ED ‘like a war zone’

Coffs Harbour protest demands another nurse per shift

To understand why Emergency Department nurses at Coffs Harbour Hospital took to the streets in protest last month, consider the following:

  • The ED waiting room is packed with people waiting up to three days for a bed.
  • ED acuity levels are so high that procedure rooms designed for plastering, suturing, and so on are used to hold seriously ill patients awaiting admission to a ward.
  • Despite the need for close monitoring of mental health patients in particular, procedure room beds are given no funding for nursing staff.
  • This diverts ED nurses from their normal duties – including the Clinical Initiatives Nurse allocated to the waiting room to monitor and care for patients during their long wait for admission, who is instead obliged to attend to ‘overflow’ patients in the procedure rooms.
  • Night shift can be a nightmare. Only four nurses are rostered on night shift (eight on day shift) yet patient turnover in the ED can be up to nine patients per bed over a 10-hour period.

NSWNA General Secretary Brett Holmes said these are a few examples of the North Coast Area Health Service’s lack of support for Coffs Harbour nurses as they struggle to respond to community needs.

‘We just cannot continue to run our Emergency Departments like this. It is not good for patients and it is not good for the staff,’ Brett said.

The Coffs Harbour ED has 14 general beds, two resuscitation beds and six procedure rooms, which means it should have at least nine or 10 nurses on duty each shift – one triage nurse, one in-charge nurse and one nurse per three beds/rooms, according to Brett.

Amanda Short RN, the NSWNA’s Branch Secretary at the hospital, describes the ED as ‘like a war zone.’

‘There was an 8% increase in patients presenting to the ED last year alone – including an increase in triage 1 and 2 patients – but we received no extra staff,’ Amanda said.

‘Sometimes they have a worse staff-to-patient ratio than on the wards. The staff are sick of it.’

The ED protest rally, which heard from several speakers including Amanda and Branch Vice-President Jenny Ryan, called for reduced waiting times for patients and one more nurse per shift with priority to be given to one more nurse at night.

NSWNA members handed out pieces of fruit to those patients in the ED waiting room who were allowed to eat, because ‘they’ll be waiting for a while’, and other members erected a placard on the Pacific Highway.

‘The public were very supportive,’ Amanda said.  ‘A patient who came out of ED saw the cameras and starting going on about his nine-hour wait, which was excellent publicity.’

Amanda said there was significant bed block in mental health and general wards.

‘What makes it worse for regional hospitals like Coffs is that, unlike Sydney hospitals, we’ve got no bypass facility. Our area has increased, meaning we now take people from Maclean, as far north as Grafton down to Kempsey.

‘There is no orthopaedic surgeon in Grafton anymore so all those patients who would have gone to Grafton Hospital before, come to us.’

She said the hospital had been hit by a recent exodus of senior staff, mainly due to excessive workloads.

‘This has been followed by abominably slow recruitment, which has plagued NCAHS for years. For example, an incumbent on maternity leave can often come back to work before the vacant hours are filled!

‘Jobs sit on e-recruit, unadvertised for months, and some for over a year. The ED in Coffs has had no permanent local ward management for months either. This creates uncertainty among staff as well.’

Amanda said Coffs Harbour staff considered current ‘reasonable workloads’ provisions and procedures to be inadequate.

‘We went to the reasonable workloads committee where management said some of the paperwork hadn’t been done properly, which meant we had to re-submit a brief.

‘Area management are really good at stalling the process. Some cases have been before the workloads committee for two years and the data we submit is never good enough.’

Staff allocations ‘political’

Coffs Harbour MP Andrew Fraser (National Party) has called for nurses to be recruited based on specific needs rather than staff numbers at other hospitals.

Mr Fraser said he was ‘appalled’ by a statement attributed to North Coast Area Health Service Chief Executive Chris Crawford regarding staff levels at Coffs Harbour Hospital’s Emergency Department.

Mr Fraser took exception to Mr Crawford’s statement: ‘The key question is whether the staffing levels in the Coffs Harbour Base Hospital ED are less than in equivalent hospital EDs.’

‘This statement proves that politics are entering into staff allocations in health care in NSW,’ Mr Fraser said.

‘Coffs Harbour health campus should have staff allocated on the basis of demand, not on whether the staffing levels are more or less than other hospitals on the North Coast, or anywhere else in NSW.’

He said nurses had already provided evidence that staffing levels are too low, yet it could take up to seven months for the North Coast Area Health Service (NCAHS) to recruit one new nurse.

‘When the decision is made that you need more staff, it has to go to the North Coast Area Health Service, then it has to go to the Premier’s Department, then it’s advertised,’ he said.

‘If an agreement has been reached through the Industrial Relations Commission that staffing levels are to be determined by the “reasonable nursing workloads” process, it is totally inappropriate that submissions for extra nursing staff have to be presented to the Premier’s Department for approval,’ Mr Fraser said.

Amanda Short, NSWNA Branch Secretary at Coffs Harbour Hospital, said the North Coast Area management compared Coffs Harbour to Lismore, Tweed and Port Macquarie hospitals, despite them having lower ‘on the floor’ staffing levels.

‘Coffs has a consistently higher presentation rate than Lismore and Port, though Tweed’s presentation is higher,’ she said.

‘2010 figures are that Coffs has 42.43 FTE, Tweed 47.69 FTE, Lismore 54.47 FTE and Port 49.44 FTE. The staff at Coffs are not asking for more staffing than other facilities but parity with other facilities.’