NZNO delegate, Erin Kennedy asks an important question: “Is unsafe staffing a breach of the Code of Health and Disability Services Consumers’ Rights?”
Like most nurses, I am not easily shockable, but I found myself almost speechless last week on learning that three nurses had been forced into the position of caring for 40 patients overnight on a heavy orthopaedic ward. (A pool nurse also came to help for part of the shift.)
NZNO organisers and delegates have argued strongly for safe staffing for years now, but unfortunately, the level of permanent and pool staffing means that staffing levels including skill mix are often unsafe, with sick staff unable to be replaced. The constant push to avoid financial penalty when the 6-hour Emergency Department rule is breached also leads to patients being moved from the Emergency Department to areas where there are simply not enough nurses to care for all the patients safely.
Under the Code of Health and Disability Services Consumers’ Rights, patients have a number of rights, including the right to co-operation amongst providers to ensure quality and continuity of services, and the right to informed consent. The right to be fully informed means information must be conveyed to the patient in a way that enables the patient to understand the treatment or advice. Right 6 of the code states that every consumer has ‘the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive’. Specifically, it states that patients are entitled to an explanation of his or her condition and an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option.
Given the unsafe staffing levels at some of our DHBs, it is high time that explanations around surgery, for example, go further than simply outlining the procedure and its risks and benefits. Patients should ask, and should be told, whether their post operative care will be safe. A “reasonable consumer” clearly has the right to know whether their recovery might be hampered because of unsafe staffing. Certainly, if I have surgery any time soon, I will be asking whether there are enough nurses rostered on to provide all of the care I and other patients require. Will there be enough staff to ensure that I can obtain analgesia or other medications on time? Will the nurses be able to check my vital signs often enough to notice if I am bleeding, or have arrested or need medical intervention? If I need help mobilising to the toilet, will there be someone to help me or will I risk a fall and further injury? Will there be someone to answer my call bell if I need help?
Nurses do not like being forced to ration care, but until all DHBs accept that in many instances staffing levels are unsafe (for both patients and nurses), it is a fact of life and one which can seriously impact patients’ wellbeing and recovery. Not warning patients that their post-operative care may not be optimal, and could be downright dangerous, is, in my opinion a breach of the code.
March 30, 2015 at 3:58 pm
Awesome blog Erin and so true! Puts a completely different perspective and spin on the Code. I feel if they are obliged to with hold these consumer rights they may have to reinvent the wheel and rewrite them! I wonder how much longer patients will be able to expect safety as part of their hospital journey.? There’s only so much you can do with very little. We ‘did away’ with most of our casual pool some time ago when they came up with the brilliant concept of ‘gifting’ nurses to other areas – great plan – NOT! How is a pediatric nurse meant to just ‘slot into’ an ICU shift for a shift or a a ortho nurse find her way around an ED shift? It’s absolute rubbish and completely unsafe – it was about this time that ‘safe staffing’ really went to the wall! Nurses registrations are becoming so compromised every day, it’s only a matter of time (and I hate to say it) that an enormous, irreversible error is made at the cost of a patient and individual.
March 30, 2015 at 4:37 pm
Good on you for bringing this up!
March 30, 2015 at 7:46 pm
Its not just in the public sector its in the private hospitals too, Staffing is often risking registrations, with very large patient numbers with very few staff and registration being on the line all the time. always comes down to dollars and cents. In my previous job we often said we felt unsafe but told we were working within the “clinical calculator”. And told its managable but we were unable to keep up with paprwork and things easily got missed. Patient did not get the care we were capable of giving,or the care they deserved. if we were not so stretched trying to do so much because of the nurse patient ratio. Something needs to be done to stop this happening, The safe staffing levels need to be reviewed, So many more cases go to Health and Disabilities these days and its no wonder. We are in the job because we care and enjoy that patient contact, but if we don’t have time to really assess our patients properly. I hate working like that and hate feeling that I am going home feeling like i have not done my job to the best of my ability for my patients.
April 7, 2015 at 1:01 pm
Thanks Erin. I agree with what you have said. I think we need to use the words ‘Care rationing’ a bit more as it describes exactly what you have said. The ‘Care Rationing’ position statement is on the NZNO website and worth reading if you haven’t seen it. If it carries on like this there WON’T be any nurses left able to work. it’s looking more and more likely that we won’t be able to get sick and if we do then we will have to look after ourselves.
April 11, 2015 at 6:23 pm
Thanks for raising this Erin.
I think this sort of unsafe staffing is a breach of patients rights and it’s really concerning that it’s continuing to occur across the health sector.
As was said earlier we went into nursing because we cared about patients rights and believed in the importance of a health system that ensures everyone has access to safe health care Care rationing as is going on is harmful to both consumers and nurses.
April 16, 2015 at 9:35 pm
Very relevant after hearing of a friend who had to stay over with her grandfather, in hospital, to make sure he got what he needed and was fed! Where are all the nurses she asked me?