An alleged lack of staff at Shoalhaven District Hospital has seen a second-year graduate nurse left in charge of three critically ill intensive care patients who would have otherwise required one-on-one care.
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General secretary of the NSW Nurses and Midwives Council Brett Holmes said this is not a unique situation and that he hears many instances like this frequently reported to him.
He said the government is "blind and deaf" to what goes on in hospitals, with the health system "being tested significantly" and received feedback from members saying "they're burning out".
The Illawarra Shoalhaven Local Health District says patient needs determines nursing staff levels, with care for critically unwell patients provided by a skilled mix of multidisciplinary teams including doctors, nurses and allied health staff that respond to the demands of the unit.
"Patient need determines nursing staff levels," an ISLHD spokesperson said.
"Different patients have different care needs. There is not a one size fits all approach to staffing for complex medical and clinical situations."
Mr Holmes said unfortunately the ICU incident is not an isolated case.
"This is not a shock to me because it's being reported as an all too frequent occurrence," said Mr Holmes.
"This is bad for the nurse, it's bad for the patients. It's bad for our whole system.
"The nurse can do all they can within their level of experience and knowledge but that leaves them vulnerable.
"It's a question about will they be at risk of losing their livelihood?"
He said the NSW health system is under "enormous pressure", with the latest Bureau of Health Information statistics showing a rebound impact from COVID-19.
"It's frequently the case that staff members are being asked to work short, vacancies are often not filled and in many instances, they're filled with a staff member with less experience or qualification," he said.
"For instance, registered nurses are being replaced with assistant nurses.
"There has also been a significant spike in the numbers of patients presenting through emergency departments.
"That means that there's a lot of pressure on emergency departments. And there is what we call bed block and ramping, which means ambulances can't unload and emergency departments are full because the beds are full.
"And there's a shortage of replacement staff because replacement staff have been absorbed into testing and vaccinating."
He said the health system is "being tested quite significantly".
"We're receiving a lot of feedback from our members that they're burning out," he said.
"They're being asked to do excessive amounts of overtime, or extra shifts.
"Naturally, the health system has tried to do a big catch up. Doctors are certainly also talking about experiencing the consequences of care that may have been delayed during COVID-19 now presenting itself in the way of higher levels of acuity in emergency departments."
Mr Holmes said the NSWNMA had been campaigning to make sure there's enough staff in the system to match the numbers of patients.
"From our perspective that means you need shift by shift nurse to patient ratios," he said.
"The current system we have is too easy to overlook those requirements, and say, 'I will provide them later in the week'. And they never end up being provided."
Secretary of the Shoalhaven Branch of the NSWNMA Melissa Henderson believes there is nothing stopping the government from setting new ratios.
"This is something we've been campaigning for over a decade, to improve our ability to care well for our patients," she said.
"Our patients deserve more than "just enough". And we'll be better off financially with ratios, instead of the excessive amounts being spent on overtime.
"There's proof to the north and south, as both Queensland and Victoria have ratios and they're working well from both a financial and patient safety perspective. It's a no brainer - we need to get with the times, we need ratios."
Mr Holmes said the government is ignoring the calls of members to match the numbers of patients with up to the number of staff available.
"Until that occurs, we're going to burn out our nurses and midwives and the patients are at a higher level of risk of adverse outcomes, or, at the worst if their deterioration is not detected early enough that they proceed to die," he said.
Illawarra Shoalhaven Local Health District said there is 'not a one size fits all approach to staffing for complex medical and clinical situations'.
"The current nursing hours per patient day staffing system is a flexible ratio which enables nursing staff to be redeployed where patient need is greatest," the spokesperson said.
"This ensures the busiest shifts have the most staff and local knowledge of workflows is taken into account in building the roster.
"Nursing hours are not rationed out on a daily basis to each patient.
"The complexity of a hospital and its patients, as well as the professional judgement of nurses and managers is what decides staffing levels.
"This approach allows for staff to be redeployed where needed."
The spokesperson said the award also provides for local consultation processes to discuss workload issues.
"For areas where the nursing hours per patient day system does not apply, the award contains nursing workload principles that support decision making regarding staffing levels," the spokesperson said.
The ISLHD said Shoalhaven District Hospital received no notice of the stop work action last month, which left some patient areas short of nurses for approximately one hour.
"Hospital management works closely with staff to address workplace concerns and is always receptive to discussions with staff that are open, respectful and collaborative," the ISLHD spokesperson said.
"Overtime and other staffing arrangements were implemented so patient areas were appropriately staffed during the action which lasted approximately four hours.
"On June 2, the Industrial Relations Commission ordered the NSW Nurses and Midwives' Association and its membership not to engage in any kind of industrial action. These orders are in place until June 30."
Mr Holmes said members were taking industrial action across the state as a sign of urgency that they feel the problem needs to be fixed.
"They've been waiting for a long time for the current system to work properly and to be properly applied," he said.
"The really unusual situation where many of our branches as Shoalhaven has demonstrated are so frustrated that they feel they have to actually leave their workplaces and sacrifice their own pay in order to try and highlight this message they have for the government.
"The government is blind and deaf when it comes to going on inside the walls of the hospitals.
"The responsibility for our public health system lies squarely with the state government."
ISLHD says there are more nurses and midwives in NSW public hospitals than at any other time in the history.
"Between 2012-2020, the nursing workforce and midwifery workforce in NSW increased by 7693 full-time equivalent (FTE) staff, or 18.2 per cent, to 49,889 FTE," the spokesperson said.
"The NSW Government is also investing in a further 5000 nurses and midwives over four years under a record $2.8 billion boost to frontline staff, as well as increasing nursing hours per patient day in Peer Group B and C hospitals from 5.5 hours to six hours and 5.0 to six hours respectively."
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Grace Crivellaro
Court reporter for the Illawarra Mercury.
Court reporter for the Illawarra Mercury.
