Understaffed rural EDs face security risks

Narrandera nurses seek better staffing and improved security.

The NSWNMA has warned of security risks facing small country hospitals that have emergency departments gazetted as mental health assessment centres.

These hospitals do not have mental health beds or trained mental health nurses.

They must care for patients at least until a telehealth assessment can determine the next step in the treatment process.

The 34-bed Narrandera Hospital in the Riverina region is one of about 12 NSW facilities in this category.

Following an NSWNMA safety inspection of the hospital, General Secretary Brett Holmes wrote to Murrumbidgee Local Health District warning that Narrandera nurses are at serious risk from violence and aggression.

This was due to inadequate nurse-to-patient staffing ratios, inadequate security coverage and poor facility design.

“Add to this that Narrandera is a declared mental health emergency assessment centre and it is only a matter of time before a major incident occurs,” Brett said.

Overnight, the hospital is staffed by three nurses with no security guard working across the ED and 20-bed ward. The nearest full-time police service is 90km away at Griffith.

Nurses must often work in isolation in the ED or ward, which does not allow for an effective duress response in an emergency.

This is in breach of NSW Health’s “Protecting People and Property” policy and Australasian health facility guidelines, which say no nurse should work alone or in isolation, Brett pointed out.

“Staffing numbers must not only take into account patient numbers, but also the safety of staff,” he said.

He recommended a minimum of four nurses be rostered to work at night to ensure that none were forced to work in isolation and an additional security guard be employed.

Vulnerable in the ED

NSWNMA delegate and branch secretary Linda Sommerfield told The Lamp the hospital employs just one security guard from 2pm to 11pm Wednesday to Sunday. The guard is not replaced when sick or on leave.

She said the branch had asked for better staffing and improved security for several years.

“The LHD gave us a new duress alarm system in 2016 but they are the most cumbersome devices ever invented. They have a button at each end and you must be sure to press the correct button twice. That’s not always easy when you are being assaulted.

“The duress rings through to a security company in a remote location, which then calls the hospital to find out if there is a problem. If there is, security calls the police who could be 100km away as the local station is not staffed 24 hours.

“The police always arrive in pairs, yet we are expected to deal with these patients in isolation. In the last 6–12 months ED has been very busy with at least one nurse working down there for a whole eight-hour shift.

“We don’t have a safety lockdown area or triage area in the ED. We open the door to the public and they can walk straight in to access the whole department and go through to the ward.

“We have no cameras in ED and, if a nurse working in isolation can’t get to their personal duress or the duress emergency button behind the nurses’ station, that nurse could be unconscious or dead on the floor and we in the ward would be none the wiser.

“If a nurse is concerned about someone’s behaviour in ED they have to ring the ward for assistance, which leaves one ward nurse alone with up to 20 patients on a night shift. That includes patients with dementia and at high risk of falls and three close-observation patients.”

Multiple issues with mental health patients

Linda said despite the hospital being listed as a mental health emergency assessment centre, none of the nurses are mental health-trained apart from doing a 30-minute online course.

“Given our staffing situation, how are we supposed to give mental health patients the best-possible care while ensuring our own safety and that of our other patients?

“Quite often, mental health patients have to be sedated before being admitted to our facility. ED presentation is only supposed to be for four hours, but they are sometimes here for up to eight hours waiting for a telehealth linkup or transport. That’s not fair on the patient, their loved ones or staff.”

There have been several violent incidents at Narrandera hospital in the past 2–3 years.

A patient held a doctor and two nurses hostage for several hours; a handcuffed patient in police custody tried to strangle a nurse, dragging her to the ground; a security guard was badly bitten and permanently scarred; and a nurse was forced to change work patterns following threats and verbal abuse.

Linda said the LHD has made some improvements including: more swipe card access; installation of an internal door to prevent free access to wards and to isolate aggressive ED patients from wards once the door is closed; and enhanced safety in the doctors’ consulting room.

In a letter to Brett Holmes, the acting Chief Executive of Murrumbidgee LHD said an “action plan” to improve security had been developed.

Narrandera Shire councillor Barbara Bryon told the Narrandera Argus newspaper that violence towards nurses was on the increase and security must be improved.

“John Barilaro, Minister for Regional Development, talks about money into the regions and 
the regional funds and grants available. But at the same time, the state government is pulling services out of the regions,” councillor Bryon said.

“If there is a violent incident, who do you phone? We don’t have 24-hour police services, because that’s another arm of government that they’re pulling out of the regional centres.”

Letters to the Editor
Share your thoughts on this article or anything else important to you as nurses and midwives by sending a Letter to the Editor.

Four letters are published in the Lamp each month and the letter chosen as Letter of the Month will win a gift card. Please include a high-resolution photo along with your name, address, phone and membership number. You can submit your letter by emailing the Lamp:lamp@nswnma.asn.au