A nurse at Whangārei Hospital's Emergency Department says staff are so tired from working long hours they are making major errors with medication.
The Advocate reported in August there were 30-40 shift gaps per week in the emergency department roster at Whangārei Hospital.
The nurse, who did not want to be named, claimed the number was up to 60 a week just two months later.
The shortage was having a huge impact on staff, she said.
"People are doing 12-hour shifts and double shifts so that's 16 hours. Big mistakes are happening, medication errors. People are tired.
"It's quite a scary place to be at the moment, to be honest."
The nurse said the workload was huge and what staff were asked to do was impossible. Beds were frequently closed due to a lack of nurses, she added.
"Everyone's just so burnt out and what worries me is it's going to scare the younger nurses who are probably already scared and a bit stressed as it is."
Maree Sheard, chief nurse for Te Whatu Ora Te Tai Tokerau, said multiple strategies were used to keep patients safe.
"Health professionals of different disciplines can work with nurses to deliver care under a team model and there is also support after hours from senior nurse managers as well as nurse coordinators.
"Specialist nurses are available who work with patients who need particular attention due to their health conditions.
"Each day a plan is put in place to identify patients of concern or areas that may have reduced staffing and nurses are allocated and reassigned according to need."
The nurse said the demand was worsened by the number of people heading to the emergency department because they are unable to get an appointment with a GP.
People with minor ailments still turned up and waited a minimum of seven hours to be seen, the nurse added, and a lack of available beds in wards meant patients could spend 24 hours in ED.
"I said to one guy, 'are you kidding me?' You've got a little cut on your eye and we're in Code Black' [when there are no available beds]."
She recently decided to resign due to issues in the emergency department, including short-staffing and escalating violence towards nurses.
The department had been losing five or six nurses every few months, she added.
Offers of treats such as chocolates and lollipops for nurses working long shifts were not enough for her.
"It just makes my toes curl. It's like, is this all we're worth?"
Winter bonus payments were inadequate, she said, especially compared to those offered to doctors.
The payments to doctors were eight times higher, depending on the timing of shifts, according to the New Zealand Nurses Organisation (NZNO).
The winter payments have now stopped, and nursing staff across the country refused to do extra shifts last week in response.
New Zealand Nurses Organisation Northland organiser Julie Governor said the winter payments were complicated and it was not for everyone.
"They don't want to do that [turn down extra shifts] but then they also want to look after their own health and safety as well."
Governor said issues with demand in winter were now year-round, and staffing had not improved in the last few months.
"When we come up to the Christmas break, the population increases in Northland. Demand on the services is really high."
Nurses were feeling fatigued after a difficult time, Governor said.
"If you're stretched and not having breaks and doing a lot of time for free, it gets a bit wearing after a while."
Healthcare in New Zealand had always been very reliant on nurses from overseas to fill gaps, Governor said.
"We need the staff, we need the money to attract and retain staff, we need good working cultures for people to stay there," she added.
Sheard did not confirm the number of gaps in the current emergency department roster.
"Roster gaps are not an indication of whether a ward or department is staffed according to need on a given shift," she said.
Instead, they provided an indication of where the hospital needed to activate its response plan, Sheard said.
"This can include reassigning nurses from areas that have surplus staff, reducing planned care so that fewer nurses are required, using bureau staff to assist, and changing models of care.
"Part-time nurses and nurses who work on a casual basis can also be offered extra shifts."
The total number of staffing shortfalls last week was less than expected for this time of year, Sheard said, and some staff members continued to work additional shifts.
"We are certainly grateful to everyone who picked up extra shifts and additional hours."
Te Whatu Ora Te Tai Tokerau was recruiting at 30 per cent above the resignation rate, she said.
This story has been corrected, it originally implied that there were up to 60 medication errors a week at Whangārei Hospital's Emergency Department, this was incorrect and the nurse was referring to gaps in the roster.
According to Te Whatu Ora Te Tai Tokerau there were 12 medication errors reported in the Whangārei Emergency Department for the 2021-22 financial year.
During 2021-22 there were on average 164 ED presentations per day, 59,860 presentations for the year.
This is a rate of 0.2 medication errors per 1000 ED presentations.
The error occured in the editing process and we apologise for this.