Nurses pushed to the limit
Emily Shepherd knows how hard it is to do a job when your workplace is crumbling about you
REVERSING hard into a tree as she headed home from a double shift at Launceston General Hospital was a wakeup call for nurse Emily Shepherd. Clocking on at 1.30pm, she had worked until 7am the next day.
“It highlighted to me that you can feel you are still functioning appropriately when your perceptions are diminished, as mine obviously were when I failed to notice the tree,” says the Australian Nursing and Midwifery Federation’s Tasmanian branch president.
A decade later, our public hospital nurses remain beset by exhaustion from working double shifts and overtime. Shepherd cites Workplace Tasmania figures showing the effect of working beyond 17 hours in a day is akin to operating with a blood-alcohol level of 0.05.
Nurses are often so tired on the job, she says, that they are frightened of making mistakes and deploy error-reduction strategies such as getting colleagues to triple-check their medications before they administer it to patients.
“They always make sure patients are safe, but they don’t feel that it is quality care. We recognise it isn’t best practice, but there is no alternative at the moment.”
The nursing union boss says her profession’s goodwill is exploited, with nurses feeling duty-bound to accept long hours at public hospitals. Saying no is hard. “It comes with being a nurse or midwife that you put others before your own health and safety.”
Rolling industrial action under way is a response to onerous hours and hospitals’ lack of capacity, ongoing bed block and an underfunded health budget that impacts her membership hard.
“Nurses and midwives are feeling the drain of propping up a health system in crisis,” she says. “They are the ones who are with patients 24/7.”
She says system failures are contributing to patient deaths. “Not through [our] negligence, but certainly in our emergency departments when we have patients ramped on ambulance trolleys, a waiting room overflowing and no room in the emergency department.
“There are incidents where patients have died in the back of ambulances and on ambulance trolleys.
“Investigations [have tended to] show they would have passed away anyway, but if they had received appropriate care and treatment in a timely way, would they have died then? Or might they have got to a ward and had the dignity of passing away with their family rather than in an overflowing emergency department where it’s utter chaos?”
Couple difficult working conditions with pay that is 10 per cent lower than interstate and it’s hardly a surprise recruiting nurses to Tasmania is so difficult, though there has been a slight drop to 200 vacancies for fixed term and permanent positions this year.
Plenty of nurses are graduating from the University of Tasmania annually, but their lack of experience precludes them from filling the crucial gaps.
Perpetuating the problem, there are too few nurse educators employed to train and guide them, which would enable the health service to bring through a robust young cohort of locally educated and trained nurses and midwives. It’s a vicious cycle. On the North-West Coast a curious situation exists where despite a lack of midwives, those working in the public system are vocationally robbed by being unable to deliver babies, with birthing contracted to private hospitals for the past few years.
About $7.4 million was spent on short-contract agency staff from interstate and overseas last year, and $7.5 million more on regular staff overtime and double shifts.
As if on cue, her predecessor Neroli Ellis, with whom Shepherd worked before her promotion, appears at the same cafe, Boutique Espresso on Macquarie St, for a takeaway coffee. It’s a reminder of how little seems to have changed despite that stalwart advocate’s efforts over many years.
The fundamental problem, says Shepherd, is the State Government’s lack of strategic planning for staffing despite clear projections for critical shortages.
“It reflects the way health is so politicised,” she says. “It’s about short-term planning, jumping from crisis to crisis, and longer-term vision has been missing in Tasmania.”
Only this year, she says, has the Government started to look at the nursing workforce strategically to 2040.
A health system can’t be run, she says, like a business that can tighten its belt by cutting corners. “You can’t fund it at 70 per cent and expect it to function at 120 per cent, which is what is happening.”
The workload model for nurses needs to change, from a complicated algorithm based on nursing hours per patient days, which currently fails to provide adequate backfill.
In its place, the federation wants a hybrid ratio model closer to the Victoria’s pioneering one, which is based on a nurse to patient care ratio that is 1:4 for general ward care but intensifies according to care level.
Shepherd says the federation has spelled out the reform benefits to Government, but so far, like so many other Tasmanians, it is stuck in the waiting room.