As the most visible and high-profile public face of the hospital, we in emergency departments (EDs) tend to wear the wider problems of the health system.
We are the path of least resistance to health care, because we’re free, our doors are open 24/7 and we provide care at no cost. People will always be welcomed in. And more and more are coming because they can’t get into their GP practices, as many are at capacity and unable to enrol new patients.
While managing increasing presentations, we are also being told by the Government we must do more, move faster — get 95 per cent of patients through EDs within six hours.
The vast majority of patients who breach the targets by staying more than six hours are those who have been seen by us and are waiting for a hospital bed on a ward.
But whether we have enough staff to manage our current workload let alone go faster is unclear — for the past three months Te Whatu Ora has paused its safe staffing calculations and hiring as it tweaks the former region-by-region tool CCDM (care capacity demand management) into a nationally consistent one.
So we are currently flying blind on whether our staffing levels are actually safe for the patients coming on the day, especially when it comes to senior nurses.
But given that previous calculations have shown up to 48 per cent understaffing in some of the larger EDs, our staffing levels probably aren’t safe. Pausing the CCDM calculations hugely heightens the risk — to patients, staff, everyone — of something going wrong.
We simply can’t get patients out of ED if there are no hospital beds to admit them to — and hospitals can’t discharge elderly patients if there are no aged-care beds for them to go to.
But without significant investment and intervention from this Government into the health system as a whole, the risk to patients — and to us — will continue to grow.
As we have flagged with the new Minister of Health Simeon Brown , it’s not just ED which should be the focus, it’s the whole hospital — and community. We simply can’t get patients out of ED if there are no hospital beds to admit them to — and hospitals can’t discharge elderly patients if there are no aged-care beds for them to go to.
That leaves a bed block — and apart from having to care for patients in corridors or short-stay beds — there’s not a lot we in ED can do about it.
The vast majority of patients who breach the targets by staying more than six hours are those who have been seen by us and are waiting for a hospital bed on a ward.
EDs continue to give some really great care. On average, we refer about 30 to 40 per cent of ED patients on to be admitted to wards. The remaining 60 per cent, who are discharged, we manage well — if the targets were measured just for them, you’d find a different scenario.
We believe this Government’s ‘ruthless focus on execution’ of health targets, without any support, funding or resourcing is not achievable.
In some EDs, we’ve even seen a rise in the number of lovely compliments we’ve been getting from patients, who perhaps are aware of the pressures we face, or see that we are doing our best to care for them.
We believe this Government’s “ruthless focus on execution” of health targets, without any support, funding or resourcing, is not achievable.
We have not been able to employ as many new graduates as usual, as Te Whatu Ora says there are not the vacancies. In Whakatāne, for example, we got one instead of the four or so we normally take on. Wellington got six instead of eight and Taranaki got two instead of four.
We are also having to heavily advocate throughout the country to maintain a safe level of senior nurses in EDs, so that is a big concern.
While CCDM is still not fully up and running in every ED, we do want it to be and are concerned about the pause. But at the moment, with the current cost pressures Te Whatu Ora is under, there is not even a guarantee that hospitals will budget to fill the staffing shortfall it calculates.
Security ‘high priority’
After a shocking summer of violence for nurses including in EDs, better security is also a high priority.
We support the new safety training currently being rolled out, but — again — believe it has not been adequately resourced and was rushed. We were not given enough time to roster around the four-week programme, or funding to backfill clinical staff to attend.
We would also have loved for CENNZ to been consulted on developing the programme — we are New Zealand’s national committee of emergency nurses! So not only are we emergency nursing’s professional voice, we have a network of emergency nurse leaders, managers and educators who can contribute.
- Lauren Miller is CENNZ chair.