More than 150 nurses at Auckland City Hospital have signed a document warning that dire staffing shortages in its emergency department (ED) are putting workers and patients in danger, the Herald has learned.
Health and safety representatives submitted the warning to senior executives at Te Whatu Ora Te Toka Tumai Auckland, the local health authority, on October 4, prompting a series of urgent meetings about improving conditions in the ED and adjacent clinical decision unit (CDU).
“Chronic understaffing of nursing on all shifts continues to create unsafe work environments for workers,” said the document, which was accompanied by two pages of signatures representing most of the department’s nurses.
It alleged safe staffing limits are being “consistently breached” in the ED, one of the busiest in the country, despite repeated attempts to reduce the strain on the service.
The collective action illustrates the dismay among frontline clinicians as New Zealand’s disjointed, underfunded, and understaffed emergency medical system struggles to cope with increasing demand for acute care.
In hospital EDs across the country, workers say they are stressed out and exhausted after the Covid-19 pandemic evolved into a different crisis. Waiting times for patients are increasing. Ambulances are getting stuck on ramps for hours. Incidents of violence and aggression against staff are increasing.
Clinicians say these strained conditions are affecting the quality of care they can provide and putting patients at risk of serious harm or death, but they often feel that their concerns are not being treated with urgency at the highest levels.
At Auckland City Hospital, nurses decided to begin a formal health and safety process amid frustration that Te Whatu Ora has not done more to rectify the chronic understaffing and the dangerous conditions that it creates, according to people familiar with their discussions.
The document submitted on October 4 called for a ratio of no more than four acute patients for every nurse in the ED and for gaps in the roster to be filled by “appropriately skilled” staff.
This prompted a meeting between nurses and management on October 10, where executives attributed the staffing gaps to a range of factors including resignations, difficulties recruiting replacements in a competitive market, and more employees taking sick leave after the pandemic.
“We have had a tough past three years,” one executive said in a slide presentation.
Nurses were told the department’s fulltime nursing staff will increase from around 170 to 194 by March because of a recruiting drive and new graduates joining the department. Executives believe this will make a significant difference in the pressures on the workforce.
One hospital source said the meeting, and subsequent communications with management, were inconclusive. Their immediate bosses appear to be taking the nurses’ concerns seriously, this source said, but there are no easy solutions to the crisis and the message from hospital executives in these conversations was that they believe they are already doing everything they reasonably can.
Some nurses are frustrated that executives have not explicitly acknowledged that staff are being made to work in unsafe conditions and the continuing risks that this poses to staff and patients, the person said.
Colleagues are worried about the professional consequences if one of their patients gets hurt in these circumstances, but Te Whatu Ora has privately assured employees it would support them if they are embroiled in a formal complaint or investigation because of resourcing issues.
Dr Mike Shepherd, group director of operations at Te Toka Tumai Auckland, said in a statement: “The wellbeing of our kaimahi [employees] is very important to us and we have been working with our teams to manage many challenges through the winter period. We appreciate hearing the concerns and the considered recommendations of our kaimahi, and value the open and constructive discussion.
“We acknowledge that at times staffing in our ED/CDU has been very challenging, especially over the past six months,” Shepherd added.
Te Toka Tumai Auckland says it is working on short- and long-term plans to improve conditions in the ED, including recruiting to fill vacancies, providing more training to current staff, pulling in reinforcements from other departments at the busiest times, adopting escalation procedures more quickly when demand surges, and improving the “flow” of patients through the hospital.
“We’re committed to working with our kaimahi to put in place further solutions to the challenges they’re facing,” Shepherd said. “This includes working in partnership with our kaimahi and setting up a working group to continue responding to issues, monitor processes, and share feedback.”
This month’s health and safety action is the latest in a series of events that have highlighted the enormous pressures on emergency medical services nationally.
In May, the Herald revealed that a person with serious mental illness spent 94 hours in Auckland City’s ED before being admitted to a psychiatric unit, the longest wait for a ward bed in the hospital’s history. In July, a senior doctor in the department told the Herald she was so concerned about patient safety she was considering leaving the sector. “Everyone’s getting burned out,” she said. “We’re exhausted.”
In August, the Herald revealed that Palmerston North Hospital’s head of acute medicine had written to Te Whatu Ora’s chief executive claiming the hospital did not have enough doctors to provide a safe emergency service. Last month, it reported that the Australasian College of Emergency Medicine was calling for security guards to be embedded 24/7 in all EDs to protect staff from increasing violence from distressed and aggravated patients.
National Party MP Dr Shane Reti, who is expected to become the new Health Minister, said in an interview during the election campaign that he regards emergency medicine as one of the two most pressured parts of the health system, along with aged care, and that this will be an area of focus for the new coalition Government.
Alex Spence is a senior investigative journalist based in Auckland. Before joining the Herald, he spent 17 years in London where he worked for the Times, Politico, and BuzzFeed News. He can be reached at alex.spence@nzme.co.nz or by text or secure Signal messaging at 027 235 8834.
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