very time consuming because you have got to dress up and dress down every time you go in and out of their room.”

District management withdrew the cut to nursing hours the day before nurses were due to close beds. It also withdrew the planned change to the nursing management structure.

Management and the NSWNMA agreed the medical ward would continue to have five nurses on mornings for the next three months, while both sides carried out an investigation of the hospital’s staffing needs.

A few weeks later, district management agreed to maintain the fifth nurse in the medical ward, provided occupancy levels did not fall below a set level. If occupancy fell to 18 or lower, the fifth nurse could be redeployed to another clinical area, Heather Austin, Acting General Manager of Bega Valley Health Service, wrote in a letter to the NSWNMA branch.

She said terminal bed cleaning would be transferred to non-nursing staff, a casual wards person would be trialed for patient transfers to medical imaging, and creation of a pool of casual nurses would be examined.

“Please convey my thanks to your colleagues for a great job in caring for our patients,” she also wrote. Amanda described it as a good outcome.

“People are very happy and there is a sense of achievement that they have stopped an undesirable change. Losing that fifth nurse would have made the ward completely unmanageable and unsafe.

“Our action achieved its purpose of getting the message across that nurses and the community weren’t going to be happy if they took that fifth position away.”

Amanda said the branch would now turn its attention to getting more nurses on the understaffed surgical ward.

“With our achievement up here the surgical floor nurses feel that the branch as a whole can help them achieve an outcome.”

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Questions raised on AiNs

Southern New South Wales Local Health District has guaranteed that AiNs will only be used at Bega District Hospital in accordance with NSW Health policy, such as “specialing” dementia and delirium patients who need watching.

NSWNMA Assistant Secretary Judith Kiejda said the introduction of AiNs raised serious questions.

“Skill mix is an important determiner of the number of nurses that should be on duty,” she said. “There is a place for AiNs, and many are already employed in our health system, but not as a cheap replacement for RNs and ENs.

“NSW Health’s own research proves that using RNs increases patient safety by reducing bed sores, patient falls, gastrointestinal bleeding, sepsis, shock, physiologic/metabolic derangement, pulmonary failure and ‘failure to rescue’ before cardiac arrest or death.