Tuesday 20th March 2007
Understaffed and overworked, Maclean nurses say enough is enough.
Sometimes it takes more than a sound argument to convince the bean counters who run the hospital system that health care is not only about balancing the books.
Nurses at Maclean District Hospital were forced to adopt work bans to ensure safe and appropriate patient care and reasonable workloads for staff who provide it.
Their action achieved in a couple of hours what six months of carefully researched argument failed to accomplish: an additional RN for the emergency department.
The ED is cramped and short of beds, with patients often forced to be treated on trolleys in the corridor.
It was also seriously understaffed, having to call for assistance from ward nurses who had to abandon their own patients.
‘Even when we were very busy the ward nurses couldn’t stay in ED because they have their own staff shortages back on the wards,’ said Cath Osbourne, ED nurse unit manager and secretary of the Nurses’ Association branch at the hospital.
Cath asked for more RNs and backed the request with statistics showing the ED had tripled its presentations and workload in three years.
She supplied graphs showing the number of hours per day ward nurses were called in to assist, and the growing time lag of up to two hours between presentation and triage.
‘Hospital management were very supportive and sent the request to top management of North Coast Area Health Service, who ignored it,’ Cath said.
The nurses took their claim to the Reasonable Workloads Committee which twice endorsed it, but Area management did nothing.
‘Our morale was very low because we felt our concerns weren’t being considered. It seemed Area management in Lismore didn’t want to know about a small 42-bed community hospital like ours,’ Cath said.
The union then lodged a workloads dispute, prompting management to offer the ED an endorsed enrolled nurse, which the NSWNA branch rejected.
‘An EEN didn’t meet our needs and the requirements for patient safety,’ Cath pointed out.
‘We often work with a doctor on call only, and need someone qualified to do triage and advanced protocols, which must be done by RNs.
‘Our ratio of RNs to ENs was already well below the 80% benchmark set by the Area.’
At a phone conference including a union organiser, Area management claimed the nurses’ statistics did not show a need for an extra RN.
So a union branch meeting voted unanimously to give five days’ notice of industrial action if management failed to agree to a final request for an additional RN.
‘They didn’t even bother to reply to our final request,’ Cath said.
Given no alternative, the nurses held another branch meeting and decided to take action within two days.
‘We sent the CEO a fax saying we would be going to code red in ED and would refuse to see any patient in triage category 4 or 5, meaning non-urgent cases and GP presentations for example,’ Cath said.
‘With the next hospital 40 minutes down the road we did not want to turn away anyone who needed to be seen promptly.’
Meanwhile NSWNA Assistant General Secretary, Judith Kiejda, got on the phone to senior officers of NSW Health.
Within two hours of sending the fax the nurses had what they wanted – a guarantee of a RN on the overlap 9am-6pm shift.
‘Management say the RN is being provided “on a temporary basis” for 12 months until they review our numbers, but we are sure that the review will find we still need a few more hours in the ED,’ Cath said.
‘And we have management’s agreement that we will have a say in the way the review is carried out.’