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8/11/21 12:05 pm
50 shades of tiredness
I’m a registered nurse and have worked in health for 40 years. I am tired. Tired of being told we have adequate staffing (we don’t), tired of being told the system is coping well (it isn’t), tired of fighting for safe patient ratios that never seem to come. Then COVID came and it all got worse. I currently work six shifts per week and get daily texts offering me up to 10 different shifts per day. The staff are tired due to leave cancellations and extra shifts. I don’t want to get flogged on every shift, but the system is overwhelmed and understaffed. The NSW health system needs to dramatically increase the FTE of nurses.8/11/21 12:05 pm I just want to provide safe patient care. Tod Adams, RN
8/11/21 12:05 pm
It’s unsustainable
COVID-19 has shown how vulnerable our public health system is – and nurses and midwives are crucial to keeping it running. However, our current workloads are just not sustainable. We’re tired, we’re burning out, and we don’t feel supported at work. The system is at breaking point. Nurses and midwives like me have been fighting for safe staffing ratios for over a decade, but our stubborn state government refuses to listen. A nurse-to-patient ratio is the number of nurses working on a ward or unit in relation to the number of patients they care for. There aren’t enough nurses to patients, and it’s risking lives. Research has shown time and again that the number of patients allocated to a nurse or midwife on a shift is directly related to patient safety, mortality and quality of care. To put it simply, safe staffing ratios save lives. It’s time the NSW government stopped patting us on the back and calling us heroes. They need to listen to us as trusted health professionals and deliver the health system we all deserve. Together, we can help deliver the public health system NSW deserves. Skye Romer, EN
We need community support
Emergency nursing has always been a very complicated and demanding job. Over the past two years, this pandemic has made it even more complicated. For example, many nurses must dress in uncomfortable PPE to protect ourselves and our patients. It has also made staffing more complicated, because when a nurse becomes a close contact, whether it’s in the ED or in the community, they need to isolate. This can really affect the number of nurses we have working at any time. It can also impact on the range of necessary skills that we have in our ED while staff are in isolation. What would really help us in our EDs is if we had mandatory ratios of one nurse to three patients. Safe staffing ratios would ensure we can offer the best possible patient outcomes for our community. Emergency nurses like me are doing our best to deliver quality healthcare during this pandemic. Now we need our community to support us with our fight for ratios of 1:3 in ED. Steven Zorgios, RN
SEND YOUR LETTERS TO: Editorial Enquiries EMAIL lamp@nswnma.asn.au fax 9662 1414 MAIL 50 O’Dea Avenue, Waterloo NSW 2017. Please include a high-resolution photo along with your name, address, phone and membership number. Letters may be edited for clarity and space. Anonymous letters will not be published.
LETTER OF THE MONTH Better listen up
The last two years have been tough, particularly for nurses and midwives, and most particularly in NSW. Interminably hailed as heroes and angels, but still not many people get it. Not the NSW government, not the federal government and not most of the general public. It’s been consistently too little, too late, with both government jurisdictions on the back foot. It has taken the Omicron variant to at last get us the media coverage we have been seeking. To articulate the anger and frustration, knowing that if we’d had nurse/midwife patient ratios when we first requested them years ago, at least we’d have a bit of padding in the health system now. To tell the heart-wrenching stories of the day in, day out slog, stress and anxiety of every shift, knowing that patient safety and your registration are both on the line. What it’s like actually wearing PPE until you are dehydrated and depleted by shift’s end, your face wearing the scars of yet another eight hours in an N95 mask. Fearful for the professional future of the undergrads and new grads, who will be deprived of mentorship when they most need it due to the attrition rates in our professions. Describing what it’s like to see another colleague take early retirement, or leave to find work outside a system that has never looked after us, never cared for us, never wanted to understand that our professions are labour intensive because they need to be. It doesn’t mean we’re any less worthy of reasonable workloads and equitable pay rates and conditions commensurate with our knowledge, skills and qualifications. It means that everyone had better listen up – finally. What I say is this: never again. When the pandemic is finally over, I implore every member to stand together and fight for our professions. Liz McCall, Byron Central Hospital NSWNMA branch assist sec/delegate
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Nurses left to clean up Perrottet’s ‘shambolic mess’
The nursing workforce barely has its head above water trying to manage a disaster of our governments’ making.
Areport by an independent, multidisciplinary group of experts has laid bare the disastrous strategies of the NSW and federal governments to deal with the Omicron outbreak.
The OzSAGE report (see pp 12–13), compiled by an advisory group of experts in epidemiology, health and economics, is scathing of both governments’ “let it rip” policy, which it says will condemn vulnerable Australians to death.
One member of the group, Dr Kerryn Phelps, a former president of the AMA, told The Guardian that after an initially sound response to the coronavirus, “the only example Australia is providing to the world now is a warning about what not to do with the COVID-19 pandemic”.
“How did Australia go from being the envy of the world, with our best practice public health measures, low case numbers, a prepared health system and an economy ticking along nicely, to what can only be described as a shambolic mess?” she said.
Dr Phelps was highly critical of the governments’ misleading public announcements.
is ‘strong’.’ — NSWNMA Acting Secretary General Shaye Candish
“The population was softened up with a false narrative that ‘Omicron causes mild disease’, ‘this could be the gift we have been waiting for’, and ‘this could end the pandemic’.
“Perhaps the most insidious piece of messaging was the pronouncement that ‘everyone in Australia is going to get it’. In other words, why bother trying to prevent transmission?
“In one previously unimaginable act, the premier, in a double act with Scott Morrison, announced a lifting of all restrictions, including mandatory mask wearing and QR code check-ins.
“Despite the warnings that the health system was under pressure and that party season was about to kick off, the message to the community was: ‘Go out there and spend, head to the pub and get back to normal.’”
A PUBLIC HOSPITAL SYSTEM ON THE PRECIPICE
The OzSAGE report found the burden placed on the public hospital system was alarming and underreported.
“Our health system, stretched before COVID-19, has had its capacity eroded by staff resignations and a blow-out in waiting lists. The further impact on the health system, by the sheer number of Omicron cases, at this time of year especially, could be enormous.
“A person who has been hospitalised for COVID-19 is no
MEMO TO THE PREMIER: NURSES FROM WESTMEAD HOSPITAL MAKE IT CRYSTAL CLEAR WHAT THEY THINK OF THE NSW GOVERNMENT’S DANGEROUS AND DISHONEST PUBLIC MESSAGING ABOUT THE STATE OF OUR PUBLIC HOSPITALS.
longer counted in the hospital statistics once they have cleared the virus, even if they still require a high level of care. Therefore, the true number of hospitalisations for COVID-19 related disease accruing in the wards and ICU is not transparent to the public.
“We note that the shortage of staff is such that they are now asked to work after shorter isolation and that there is concern for burnout and fatigue.”
NSWNMA Acting General Secretary Shaye Candish says nurses and midwives are rightfully furious with the NSW and federal governments.
“Their actions and inactions have led us to this. Their persistence in saying the system is coping reveals a complete disregard for the truth,” she said.
“It is outrageous that NSW Premier Dominic Perrottet continues to spin the lie that our public healthcare system is ‘strong’.
“He repeats this lie while nurses and midwives are exhausted, working excessive overtime and still remain short-staffed. Patient care is suffering.”
VIRUS SPREADS LIKE WILDFIRE IN AGED CARE – AGAIN
On 14 January, more than 1100 aged care homes across Australia had reported new COVID outbreaks, with 7014 active cases in residents and aged care workers.
Experts have highlighted two failures that have left aged care residents and staff vulnerable: the “stroll out” of vaccine boosters and the scarcity of rapid antigen tests (see pp 10–11).
Shaye Candish says aged care nurses are “desperate” and are telling the Association that residents and staff are being placed at significant risk due to the severe lack of preparation by providers and the federal government.
“They are reporting a staffing crisis, a lack of access to suitable PPE, substandard infection control practices, and with many residents and staff still awaiting their booster. Some aged care facilities are being forced to ration rapid antigen tests, only using them every 72 hours,” she said.
“The Royal Commission into Aged Care identified significant issues with infection control across the sector. These issues have still not been addressed by the federal government, so it seems inevitable that residents without their booster shot and who are locked down in their facility will likely contract COVID-19.”
Federal government goes missing as Omicron rips through aged care
COVID and the federal government’s incompetence is putting elderly Australians living in residential aged care facilities in grave danger.
Scott Morrison’s “live with COVID” strategy has put the lives of elderly people living in aged care homes in peril, say experts.
On Christmas Eve, 105 aged care homes around Australia had an active outbreak. Two weeks later, the number of homes with COVID had exploded, more than quadrupling to 495 (168 in New South Wales), with 1465 residents and 1875 staff testing positive for COVID.
A week later, on 14 January, the numbers had doubled again with more than 1100 aged care homes across Australia reporting outbreaks, and 7014 active cases in residents and aged care workers.
Dr Sarah Russell, a public health researcher, told The Guardian that the booster vaccine ‘strollout’ and inconsistent infection control protocols had allowed the virus to spread like wildfire.
She said the federal government inexplicably bypassed the existing structures that successfully administer the annual flu booster to residents and outsourced the COVID booster rollout to private companies.
“These ‘in-reach clinics’ had only visited around 50 per cent of aged care homes before Christmas. And then one of the private companies, Aspen Medical, took holidays over the Christmas break,” she said.
On 15 August 2021, health minister Greg Hunt had announced rapid antigen tests would be available to aged care homes.
“We anticipate that regular use of RAT to screen aged care employees and visitors will provide much greater reassurance,” he said.
Sarah Russell argues that “many of the lockdowns could have been avoided if all staff had taken a rapid antigen test before each shift since August”.
“Yet some aged care homes have not had free access to the national stockpile of rapid antigen tests, while other homes have,” she said.
On 23 and 24 December, a deployment of rapid antigen tests was finally distributed to primary health networks in NSW for distribution to aged care homes.
“Once again, this was too little and far too late,” she said.
REGULATOR JUST AS “HANDS-OFF”
An analysis by the NSWNMA has shown the government’s regulator – the Aged Care Quality and Safety Commission (ACQSC) – to be shockingly absent in their oversight of the sector during the pandemic.
— NSWNMA Acting General Secretary Shaye Candish
The Association cross-checked 35 facilities listed with known COVID cases, with site visits by the ACQSC as documented on their website. The analysis made these findings: • Some of the facilities currently reporting COVID outbreaks hadn’t received a site visit since 2017. • Ten of the 35 facilities reporting COVID cases were last visited in 2017 or 2018 and had been granted ‘exemptions’ from further visits. • A suite of ‘exemptions’ had been issued to facilities deemed ‘low risk’. This means they had been given a green light to continue to operate without having a site audit. • Nine of the 35 were not required under NSW legislation to have registered nurses on site 24/7. Of these, three were experiencing their second COVID outbreak. • One facility failed across all outcomes on 4 March 2021 but surprisingly passed Requirement 3(3)(g) ‘Infection Control’. It was deemed suitable to re-accredit until October 2022 with no further site visits recorded. It is now reporting COVID cases.
The aged care regulator was heavily criticised in the aged care royal commission findings over a year ago for their failure to ensure people received safe and dignified care.
The federal government responded by committing to undertake a ‘capability review’ of the ACQSC but then deferred this until 2023.
NSWNMA Acting General Secretary Shaye Candish says this failure to act by the federal government and its regulator means “aged care is a disaster waiting to happen”.
“The Royal Commission into Aged Care identified significant issues with infection control across the sector. The federal government has still not addressed these issues,” she said.
“Our members in aged care are reporting a staffing crisis, lack of access to suitable PPE with many still not fit tested to a P2/N95, substandard infection control practices, and with many residents and staff still awaiting their booster. Some aged care facilities are being forced to ration rapid antigen tests, only using them every 72 hours.”
Dr Sarah Russell agrees that “the lack of leadership” and the “hands-off approach” of the federal government and its regulator during the pandemic “has had heartbreaking consequences for many residents and families around the nation”.
“Sooner or later, our federal government must be held to account for the numerous preventable tragedies that have occurred in the aged care sector,” she said. n
A fatal approach to Omicron
NSW’s “Let it rip” strategy will condemn many people to death – especially among the vulnerable – and has placed an enormous strain on an already exhausted health system, says the independent expert group OzSAGE.
OzSAGE is a multidisciplinary group of infectious disease and public health experts, engineers, architects, economists and social scientists. Here is a summary of their critique of Australia’s COVID response:
REMOVAL OF RESTRICTIONS IN NSW HAS COST DEARLY OzSAGE remains deeply concerned about COVID-19 in NSW, which is already affecting all of Australia. The decision to remove restrictions just as Omicron surged has cost us dearly. All models to date assumed good testing capacity and adequate contact tracing. Without these, case numbers will blow out further. At this point in time there is no publicly available modelling to support a national plan that is based on public health principles, which will protect our hospital systems from collapse.
TESTING DISASTER
Testing in NSW is failing, with many people turned away after waiting in queues for hours and many testing centres shut. Regional and remote areas have even less capacity. There are unacceptable delays in testing results being sent. Rather than investing in expanded testing capacity, the response of government is to restrict access to testing by changing the definition of close contacts and requiring PCR tests only for family contacts, health workers and a few other groups. This will reduce our surveillance capacity for new variants and give falsely low case numbers.
There is a severe shortage of RATs nationwide. This means that even people who can afford them and could thus relieve the pressure on the laboratories, simply cannot buy a RAT kit. RATs are useful for screening of asymptomatic cases, but cannot serve as the backbone of the public health test-and-control system. We are disturbed by the repeated messaging that only symptomatic people should get (PCR) tested, when 40 to 45 per cent of transmissions are asymptomatic, and even in people who develop symptoms, the peak of infectiousness is in the two days before symptoms begin. The false reassurance of the messaging will result in more cases of viral transmission that otherwise would have been prevented.
CHANGES TO A DEFINITION OF ‘CLOSE CONTACT’ ARE NOT BASED ON SOUND PUBLIC HEALTH PRINCIPLES
Close contact definitions need to be based on risk. Risk is related to the amount of exposure to virusladen aerosols. Risk is not limited to arbitrary four-hour time frames within households.
Settings like nightclubs and restaurants have been sites of superspreading events, and if people exposed in these settings cannot get a PCR test, spread will accelerate. Introducing a narrower close contact definition when the test positivity rate is currently 13 per cent in NSW, is unlikely to improve the burden on the health care system and will instead fuel the outbreak. Limiting the amount of testing reduces pressure on the test-andtrace system in the short term, but will worsen the health system burden because it will result in chains of transmission that could otherwise have been stopped. Over the long term, these quick-fix adjustments for resource reasons and better optics will be detrimental.
CASE NUMBERS MATTER – IT’S SIMPLE MATHS
The rhetoric that case matters “do not matter” is incorrect – particularly in the face of the Omicron variant. Even if hospitalisation rates are lower with Omicron compared to Delta, a halving of hospitalisation rates with a 10-fold or 100-fold increase in cases will still translate to a high burden on the health system. This is likely to overwhelm the health system, with regional services at particular risk. The trajectory of observed data suggest that hospitalisation and ICU occupancy are on a steeply rising trend and anticipated to exceed earlier peaks quite soon. In other words, optimistic assumptions about the impact of the Omicron variant on hospital admissions are unrealistic.
OMICRON CANNOT BE DESCRIBED AS MILD
Preliminary data suggest that compared to the Delta variant, Omicron infections are 40 to 45 per cent less likely to result in hospitalisation. This means that the Omicron variant is at least as virulent as the original strain of Sars-CoV-2, with far greater vaccine escape, and cannot be described as mild.
LACK OF ACCESS TO HEALTH CARE AND DEATHS AT HOME
Our health system, stretched before COVID-19, has had its capacity eroded by staff resignations and a blowout in waiting lists. We remain deeply concerned that people with preventable and treatable complications of COVID-19 may die at home in NSW, without access to even the support of Hospital in the Home.
‘LET IT RIP’ KILLS
The “let it rip” strategy and defeatist narrative that “we are all going to get it” ignores the stark lived reality of the vulnerable of our society. Despite three doses of vaccine, some patients with cancer and other immunosuppressed people have substantially reduced protection against Omicron. Similarly, people with co-existing health conditions (estimated to be 50 per cent of the adult population) are at increased risk of illness. The impacts of a fragmented testing system and disrupted health system will be felt most by our elderly, lower socio-economic groups, First Nations people, people with disability and regional populations.
Read the full report
Dismantling health resources and infrastructure is not a solution to the pandemic. https://uploads.guim. co.uk/2021/12/30/Advice_ Omicron_December_30_2021_(1). pdf
We need practical help, not platitudes
The NSWNMA’s Liverpool Hospital branch has called on the NSW government to take concrete steps to alleviate the staffing crisis impacting many of the state’s hospitals.
Liverpool Hospital Branch secretary Mirabel Nelson says south-west Sydney’s hospitals, including Liverpool, are experiencing an “unofficial emergency response”.
“I say unofficial because politicians are refusing to actually acknowledge this current disaster.
“We are told we are coping well. I wish our government would ask us – the frontline COVID nurses – if we are coping, instead of speaking for us,” she said.
Premier Dominic Perrottet has repeatedly asserted that hospitals are in a “strong position” and Chief Health Officer Dr Kerry Chant claimed the health system was “very well placed” to cope with rising hospitalisation rates.
Mirabel said the government should acknowledge the extent of staffing shortfalls and their effect on nurses, midwives and patients.
“We’re definitely not OK, our health system is not OK, and our patients are not OK.”
She challenged Premier Perrottet and Prime Minister Scott Morrison to “throw on a pair of scrubs and
work a double shift” in the hospital’s emergency department.
“ED is just jammed with patients, who sometimes have to wait 12 hours or more for a bed on a ward.”
DANGEROUS STAFFING LEVELS
“Our hospitals are crippled with dangerous staffing levels and our staff have hit a level of exhaustion that is mostly incompatible with basic functioning.”
When The Guardian newspaper visited Liverpool Hospital in early January, it found the main ED waiting room was full and would-be patients were spilling out into the street in 30-degree heat.
The Guardian said a 70-year-old woman with stomach pain had been waiting four hours to be seen and a young woman was vomiting into a plastic bag as she waited.
Mirabel said Liverpool Hospital was understaffed even before the pandemic and called for mandatory staffing ratios “to make management accountable for safe staffing”.
“If we had strict staffing ratios in place before the pandemic, we would be far better off now.
“The fact that we don’t have ratios like Queensland and other states gives management too much leeway to make us work short.
“On my ward pre-COVID, when we were down to four staff instead of the five or six we normally had, we would just have to wear it.
“It doesn’t matter if we are run off our feet, stressed or missing out on
breaks. We just get told there is no other option, that we just don’t have the staff.”
INCIDENT REPORTS NEEDED
Mirabel urged her colleagues to lodge incident management reports whenever their shift is understaffed.
“Our patients’ safety and our own safety is threatened by a poor working environment.
“We need to be strong enough to make incident reports without worrying that there could be any backlash.”
At Liverpool, five general wards and two ICU wards had been set aside for COVID patients by mid-January.
Mirabel usually works in Liverpool’s oncology and palliative care ward but has been regularly deployed to a COVID respiratory ward.
“We are all working huge amounts of overtime, we are spending more time at work than with our own families. It’s been going on for at least two years and we are not coping, that’s for sure.
“We obviously weren’t trained to work in a pandemic but we feel an obligation to help out even when we are dead tired.
“As nurses we care about our patients, and we care about each other. I will always agree to do a double shift because I want to make sure my patients are safe and my colleagues are safe.”
OVER-RELIANT ON JUNIORS
She said many senior nurses were taking early retirement. “They haven’t seen any progress on staffing in many years of nursing and they are sick of it, which is sad.
“Their departure is leaving us over-reliant on junior nurses, who are working without adequate support.
“Our educators are having to take patient loads, and other senior nurses who would normally mentor new grads are leaving or taking on in-charge roles or NUM roles for others who are off on COVIDrelated leave.
“An email went out to all the new grads saying if you have your registration now and are willing to start, we will take you now, without waiting for your official intake.
“It’s too much for a new grad to be thrown in at the deep end when we don’t have the support system we normally would have.”
Mirabel said the NSW government has had two years to put adequate measures in place to help staff handle the current surge in patient numbers.
“By telling us we have to live with the virus, and not taking extra steps to support us, the government is taking advantage of nurses’ goodwill.”
She criticised the Perrottet government’s attempt to strip nurses and other essential workers of their automatic right to workers compensation cover for COVID-19.
Mirabel said it is very hard for nurses to know and prove exactly where they caught the virus. n
Juniors unsupported as hospital bleeds staff
An exodus of nurses from Tweed Hospital in the far north of NSW tells a tale of two health systems.
Tweed Hospital lost 18 nurses from its Emergency Department (ED) between December 2021 and midJanuary 2022. Many of these nurses were the hospital’s most experienced ED nurse clinicians.
Most of those 18 left to take jobs at Gold Coast University Hospital and other Queensland health facilities within a 45-minute drive from Tweed Heads, which is one kilometre from the state border.
Their departure comes as no surprise to senior nurse Kristin Ryan-Agnew, president of the Tweed Hospital branch of the NSWNMA.
“In Queensland, a Labor government gives nurses guaranteed staffing ratios, COVID bonuses, an $1800-a-year education allowance with dedicated fixed times for education, and maximum salary sacrificing,” Kristin says.
“Here in New South Wales, we get none of that. We are bleeding staff who are burnt out and looking for better employment.”
Tweed is a Level 5 referral hospital serving a hinterland that includes the major tourist destination of Byron Bay.
It has the busiest ED outside of Greater Sydney/Newcastle, with the same UDG level of presentations as St Vincent’s in the heart of Sydney.
However, long-term understaffing and over-reliance on junior nurses
sacrificing.’ — Kristin Ryan-Agnew
has been made worse by pandemicrelated staff shortages.
“People are doing double shifts every day with just one day off after night duties,” Kristin says.
“This week we are supposed to have 18 nurses per shift, but we only have 10 nurses to staff morning and afternoon shift. The junior nurses are out of their depth and freaking out completely.”
INCREASINGLY RELIANT ON JUNIOR NURSES
Tweed ED is increasingly reliant on junior nurses, yet has just one nurse educator for an FTE (full timeequivalent) staff of 150.
“We have been pleading for three years to get a second nurse educator in ED, because most of the new staff appointments have been second- and third-years with no emergency experience.”
Many of Tweed’s junior nurses unsuccessfully applied for graduate positions, which are in short supply.
“As a graduate you come into a designated position in the hospital for 12 months and you are supported by a clinical nurse educator (CNE) for the year.
“Those who missed out on graduate positions have been working in nursing homes or on the wards, but very few have acute experience.
“A lot of them are straight out of uni and did at least part of their study remotely during COVID – so how much practical experience did they get?
“If management is going to put junior people out there, it has to have someone there to show them how to do the job and back them up.
“But management won’t give juniors the support they need.”
STAFF SHORTAGES PRE-DATE COVID
Kristin says inadequate staffing and unsustainable workloads predate COVID.
“We have been raising these issues for years and COVID has pushed the situation over the edge.
“Our hospital executive says they have escalated our request for a second CNE to Northern NSW LHD executive and their response was ‘no’.
“The Tweed branch (of the NSWNMA) prides itself on its philosophy of working with the hospital executive for the best possible outcomes for the nursing staff.
“If both parties are committed to a common goal, the relationship needs to be bipartisan. It just won’t work if we are working with one hand tied behind our back.”
Kristin says local National Party MP Geoff Provest has never actively supported nurses and midwives.
“We have appealed for his support previously. Our branch executive has sat with him in his office to explain how dire the situation is – all to no avail.”
She says NSW has gone from “one of the best paid nursing and midwifery services in the country to the worst.”
As an example, she cites the Queensland Health Service policy of allowing nurses and midwives to salary sacrifice to the full extent permitted under the tax system.
“We have never received a single pay rise above CPI, but the NSW Government has continued to take 50 per cent of nurses’ and midwives’ potential salary sacrificing and put it into government coffers.”
Kristin says the rapid escalation of COVID has seen a severe deterioration of working conditions for all nursing staff.
This is compounded in regional areas by delayed transportation of critical equipment, resulting, for example, in shortages of some PPE.
“Some nurses and midwives can’t access the masks they were fitted for because the trucks are not delivering. These nurses and midwives are worried – some have got children at home and the masks they now have to wear are not safe.” n
Byron hurting from refusal to adopt ratios
Byron Bay Hospital is another Northern NSW health facility losing experienced nurses due to unsustainable workloads. Senior Byron nurse Liz McCall, a member of the NSWNMA State Council, said the state government’s refusal to set minimum nurse- and midwife-topatient ratios as they exist in Queensland and Victoria had left NSW more exposed to COVID pressures. In media interviews, Liz said that while hospital services in Byron had long operated with skeleton staff, conditions had become increasingly worse. The loss of experienced nurses meant new graduates and junior staff would not be adequately mentored. “The loss to the profession and the loss to our communities is immeasurable, absolutely immeasurable,” she said.
Sleeping on floors while waiting for beds
ED clinicians at Western Sydney’s largest tertiary referral hospital say they will no longer accept “relentless, unsafe working conditions” as the standard.
At Westmead Hospital in Western Sydney, patients suffering heart attacks, strokes, and major trauma must often be treated in hallways and waiting rooms due to bed shortages and severe access block.
Westmead nurses have been calling for more resources and increased staffing for almost three years, with no result.
In November, Westmead’s emergency department nurses initiated an open letter to the NSW Premier, Dominic Perrottet, and Health Minister, Brad Hazzard.
Signed by more than 200 nurses, registrars, senior medical officers, administration staff, orderlies and security guards, the letter called for a “significant and immediate” increase in funding.
The letter prompted Graeme Loy, Chief Executive of Western Sydney Local Health District, to meet with ED staff representatives, including NSWNMA members.
Loy referred concerns raised by staff to hospital-level working groups.
NSWNMA General Secretary, Brett Holmes, said it was unacceptable the ED of Western Sydney’s largest tertiary referral hospital was consistently one of the poorest performers.
“While our members will try to work with local management on this, they are concerned the working groups will not deliver the changes
— Westmead staff letter to Perrottet and Hazzard.
that are needed within a suitable time frame,” he said.
“The Health Minister needs to step in and provide assurances that the LHD will get the additional funding needed to match the growing demand being placed on this facility.”
STAFF ARE PHYSICALLY AND MENTALLY EXHAUSTED
Brett said expert advice is also required to develop effective longer term strategies to fix access block and relieve constant congestion in the ED.
The staff open letter said conditions had steadily deteriorated, despite recommendations from a December 2019 Health Ministry review of the ED and numerous staff meetings with hospital management.
“Advertised registrar positions remain unfilled and staff deficiencies remain a chronic problem for all levels of medical and nursing staff,” the letter said.
“The recent surge in COVID presentations has added additional risk and safety concerns to an already overwhelmed department.
“It is common to have 30 to 50 admitted patients within the ED at the start of the day, for patients to leave while still unwell, and admitted patients sitting in the waiting room for 15 to 20 hours.
“ED staff feel strongly that patients are treated without dignity, when staff are forced to provide treatment in hallways and patients need to sleep on the floor.”
The letter said the consequences of management’s inaction included extended ED stays, poor patient outcomes, increased risk of violence and low staff morale.
“These relentless workplace conditions have taken a massive toll on staff wellbeing, mental health and morale, with an increase in sick leave, overtime and resignations.
“Staff are physically and mentally exhausted from having to endure these relentless unsafe working conditions and can no longer accept them as the standard.” n
WESTMEAD NSWNMA MEMBERS PROTEST AGAINST THE UNSUSTAINABLE CONDITIONS THEY ARE EXPECTED TO WORK UNDER WITH EXCESSIVE OVERTIME, UNREASONABLE WORKLOADS AND A CRITICAL LACK OF STAFF.
A NSWNMA representative in Westmead Hospital’s ED, RN Farah Ismail, said the hospital-level nursing working group includes three experienced and senior ED nurses. “They are all NSWNMA members, and they will definitely get our message across,” she said. She said the united stand by nurses, doctors and other staff “seems to have got the wheels in motion”, with reports that management was considering the early opening of a planned Psychiatric Emergency Care Centre unit attached to the ED. “Management needs to come up with solutions now, because the department is losing senior nurses due to the appalling, unsafe working conditions. “Some nurses who were hired at the start of the pandemic have already applied for other jobs because our ED isn’t what they thought it would be and they are not coping. “On my last shift on a Thursday, we had 37 unplaced admissions with no allocated beds, and throughout that shift there was a page saying ‘the hospital is at capacity, please prioritise discharges’. “It is common for medically cleared psychiatric patients who are not critically unwell or in need of a telemetry bed to sit in the corridor for up to 18 hours, or sleep on the floor while waiting for a psychiatric assessment. “Sometimes your heart breaks for these poor patients; it’s just not fair. Even geriatric admissions were sitting in our waiting room for nine to 12 hours last week. “After patients are eventually admitted by a psychiatrist or psych CNC, they might have to wait two days for a bed at Cumberland Hospital, which is where most of
United stand ‘gets wheels in motion’ ‘Sometimes your heart breaks for these poor patients; it’s just not fair.’ — Farah Ismail our psych patients go. Or wait up to 16 hours for transport.” Farah says such conditions are a “recipe for increased aggression”. “We have had multiple incidents where staff were badly assaulted, and we now have at least two security guards in ED at all times. “But if it wasn’t for a regular police presence in our department we would sometimes really be in trouble.” In October, a 26-year-old man who attacked a Westmead ED nurse, escaped jail when he was sentenced to two years and six months to be served under supervision in the community. The nurse's scalp was split to her skull during the attack, and she needed 16 stitches. n
Opposition leader Anthony Albanese talks to The Lamp about his commitment to improving aged care and public health.
You’ve signed the ANMF/ NSWNMA pledge to support reform in aged care. What motivated you to make this commitment? I have had the opportunity to meet many ANMF/NSWNMA members in the aged care sector. You are hardworking, dedicated and inspirational in your commitment to quality aged care. Labor appreciates you but we don’t just want to say ‘thank you’ – we will show our appreciation in a real way. Would you expect the rest of your team to sign up to the pledge? Your pledge has my support and the support of my Shadow Minister for Health and Ageing, Mark Butler. We encourage all of our caucus and candidates to get on board because Labor is committed to the principles of reform ANMF/NSWNMA members are campaigning so hard for. Nurses have been campaigning hard for many years to improve the care of older Australians in the aged care sector and despite the numerous inquiries and commissions not much has changed. What sense of urgency will you bring to this task? The challenges the aged care sector faces are not new – as you know better than anyone. However, the combination of the Royal
— Opposition leader Anthony Albanese
Commission and the coronavirus outbreak can leave no question in the mind of any Australian that we have a crisis on our hands. And this isn’t a theoretical concept – most Australians have a loved one in aged care or headed towards it. This is a very real experience for us all. We are working with the ANMF/ NSWNMA and other aged care unions on finalising our aged care election policy, which will address the priorities set out in your pledge. Fixing aged care will be a central priority of an Albanese Labor Government. The Gillard government in its last days linked aged care funding to staffing and wages to ensure taxpayers’ money was allocated by providers as it should be. Would an Albanese Labor government consider a similar approach to make the sector more transparent and accountable? Labor agrees that transparency and accountability measures are needed to ensure resources devoted to the sector are translated to better patient outcomes, and not greater financial returns for unscrupulous providers. Mandated staffing, increased care hours and better skills are at the heart of what nurses at the front line see as necessary to provide proper care for our elderly. Do you share that analysis and how would your government respond? We absolutely need minimum staffing ratios in residential aged care so that residents get the care they deserve. In its response to the Royal Commission recommendations, the MorrisonJoyce Government failed to properly address ratios or any workforce matters. COVID has wreaked havoc on the economy as well as on public health. Do you recognise increased investment
in public health as an economic imperative as well as a public health necessity? It is very clear that if you don’t get the health response right, it has a consequence for the economy and for jobs. We are seeing businesses unable to open because staff are isolating. There has been a massive withdrawal of economic activity as a result of the Morrison-Joyce Government’s failure to get the health response right. All Australians are suffering because of the Morrison-Joyce Government’s failure to plan. What lessons have you derived about our public health system from the pandemic? Above all that you – on the frontline – are heroes and the world’s best at what you do. Our public health system has been let down by the MorrisonJoyce Government – we know nurses, doctors and health workers are exhausted, and we know hospitals are overwhelmed. Further, it is clear that primary health care has been neglected by this Government. Only Labor can be trusted to have Medicare at the heart of our health care system. What is your assessment of how the federal government has handled the COVID crisis? What would you have done differently? Australians are still paying the price for Scott Morrison’s “it’s not a race” approach. Scott Morrison had two jobs last year: a speedy effective rollout of the vaccine and quarantine. He failed at both. At the start of 2021 he said his number one priority for the year was to ‘suppress the virus and deliver the vaccine’. If his failures weren’t so serious, it would be laughable. It is inexcusable that in the third year of this pandemic we have such serious testing and vaccine rollout issues. The Morrison-Joyce Government has been complacent, particularly in aged care and once again we are seeing aged care residents struggling to receive their booster shot. If I were Prime Minister, I would have taken responsibility. I wouldn’t have waited until there was a crisis to act. I would have secured vaccines earlier – as we said at the time. If we had done that, people would have received their booster shots well and truly by now. What’s more, Labor would have made rapid tests free right at the time that we needed them the most. Nobody should be denied a test because they can’t afford one. We are only months away from a federal election. What would you like nurses and midwives to know about you before they vote? A Labor Government will not allow older Australians to grow old alone, deprived of proper care and dignity. We will not forget the dedicated, mostly female staff who care for our elderly, almost uniformly understaffed and underpaid. We value you. Thank you for work during pandemic. Labor will rebuild broken aged care system. Labor will put Medicare at the centre of the health system – only Labor can be trusted to strengthen Medicare. n
Jocelyn and Maria speak truth to power
Jocelyn Hofman, an RN in aged care, and Maria O’Neill, a retired aged care RN and honorary NSWNMA member, met with Leader of the Opposition, Anthony Albanese, to give him a firsthand account of how the sector is suffering.
Jocelyn Hofman says she is encouraged by Anthony Albanese’s support for reform in aged care. “He seems to know the issues surrounding aged care. He signed our pledge, which asks him to support 24/7 RNs in aged care facilities, minimum mandated care hours and the right skills mix, greater transparency in the system (which means Commonwealth funding is tied to care), and improved wages and conditions for staff. “I’m relieved that a major political leader is listening to our concerns in aged care. With the federal election coming up, we really need a true leader who stands up for aged care residents and staff,” she said. She says there is still a lack of political leadership to fix the sector nearly a year after the Royal Commission handed down its report. “This current government is still dragging its feet on fixing aged care. It has proposed an RN for 16 hours in a 24-hour cycle. That means from 10.30pm there is no guaranteed RN on the floor. I worry about that. Who will assess the resident who has had a fall? Who will administer the pain relief? We still haven’t seen any transparency on where the extra money that the government committed to the sector is being spent. Residents and people who work on the floor are being neglected again.” Jocelyn says the federal election – due to be held in the coming months – will be crucial for aged care. “This will be a very significant election, because our aged care system is collapsing, and we need a government that will really take this issue seriously; we really need a leader who will take action. Our society is judged by the way we treat our vulnerable people, and this process needs to start from the top. Mr Albanese is the first leader of a major party who has committed to meaningful aged care reforms. “We need to know where every member of parliament stands on aged care. We are all going to age. This election, I urge our NSWNMA members to vote wisely.”
— Jocelyn Hofman
Next step: implement the pledge
Maria O’Neill says it is great for the Leader of the Opposition to sign up to our aged care campaign goals, but the ALP now needs to turn that into action. “I think he knows the issues, but Labor has talked the talk, but not walked the walk. Labor has promised reform but hasn’t done anything yet. “I wanted to talk to him about the absurd situations in aged care. For example, towards the end of my working life, I saw one woman in aged care with heart failure admitted to hospital because there was no RN to take over her care when she went back to the nursing home. She spent six weeks in hospital. This was financially absurd, and it was inhumane, because she was on the edge of dementia and couldn’t really understand why she couldn’t go back to her home and why she was in this busy, crazy environment. “An acute bed in a public hospital is not relaxing for anyone, let alone someone old and fragile. We know that people with heart failure, with correct medication and nutrition they can be stabilised. But people are not getting regularly assessed and their medicines titrated in aged care, which needs to be done by the RN on site.” Maria says it is important that we get the rest of the ALP federal candidates to sign the pledge. “When I receive letters from Labor candidates in my area asking for my support, I’ve written back listing the issues they need to listen to and fix. I say ‘I am happy to support you as soon as you do something about this’. “I also think personal visits are a good thing. I think these kinds of actions are very useful to get politicians to focus on the issues.” Maria says she finds the latest outbreak of COVID in aged care heartbreaking. “I am hearing from women working on the aged care campaign about how the staff don’t have enough PPE. They are fighting to keep people safe. Access to RATs is going to be a huge issue, and we don’t have enough now.”
— Maria O’Neill
Leader of the Opposition Anthony Albanese signs the pledge to support reform in aged care:
• RN24/7 – at least one registered nurse on site at all times • Minimum mandated care hours and the right skills mix • Greater transparency – funding tied to care • Improved wages and conditions
Push for mandatory Intensive Care standards
Critical care nurses take staffing case to health minister.
Nurses seeking solutions to the staffing crisis that is hammering intensive care units across NSW are due to meet Health Minister Brad Hazzard for a fourth time in February.
The nurses want practice and workforce standards set by the Australian College of Critical Care Nurses (ACCCN) to be made mandatory and uniform across NSW ICUs.
Critical care nurses, led by NSWNMA members, have campaigned for three years to have ACCCN standards accepted as the benchmark for critical care and staffed accordingly.
The campaign took a step forward in September when media publicity highlighted the ICU staffing crisis and around 750 critical care nurses signed a letter to then Premier Berejiklian and Minister Hazzard, calling for permanent staffing improvements to ensure safe patient care (see story page 26).
“We desperately want you to meet with our representative group so that you will understand the problems and work with us to fix them urgently,” the letter said.
Mr Hazzard accepted the invitation and had three meetings with a sub-group of a statewide ICU nurses’ network late last year.
NSWNMA officials including Brett Holmes (General Secretary), Shaye Candish (Assistant General Secretary) and Michael Waites (Manager, Public Health Organising Team) also attended meetings.
ICUS ARE OPERATING TO DIFFERENT STANDARDS
Michelle Rosentreter was among the experienced ICU nurse delegates from Level 5 and Level 6 ICUs, who met with Mr Hazzard and met separately with his ministerial advisers.
“The meetings were a bit frustrating because we had to repeatedly explain the functions of the various nursing roles – what a clinical coordinator is, what a team leader is, what an ACCESS nurse is, et cetera,” she said.
“I was taken aback to discover that the people who decide workforces for hospitals and advise the minister, do not even understand what their own clinicians do every day.
“We are encouraged that the minister is actually meeting with ICU nurses rather than only listening to district and local executives, who are trying to meet their KPIs and produce reports that don’t reflect the challenges resulting from inadequate staffing.
“We hope the next meeting will discuss how ACCCN standards can be implemented as a mandatory requirement, especially for levels 4, 5 and 6 ICUs.
“At the outset, we asked the minister to take the appropriate time to analyse what we were saying and meet us with a prepared response.
“We didn’t want rolling meetings for the sake of it; we wanted to reach some sustainable solutions.
“At the third meeting, the minister appeared to agree with us that it is unsatisfactory for every ICU in the state to operate according to different standards, which allows LHDs and local hospital executives to not honour the safe staffing profile we need on every shift.”
With at least one Sydney public hospital offering cash bonuses to nurses who agree to cut short their annual leave, and efforts to bring in more overseas nurses, Michelle says such “band aid” solutions can’t last forever.
“NSW hospitals have had a deplorable record of working under-resourced and over-census for many years.
“There needs to be the political will to lift budgetary restraints and allow hospitals to be adequately staffed and recruit the people they need.” n
— Michelle Rosentreter
Australian hospitals are experiencing a “mass exodus” of experienced ICU nurses, the Australian College of Critical Care Nurses (ACCCN) has warned. “They are not taking sick leave or annual leave, they are working extra hours, and at the end of all this we are seeing lots of senior people, who have worked in intensive care for years, leaving ICUs at a time when they are so valued, and we need them so much,” the college’s chief executive, Rand Butcher, told The Guardian news site. Sydney ICU nurse Michelle Rosentreter oversaw a shift when a nurse collapsed shortly after starting work. “She had been feeling unwell but came to work because she didn’t have any sick leave,” Michelle said. “We sent her to Emergency, and she was diagnosed with viral endocarditis. “It is appalling that hospital administrators are sending out letters warning nurses their sick leave is becoming excessive, while more and more nurses are presenting to Emergency with acute and chronic issues. “This is the real face of burnout.” After almost 20 years of nursing – 10 as an ICU nurse – Michelle had her own frightening experience of burnout in September. “I was working a night shift looking after a ventilated patient and I felt sicker and sicker,” she said. “I found I couldn’t raise my arms, or move them from the elbows up, and the pain was excruciating. “I assumed it was dehydration, took Panadol, and managed to drive myself home, where the pain hit my chest. “I had to call an ambulance and be taken to Emergency, was given pain relief and anti-inflammatories, and after a couple of months seeing specialists, I have been diagnosed with fibromyalgia, resulting from chronic fatigue and stress. “The way to manage that is with a regular routine and good sleep, so for 2022, I’ve reduced my nursing hours and will be working in a nonclinical role three days a week. “I’m hoping this will help me balance my health and avoid flare-ups. “I love my job as an ICU nurse, but I have to find a way to look after myself.” n
Pressure mounts on government over ICUs
NSWNMA survey shows ICU staffing levels fall way short of key ACCCN standards.
Sixty per cent of NSWNMA members who work in ICUs say they will leave critical care nursing within five years. Most of them will leave within three years.
The disturbing finding comes from a union survey of members in 37 of the 40 ICUs in NSW.
Seventy-five per cent of respondents said they are at “breaking point” due to the chronic staffing crisis.
When asked whether they can deliver safe patient care at all times, 88 per cent of respondents answered no.
The union outlined the survey findings in a letter to Health Minister Brad Hazzard during talks about critical care nursing standards (see story page 24).
In the letter, NSWNMA General Secretary Brett Holmes said the implementation of standards set by the Australian College of Critical Care Nurses (ACCCN) would deliver a “significant and rapid” improvement in working conditions and raise the standard of care delivered.
“This will in turn allow nurses to continue working in our ICUs across the state,” Brett said.
— ICU nurses’ letter to NSW Government
In September, around 750 critical care nurses signed a letter to then Premier Berejiklian and Minister Hazzard calling for permanent staffing improvements to ensure safe patient care.
The letter said ICUs were in crisis before the COVID-19 pandemic.
“We experienced chronic understaffing, an increased junior skill mix as a result of senior staff leaving due to burnout, and everincreasing workloads.
“The added demands of the COVID-19 pandemic, testing capacity and surging admissions, is forcing our clinical workforce to the brink, placing our registration at risk on every shift and compromising safe patient care,” it said.
NURSES GET SUPPORT FROM CICM
The letter added that critical care nurses’ health and safety “are constantly being placed at risk both physically and mentally by the current inadequate staffing levels. The pandemic has only multiplied these impacts.”
“We believe that the Local Health Districts, the Ministry of Health and your government are failing to consider or meet your obligations in relation to our mental health and wellbeing, as well as the impact this pandemic is having on an already overstretched system.
“We do not want to be harmed, just by attending work. We do not want to see our patients die as a result of understaffing.”
Michelle Rosentreter, an ICU nurse delegate taking part in talks with Mr Hazzard and ministry officials, said the nurses’ position was strengthened when the NSWNMA secured a letter of support from the College of Intensive Care Medicine (CICM), which oversees the training
— Brett Holmes
and education of intensive care specialist doctors.
“Intensivists find it incredibly frustrating when they cannot accept a patient with a life-threatening illness, because they don’t have enough nurses with the required skills to deliver the high level of care associated with intubation, dialysis, ECMO et cetera,” Michelle said.
In January, Brett Holmes authored an article in the Sydney Morning Herald that outlined the strains being placed on nurses in all areas of the NSW hospital system.
Regarding ICU nurses, Brett wrote that they “are once again working excessive hours of double shifts and overtime. They are caring for a combination of ventilated and high-dependency patients, some with COVID-19 and some without.
“Over the weekend, ICU nurses at an outer-metropolitan hospital declared, ‘we are falling like flies’. In the state’s north, an ICU nurse said, ‘we’ve had two years to prepare for this, and it’s still shit everywhere’, while another reflected, ‘there’s nothing left in the tank’.
“Staffing has become so bad that many ICUs are working without team leaders or the nurses they need in addition to bedside nurses, to keep the units working seamlessly.
“Nurse educators have been forced to stop offering clinical supervision to take on patients of their own. Meanwhile, ICU teams are still attending to medical emergency calls from other parts of their hospitals.” n
What nurses need to stay safe
In their letter to NSW government ministers, ICU nurses called for the following improvements to staffing to ensure provision of safe patient care: • ICU: one RN to one ICU patient. • HDU: one RN to two patients, • An in-charge RN (however titled), plus an ACCESS nurse per pod/unit on all shifts without a patient load. • Nurses who are part of a response team (however named) to be provided in addition to the minimum ratios. The ratios will apply to patients who are clinically assessed as requiring critical nursing care, even if they are not situated in a designated ICU or
HDU (however named). • A clinical nurse consultant and nurse practitioner, as appropriate, to be provided in addition to the minimum ratios. • One clinical nurse educator per 30 nurses – in compliance with the Award provision without a patient load. • One RN to two patients (doubled patients) to be no more than one room maximum apart, maintaining visual line of sight at all times. “In addition to this base staffing, we require a COVID float nurse (however titled) without a patient load to assist in the current pandemic,” the nurses said.
