Eleven nurses resigned from Wellington Hospital's emergency department within 10 days last month, the region's union representative says.
It came at the same time health and safety complaints - including nurses feeling unsafe because of overcrowding - were being formally addressed by management.
Conditions at the overcrowded ED of Wellington Regional Hospital have been under the spotlight for weeks, with wait times blowing out to more than 15 hours and one patient describing the waiting room as "busier than an airport terminal".
On July 8 the ED's health and safety representatives issued a Provisional Improvement Notice (PIN) to Capital and Coast DHB, which formally tabled health and safety issues such as overcrowding and feelings of unsafety.
It was the first time a PIN had been issued at Wellington's ED, and CCDHB implemented a number of changes, including increasing security capacity.
New Zealand Nurses Organisation (NZNO) Wellington representative Jo Coffey said the ED had also been plagued by vacancies and resignations throughout this time, with seven or eight jobs vacant in the week the PIN was issued.
On July 23, there had been 11 resignations of ED nurses within ten days, she said. The PIN was lifted five days later on July 28.
"There'd been quite a bit of churn and quite a few vacancies for quite a while, and lots of people going to Australia."
Coffey said in the first week of the transtasman bubble in April, seven CCDHB nurses had resigned to go work in Australia.
Last week there had been seven vacancies, although this was the lowest in over a month.
With nearly 70 fulltime nurse positions at Wellington's ED, this was the equivalent of roughly 10 per cent of the ED nurse workforce.
CCDHB provider services director Joy Farley said in response to the PIN a number of registered nurses (RNs) – 5.34 fulltime-equivalent positions – had been relocated from non-clinical work into the emergency department.
An extra 3.56 fulltime equivalent staff members were also being recruited for a Waiting Room nurse, on top of another 3.56 recruited during winter planning.
This amounted to an increase of more than 12 fulltime nurses in the emergency department over the past three months.
Farley said there had been 26 registered nurses – six of them senior nurses – resign in the year up to June 2021.
"Over the same period, we filled 28 RN positions and two senior nurse roles and appointed an additional seven RNs for Covid-19 screening at the ED entrance," she said.
"Resignations can be multi-factoral – with contributing factors including internal and external opportunities, family reasons, and house and rent prices."
Farley said the two DHBs had created a nursing recruitment and retention strategy to address these challenges, which would include return to work programmes and international recruitment.
Nurses around the country are also planning further strikes later this month and next, with NZNO rejecting the DHB's latest pay offer in July.
The resignations came against the backdrop of an ED that had been operating at capacity for months on end, with CCDHB saying it had been full for more than two thirds of each day since March.
Longer wait times to see a doctor were further exacerbated by an outbreak of respiratory illness that put hundreds of children in hospital throughout June and July.
Coffey told the Herald wait times for a bed had averaged about nine hours - the target was six - but that on occasions people had waited upwards of 15 hours, or overnight.
Earlier this week the Herald reported a woman with terminal cancer waited more than 30 hours for a hospital bed, according to an ED doctor.
Coffey said Wellington's ED likely needed double the amount of staff, but the facilities were not big enough to accommodate that many recruitments.
The two DHBs were looking to increase capacity at Wellington Regional, Kenepuru Community, and Hutt Hospital because of the continued high levels of occupancy, requiring investment in the coming year, Farley said in June.
Coffey said the project underway to redesign Wellington's ED would hopefully provide the space for more staff to be hired.