Just one doctor at Thames Hospital – ‘a huge risk’

January 24, 2023

Thames Hospital ED normally has three day shifts for doctors, but recently this dropped to just one – a situation which left patients and staff vulnerable to serious adverse events, NZNO members say.*

Thames Hospital members were prepared to picket their employer over last weekend’s roster which had no ED doctors – but the event was cancelled after a locum from Kaitaia volunteered to fill the gaps.

The action came as concerns grow over short-staffing in the department – with members left to manage without any doctors – from 6pm on January 12, until 8am the following morning.

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The roster requires three doctors on day shifts, and one at night, at Thames Hospital ED.

NZNO organiser Nigel Dawson said Tokoroa Hospital was also without a doctor on-site on the night of January 15.

Last Saturday, a locum doctor left his home at 4am and arrived at Thames Hospital just before 10am. He worked until midnight and then again from 8am to 6pm on Sunday. A local doctor who was rostered on for the night shift was asked to come in four hours earlier than her usual start time of 10pm.

Te Whatu Ora Waikato denies Thames or Tokoroa Hospitals were without doctors at any time in the New Year.

“Doctors were on-site at each hospital during this period,” operations director, rural and community for Waikato Jade Sewell said in a statement to Kaitiaki.

Asked if Te Whatu Ora could confirm the hospitals would be fully staffed in coming weeks, Sewell said: “We will continue to roster as normal.”

Dawson raised the alarm about the weekend roster with no doctors on Tuesday, January 17, but had no response from hospital management until Thursday.

Interim hospital and specialist service lead Chris Lowry called him to say they were working on finding someone, but hadn’t been successful.

‘We are scraping through day by day by the skin of our teeth, and at some point, something’s going to happen, and it’s not if, it’s what and when.’

That afternoon, delegates texted members about a protest outside the hospital at 12.30pm on Friday.

Within a few hours Dawson received a call from the hospital’s director of nursing to say cover was in place as a locum had volunteered for the work.

NZNO Organiser Nigel Dawson

Members were pleased a doctor had agreed to work, but said the staffing was still woefully inadequate, leaving patients vulnerable to poor outcomes.

Dawson said this week’s roster showed ED several days without doctor cover, but hospital management had assured him at least one doctor would be working.

But he says a “new normal” of just one doctor for all day shifts is not acceptable.

“We can’t let that become the new normal because the nurses just aren’t coping.”

An RN who worked at Thames Hospital on the weekend, and did not want to be named, said “it was crazy”.

“It’s a huge strain, I think . . . I just want to go and work at PAK’nSAVE.”

In addition to the doctor shortage, there were gaps in the nursing team due to illness. 

A patient on the hospital’s sole ward went into cardiac arrest, and was attended by the locum. But this meant he was not available for other patients who were being treated in ED – should he be needed. 

‘If a nurse is triaging and a patient fails to wait, and they go home and die, that comes back on that nurse.’

“We had fail-to-waits, and we know what can potentially happen. It was pretty crazy,” the nurse said. 

The RN said she was very worried about what to do if one of her patients deteriorated while the doctor was attending to a critical event.

“If I know my patient needs specific medications, I need to get that doctor to do it . . . and I can’t pull him out of resus. I thought I’d have to run in there with a chart and quickly try and explain the situation – but the doctor hadn’t seen that patient yet. It’s a huge risk.”

Many patients – including some who were very elderly – waited longer than six hours, she said. 

Nurses were being put in an impossible situation where they could be held responsible for a serious adverse event.

“If a nurse is triaging and a patient fails to wait, and they go home and die, that comes back on that nurse.

“That can be quite devastating for us as nurses, even though it is completely out of our control because we are so inundated. The triage nurse is trying to fill other roles, trying to help out on the floor.”

Another RN who worked on the weekend said it was lucky a poor outcome had been avoided – but there were no guarantees for patient safety.

“We are scraping through day by day by the skin of our teeth, and at some point, something’s going to happen, and it’s not if, it’s what and when. It’s going to happen because we don’t have the ability to deal with what potentially could walk through the door.”

Senior doctor’s union, the Association of Salaried Medical Specialists (ASMS), has raised concerns on behalf of their members with Te Whatu Ora Waikato, over unsafe staffing at Thames Hospital.

Executive director Sarah Dalton said the authority would need to close the ED service at the hospital, if it could not provide safe staffing levels.

ASMS executive director Sarah Dalton

“It’s an absolute pattern, particularly across smaller rural hospitals and it’s something employers have been absolutely reluctant to address over a long period of time, but I think all of the other staffing pressures are just making it not only untenable but actively unsafe now.

“It’s really great the nurses are being proactive at registering concern over this unsafe staffing and it’s something we look forward to continuing to partnering on, to stop, because it’s terrible.”

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Sewell said there were additional services available in Thames, “which have helped to ease demand on Thames Hospital ED such as having a GP clinic onsite for referrals, availability of the Primary Care Response Unit which provides 24/7 consultation, and additional community care resources with better coordination between services.”

* This sentence was updated on January 25, 2023, to clarify the usual number of doctor shifts at the Thames Hospital ED.