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Emergency departments seeing 'extreme' number of patients

Feb 21, 2022

An experienced nurse says conditions at Palmerston North Hospital's emergency department are pushing staff to their limits.

Her comments come after RNZ reported how an 84-year-old woman waited almost a day to move from the emergency department to a ward.

New Zealand Nurses Organisation workplace delegate Christina Emerson said workers were every day filing reports about what was happening, but nothing changed.

This was having a detrimental effect on staff morale.

"Most days it's just absolute chaos. We are really busy all of the time. We operate at 90 percent capacity, 76 percent of the time. Other EDs around the country operate at 90 percent capacity, 30 percent of the time.

"We just see extreme numbers."

The department was old and built for 17,000 people a year, yet three times that were coming through.

Emerson said the department had 24 beds where staffing was allocated, but people were often put elsewhere as they waited, places "that don't have allocated nurses".

"They don't have equipment. They don't have curtains. They might be in a chair in a corridor. There's no privacy for patients.

"I think of the grandma test. I think if that was my grandma would I be happy with the treatment she's getting, and a lot of the time I can't say yes to that question," Emerson said.

This left staff feeling disheartened they could not do the job to the standard they wanted and led to a high turnover.

"Those poor patients that are waiting for beds ... 24 hours is not unusual and it's just demoralising when you know that you're coming back to this again and again.

"Things don't seem to be changing," she said.

"I worked [last] weekend and my shift started at 7am on Saturday. The first patient that I saw had been waiting since 5.30 the night before. The second patient I saw had been waiting since 7.30 the night before.

"That's not uncommon. It's happening more and more. We would commonly have anywhere between 40 and 60 patients in the department."

Last year the organisation mooted taking the issue to WorkSafe, but this was averted after a provisional improvement notice was issued to the MidCentral District Health Board (DHB).

Emerson said some short-term improvements followed.

MidCentral DHB acute and elective specialist services operations executive Lyn Horgan said all incidents at the emergency department were reviewed by the department's leadership team and followed up with staff "as appropriate to ensure wellbeing support is available if required".

All staff could access support, including individual or group support. The health board encouraged staff to take planned leave to ensure their wellbeing.

Horgan said after the provisional improvement notice was issued, the response from the health board included "increased budget across key staff groups", "increased staff wellbeing structure-resource" in the emergency department, and "increased enabler staffing, such as cleaning, support services".

"A key constraint remains the limited staffing availability for nursing and medical, not just locally, but also nationally. Any recruitment possibilities are being pursued actively and with vigour.

"We continue to focus on recruitment and to pursue all possibilities, however, the international market is further constrained by Covid. This is an issue in all services."

The DHB recognised the issue of patients facing long waits was "multi-faceted", including issues such as the size of facilities, and the flow of patients to other parts of the hospital or their discharge.

"There are a number of projects and new positions established to assist with patients delayed in moving to inpatient beds and discharge facilitation," Horgan said.

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