ANMF highlights PPE and workforce planning issues to SA's COVID-19 Response Committee

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22 May 2020

ANMF (SA Branch) CEO/Secretary Adj. Associate Professor Elizabeth Dabars AM presented at the Legislative Council today (May 21), raising issues about the impact of COVID-19 on the health care community and associated issues such as PPE, preparedness, member concerns and lack of Government support for health care workers adversely affected by the elective surgeries ban.  

Below is a summary of some of the issues raised.

Personal Protective Equipment (PPE)

In an environment which was evolving daily, as everyone dealt with the emergency created by COVID-19, one of the consistent issues of concern being raised by ANMF (SA Branch) members was around the question of PPE.

The level of concern expressed by members was fuelled by media and social media reports from overseas, confusing information from SA Health and inconsistency in implementation and education across the Local Health Networks (LHNs).

There was significant variation across LHNs in relation to issues regarding PPE, with some nurses and midwives confident with the process implemented at their site and others expressing concerns and unsure of the procedures relating to the use and appropriateness of PPE in specific circumstances.

We, and other unions, raised the issues of PPE availability, supply, guidance on appropriate usage and most importantly safeguarding our members, their families and their clients, from our very first interactions with the Department of Health.

The Department’s responses were in most cases expressing concern and intended action but our experience was one of extreme frustration with delays in action and response, bureaucratic structures and processes that were unable to keep pace with the need for action on the frontline, and a lack of flow of information and knowledge. The policy and operational gaps between the Department and its role and the LHNs was evident with each suggesting that the other was responsible for issues – this led to duplication of discussions just to get answers and the inevitable buck passing.

ANMF (SA Branch) took the stance of examining a range of guidelines from different local jurisdictions and national and international guidelines.

Local
SALHN, CALHN, NALHN, SA Health

National
Department of Health, NSW Health, Queensland Health
CDNA – Communicable Disease Network Australia
Clinical Excellence Taskforce

International

World Health Organisation
Public Health England Centre for Disease Control
Handbook of COVID-19 Prevention and Treatment   
The First Affiliated Hospital, Zhejiang University School of Medicine, Compiled According to Clinical Experience

Following reviews of all the guidelines, ANMF (SA Branch):

  • Developed and updated PPE guidelines for ANMF (SA Branch) staff to assist with answering queries from members.
  • Developed and updated a simple PPE Matrix for ANMF (SA Branch) staff and members (made available via our website).
  • Provided summarised evidence to support the guidelines and answer questions relating to PPE.
  • Undertook education sessions for ANMF (SA Branch) staff on correct PPE use according to SA Heath guidelines and then delivered training to our Worksite Representatives (WSRs) on correct PPE use according to SA Health guidelines.

 

What we learnt from our WSRs were:

  • Very few seemed to have seen or worked with the guidelines prior to the sessions we provided, raising concerns about the consistency of implementation and depth of education.
  • Overwhelmingly WSRs indicated that they would refer to the guidelines and ensure members in their area were aware of them – suggesting they would laminate them and display them in the ward areas.
  • Many indicated they now felt comfortable to escalate PPE issues (with reference to the guidelines) locally and felt supported by their worksite ANMF (SA Branch) officer if they needed to escalate further.
  • There was a sense of increased confidence in the support and expertise of the ANMF (SA Branch).
  • WSRs found the session to be very informative.


Department for Health and Wellbeing liaison   

ANMF (SA Branch) had (teleconferenced) meetings with SA Health staff and Chief Nurse & Midwifery Office staff twice weekly. The items tabled by ANMF (SA Branch) for the meetings were:

 

PPE Provision across all SA Health sites
  • No information was available on PPE stock and strong rumours persisted that PPE was in short supply leading to staff stockpiling, misuse and increased stress levels of staff.
  • ANMF (SA Branch) requested SA Health to send bulletins (similar to those issued by WA Health) to staff regarding PPE supply and stockpile to relieve stress and prevent future stockpiling. This information bulletin was only started approximately three weeks ago.

 

Use of PPE guidelines
  • SA Health guidelines were developed late and not referenced. Staff at the bedside were not aware of the guidelines and were not made aware of the guidelines by management in the LHN.
  • A PPE matrix was developed and circulated by SA Health mid-April (we gave them our matrix some time before that).
  • ANMF (SA Branch) requested that an implementation and education plan be put in place across all the LHNs. This was not actioned and instead was left to the LHNs.

 

Issues from members
  • Carparking concerns were raised that, if public transport reduced times or ceased, nurses would have difficulty getting to work as not all staff had access to carparking.
  • This issue was addressed – weeks after we raised it - by SA Health and a subsidised parking initiative was put in place for all health care workers.

 

Casual Pools (LHN) vs Resource Pool (SA Health)
  • ANMF (SA Branch) reinforced that casuals within the public sector needed to be given priority for work if demand increased.
  • Issues regarding the private sector were eventually resolved by the Commonwealth subsidy requirements associated with funding support of private hospitals.

 

Uniforms and scrubs
  • ANMF (SA Branch) reviewed and summarised relevant literature on the role of healthcare apparel and the potential to spread infection in response to the abuse nurses are facing in the community at present.
  • We sought provision of additional scrubs and uniforms.
  • This request was presented to SA Health with no response – to the present date - regarding concerns and use of scrubs in clinical areas.
  • We issued advice to members not to wear uniforms home if stopping off on the way.

 

Fatigue management and wellness for staff
  • Change fatigue and emotional support needs of staff was an issue regularly raised by the ANMF (SA Branch) and to date no framework has been shared by SA Health – again this was left to the LHNs.

 

Private Hospitals contract and Models of Care – Wakefield/Calvary/Repat hospitals
  • As changes to the working environment progressed ANMF (SA Branch) was updated ‘as needed’.
  • It took several weeks to get agreement to staffing principles for the health system in case there was a need to flex capacity or if the workforce was not able to keep pace with demand.

This was a very frustrating and challenging process.

At the meetings SA Health was not able to respond to many of the questions, and would take issues on notice as the person that could answer the questions was from another department in Health and would need to be followed up.

When requested further information often the response was delayed or ANMF (SA Branch) learned of new strategies or directions via media announcements. At times it felt that SA Health was not forthcoming with information and not willing to work with the unions.

We never throughout the period met directly with the Minister for Health and Wellbeing nor with the CEO of the Department.

Impact on the Nursing Workforce due to the COVID-19 pandemic

In the immediate aftermath of the Government’s introduction of travel restrictions, there were a significant number of staff who were required to self-quarantine on their arrival back to South Australia. The Government’s paid special COVID leave was made available for many employees (i.e. those who travelled before the Government’s direction on 15 March 2020).  

However, any travellers who chose to travel after the Government’s direction were not entitled to any paid special COVID leave. We saw a few instances where there were exceptional circumstances for the travel and where we believe the individuals would have benefited from the application of paid discretionary leave notwithstanding their decision to travel. However, there is no flexibility within the Determination 3.1 – Supplementary Provisions for COVID-19, for the employer to use their discretion.

Following the Government’s direction for elective surgery to cease, hospital activity dropped dramatically.

Whilst there was an impact on the permanent workforce (some were directed to use available leave and redeployed to other areas of the hospital network), by and large casual employees bore the brunt of this direction. Many went from steady and reliable shifts to no work at all.
With other financial support not available to public sector employees (such as JobKeeper), casual employees were forced to apply for JobSeeker payments, many for the first times in their nursing careers. There were extensive delays in obtaining these payments, which exacerbated the financial stress on those individuals who were unable to meet mortgage and rental payments.

The SA Government provided no support to these workers, many of whom would be considered regular and systematic casual employees with greater than 12 months service.

This was exacerbated by the Government’s massive recruitment drive that commenced at about the same time, where due to poor communication with staff, casual employees felt they were being locked out from work that might become available when activity picked up.

The ANMF (SA Branch) requested on a number of occasions that casuals be provided the same entitlement to paid leave as permanent employees. This was rejected by the SA Government. The ANMF (SA Branch) ran a petition urging the State and Federal Governments to guarantee an additional 15 days of paid special COVID leave for all nurses, midwives and carers to align with the entitlements for permanent staff.

It is clear in the absence of paid leave, casuals are either going to be forced to continue to work or as some of our members have determined, there is no point working in a high-risk environment or setting because if required to isolate, they would not get paid.

The impact of the elective surgery decision on private hospitals and day centres was not in our view comprehended by the Department of Health or State Government. Overnight the workloads and jobs of nurses across the private sector evaporated with stand-down actions being contemplated by employers within days.

Faced with the severe impact of cancelling elective surgeries, the Commonwealth announced its subsidising of private hospitals for six months which included a provision that they had to maintain the workforce at levels to sustain their usual activity.

Vulnerable employees

The Government issued recommendations that certain cohorts of the public should take higher precautions, this included those with health issues or workers over 65 years of age. For those that decided or were medically advised, to not attend work, they were encouraged to work from home if this was possible. We appreciate that there may be difficulties with providing suitable redeployment opportunities during a time of crisis, however such opportunities did not appear to be properly explored by LHNs with the individuals impacted by this Government recommendation.

ANMF (SA Branch), as mentioned earlier, has over 21,000 members across all areas of health provision and was inundated with calls from concerned members wanting reassurance and answers. We were willing to work closely with SA Health in a constructive and supportive manner and deliver informed answers to our members to relieve stress and fatigue of staff.

Such an approach is about recognising the value of the entire workforce and how collectively engaging this way will result in better health outcomes for our staff and the community we serve.