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'The system is broken': Nurses' damning evidence about WCH care

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Childhood cancer patients are having treatment postponed and safety is being put at risk “every day” because of “chronic” understaffing at the Women’s and Children’s Hospital, senior nurses have told a parliamentary committee in damning secret evidence now made public.

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Nurses said there was a “very high risk” of deaths occurring, prevented only by “hypervigilant” staff forced to do double shifts “to ensure that’s not happening”.

“We are the safety barrier and it’s about to break,” one nurse said.

The nurses gave evidence to the select committee on health services in August behind closed doors.

They have agreed to release their evidence publicly on the condition of anonymity because they fear reprisals from management, saying those who speak out are “labelled toublemakers” and subjected to “bullying behaviour”.

Their disturbing evidence included:

One nurse told the committee clinic lists were often overbooked and staff couldn’t keep up with demand.

“Some staff have been working close to 100 hours a fortnight and not all of it is being accurately captured,” she said.

“This is resulting in delayed waiting (for) cancer patients and in some cases postponement of treatment.

“We don’t have the physical capacity or the staff to accommodate their needs.”

Instead of being treated in the dedicated cancer ward, the nurse said some children were moved to other wards where staff “do not feel safe in providing care to these patients”.

“They feel ill-equipped and they are unsure about what to do around the complexities of care surrounding this patient population,” she said.

“You can imagine how disheartening this would feel to a family if they are being told, ‘I don’t know what I am doing,’ on a regular basis.”

The nurse said the hospital has had patients collapsing in the front waiting room “because there has been no staff around to be able to see that they have presented unwell, and admin staff do not have the medical capability or knowledge to determine illness of patients”.

“Treatments are being delayed or reshuffled, and this is inconvenient and distressing for families and patients,” she said.

The nurse said staff who speak out, including managers and unit leaders, to try to advocate for patients “are being met with hostility and indifference from managements”.

“We are being labelled troublemakers, and as a result we are being subjected to bullying behaviour,” she said.

She said clinicians have been reprimanded for speaking to union staff.

“At the meetings, staff have been asked to name and shame other staff members by higher management,” she said.

Another nurse who works in the the Micheal Rice Centre cancer ward said the problems were hospital-wide and she was “plagued with complaints” from unhappy families “every day”.

“They are not unhappy with the staff – they are unhappy with the system,” she said.

“The system is broken. It is simply not working.”

“Every day, when we leave work, my colleagues and I all debrief. We survived another shift. The patients all survived. There were no major incidents.

“Everyone got the chemo they needed. They may not have got other medications on time, their nasogastric feed started on time, observations done on time or the correct monitoring after surgical procedures or during blood transfusions, but we all survived – just.”

She said there was a “chronic” staffing crisis at the hospital, with clinicians constantly receiving text messages on days off, during annual leave and even during sick leave asking them to come in or when they’ll be back.

“Nurses are doing double shifts and not getting a meal break – 18 hours, no break, how is that safe?” she said.

“The problem is so great that staff are sent home some six or so hours into an early shift to go home and sleep for the afternoon, to then come back for a night shift that night.

“I can’t comprehend how they would even be rested enough.”

When we are tired things go wrong, mistakes happen, and this will be their child that is harmed.

The nurse said “our call bells are constantly ringing”.

“Families feel bad for ringing their call bell now – they feel that they are giving the nurses more work to do, and they are sad because of this,” she said.

“They see the nurses doing double shifts and they are scared for their child’s safety.

“They know that we are only human and that we would be tired.

“When we are tired things go wrong, mistakes happen, and this will be their child that is harmed.”

The nurse said chemotherapy dosages were being checked in the main treatment area instead of in the dedicated drug room “as there are not enough nurses in the clinic to safely leave the area and check these medications”.

“It is not a safe area to be checking high-risk medications,” she said.

Her colleague said: “You are checking medication in a room that has screaming kids, stressed parents and other staff conversations going, and you are trying to concentrate and take safe measurements. I just can’t fathom it. It’s ongoing. It’s not just winter, it’s not just COVID. This is a pattern. There are not enough staff.”

One of the nurses said staffing levels in the cancer ward had not increased in more than a decade “despite the service growing and complexities in treatment rising”.

“Our clinic currently closes at five, and there are often late finishes that can’t be accommodated on the ward because there are no staff or no spare beds,” she said.

“We are trying to run a seven-day service over five days. With pressure to just make it work.

“After a public holiday earlier this year, there was no chemo available until 11am. Sometimes, there are no chemo orders written, so pharmacy can’t prepare the chemo in a timely manner and, at other times, some chemos have a very short lifespan so it has to be made up on the day.

“Our planned theatre list on this day then ran late. Patients were bumped to the emergency theatre list, causing delays in procedures, extended fasting times for young children and distress to their families.”

The nurse said new staff were often “left floundering and unable to adequately care for cancer patients” because they lost orientation days as a result of the nurse educator being “pulled to the floor to work due to staff shortages”.

The nurse said the cancer ward needed extra staff across all disciplines – nursing, medical, psychology, social work and pharmacy.

“I still can’t comprehend why such a crucial service for what could be considered one of the most vulnerable cohorts of our community is so depleted of funds,” she said.

“As I mentioned at the beginning, this is not unique to just my unit. This isn’t unique to the Women’s and Children’s. This is right across SA Health.”

She said care was “missed and delayed” and patients and their families were “struggling”.

“None of this is safe for our patients, families or staff,” she said.

The nurse said staff from across the hospital were getting pulled to work in areas they had “no knowledge in” because of the shortages.

“I am sure this is great from a numbers perspective, but this Band-Aid approach does nothing to help staff on the floor, when some don’t even know how to do the most basic of tasks,” she said.

“Our patients are the ones who suffer. Staff are sick of the 5am wake-up calls on days off, asking them to come into work. Some of these staff are full-time staff and are getting asked to come in.

“Staff go home stressed, they aren’t sleeping, they are unable to switch off or concentrate, as they are thinking of work constantly and fielding multiple calls and texts for extra shifts.”

The nurses said “multiple patients” were being put at risk “every day”.

One nurse said she would often finish her shift by submitting a safety incident report – known as an SLS – about a patient.

She said staff submitting safety incident reports about the need for extra staff had had those reports “removed”.

“When there have been cases that have resulted in a death or a critical event, and they have been SLSed, it has not been unheard of that they have said, ‘But that’s not an SLS because we don’t currently provide that service in this hospital’,” she said.

“I am sorry; someone has died or had an adverse outcome because a lack of experience in therapy in our hospital that should be provided. Yet, because it’s not a current therapy, that child has died, that’s not an SLS? I’m sorry. That’s not good enough.”

The nurse said she believed there had been a death a few years ago of a patient who was “outlying” in a different ward.

“Our unit had been closed at the time because we didn’t have enough patients to maintain it,” she said.

“My understanding was that there was actually a safety recommendation that was made that our unit was not to close, despite our patient numbers, and that we could take outlying staff.

“What happens is we might go from not having a patient and then all of a sudden on one shift you might get three or four admissions and you have one staff member who is allocated to accept those admissions on a unit.

“But the other staff members are sent to other areas. We cannot rapidly recruit those staff members back in to then care for those patients.

“I believe—I would have to double-check the facts, to be completely honest—that one of the contributing factors (in the death) was that they were being cared for outlying. They hadn’t been in our unit and they believed that wasn’t one that changed the outcome.

“The care that led to that patient deteriorating could have been picked up a lot quicker, if they had been in an environment that was more familiar with their care.”

One of the nurses told the committee that double shifts were daily practice at the hospital but that management denied this, instead calling them “extended shifts” because it “softens the blow”.

A retired nurse with 42 years experience at the Women’s and Children’s Hospital also gave evidence to the committee.

She said the “deterioration in facilities and care provided” were part of her reasons for leaving.

“For several years I often felt that in my role all I was doing was putting out fires,” she said.

The committee’s chairperson, SA-BEST MLC Connie Bonaros, said the nurses’ evidence “should send shockwaves throughout the community”.

She said they articulated “the demise of crucial services at our once world-renowned Women’s and Children’s Hospital” and also “outlined the heavy personal toll” being experienced by nursing staff at the hospital.

“Despite denials by hospital management of nurses working double shifts, we have heard from nurses who work double shifts,” she said.

“We’ve also heard of nurses working close to 100 hours a fortnight.”

She said “these dedicated professions need a medal for the work they do – not be harassed by their managers and/or senior management”.

Bonaros said if this was happening at the WCH “what is occurring at our other public hospitals”?

“My fear is many of these dedicated nurses will simply abandon the public health system in preference of the private sector, then what for our public hospitals?” she said.

In a statement, a spokesperson for the Women’s and Children’s Health Network said “the South Australian community should be assured any family requiring care through Michael Rice Unit will always receive the treatment they need”.

“We always maintain safe staffing levels to ensure all our patients receive the same high level of care,” the spokesperson said.

“Based on an increase in activity in the Unit, we have employed an additional 7.5 permanent full-time nursing roles, and all nine beds within the unit are currently utilised and staffed.

“When we do experience periods of increased activity, Cassia Ward is used for oncology patients who require admission and meet the criteria for their care to be provided in Cassia Ward.

“All oncology patients located on Cassia Ward receive high level nursing care from Cassia ward staff who are supported by oncology nurses.

“There is a dedicated Nurse Educator role in the Michael Rice Unit that also supports other areas caring for haematology oncology patients.

“We have implemented workflow improvements to ensure only patients ready for treatment are in the Unit at any one time.

“All clinical decisions, including changes to treatment schedules, are made by our highly skilled doctors and nurses, with the safety and wellbeing of our patients the number one priority.

“We thank our doctors and nurses for their dedication to providing our young patients with the highest level of care and remain committed to working with them to address any of their concerns.”

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