Dr Shane Reti: Provincial hospitals like Northland have highest ED nursing shortages

Northland hospitals have one of the highest emergency department nurse vacancy rates in the country, National’s health spokesman Dr Shane Reti says.

Every day, our emergency department staff go to work providing critical services knowing that they will be understaffed and overworked. This is a segment of the health sector that makes the headlines when people wait more than 24 hours and, tragically, when people die.

The rate-limiting step just now is primarily ED nurses. This is not at all to diminish the shortages in ED doctors, HCAs and other staff; it is just number-wise, ED nurses have the greatest number of vacancies - currently in the 100s.

I asked the minister what a full roster of ED nurses was for each DHB and the current number of vacancies. This gives an indication what parts of the country have the greatest proportion of vacancies.

This table shows the top four DHBs for ED nurse vacancies (FTEs).

What this shows is severe shortages in provincial areas. Wairarapa leads the way with an astounding vacancy rate of 69 per cent, representing 9.8 vacancies against a full roster of 14.2. Northland is next with a vacancy rate of 42 per cent; West Coast at 41 per cent and Hawkes Bay at 40 per cent. Four provincial DHBs are short nearly half of their roster. To put this in context, Counties Manukau has the greatest number of overall ED nurse vacancies at 29, but with a full roster of 206, their percentage doesn’t make the final four.

I have said before and will say again, the two parts of the health sector I believe will break next are aged residential care and emergency departments. A 50 per cent ED roster shortage is simply unsustainable, and even worse when it occurs at the critical care end of the healthcare spectrum. Long surgical waiting lists will get you eventually - ED wait times will get you now.

All pathways to the health crisis resolve to workforce shortages at the moment, and as I have shown, EDs are no different. I personally found the short stints in the ED that I trained in (including Middlemore) to be wonderfully fulfilling, and I strongly support this career pathway.

So, how can we help our ED staff ? ED is not a medical home - that is your GP, and it was very disheartening this week to see the medical council survey showing that in the past year, we have added only 15 specialist GPs, where previously there were 60-70 per year. We need GPs to be the gateway to hospitals during business hours and after hours. They should be supported appropriately for this.

We need to turn on the day-one pathway to residency and bring in more nurses. Targets focus resources and ED benefits from targets. Finally, there needs to be appropriate funding. The $486 million in health reforms centralising decision-making to Wellington seems like a good place to start reprioritising funding, and what we now know is that we may well need to start in the provincial areas.