25 March 2021
ANMF officers led by CEO/Secretary Adj Associate Professor Elizabeth Dabars AM met with the Minister for Health and Wellbeing, the Hon Stephen Wade, on 24 March to once again discuss the issues of patient demand, bed blockage and the effects on nursing and midwifery staff.
Ms Dabars noted that most of the issues canvassed today were the subject of a series of meetings the ANMF (SA Branch) and other unions had held with Mr Wade shortly after his ministerial appointment and that had led to his agreement to take action more than two years ago. If anything the problems facing the hospital system had worsened over time and members felt there was little being done to address the chronic overcrowding and overwhelming demand for services, leading to ramping, immense pressure on staffing and resources, increased use of temporary contracts and casual staff and discharge block, particularly for older people and people with disabilities needing sub-acute or ongoing care.
We shared examples of people waiting for disability care and accommodation who had been held in a tertiary hospital for, in one case over two years and in another for 18 months. Both of these people required security specialling as well as care staff as a consequence of behavioural issues and violence. Their continuing location in a hospital not only was inappropriate (if not inhumane) for their own accommodation and support but also placed nurses at daily risk and made already scarce hospital beds unavailable for the patients waiting in EDs to access them.
The ANMF has asked the Minister to take responsibility for the production of:
An urgent plan and clear framework for how the health system is to address the issue of demand for hospital services in SA including the following:
- ED activity, ambulance ramping and the effects of these demands on ED nurses and other staff;
- The lack of availability of acute hospital beds to take patients from the EDs and move them into appropriate places for their ongoing care;
- The need to provide alternative locations for the care of people presently held in acute hospital beds and who are waiting for placement into aged care or disability services when they no longer require acute care services;
- The need for mental health services to meet the demand of clients without undue length of stay in EDs; and
- Measures that can address the failure to implement arrangements for criteria-based discharge and to facilitate discharges on weekends.
We noted that such a plan needed to provide a comprehensive framework to address the ‘whole of system’ issues rather than the piecemeal approach taken to date. For example, improving the size and functionality of EDs will not work to address the issues of ramping and overcrowding unless we provide places for ongoing care and treatment of people in EDs.
Ms Dabars informed the Minister of some of the stories shared by members in recent workplace visits to many public hospitals. She described the levels of frustration experienced by members, the fatigue and emotional toll that workloads, overtime and double shifts were having, the numbers of members expressing their sense that unless things changed markedly and soon that they may seek to leave the profession – despite their love for it.
We also noted the effect of the current emergency load on the cancellation of elective surgery and the toll on patients and the growing lists of people that would need to be ‘caught up’ at some stage.
We also demanded action to deal with measures impacting on the stress and burnout in the nursing & midwifery workforce including:
- Increasing the number of permanent nursing and midwifery staff to meet the demand and activity of the hospitals. Too many services are reliant on members working overtime, additional and sometimes double shifts, the reliance on casual and temporary contracts;
- Addressing the levels of violence in the workplace which appear to be continuing without LHNs taking comprehensive action of the type envisaged in the ‘challenging behaviours’ policy and guidelines issued in 2020 by the Department;
- The fact that the levels of stress and reported burnout of nurses and midwives across SA had deteriorated over the last 3 years (before the effects of COVID-19) and that they have worsened given the additional stressors created by the pandemic.
We again shared members’ stories of episodes of violence and aggression across the state that left them injured, traumatised and frightened in the workplace, as well as the failures to provide meaningful security in country sites where nurses have been and continue to be placed at risk. We expressed our opinion that SA Health and the Government is culpable in the continuing exposure to violence and aggression that nurses and midwives are enduring, and SA Health policies relating to violence, aggression and fatigue must be implemented urgently. We compared the situation of construction work where in the event that injuries of a similar nature were sustained, the entire workplace would be shut down until the issue was resolved.
We also expressed our concern that in an environment where women are being encouraged to speak up against abuse, that the female-dominated professions of nursing and midwifery are being exposed to a near daily experience of violence, effectively allowed by their own workplace, and that this is unacceptable.
Finally, we also shared specific issues of missed care and the serous risk this causes to patients. We referenced the public case of missed care involving the death of a patient at Lyell McEwin Hospital in November 2020. We noted that the reported outcome of that case did not appear go to the heart of the issue which seemed clearly to be inadequate bed availability and inadequate numbers of staff. (Read the article here)
We expressed our grave concern that this missed or delayed care experience was not isolated, but a daily occurrence, and gave recent examples that members have generously shared during walkarounds. We expressed our concern that many of these events could also have been catastrophic and that it is only a matter of time before further deaths occur.
We also advised that the issue of precarious employment, in particular the apparent increase and regular use of short fixed-term contracts, is feeding into that risk as staff are disempowered from speaking out about the risks for fear of not being offered another contract.
The Minister has agreed to consider responding to the issues but did not give specific commitments or references to potential actions.
We have indicated that, in the absence of a clear plan or strategy, we will continue to publicly campaign to address these and related issues that are impacting both on members and the community at large.
We cannot accept the continuing deterioration of a health care system chronically unable to meet the needs of the South Australian community.