NSW Nurses and Midwives Association, June 2023: between Grafton and Maclean Hospitals another 40 nurses are needed to provide adequate staffing levels

 

Grafton Base Hospital is a Level 3/4 rural community hospital with an est. 68 bed inpatient capacity which provides acute medical, surgical, orthopaedic, paediatric, anaesthetic, geriatric, obstetric and maternity, intensive and critical care, renal, oncology, palliative care, emergency, some specialist outpatient services and day surgery facilities. Maclean District Hospital is a Level 3 rural community hospital with an est. <43 inpatient bed capacity, an inpatient Rehabilitation Unit and a Day Surgery Unit.

Clarence Valley Independent, 14 June 2023:

Between Grafton and Maclean Hospitals another 40 nurses are needed to provide adequate staffing levels say the NSW Nurses and Midwives Association as the Local Health District tries to fill 180 nursing vacancies across the region.

NSW Nurses and Midwives Association Clarence Valley branch secretary Thea Koval said without agency nursing staff being called in, who are paid significantly more than NSW Health nurses, Maclean and Grafton hospitals would struggle to operate.

“Without agency nursing staff our hospitals would not be able to be run with the nurses employed only by NSW Health,” she said.

“Without that external agency support we would be completely drowning, there just would not be enough staff.”

Ms Koval said both Grafton and Maclean hospitals are continuing to experience increasing numbers of patients presenting to the emergency department ED, which leads to increasing wait times until they are treated.

This combined with the lack of nursing staff, Ms Koval said is leading to a decline in patient care.

“We are constantly and have been for the last 10 years saying that the amount of staff we have is not enough to provide the care we are expected to our patients,” she said.

“That can range anywhere from not being able to provide a shower, so there’s patients going without showers on the wards, to people waiting excessive amounts of time in ED to be seen by a nurse, or once they’re seen by a nurse waiting for pain relief, waiting to be helped to the toilet or delays in getting antibiotics.”

Ms Koval said the frustrating lack of staff led to nurses striking four times last year.

“We raise the issue through to our managers, we try and raise it with the Ministry of Health and so far, nothing has changed,” she said.

“This new government has promised to introduce the ratio system, which they termed ‘safe staffing’ but that hasn’t happened yet.”

Ms Koval said the planned ratios are one nurse to three patients in ED, with a dedicated resuscitation nurse, a dedicated triage nurse and a dedicated team leader on all shifts.

“That would make a massive difference to Grafton and Maclean Hospitals, particularly on our night shifts when our staffing drops from seven nurses to three nurses, and more often than not these days the ED is full of patients,” she said.

As Queensland Health have implemented nurse to patient ratios, where nurses experience better conditions and earn $10 an hour more than in NSW, Ms Koval said a number of local nurses have left to work over the border.

As a result, the Northern NSW Local Health District has confirmed there are 180 full time equivalent nursing vacancies across the region.

“Grafton and Maclean hospitals have approximately 40 of those vacancies,” Ms Koval said.

“That is just to make it back up to what the government currently considers as reasonable staffing levels…and when this new ‘safe staffing’ comes in as promised, that level of vacancies will increase.”

Ms Koval said staff shortages extend to the number of local doctors, as two surgeons have recently left Grafton hospital without being replaced and locums are regularly called in to fill positions in Grafton and Maclean hospitals.

“It’s a very large expense (for locums) but it’s what you have to do otherwise you don’t have medical coverage,” she said……

Read the full article here.

Northern NSW Local Health Area backs down for now - but Lower Clarence communities are closely watching for any move which will effectively reduce available bed space at Maclean District Hospital

The Daily Examiner, 6 March 2020: 

The decision by the Northern NSW Local Health Area to back away from plans to reconfigure the wards of Maclean District Hospital represents a win for the people, and a new opportunity for the community of Maclean to have a greater say in their beloved hospital. 

In an announcement made on Wednesday, NNSWLHD chief executive Wayne Jones said the Maclean Community Advisory Group would be established to help steer future decisions on the hospital, which is what they should have done in the first place, rather than ram through unpopular changes without adequate community and staff consultations. 

I sincerely believe the NNSWLHD Board underestimated just how hard the Maclean community were prepared to fight for their hospital. 

Community meetings, petitions and even a march were all planned and organised in no time to fight against the changes....

BACKGROUND

Click on: Two public meetings revealed that patient comfort & care at Maclean District Hospital is being downgraded and Lower Clarence Valley residents are not happy

Two public meetings revealed that patient comfort & care at Maclean District Hospital is being downgraded and Lower Clarence Valley residents are not happy

Maclean District Hospital
Image: Clarence Valley Independent, 26 February 2020

Two community meetings were called in the Maclean, NSW, concerning changes to the Level 3 Rural 43-bed Maclean District Hospital (established 1885) which services communities in the Lower Clarence Valley and the holidaymakers who flock in large numbers to Clarence coastal towns and villages.

The first meeting was called by the NSW Midwives and Nurses Association for 6pm on Thursday, 27 February 2020.

However, apparently having realised it had not fully consulted with the community, Northern NSW Local Health District quickly called its own community meeting which it scheduled a day earlier - from 3.30pm to 5pm on Wednesday, 26 February.

Readers should note the timing of this local health district meeting - it conveniently knocked out concerned residents who worked on that day as well as nursing staff who were doing shift handovers during that time period. Thus reducing community scrutiny of what heath officials said at this meeting.

The Clarence Valley Independent reported that this meeting's intention was "to counter the misinformation in the community and reassure them that the services at the hospital are not being reduced".

The Daily Examiner, 29 February 2020: 

Maclean voices opposition to hospital reconfiguration 
Fight is on for hospital 

The real costs of the proposed reconfiguration of Maclean District Hospital were laid bare to a full house on Thursday night as opposition grows to the plans announced by Northern NSW Local Health District..... 

Both the union members and community involved expressed their frustration at the NNSWLHD plan for Maclean District Hospital to move the 14-bed acute section on Level 2 downstairs into a combined subacute and acute 33-bed ward on Level 1. 

The vacant upstairs level of the hospital would be used for peak times in a “surge” capacity only. 

NSW NMA Clarence Valley branch vice-president Narelle Robison outlined some of the concerns raised by their members over the proposal, such as reduced bathroom and bed numbers. 

“(Nurses) may find themselves sponging people that are capable of having showers with assistance and maybe even panning people when toilets are full,” Ms Robison said. 

“Yes, it has been mentioned that we’ve managed before with those few bathrooms in years gone by but just because we have done it before does not make it acceptable in 2020. “There will be reduced single rooms and two-bed areas and they would need to be prioritised for infectious patients or those that are immunosuppressed and to our palliative patients. 

“With this in mind, there will be a higher chance of a palliative patient, end stage of life, receiving nursing care in a four-bedded room. 

“Our patients deserve better than this. It’s 2020 and this is not acceptable. “All patients who enter the public health system deserve to be afforded quality care and have their dignity respected and maintained as a bare minimum.” 

Australian Paramedics Union delegate Tim McEwan said nothing in healthcare happened in isolation and a ­reconfiguration of the hospital would have flow-on effects. 

“What’s going to happen is that when paramedics transport someone to Maclean hospital and that patient is unwell enough to require admission, if there are less beds than what there are now in Maclean hospital they’re going to have to be transferred to another facility,” he said. 

“The majority of the time for acutely unwell patients it is NSW Ambulance that does that transport. Not only do we respond to 000 emergency calls, we do transports between health facilities.

“If you’re unfortunate enough to have one of us ­attend when you need transport to hospital, what you’re likely to experience after this reconfiguration is a delay ­getting off the stretcher and on to one of the few beds at ­Maclean emergency department and while that’s happened we’re with you for every minute you’re waiting there and we’re unable to respond to other emergencies in the community.”

The Daily Examiner, 28 February 2020:

The largest roar from the crowd came after repeated questioning from Patrick Morgan, who stated he was looking to become part of the community. 

Not satisfied with the first response to his question, he pushed back, asking what the actual dollar figure would be saved by the new plan. 

“You wouldn’t be going to this trouble if there wasn’t a pot of money at the end that you were hoping to achieve,” he said. 

“How much are the opinions of this room worth?” 

“It’s about $150,000,” Ms Weir said. 

“Is that all?” came the reply chorused through the room.

NSW HEALTH, Northern NSW Local Health District, 13 February 2020:

Community Information regarding Maclean District Hospital [with my red annotations]

Q: Are beds closing at Maclean District Hospital? 
A: No. We are consolidating patients and staff into one ward, while the other ward will remain available for ‘surge’ capacity in times of peak activity. This ward reconfiguration will continue to deliver high-quality patient care, as well as maximise the use of existing hospital resources and space. 

According to the NSWMNA (as reported in the Clarence Valley Independent) in the planned merging of the Acute Ward, with the Sub-acute and Rehabilitation wards, one-third of the present available beds are being lost. 

In practice this loss would represent the total 14 available bed spaces on a closed Level 2 and, the crowding of 43 beds into a Level 1 floor area which would only comfortably hold 29 beds.

Q: What does ‘surge’ capacity mean? 
A: Surge capacity, or surge beds, are additional beds, which become available if there is high demand at the hospital. 

Q: Are the services at Maclean District Hospital changing? 
A: No. There are no changes to any services provided at the hospital. As with any hospital stay, patients are admitted to the appropriate facility and ward based on the level of care and treatment they require. 

The NSW Nationals MP for Clarence, Chris Gulaptis, was quoted in the Clarence Valley Independent as stating he has been “reassured” the hospital would not be disadvantaged by the proposed changes. 

Local readers might remember that Mr. Gulaptis has a track record littered with failed assurances from his masters in Sydney. Gulaptis did not attend either community meeting citing a need to be in Macquarie Street.

Q: Are staff being laid off? 
A: No. There will be no loss of jobs. All nurses will transfer to the reconfigured ward. Two substantive positions will be affected by the change, and the hospital is talking with these staff about opportunities to work elsewhere in the hospital. 

Q: Will patients continue to receive the level of care they need? 
A: Yes. The hospital is increasing the Nursing Hours Per Patient Day (the number of nursing hours available for each patient) and are recruiting additional staff to support this increase.

Again, according to the NSWMNA, there will be no Acute Ward. Level 2 will be closed, including the est. 7 toilet/showers on this floor.

On Level 1, there will be the existing 10-bed Rehab facility, consisting of five 2-bed rooms with ensuites. 

All other patients, whether they be Acute, Sub-Acute, Palliative Care or Infectious will be placed in the remaining four 4-bed rooms, three 2-bed rooms and one single bed (with ensuite) on Level 1. 

For these 23 patients they will be sharing a toilet/shower between 4.4 patients. This ratio is more than double that of the present Acute ward. 

Q: Is Maclean District Hospital closing? 
A: No. There are no plans to close Maclean District Hospital. We value the ongoing role that Maclean District Hospital plays in the Clarence Health Service and our public health system, and our staff play an essential role in caring for this community. 

Q: Is consultation occurring with staff and Unions? 
A: Yes. Hospital management have met with staff this week, and will continue these discussions over the coming weeks. Northern NSW Local Health District will meet with the NSW Nurses & Midwives Association soon to discuss the changes.