Nursing staff claim they are being pushed to "breaking point" in hospital wards across the region due to chronic understaffing.
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Patients too, they say, are missing out on hundreds of hours of nursing care each month with many shifts left unfilled due to ongoing staff shortages.
Data analysis by the NSW Nurses and Midwives' Association (NSWNMA) has revealed that 1622 hours of care were withheld from patients across the district's hospitals over four weeks during April and May.
The nursing care hours were lost at Wollongong, Shellharbour, Shoalhaven, Coledale, David Berry and Milton Ulladulla hospitals.
According to the union, the amount of care withheld was the equivalent of 203 nursing shifts, spread across medical and surgical wards, acute geriatrics and mental health units.
NSWNMA Shoalhaven District Hospital branch president Michael Clarke said the amount of care withheld because nursing shifts had not been rostered was unacceptable.
"The local health district data showed a significant shortfall in the nursing roster in the four-week period," he said.
"That indicated to us there's compromised patient safety and that patient care cannot be suitably provided on those numbers.
"We believe shift-by-shift nurse patient ratios need to be put in place to ensure patient safety and effective patient care."
Mr Clarke said the failure by the Illawarra Shoalhaven Local Health District (ISLHD) management to adequately cover shifts was "demoralising" for staff.
"They're stretched, they're at breaking point," he said. "They are disillusioned and disappointed that they cannot provide the level of care they need to provide to patients.
"They see nursing management as ineffective in ensuring every roster is maintained, and their morale is low."
The union has long campaigned for a safe nurse-to-patient ratios system in public hospitals across the state, Mr Clarke added.
"Nurse-to-patient systems are working in Victoria, Queensland and the ACT, and peer reviews have showed they provide excellent patient outcomes," he said.
"They are a lot fairer, a lot safer, and less able to be manipulated than the nursing hours per patient day (NHPPD) system in use, which we think is flawed."
NSWNMA general secretary Brett Holmes said public hospitals were required to provide a minimum number of NHPPD, yet the local health district was ignoring its obligation to provide this.
"Presentations are increasing across local hospitals but staffing inside the wards and units haven't improved," he said. "When sick leave can't be replaced, the nurses or midwives on shift must carry the extra workloads.
"This evidence of nursing hours being withheld from local patients is a significant breach of the minimum care required under the state award."
ISLHD Executive Director Nursing & Midwifery and Clinical Governance Deborah Cameron said the district employed more than 3500 nursing and midwifery staff.
"Safe and effective staffing involves more than just numbers of staff, it is about making sure there is the right number of staff in the right place at the right time," she said.
"The current NHPPD system used under the Nurses Award in NSW Health is a flexible ratio which enables hospitals to increase staffing, where needed, to ensure safe and effective care.
"The flexible ratio system used in NSW Health is a multifaceted approach and considers the numbers of patients, their complexity, acuity and care needs whilst allowing for the professional judgement of nurses and managers to adjust staffing levels to reflect the changing care needs of patients.
"This contrasts with the ratio framework of the NSWNMA which is based solely on the number of patients per shift."
Ms Cameron said nursing rosters were reviewed daily to ensure adequate staffing, including during unexpected periods of increased demand and unplanned staff leave.
"Rostering also takes into account our nurses' wellbeing, ensuring a reasonable workload," she said.
"As part of our normal workforce attraction and retention processes, ISLHD actively identifies and recruits to fill any new or vacant roles as they become available.
"The organisation is constantly reviewing and exploring new recruitment strategies together with a number of programs aimed at fostering and growing the capacity of our workforce."
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