Critical care staffing ‘dire’ inside top hospitals

The NSW Nurses and Midwives’ Association (NSWNMA) has warned critical care units, which have been vital in the fight against COVID-19, are so poorly staffed*, patients are at risk of dying.

Nurses inside critical care units, which combine intensive care, high dependency and coronary care patients, say the shortage of appropriately skilled nurses has left their units “stretched” beyond comprehension and in a “dire state”.

One nurse, with 22 years of intensive care experience, said the situation was so bad they could no longer guarantee the best possible ‘life or death’ care that patients required.

NSWNMA General Secretary, Brett Holmes, said the level of risk and demand put on senior ICU nurses was so high, many were quitting or moving out of critical care because of the stress, burnout and fear for their professional registration.

“I am deeply disturbed by the fact that staffing inside our intensive care units is at such a critical point. It is beyond unsafe, it is criminal,” said Mr Holmes.

“I, like the rest of the community, expected it would go without question that critical care units would be staffed better than most, that there should be a one-to-one ratio for ventilated patients. But there’s not and patients are at risk of dying.

“At Blacktown, we know their ICU nurses have been looking after six patients at once, sometimes more.

“Every critical care nurse we have spoken to in the past week said their unit was stretched by a shortage of staff and patients’ lives were at risk. The situation is so bad many of the hospitals are forced to close beds on a weekly basis due to short staffing.

“In the state’s north, we know that three patients who needed critical care died in their emergency department in as many days, while waiting for a bed to open up in the ICU.

“The pressure being put on ICU nurses is shameful. Putting inadequately trained and unqualified nurses into this environment to observe ventilated patients and saying ‘our staffing is fine, everything’s fine’ is just not acceptable.

“The government cannot continue to ignore that this is happening. If they can’t staff these ICUs and HDUs properly and competently, what hope do the rest of these hospitals have?

“Our state’s nursing workforce needs to expand significantly, and we need shift-by-shift ratios mandated, to have any chance of addressing these issues.”

Mr Holmes said the lack of safe, properly skilled staff in ICUs was widespread across Sydney’s major hospitals including Royal Prince Alfred, St George, Blacktown and Hornsby, but also several regional hospitals such as Lismore and Shoalhaven.

*Under the ACCCN standards, an ICU must be staffed at a ratio of one nurse to one patient (1:1), a HDU must be staffed at 1:2, while a coronary care unit must be 1:3. In addition, a pre-determined number of critical care trained nurses, called ACCESS nurses, must be rostered to provide ‘on the floor’ support for the critical care staff, to be able to assist in the care of patients requiring at least two nurses and to cover meal or toilet breaks. Where single rooms are in use, a ratio of one ACCESS nurse for every four patients is required.

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