The metro-rural divide

A clearly discriminatory health environment exists between city and country in New South Wales, according to new research undertaken by the NSWNMA.

In her address to the Association’s annual conference two months ago, health minister Jillian Skinner conceded that rural health suffers in comparison to metropolitan areas.

“Rural hospitals do not always have the level of access to professional infrastructure and support that might be available in metropolitan and major regional centres,” she said.

It was stating the obvious for rural nurses and midwives who participated in a recent research project undertaken by the NSWNMA.

The study found that in the absence of the same level of medical staff and allied health professionals as in major metropolitan areas, rural nurses and midwives are required to multitask, and that this lack of resources can compromise care in a way that ripples through hospitals. This was consistent with previous academic research on the issue.

A nurse or a midwife has become the go-to person who picks up additional tasks and responsibilities in the absence of allied and ancillary staff. In rural and regional facilities, where there is less clinical support and inadequate numbers of allied, ancillary and medical staff, the situation is exacerbated.

The problem is significant, with more than 30% of the nursing and midwifery workforce working away from major cities.

Throughout the public health system unpaid overtime, working through lunch breaks, not being replaced on sick leave, or being replaced by a lower level staff member, has become the norm according to the study.

Across all peer groups surveyed there was a generalised sense of dissatisfaction with respect to the time available to provide patient care. However, these issues were more acute in the country.

Nurses working in District Group Hospitals (peer group C) reported an inadequacy of staffing and resources and high numbers of patients-per-nurse.

Nurses and midwives in D1b (Community Acute without surgery) facilities are spending considerable time on “other” tasks or responsibilities, with 55.2% of study respondents indicating that they had spent greater than two hours on their last shift undertaking “non-nursing” roles.

Key findings

Across the five peer groups surveyed nurses and midwives are struggling to cope with increasingly heavy workloads.

  • Unpaid overtime, working through lunch breaks and not being replaced when on sick leave have become normal features of the work environment.
  • A nurse or a midwife has become the “go to” person to pick up additional tasks and responsibilities in the absence of allied and ancillary staff.
  • The situation is exacerbated for nurses and midwives in rural and regional facilities with higher patient-to-nurse ratios, inadequate skill mix, less clinical support and inadequate numbers of allied, ancillary and medical staff.
  • There is a strong belief among nurses and midwives that neither senior managers nor the Department of Health respects, values or is interested in supporting them.

Research builds on past work

Nearly a thousand nurses and midwives participated in the study undertaken by the NSWNMA. The findings build on a previous study conducted for the Association’s 2010 wages and conditions claim.

The new study widens the focus to include nurses and midwives in Peer Group D and F3 facilities.

The study sought to investigate nurse and midwife perceptions of patient acuity and provision of service, and determine the range of staff, clinical and infrastructure resources available in New South Wales’ hospitals across the different peer groups.

The study also investigated nurses and midwives’ perceptions of the current health care environment and the factors that impact on the provision of care.

What nurses and midwives had to say:

On Country Workloads

“We don’t have administration staff from 1700 to 0840 weekdays and none at weekends. All admissions and discharges are done by nursing staff. All pathology is collected by nursing staff. Cannulation is done by RNs. Some of the RNs suture simple wounds. Most nights we don’t have a doctor on call and some weekends. — Country Hospital (D2)

On security

“Security staff are not always provided … nurses are required to conduct searches of patients on admission and on return from leave with no security guard present.” — Country Hospital (B Non-Metro facility)

On the lack of CNEs

“Our CNE is shared with three other hospitals, thus only see her once to twice a week. She often takes a clinical role to help out when the ward is busy, ranging from triage, patient personal hygiene, medication administration to procedures like cannulating, catheter insertion, wound dressings, even attending to doctors’ rounds.” — Country Hospital (D1a)

On rural EDs

“Our Emergency Department is staffed by one RN and one doctor. The doctor is called in from the local doctor’s surgery for any presentations. It is not unusual to have up to 15-21 presentations in six hours with only one RN and the VMO to do all the triaging assessments and care. There is a little bit of backup from the hospital coordinator when it’s really busy. This is very unsafe for patients and puts enormous pressure onto the ED staff.” — Country Hospital

On a midwife’s workload

“The post natal ward has 19 beds = 38 patients (mum and baby). Last week I had eight women and their babies to look after; 16 patients in my care. It’s dangerous. You are not physically able to provide quality care when you have that many patients in your care. — Country Hospital (B Non-Metro facility)