More than one in four hospital shifts do not meet the new nurse to patient ratios the ACT Government was meant to implement by July, Canberra Health Services CEO Dave Peffer admitted at Budget Estimates hearings on Wednesday.
Only 73 per cent of nursing shifts were fully compliant with nurse-to-patient ratios the government agreed upon with the ACT Branch of the Australian Nursing and Midwifery Federation (ANMF) in September.
That, Liberal MLA Leanne Castley, shadow minister for health said, meant 27 per cent of shifts failed to meet the agreements struck between the government and nurses’ union.
Health minister Rachel Stephen-Smith, she stated, could not tell her when the government would meet its nurse-to-patient ratios.
“I cannot give you a date when we will be fully compliant,” she reported Ms Stephen-Smith to have said.
Ms Stephen-Smith told Canberra Daily the ACT public health system had recruited the 90 full-time equivalent nurses required for the first phase of Nurse-to-Patient Ratio implementation, and planning for the second phase had started.
The first phase of ratios was introduced in general medical, general surgical, acute aged care, and mental health wards / units on 1 February. Ratios mandate a minimum number of nurses or midwives to ensure the health system is safe and effective for both patients and staff. Ms Stephen-Smith said last year that ratios would guarantee more staff on wards to care for patients, ensure an increased skill mix on each shift, and so reduce staff fatigue and increase job satisfaction for nurses and midwives. Since last year, nurses and midwives have been ‘burning out’, overworked and psychologically distressed. Ratios are intended to ease that pressure: a nurse on a day shift in a medical ward will now care for four patients instead of five, for instance.
The ANMF welcomed this as “a big win” in February: “ACT Public Sector nurses now have some of the best ratio conditions in Australia.”
- Organisations welcome ACT Government’s four-year plan for more nurses and midwives (28 September 2021)
- Fifty new nurses begin working in the ACT (10 March)
Today, however, ANMF secretary Matthew Daniel told Canberra Daily the government’s compliance claims were “pointless” and “empty”.
“[The compliance claim] doesn’t really talk about what is happening on the wards for nurses and midwives right now, because the government can’t say with any certainty, and our members are telling us otherwise, that rations are being met for the entirety of the shift.”
Neither Canberra Health Services nor Calvary Public Hospital Bruce were able to show they met the ratio for the entirety of the shift, only for a single point in time, Mr Daniel stated.
“The government can’t confirm that it is compliant in any way, because compliance requires that the ratio be met for the entirety of the shift. At this point, neither Canberra Health Services nor Calvary Public Hospital are able to do that.”
The ANMF had asked for real-time reporting for the entirety of the shift, and for data around when the point time in reports were done: “Is it during the most advantageous part of the shift? Is it not being met for the second half of the shift, but not being reported?”
Last month, Mr Daniel told CW, that while the government had recruited to the ratio numbers, they had also lost people out of the system. There was, he said, a net loss of nurses out of the system.
“We seem to be losing more people than we’re gaining,” he said today. “While recruitment has been going at a pace, they are still losing nurses out the door. … There is a lot of churn going on.”
- ANMF cautious about ACT government’s healthcare recruitment plans (29 July)
- ACT nurses and midwives call for recovery plan (30 July)
The government, he claimed, was redistributing workers, rather than increasing the total number of nurses and midwives.
Ms Stephen-Smith said that it was challenging to find appropriately trained and skilled staff for the public health system, due to COVID-19. However, the government had embarked on a national nursing and midwifery recruitment campaign, which will go live soon.
The government also allocated $84 million in the budget to recruit more healthcare workers.
Other steps to help meet nurse to patient ratios include:
- Calvary Public Hospital Bruce has employed a Clinical Development Nurse for each ward, to support the new staff starting from ratio recruitment and from internal recruitment.
- Both Canberra Health Services and Calvary Public Hospital Bruce have used additional staff to meet minimum ratios. Other strategies include overtime, offering extra shifts, using agency staff, and publishing compliant rosters.
- Canberra Health Services now has a Clinical Development Nurse in the relief pool to help practitioners from the COVID-19 workforce and new employees transition into hospital settings to ensure safe patient care.
- Education strategies, including a managers’ toolkit, have been developed and published to support managers in rostering and reporting on meeting ratios.
The government was 769 elective surgeries short of its annual target of 14,800; 14,031 had been performed, Estimates also revealed.
Ms Stephen-Smith said last month that elective surgeries were delayed due to staff shortages caused by COVID and leave. (Nevertheless, she maintained, 14,000 elective surgeries were likely the second-best result for elective surgeries in a single year.) The government announced $30 million in this year’s budget to meet its target of 60,000 elective surgeries by 2024-25, and Ms Stephen-Smith believes health services will catch up to the 14,800-target next financial year.
Ms Castley accused Ms Stephen-Smith of failing to properly implement a workforce plan and retain senior experienced nurses. She claimed patient care was suffering as the Labor-Greens government failed its own staffing commitments.
“Patient care is compromised, and there is extra pressure on nurses, which is unacceptable,” Ms Castley said.
“Our nurses are exhausted and feel undervalued, are so flat out they cannot take toilet breaks, and are leaving the profession in droves. Now we learn the government is dragging its feet on nurse-to-patient ratios that would ease the load on our hard-working nurses.”
Ms Stephen-Smith said the government was implementing several activities and strategies to retain senior nurses and midwives.
- The ACT Scholarships Program: professional development for nurses and midwives across the ACT public health system.
- Clinical supervision: develops reflective practice and grows the professional skills of nurses and midwives.
- Leadership training and support for senior nursing and midwifery staff:
- A leadership development program, instigated in partnership with the Australian National University, has trained 190 managers from across the health system
- The ACT Public Health System Leadership Development Program, piloted in December 2021 with more than 280 senior officers from across the public health system, is being delivered throughout 2022
- The Leader’s Mindset Series 2, in partnership with the Australian College of Nursing, trains aspiring nursing and midwifery leaders.
“There is no quick fix to the issues outlined, but the ACT Government continues to work in partnership with key stakeholders to address issues of nursing and midwifery recruitment and retention, workforce planning, health, welfare, and culture improvement,” Ms Stephen-Smith said.
