Hawke's Bay Hospital's ED nurses are crying out for management to help. Photo / Warren Buckland
Senior nurses at Hawke's Bay Hospital emergency department say ED is "going to break" if confronted with a Covid outbreak over summer.
Clinical nurse coordinators wrote an impassioned letter to the heads of the hospital this week.
It warns that "when" clinical incidents happen that cause harm to patients during a Covid outbreak "we will be standing back and saying 'we told you so'".
"We are the most senior group of nurses in your DHBs Emergency Department, with a combined total of over 100 years of nursing experience," the letter states.
"We know our stuff. We know what works. We know what doesn't work. Our current ED is not working."
In response, the DHB has acknowledged the "unrelenting workloads" of nurses in ED and says it is working with ED management and health and safety staff to address issues raised.
A Provisional Improvement Notice (PIN) was issued to the hospital, on behalf of the ED nurses, in late-September.
The PIN highlighted their concerns around the working conditions at the ED, including patient numbers exceeding department capacity, and nurses working daily with "dangerously low" staffing numbers.
The PIN said the low staffing numbers resulted in ED daily working in overload capacity and often in "critical overload".
The letter this week said since the issuing of the PIN, the general feeling within ED was that there had been no traction, and "certainly no resolution" of issues raised by that PIN.
The nurses wanted the letter to be taken as a separate action.
"We are losing staff at an alarming rate, every single one that has or is leaving has cited the workload and conditions as the driving force behind their decision to leave," the letter states.
"These nurses aren't new staff, these are battle hardened, experienced nurses, some who have been with us for 15 years."
The letter said the DHB had been aware of Covid for 18 months, however it was only last week that it had 'substandard' glad-wrap put onto five rooms.
"B2 wards have high quality thick plastic, fitted appropriately to the rooms, industrial zips, and a policy that shows the DHB are wanting to protect them at all costs.
"ED is not given the same opportunities."
The letter said they were "hugely concerned" about the glad-wrap setup.
"Today there is a rip in the plastic from the plastic pole that holds up the plastic sheet.
"Twenty-four hours after the plastic was put up we had to call 'facilities' back to repair where the cellotape had come away from the wall.
"Facilities came and put more cellotape over the existing cellotape to further fix the plastic to the wall. The zip-up doors are held up with string suspended from the roof.
"Why on earth has our department taken so long to get approval for some slap up plastic that will not protect our staff from Covid long term?"
The letter said the nurses were "terrified" that while "upper-management" were away on summer breaks, they would be "drowning" in patients, with an ED that was understaffed and under-resourced.
"You need to know that ED is going to break, staff are already breaking, and we as a group are afraid."
In response to the letter HBDHB's chief operating officer Chris Ash said it acknowledged the "unrelenting workloads" placed on ED staff as presentations remained high and demand constant.
"The DHB continues to work proactively with ED management, health and safety staff representatives and the NZNO to address health and safety concerns raised within the PIN."
The DHB placed significant investment into the recruitment of senior clinical FTE addressing requirements from HealthCert in respect of ED staffing, as well as support staff, he said.
"The DHB recognises that while funding is part of the solution, recruitment for nursing and support staff into ED remains tight as regional and national recruitment needs for staff remains high."
DHB leadership were working through the contents of the letter, he said.
"However, it readily acknowledges improvements are needed to increase frontline staff visibility of decision making and monitoring compliance against best practice standards."
He said "significant work" to ensure the hospital and staff were prepared for Covid-19 continued, with training and clinical surveillance/testing processes ongoing, as well as facility upgrades.
He said staff "were right" to raise concerns about zip-lock plastics erected within ED recently as a temporary measure while remedial works for Covid-19 preparedness were ongoing.
"While these solutions have been successfully used as temporary measures in other clinical areas, management recognised they were not durable enough for a high-volume ED and requested facilities to fast-track their removal and replacement."
Ash said the request should have been better communicated with ED frontline colleagues.
"We expect installation of a permanent solution to begin toward the end of next week."