Industrial action for ratios.
The NSW nurses association (NSWNA) is currently escalating its industrial actions in an attempt to secure safer nurse staffing ratios and to bring it into alignment with similar existing ratios in place in Victorian hospitals.
At this time the industrial actions have resulted in over 300 beds being closed across Sydney’s Royal Prince Alfred and Westmead Hospitals, St George Hospital and hospitals in Wollongong, Manly, Long Jetty, Taree. These numbers are expected to quickly escalate over the next few days.
The NSW health minister Carmel Tebbutt is refusing any negotiations with the union whilst industrial action is occurring, stating that the ratio of one nurse to four patients is not appropriate (ABC radio).
Currently, a General Workload Calculation Tool, that was developed in 2004, is used by NSW hospitals to calculate the nursing hours per patient day required on any particular ward or unit.
However, this tool has failed to meet the combination of escalating workloads and skill mix1 challenges that NSW hospitals currently face.
After examining the Victorian model and engaging nurse workforce and industrial relation academics, the NSWNA has found empiric evidence for the introduction of nurse to patient ratios.
“A nurse-to-patient ratio would mean all absences from the clinical roster must be replaced or backfilled by an employee of the same Award classification to ensure the quality and safety of patient care. Necessary budgets would be allocated to ensure this.â€
“This claim also provides a consultation process regarding the introduction of Assistants in Nursing to the roster for any ward or unit. It includes provision to ensure Nursing Unit Managers have the delegated authority to make the final decision about whether patient care can be maintained with an AiN role as part of the unit’s skill mix. This means if the NUM believes AiNs can enhance the nursing care for that unit then they can employ one as per the package but there cannot be more than one AiN per shift. No AiNs are to be rostered in emergency, palliative care or inpatient mental health units or wards.â€
:: NSWNA ::
Claims for staffing and skill mix for individual speciality areas can be found in this document. Of course, my interest lay in the emergency department model, so lets have a look at that.
Emergency Department Claim.
The NSWNA claim for staffing of emergency departments (Levels 6, 5, and 4) applies to all beds, treatment spaces, triage rooms, procedure rooms and any chairs where these spaces are regularly used to deliver care. This staffing ratio does not apply to the staffing of EMU, MAU or PECC units.
- Morning Shift: 1:3 + RN in charge + triage
- Afternoon Shift: 1:3 + RN in charge + 2 triage
- Night Shift: 1:3 + RN in charge + triage
- Resus beds will be staffed 1 nurse: 1 patient.
Skill Mix
The following provisions will apply:
- The skill mix for each ward or unit will include a minimum of 90% Registered Nurses on each shift
- Due to the nature of the service, AiNs will not form part of the skill mix
- Where the proportion of Registered Nurses on each shift in any ward as at the date of this Agreement is higher than 90%, that proportion shall not be reduced.
Clinical Support
The ratio specified above does not include the following positions or classifications: Nursing Unit Manager; Clinical Nurse Educator, Clinical Nurse Consultant, Clinical Initiative Nurse, Nurse Practitioner, administrative support staff and wardspersons.
Further, there shall be 1.4 FTE Clinical Nurse Educators employed for every 30 nursing staff, and a proportion thereof where there are fewer than 30 such staff in a unit/service. CNEs should be rostered to provide coverage on seven days of the week over each roster period.
Nurses speak up:
What say you?
What is your own feeling on this?
Do you work in a hospital that is currently affected by the NSWNA industrial actions?
What is the current nurse to patient ratio on the ward/area that you work? Do you feel this is safe? Can you give some examples?
Perhaps you are working in Victoria or other places where similar ratios are in already in place…what is your experience of this?
Over to you……
- Skill Mix: the balance of relevant knowledge, skills and responsibilities required to provide safe, quality care in any particular speciality [↩]
1 to 4 patients in Victorian public hospitals may be the rule but it is not always the case. If we then look at aged care the ratios are much different for example 1 nurse supervising 60 patients, 2 EENs and 8 PCAs. Sure it sounds alright in theory but it is dangerous in practice. There is no time to supervise the staff or assess the patients because you are too busy doing the diabetic and wound care, medical rounds, filling in reports, ordering supplies and tests, calling family members and organizing transport. You don’t get a break and work unpaid overtime to catch up. Then we say we do it for the patients. Well I disagree because the patients are suffering; but instead of speaking up and demanding proper nurse to patient ratios, we return to work the next day only to witness more patients suffering and the bearcats get richer. I always thought nurses were there to prevent abuse, but today it seems they assist the abuser by doing nothing. It is time to stand up and say no more abuse, but no one will do it.
Nice to read. There you have it. I’m either moving to Victoria or California . I recently worked a 7p-7a shift where I was the only RN and had 20 patients!!! It is a psych hospital but even so, it is impossible. Half of that is dangerous. Never again will I risk my license so some VP@UHS can get a bigger bonus.
I read this article with great interest – I work with a supplier of nurse call systems and I’ve seen just how pressurised a job nurses have and with statistics like this, it is all too clear that something needs to change. Nurses have a tough enough role as it is without this level of outnumbering. The need all the help they can get because the numbers are heavily against them and this is something that the government needs to look at much more closely.
With the baby boomers now starting to bust sprockets and clog hospitals, the only way to maintain appropriate ratios of EVERYONE – doctors, nurses, cleaners, maintenance, etc – will be to build more beds and hire more staff. OK. How are we going to pay for this? I guess taxes (esp company tax) could go up. Any other ideas?
Nurses are overloaded and abused! We cannot function the way we can and expected to because we simply are understaff! the government is not doing anything in the US and even in UK!
Lately I have become aware of some nasty undercurrents happening in the public hospital system.
We get told that we are professionals, yet are being treated like we work on a factory production line, but at least if you work on a factory production line, you do get meal breaks.
For perspective, in my ED (Toronto), broken down by CTAS
acuity (similar to your triage system) Resus Beds (CTAS 1): 1:1
Emergent Beds (CTAS 2); 2.5:1 Urgent Beds (CTAS 3); 4:1 + charge
and triage x 2 + ambulatory (CTAS 4/5) x 2-3 RNs For actual beds it
works out to an average 3.3:1. This seems to work out well for the
CTAS 1-3s but ambulatory care sucks — 80% of patients go through
there. That third of a nurse seems to be needed! Keep up the
fight!
I am an EEN in Victoria ( formerly RN Div 2 Med end until the national reg came into affect) I have been working in the private sector for near on 10years I work in acute/med surg in Neurosciences (which covers neurorolgy, vascular and neurosurg) The ratios for private is 1:5 for AM and PM and 1:10 for night. An EEN or EN in vic is every bit as competent in their nursing care an RN some can give oral meds sub cat and IM such as myself and will soon be doing the IV course so that I can then handle IV fluids and the IV pumps so as to not have to bother my off sider in the section to hang a new flask. There is only 2 en’s allowed per shift on the floor and we work with a Div 1 maybe the big difference is that we do a whole ward handover and also work as a team even the U/M hops in to assist where needed. We have a clinical educator on the floor and there is a Clinical development unit that assists the new grads and nursing students on clinical placement. We have regular inservices on everything from braces to meds to wounds, to spinal surg and brain tumours etc. An En is every bit as competent in their care as a Div one and this is often reflected in the thankyou cards received from the Patients. Now maybe Victorian nurses should push for a pay rise to bring us on par with the rest of Australia.
The NSWNA is the only crowbar nurses have in fighting the
ever-decreasing conditions of nurses in NSW/Australia. The
government does whatever it can to reduce costs, and this they see
as easy if they can crucify nurses. This is stage one in the
closure of any hospital as once reductions hit 20 percent, you lose
doctors, cleaners, domestics, cooks etc until the government now
‘justifies’ the closure (that they have orchestrated). The
authorities rely on nurses’ ‘dedication’ to not complain, but
eventually, disasters have no choice but to occur due to the
dangerous nurse:patient ratio. The answer then is : “but the nurse
never complained (in writing) that there was any problem”…which
proves that ‘the nurse’ is a witch, and as such : “burn the witch”
(that eliminates the problem entirely!) I work agency and have done
so since 1987. I rarely ever sit down on my 10 to 16 hour shifts,
and choose to work in critical care and emergency areas, but also
get allocated to other wards. I work at Westmead Hospital, and love
the work, despite the at times heavier load on some shifts in some
wards. I do realize that while I’m busy with a sick patient,
another patient may be dying/ arresting etc, but at least at
Westmead we have a great back-up to resuscitate the patient (as
long as there’s a bed in ICU!). Often ICU has been backlogged for
weeks with patients who belong in wards, yet the wards have nursing
home patients that no-one wants to take…and emergency cops the
abuse for being full! I have worked in private hospitals ….and as
an example…have had 36 patients on a night shift, with one other
nurse (a 2nd year student) and approx. 24 patients on 4/24 IV
antibiotics, and over 10 post-ops on the previous day. One night a
patient had a cardiac arrest, and in the ensuing 2 hours, …who
was left to actually check if the other 35 patients were
alive?
I totally support nurses everywhere with patient ratios 1:4 never more!!!!
I am no longer working in hospitals but am now tele nursing, I miss the hustle and bustle of hospitals but was sick of heavy workloads ie, in charge of department/hospital and also carrying a pt load of up to 28 of a night!
Then moving to a new state and not even being allowed to basically touch the drug keys!! An insult if ever I have had one.
Good on you fellow nurses, don’t back down till you get what you want. Don’t support the government in their pitiful attempts at managing health. They have done badly for a long time and it’s time they supported us all.
1:4 would be heavenly! I can’t quite translate all the
Aussie speak to my American-speaking brain, but 1:4 I understand. I
work on a busy med/surg floor where it is normal to carry 6
patients; depending on the day, there can be as many as 3 of those
who are fresh post-ops! And there is almost always a 7th patient
for every nurse just waiting in the wings somewhere: ready for
transfer off ICU or telemetry, coming up from the ED, or finished
in PACU and waiting for a bed. I would love to see ratios
instituted, but at the same time, the problem of acuity is there
too. 4 patients is not 4 patients. Do these kinds of policies
usually dictate different ratios for the sicker patients?
I’m an EEN student, 8 weeks from graduating my course with the intention to go on and study my RN from mid-year. I am watching these developments with interest as they are likely to have a huge impact on my employment. I’ve been on the wards last year, and I’m about to go back to clinical, to complete my mandatory 690 hours minimum.
Having seen a lot of what I’ve seen (in major Sydney teaching hospitals), has made me wonder if I want to nurse in the public system. As a student I’ve been left to nurse patients; have previously specialied a psychiatric patient who was acutely suicidal and worked with an RN – with the RN, me (student – supernumerary only) and 14 patients. It’s impossible and it’s scary.
I have also been a patient in a public psychiatric facility where I was being treated for an eating disorder. I was there for four months. During this time, my own treatment and recovery were impacted negatively by the lack of staffing ratios. Daily the staff had around 9 patients, sometimes more. It was rare for this number to dip below 8. This ward was not a rehabilitation ward, it was acute care. It feel that my stay was lengthened because I did not get the level of care, support and supervision I required at this time. I did not get that because ratios were too inadequate for the ward to be staffed properly. The ward was an incredibly traumatic place for a 19 year old to be; especially as I had no psychotic symptoms, nor was I particularly depressed, I was just incredibly malnourished (and pretty nuts as a result) and very, very anxious. And while that’s another issue entirely, I really feel that it is something that should be addressed as I do not believe adult general psychiatric facilities are appropriate places to treat mental illness in under 25s.
I’m so glad I found your blog today Ian, it’s very interesting! Thank you for sharing your stories and thoughts. I know I will certainly be following this particular story (and your commentary of it) with great interest.
I’m not normally a fan of industrial action, but I strongly believe in this cause and I KNOW it is something worthwhile to fight for; as both a patient AND a nurse. As Kate said, “1:4 all the way.”
Hi Ian
i am a registered nurse currently working in ICU at Westmead Hospital Sydney and support nursing ratios 110%. i was one of the many nurses who went on strike a few weeks back after months of negotiations and talks with the NSW government failed to address our concerns for safe patient care in our hospitals.
i used to work at Royal North Shore Hosiptal in the cardiothoracic ward and left for a number of reasons but a major contributing factor was the ratios and skill mix of staff and the conditions we were made to work under to perform our jobs. i was exhausted and fed up with upper management sucking us dry with regards to the ever decreasing staff numbers or experienced nurses. too many times an RN who called in sick was replaced by an AIN. and too many times i worked with a EN and shared the responsibility of 8-9 patients. it is too much and too unsafe. frequently my patients would comment on how i never seemed to stop moving.
it goes even further though. they cut back on cleaners which means it takes longer to turn of beds when patients are discharged. they reduced our wardsmen which made it difficult to physically help our patients in and out of bed and provide Pressure area cares. they reduced our pharmacists making it harder to recieve medications on time. and frequently the hospital could not afford to pay their stock bills and consequently we ran out of basics like dressings, blueys, and syringes. add to all this the increase in patient workloads and its too much.
thankfully now in ICU it is 1:1 nursing care and i feel i can give my patients the attention they deserve. but bed block and staffing issues are still a major problem on the wards and the major reason for ED bed block.
i am sick of the media and government only addressing the issue of ED waiting times as being an ED problem. the problem isn’t with Emergency departments the problem lies on the wards. and the inadequate staff to open physical beds to alieviate bed block. the issue is that too many experienced nurses are leaving the profession because of exhaustion and stress and are not being replaced.
I completely support my peers in this fight for what is right and necessary to provide good patient care. I love my work and couldn’t be happier doing anything else but somethings gotta change.
1:4 all the way
kate