26 April 2022
Article from April 2022 edition of INPractice
Exhausted nurses sleeping on pavements, in tears, newly graduated nurses pushed into roles under-prepared, causing trauma and placing their careers at risk. The pressures being placed on nurses are making many of them feel very, very ‘sick’.
An exhausted Adelaide nurse working an 18-hour double shift is photographed taking a nap on her break on the concrete ground outside of her hospital - a powerful indictment on the crushing stress and lack of resources within our health care sector.
The Intensive Care Unit (ICU) nurse was unable to sleep in the tearoom as it requires full personal protective equipment (N95 mask and goggles) to be worn at all times, making a sleep break almost impossible. The next best option was to sleep on the ground outside the hospital. There were no other no facilities available at the time to accommodate breaks.
“I know there are some people who will say ‘Oh, she made the choice’, but I didn’t,’’ said the nurse, who did not wish to be identified. “I was dog tired and did not want to go to my car and risk not waking up, of putting myself in an unsafe situation.’’
The nurse said she was “lucky the other girls (nurses) were all around”, so she could sleep in safety.
Other pictures sent in anonymously by fed-up, fatigued health professionals revealed an alarming lack of personal protective equipment at the Royal Adelaide Hospital. PPE was not being restocked and cupboards remained almost bare despite assurances that hospital stocks were adequate to meet the requirements of the workforce.
Emergency department nurses at the RAH and The Queen Elizabeth Hospital were in tears before their shift one Thursday due to sheer exhaustion. There were no staff to allow adequate breaks. As one text message reveals (pictured next page), on that Thursday night the RAH only had seven nurses to fill 36 staffing gaps across the hospital.
“They say a picture is worth a thousand words and these images do speak of a system under immense strain – a powerful testimony to the dangerous state of affairs within our health system,’’ said ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM.
In recent times we have seen ramping occurring at unprecedented levels, record numbers of people waiting in emergency departments, many for more than 24 hours, hospitals running at more than double their capacity, all ultimately resulting in delayed and even missed care. The danger this presents to health care staff and to the health of the community overall cannot be overstated.
SYMPTOMATIC OF A ‘SICK SYSTEM’
“Ambulance ramping is actually a symptom of a sick system, a system that actually has broader problems than just what’s evidenced on the ramp,’’ Ms Dabars told State Parliament in February.
The chronic under-resourcing of our public hospitals, now amplified by COVID, is leading to nurses burning out as they feel pressured to take on double and extra shifts to meet the needs of the community. Widespread fatigue across health care staff is creating unsafe hospital environments for both the workers and the people in their care.
Above: An Adelaide nurse working an 18-hour double shift is photographed taking a nap on her break on the footpath outside of her hospital.
The safety of nurses and midwives is also at risk due to the almost daily violence and aggression in our hospitals. This is exacerbated by the woefully resourced mental health system which is now in crisis and unable to cope with demand, and the lack of security in some hospitals, notably regional sites.
One Adelaide emergency nurse spokeof the toll of the COVID crisis on her fellow colleagues.
“Emergency nurses remain passionate about their role, but they are physically, mentally and emotionally burnt out,’’ she said.
“Senior staff are leaving the field daily for other positions, forced to leave permanently as executives are refusing temporary leave, hiring unskilled staff to fill rosters.
“It is well known it takes a minimum of three years to train a skilled emergency nurse. Some of these nurses are being pushed into roles unprepared, causing trauma and placing their careers in jeopardy. This jeopardy is also creating an exodus of staff,’’ the nurse said.
“Staff are working double shifts or extra hours to not only fill extraordinarily high numbers of sick leave due to COVID but also to fill an understaffed roster every day.
“Senior staff especially are having to work above their FTE (full time equivalent hours) due to the shortage of skilled senior staff. Pressure from management to accommodate SAAS to prevent ramping creates a ramping scenario in the waiting room, putting some of our most vulnerable clients at risk. This creates moral distress and frustration with nursing staff and medical officers.
“Violence within our department has escalated exponentially. Many major violence incidents have occurred within the department over the past two weeks with more than six nurses and one doctor being seriously physically assaulted.
“The Code Black team is not always able to attend incidents and the many security guards required each day to mind the violent patients that present cannot be provided. Some days we are as many 12 security guards short. On these days nursing staff are utilised to mind these violent clients.
“Duress alarms have not been available to nursing staff for over a year despite this being constantly escalated to management, Work Health and Safety and SafeWork SA multiple times over the past 12 months.
“The fear of COVID is just as real for nursing staff as it is for the community. We are exposed to patients with COVID every day. Executives change the regulations for the management of COVID patients every day.
“Due to staffing deficits, staff are often in the COVID zones for multiple days in a row with different management rules each day. How can they know if they are safe and their families are safe if the executives keep ‘pulling back’ the barriers? Less and less PPE required, passive bullying regarding the cost of PPE, lack of medical waste bins, lack of scrubs available to change into, understaffed in these areas.’’
THE HOSPITAL SYSTEM HAS NEVER BEEN WORSE
Asked if the hospital system has ever been worse, another nurse replied: “Oh God no, absolutely not”.
“I spoke to someone this week, I said ‘Are you doing double shifts’. She said ‘I can’t, I’m a single parent, there’s no way I can do that’. And the same people are doing the double shifts all the time and there’s going to be a cost.
“I’ve certainly found even working in outpatients …we certainly have been worn down. I can’t imagine how exhausting it would be on the wards to be working three-four nurses down on the shifts and having to pick up the slack.
“I attended a meeting last year where the NUMs were on the wards, on the floor, still expected to fulfill their NUM roles whilst doing patient care on the floor as well. I can’t imagine that it’s sustainable at all.
“I can remember being asked to double shifts back in the early 2000s, in Melbourne. I haven’t had to work on the wards during this COVID period, but at that point I would say to the manager ‘I’m tired enough now after a busy early shift or a busy late shift, do you want me to make a mistake because that’s what’s going to happen? I’m going to be so tired that I’m going to make a mistake and I know full well the organisation won’t back me.
“So I’ll be on my own if I make a mistake and I won’t be able to say I was asked to do a double shift because I’m sure the response will be ‘Well, you agreed to do it’.
“The safety of the patients is certainly at risk as well if you’ve got staff who are exhausted. Certainly, if you’ve worked a late and then they ask you to work a night and then you still come back on the late the following day, I think that’s a recipe for disaster.’’
Indeed, Ms Dabars told State Parliament: “The concern that we constantly hear from our members is they have a continuous fear as to whether their patients will be seen and assisted in an appropriate and timely manner without some kind of adverse event occurring or even death.’’
At the time of writing the state election outcome was unknown. “But what we do know,’’ said Ms Dabars, “is we need legislated nurse/midwife to patient ratios and 90 per cent hospital occupancy to facilitate flow and end ramping.
“We will continue to shout out loud on these issues – as well as hospital security and sufficient resourcing - until they are finally acted upon.’’
Click here to read the April 2022 edition of INPractice