– NZ HERALD
A dire staff shortage in Nelson’s busy emergency department left nurses stressed, burnt out and in tears, unable to “bounce back” from stressful events like patients dying,
At times there weren’t enough nurses in Nelson Hospital’s ED to resuscitate patients safely, while in one case a patient’s suicide attempt was thwarted with only seconds to spare, according to documents released through the Official Information Act.
Stretched nurses were working close to eight hours without breaks and felt “coerced” into working overtime until they found someone to take over their patients.
Nurses were frequently texted to come to work early or on days off, and fatigued nurses feared making a serious mistake that could lead to a patient’s death and see them struck off the register.
The resulting poor work-life balance crushed nurses’ ability to cope with the daily stresses they faced on the job.
Worksafe has found the Nelson Marlborough DHB, which runs the hospital, is taking all reasonable steps to address the staffing shortage.
The DHB says it is working closely with the ED team to support them during “periods of high or complex activity” and has provided hundreds of hours of extra resources.
But the nurses’ union says while some conditions in the hospital have improved in recent months, the ED still does not have enough experienced, permanent nurses.
Last week a new report from national senior doctors revealed acute admissions and emergency department use in New Zealand were growing more than twice as fast as the population.
In that report an ED specialist reported “exponential increases” in patient volumes over the past five years, but no extra staff.
“Effectively we’re being asked to just work harder.”
The situation at Nelson Hospital was highlighted when the ED nurses’ health and safety representative issued a provisional improvement notice (PIN) informing the DHB it was breaching the Health and Safety at Work Act 2015.
The PIN, issued in July, accused the hospital of “failure to ensure, as far as it is reasonably practical, the health and safety of emergency department nurses, through sustained sub-optimal safe staffing levels”.
Documents provided to Worksafe included notes outlining the situation nurses faced.
They included one nurse who had no chance to take a break or debrief after a patient suddenly died – she was “expected to carry on with [the] next patient”.
In another case, when a patient attempted suicide in ED – and almost succeeded – a nurse reported the near-miss as a high-risk incident so it would be reviewed by the chief executive.
But the incident was downgraded and not reviewed because no harm had come to the patient, according to meeting notes.
Nurses were actively seeking work elsewhere, with a senior doctor reportedly saying the hospital had “the worst health and safety culture I have ever worked in”.
Issues had been raised across the hospital since 2018, include “letters from senior doctors raising concern at workload and ED overcrowding”.
Yet when issues were raised with senior management, they were minimised, nurses claimed.
Worksafe cancelled the notice in August because it found the DHB was doing everything “reasonably practicable” to address staffing levels and capacity issues.
The DHB says it has consulted with staff, unions and management about a new structure that it feels addresses all the requirements of the improvement notice.
The DHB’s director of nursing and midwifery, Pamela Kiesanowski, said in an emailed statement that there had been regular meetings with staff, and the DHB was working closely with the ED team to support them during “periods of high or complex activity”.
A 10-bed Medical Admissions and Planning Unit opened in July, to take pressure off the ED and improving patient flow.
Fifteen full-time equivalent positions have been added to staff this unit.