Wollongong nurses say they are confronted but not surprised to see their workplace named as one of 10 major hospitals where the nurses and midwives union has accused the government of repeatedly breaching award conditions.
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This week, the NSW Nurses and Midwives' Association revealed it would file a case in the Supreme Court alleging non-compliance with the state's agreed staffing levels had deprived patients of more than 100,000 hours of care at multiple public hospitals.
Gathering in their own time outside Wollongong Hospitals, which the nurses union claims had 106 staffing breaches in a four month period last year, union delegates said this came as no surprise as nurses had been highlighting low staffing levels for years.
"This is not news to us because we've known that we are understaffed - but it is confronting to see the numbers," NSWNMA branch president Bianca Vergouw said.
"But it also shows that this is not a local issue here in Wollongong, it's an issue across the state."
For more than a year, Illawarra nurses have been joining statewide strike action to highlight their working conditions in what they say are understaffed hospitals.
During a strike last September Wollongong Hospital union delegate Genevieve Stone said the "nursing hours per patient day", or NHPPD, staffing system was "a danger to patient safety and nurses' quality of life."
"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 nurses union claims 'systemic understaffing" has meant patients at these major hospitals have recently missed out on 120,000 hours of nursing care, with 1484 contraventions of the NHPPD staffing agreement across 10 hospitals over "recent months and years".
The association identified Gosford Hospital on the Central Coast as the worst offender for staffing breaches, with 777 award contraventions over four years.
A further nine hospitals - including Royal Prince Alfred, Gosford, Wollongong, Westmead, Liverpool and Nepean - did not provide adequate staff per shift on more than 700 occasions, from July to October last year, the union says.
The union's general secretary Shaye Candish said the breaches named as part of the case were an underestimate.
"The 1484 contraventions we are filing today are just the tip of the iceberg," Ms Candish said.
"If anything, we have been conservative in this prosecution and have not included a large number of other hospitals that also breached the award repeatedly."
NSW Health has repeatedly defended the nursing hours per patient day system, saying it is a flexible system which "helps to ensure the right number of nurses are in the right place at the right time."
The flexible staff to patent ratio system of 'nursing hours per patient day', used in a range of wards across NSW Health, is a multifaceted approach and considers the numbers of patients, their complexity, acuity and care needs - while also allowing for the professional judgement of nurses, nurse managers and workforce managers to adjust staffing levels to reflect the changing care needs of patients," NSW Health told the Mercury last year.
Speaking outside Wollongong Hospital, Ms Vergouw said local nurses and midwives had gathered to urge Illawarra residents to use their vote on March 25 to help change the health system.
Nurses and midwives are demanding the state current staffing model, which is based on "nursing hours per patient day" be replaced with a shift by shift ratios system.
"We can't tell people how to vote," Ms Vergouw said.
"But what we have done is put together some information on what each party has promises they will do when it comes to ratios."