Under pressure all the time

cover Lamp April 2010

Helen Taylor, working just across the NSW border at Albury Base Hospital, talks about her experiences of working without mandated ratios.

Ten minutes drive up the Hume Highway from Wodonga is Albury Base Hospital where nurses work under the NSW system with no mandatory nurse-to-patient ratios.

Helen Taylor, a registered nurse in Albury’s rehabilitation ward, said nurses are under pressure and feeling the strain from ever-increasing workloads.

Helen said nurses have made several unsuccessful submissions to management over the past few years to get a clerk for the rehab ward.

‘Our research shows that similar wards in other parts of NSW all have ward clerks.

‘But here the nurses have to do all the paperwork associated with admissions, appointments and discharges on top of patient care.

‘On afternoon shift in rehab it’s one RN and two ENs covering 21 patients. It is very demanding trying to get your head around that many patients, especially when the “in charge” is not able to assist because she has her own patients and you also have to look after the paperwork.

‘If you put people under pressure all the time they’re going to get tired; they’re not going to deliver.

‘If you can take some of that pressure off with a different system, you can function a lot better; you can pick up things that might otherwise be missed.

‘I think the idea of having ratios established by legislation is good because without legislation management will find some way to work around it,’ she said.

Time to build understanding and trust

Helen Taylor, working just across the NSW border at Albury Base Hospital, talks about her experiences of working without mandated ratios.

Pam Szatkowski, a midwife and general nurse at a Melbourne metropolitan hospital, says nurse-to-patient ratios have given nurses time to get to know patients a lot better.

Pam works in the post-natal ward where the ratio is one midwife for every six mothers on night shift and one to four on day shift.

‘The workload was much more intense and tiring before ratios came in,’ said Pam, who began her career in 1972.

‘I don’t know how we looked after so many patients before ratios – I really don’t.

‘It is definitely easier working with ratios. You know your patients a lot better because you do not have to look after 15 of them as I was before ratios came in.

‘With ratios you can look after patients more safely – there is less chance of incidents such as wrong medication occurring. Quality of care is improved because time allows the building of trust between patient and carer.

‘You get to know patients – and therefore their medical conditions – a lot better. You can get to know what patients can and cannot do for themselves, whereas with 15 patients it is just impossible.

‘You get a good understanding of who you need to spend the most time with, who needs the most assistance and who doesn’t need so much and can rely on their own independence.

‘Ratios give you the time to pick up hidden problems such as mental health problems, family problems, housing problems and so on and that means things can take a different direction altogether in the way you are actually nursing the patient.’

However, Pam says it has become increasingly difficult to staff the hospital according to the agreed ratios. She thinks a population explosion over the past year coupled with a shortage of midwives has contributed to the problem.

‘We manage to meet ratios more than half the time, but we are finding it increasingly difficult to cover for sick leave, especially on night shift.

‘At night you can’t grab nurses from another ward or ring an agency to get an extra staff member.

‘We have got to the stage of saying we cannot open up more beds in the midwifery department because it is unsafe to do so.’

Pam says the Victorian nurses’ union is in discussions with hospital management about the problem of insufficient staff to meet the agreed ratios.