Nurses say they are currently short 136 full time staff in Wollongong Hospital, which is leaving them overworked and putting their patients in "dangerous" and uncomfortable situations.
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Speaking at a rally held in MacCabe Park during Thursday's 24-hour nurses strike, NSW Nurses and Midwives Association delegate Genevieve Stone said spot checks conducted at the hospital showed that not a single ward met its requirements under the current nurse staffing system in the past month.
Statewide, nurses are calling on the government to change the staffing system and put in place nurse to patient ratios, which would guarantee one nurse to every four patients in most ward, with more nurses in ED and intensive care.
Ms Stone said the current system - which is called nursing hours per patient day, or NHPPD - was "a danger to patient safety and nurses' quality of life."
"The way the NHPPD funding works is each patient is allocated hours of nursing care a day," she said.
"This is then multiplied by the number of patients on the ward and divided by eight for the hours each nurse works. You are left with the number of nurses the ward is allowed in a 24 hours period."
But she said there were often shortfalls in the number of nurses needed, and the system created an "inequitable and dangerous situation where patients are not being guaranteed a standard of care throughout the day".
"There are shortfalls they are trying to fill every day on every ward, yet not a single bed is closed, in fact they are creating more beds by putting admitted patients in the waiting room or in makeshift extra rooms on wards," she said.
"Our empathy for our colleagues is exploited and our guilt about leaving a patient in pain or lying in their own faeces is driving us to stretch ourselves that little bit more."
"The government has relied on the relentless overtime we are working to stop the health system from crumbling.
"If a hospital is 136 nurses short the only way it's functioning is from nurses working their absolute arses off on overtime, and there sure as hell are shifts where patient safety is being compromised. Heed our warnings."
Hundreds of nurses joined the march from Wollongong Hospital to MacCabe Park, with rallies also held at Shellharbour, Shoalhaven and Milton/Ulladulla hospitals.
As they marched down Crown Street, they were met with honks of support from stopped traffic and pedestrians and shoppers stopped to applaud or say thank you.
Elise, a union delegate and midwife of four years, also spoke at the rally, breaking down in tears as she spoke about not being able to properly care for women and newborn babies.
"Becoming a midwife was my dream job, but now I'm here it's actually far from a dream come true," she said.
"Maternity services across the Illawarra and across the state are in complete crisis and the problem is very, very simple, there is just not enough midwives to provide adequate care."
She said it had become the norm for just two midwives to be working on the maternity ward, and that she was sometimes left caring for 14 mothers and their babies on her own.
"We should have five or six midwives on a shift," she said.
"We're asking for [a ratio of] one midwife to three women and their babies, and one on one care in all birthing units across the state. Ratios would ensure that I never have another shift again where I am expect to care for up to 14 women plus their babies, who currently do not count as patients.
"It is absolutely heartbreaking to know that every single day I can not give adequate care to my patients because I just do not have the staff to support that."
"We need ratios now, we should have had them 10 years ago. We are losing staff to other states because they already have ratios, they have better pay, better conditions. How many more midwives do we have to lose before this government takes a hint."
Illawarra Shoalhaven Local Health District Executive Director Nursing and Midwifery Maria Flynn said the nursing and midwifery workforce included permanent, casual, temporary, and part-time staff.
"We recognise the challenges our nursing and midwifery teams have been experiencing due to local vacancies, something that is being experienced across the professions nationally and internationally," she said.
"The District continues to explore recruitment strategies and options to attract staff to ISLHD, including local, national and international staff. In addition to ongoing recruitment activity to fill any vacant positions, the District has a dedicated Nursing and Midwifery Recruitment Plan to address nursing and midwifery staffing shortages.
"As part of this plan, we have appointed dedicated roles to attract and recruit nursing and midwifery staff to all areas of the Illawarra and Shoalhaven region."
In 10 years, the district increased its workforce by an additional 1,457 full time equivalent staff, including 564 more nurses and midwives, 244 more doctors, and 173 more allied health staff, she said.
Defending the NHPPD system, a NSW Health spokesperson said "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".
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"The current 'nursing hours per patient day' system used under the Nurses Award in NSW Health is a far more flexible ratio which enables hospitals to increase staffing, where needed, to ensure safe and effective care," they said.
"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 rigid ratio framework of the NSW Nurses and Midwives Association which is based solely on the number of patients per shift."
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