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ABC News

Review of West Australian hospital staffing levels presents scathing findings of 'cumbersome' nurse rostering system

An independent review of the staffing levels of nurses in West Australian hospitals has made scathing findings about the current system.

Former West Australian chief nurse Phillip Della was commissioned by the state's Health Department to review the current system of nurse hours per patient day (NHpPD), which has been in place since 2002.

Professor Della made several findings about Western Australia's NHpPD system, including:

  • It is not the best option to move forward
  • It is not accepted by the majority of nurses and midwives
  • It does not provide staffing levels to enable safe and quality patient care
  • It is not appropriate for the maternity setting because it does not reflect current midwifery practice.

Professor Della ultimately assessed the system as "clunky" and "cumbersome", finding that it added to workload pressure and frustration.

The independent review included a recommendation that Western Australia compare its current system with the Victorian nurse-to-patient ratios system, and implement the system which has a higher number of nurses and midwives per patient.

Other recommendations included the appointment of a time-limited taskforce to implement and evaluate a safe-staffing framework.

Professor Della also found evidence that the current NHpPD model does not consider the skill mix of staff, the work environment, nurses and midwives' job satisfaction, fatigue and burnout, nor its relationship to patient outcomes.

He wrote that any new governance framework must establish clear and transparent roles and responsibilities for safe patient care that details the overall number of staff and skill mix required.

'Further research' needed, says minister

Western Australia's health minister, Amber-Jade Sanderson, was unavailable to be interviewed but issued a statement.

"Professor Della's report was commissioned by the Department of Health in 2020, with agreement from the Australian Nursing Federation (ANF), and its findings will be considered," Ms Sanderson said.

"It was anticipated by all parties that this report would provide a practical framework for reform, however, the recommendations are complex and call for further research to be undertaken. The report also deviates significantly from the agreed Terms of Reference.

"The Department of Health continues to negotiate in good faith with the ANF and acknowledges that nurse-to-patient ratios are part of their log of claims.

"We value all of our hardworking healthcare workers and are committed to doing everything we can to support them, amid global workforce challenges."

The state secretary of the ANF, Janet Reah, said Professor Della's independent review provided evidence of what nurses have known for a long time.

"We've now got a fully referenced indictment on the workloads and pressures that our nurses and midwives are under, and this report has made abundantly clear what we've been saying for years," she said.

It comes as the nurses' union prepares to take industrial action next week over the government's refusal to implement nurse-to-patient ratios. 

"We need to start somewhere," Ms Reah said. "We can use the Victorian model and see how we can apply it to the very unique needs of West Australians, especially in the rural and remote areas.

"I believe it could be quite a quick transformation, especially in the metro area, and then that would leak [out] to the country areas."

President of the Australian Medical Association (AMA) in Western Australia, Mark Duncan-Smith, said the ANF had the AMA's support.

"I certainly support any action that leads to better conditions and employment for health care professionals, because we quite simply do not have enough nurses and enough doctors in Western Australia," Dr Duncan-Smith said.

"I am certain that the ANF will ensure that patient safety is not compromised, and I respect their need to create a better environment for healthcare professionals to be employed in Western Australia."

Opposition Health Spokeswoman Libby Mettam said it would soon become too hard for the government to ignore calls for ratios.

"The McGowan government [is] not prioritising health, continues to ignore the concerns about dangerous levels of staffing in the health system, and West Australian patients are continuing to pay the price for this level of mismanagement," she said.

"It seems that everyone is listening, except for the McGowan government, when it comes to the dangerous levels of staffing across the health system.

"What will it take for the McGowan government to actually listen and change their reckless approach to managing our West Australian hospitals?"

ANF members will hold a stop work meeting next Wednesday and have warned industrial action could escalate from then.

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