Patient safety at risk

The Southern District Health Board is placing patients at risk of harm due to a shortage of nurses on its wards.

One Dunedin Hospital ward was regularly understaffed by 20% or more, and a Southland Hospital ward was also regularly poorly staffed, a report by consultant Jane Lawless to be considered by the SDHB board tomorrow said.

"There are currently too many instances of a poor shift-level match being achieved between service demand and the nursing resource provided.

"There is compelling high-level research evidence that when shifts are below target, all patients are exposed to risk and some patients will suffer consequent harms."

Because the consequences of inadequate staffing were often not immediately apparent it was difficult to ascribe a particular shift to a particular patient-harm event, Ms Lawless, a registered nurse, said.

"However, it is not necessary to have this level of information to know that shifts below staffing target are not tolerable."

The report, commissioned by SDHB chief nursing and midwifery officer Jane Wilson, set out to examine how the board was managing the care capacity demand management (CCDM) programme, an agreed safe-staffing regime.

All health boards have been obliged to hire several new nurses to meet CCDM requirements but Southern, like many other boards, seems unlikely to be able to do so.

Nurses are in short supply nationwide for many reasons, including border restrictions imposed due to Covid-19 making overseas recruitment problematic.

DHBs have been recruiting aged-care nurses, which has created a consequent staff shortage in aged-care facilities.

Ms Lawless said the SDHB had a strong and ongoing commitment to CCDM, but at the end of last year had reached only 71% of its target number of nurses.

Her report examined staffing levels in three wards, and noted that while short-staffing was a regular, persistent and concerning problem, there were also some equally unsatisfactory days when too many nurses had been rostered on.

"These represent a poor investment of health resources and lost productivity because staff time, once committed, cannot be reinvested at a future date."

Ward 4C at Dunedin Hospital, an inpatient ward with 26 beds, showed a chronic pattern of under-target shifts, Ms Lawless said.

Evening shifts were also regularly understaffed, but night shifts were usually on or above target.

"A pattern of late discharges means that more patients are present for more of the shift, adding to nursing workload."

Southland Hospital’s assessment, treatment and rehabilitation ward generally maintained an acceptable staffing level, but Southland’s 38-bed medical ward had a high turnover of patients, high bed occupancy, late discharges and low length of stay, which had significant implications for nursing workload, Ms Lawless said.

"A large number of day shifts are under target staffing. There is some evidence of a seasonal pattern with the winter months likely to be more poorly staffed," Ms Lawless said.

"There are relatively few day shifts that exceed the target staffing hours."

Ms Lawless said her principal recommendation was that the SDHB prioritise elimination of understaffed shifts as a central goal because of the association with patient risk and harm.

The SDHB has been on a recruitment drive for nurses in recent months and earlier this year hired several new graduates. However, this has meant its nursing staffing budget has overrun.

Ms Wilson said the review and other recent reports had helped determine priorities for the nursing budget for 2021-22.

"The report recommends other opportunities to improve operational efficiency by better matching workforce to demand.

"A number of recommendations related to improving workforce management ... are already being progressed."



Where is worksafe in all this understaffing? It is unsafe for nurses themselves to be placed in an understaffed environment especially continuously so. In most other industries, where there is an expectation of a level of staffing and it is not achieved and especially if then an incident occurs, for an employee or additionally in this case, a patient or member of public, worksafe would be very much involved.

Explain further how SDHB its nursing staffing budget has overrun by hiring some nursing graduates this year - surely if regularly 20% understaffed there are savings in the budget or has the situation of regular understaffing been budgetted into the budgets which would be very concerning. For then governance has an institutionalized the expectation of shortages and see it detrimental to budget outcomes to do anything about it.

In 2019 the CE and others received significant increases in their salaries. The CE is receiving (obviously NOT earning) around $550,000 p.a.
Somehow, we again find a huge gap between the poor performing seat warmers and the actual workers.....that being the medical staff, doing what they can to deliver good outcomes for patients. It's time to change the system. The money is going to the wrong people.......and yes, where is Worksafe in all this? Do they too have a role to play in this crisis?

Yet again, a lack of basic competence from the SDHB Executive. When will the Board and Minister wake up to the fact that all these issues come from the top. Time to replace senior execs and the CE in particular.