With COVID compounding decades of government neglect of the NSW health system, the path to redemption starts with our nurses.
This piece is dedicated to the nurses who have cared for me and had my back when I was at my worst, and to give a voice to patients suffering whilst politicians posture pointlessly.
Successive NSW Governments have taken advantage of the goodwill and compassionate drive of the nursing workforce for too long. This has been done knowing that our nurses will routinely turn up to work after a string of dangerously long shifts, exhausted and in need of rest because our public hospital wards are chronically understaffed.
Nurses know that the care they provide is fundamental to the health of our community, and they are prepared to stand against the tide of exhaustion at great cost to their own health in order to preserve ours. Appropriate, legislatively mandated nurse-to-patient ratios provide a safe and sustainable baseline on which the care you and I receive in our time of need is built.
The issue of nurse-to-patient ratios has been in and out of the periphery of public discourse for the better part of the last decade. Mandatory ratios and reporting measures have already been legislated in Victoria and Queensland amongst sweeping changes that are regarded as some of the most thorough in the world.
The refusal by the NSW State Government to commit to ongoing discussion with the nursing sector or consider policy and legislative amendments - amendments that would improve the way our public hospitals staff wards and maintain safe ratios - is a hallmark of a policy and political approach to leadership and governing in health that penalises nurses who are working hard to patch over the widening cracks in our health system.
Nurses are commended for their resourcefulness in continuing to deliver high quality care in spite of a system and government that they are saying fails to, in the words of former NSW Premier, Gladys Berejiklian, “support them to support patients.”
Despite repeated rallies of nursing staff outside NSW Parliament - and now protests in our major public hospitals and marches across Sydney - the underlying issues that require the application of hot fixes and on-the-go ingenuity remain unresolved.
The concerns of nurses in NSW haven’t been fortunate to have gathered a public spotlight enough to substantially shift any votes, and have therefore been disregarded by our current State Government at a time when inadequate ratios can be considered one of the greatest weaknesses in our pandemic response and public health infrastructure more broadly.
Over the last 24 months, these cracks have widened to fissures that threaten to undermine not just NSW’s claim to an exemplary standard of patient care, but further disenfranchise and discourage health workers from maintaining any trust or reassurance in the system as a whole to support them.
All of this culminates in a direct effect on the safety and quality of care provided to patients in our public hospitals. As COVID infections in NSW soared with the emergence of the Omicron variant and hospitalisations climbed with it, the prospect of even higher rates of hospitalisation from as yet unknown strains weighs heavily on the minds of nurses already pushed to breaking point.
Hospitalisations, despite the slow in cases of Omicron, remain at an unsustainable level for public hospitals to continue operating safely and effectively without the quality of care being provided to patients slipping to a state that betrays our claim to a world-class health system.
Our public hospitals, without the threat of a pandemic, are already an environment where compromises in care are made every day on the ground because there are simply not enough staff to look after patients holistically.
In light of the recent easing of restrictions and the fact that the current NSW premier Dominic Perrottet is at loggerheads with health authorities and experts, we find ourselves walking a path of pandemic recovery guided by an unsettling reliance on good fortune and the acceptance that those living with disability and chronic illness will continue to be disproportionally over represented in deaths and hospitalisations. That acceptance alone is a chilling insight into the expendability which our premier, health minister, and minister for disabilities in NSW treats the vulnerable with.
NSW Health Minister, Brad Hazzard has stated he is willing to employ more nurses if there's "a need”. For two years now our nursing sector has been saying there is a need, and that need has been dismissed.
Yet even in his avoidance of substantive commitments, Mr Hazzard does not seem to grasp that hiring more nurses is predicated on there being accredited staff available in the first place. Any commitment to employ more nurses which excludes education and accreditation is a commitment made by someone with a fundamental ignorance of basic public health education and employment strategy.
Further to this, the decision by the NSW Government to employ wage incentives to attract more nurses to COVID care environments has only acted to contribute to the mass exodus of public hospital nursing staff with general or speciality ward training, leaving patients with specific and complex care needs with even fewer staff to care for and support them.
I have spent more than 30 weeks admitted to hospital in the last 12 months, and am recovering from my second liver transplant in under a year (my fourth major operation in the last decade).
I have personally relied on our public health system for over 20 years. I now work to improve that system from the outside - an independent perspective of lived-experience and an advocate for patients and health consumers, and now the health workers that I owe so much to.
If the dismissal of nurses’ concerns can be justified, even loosely, by successive state governments’ unwillingness to cater to what some opponents of introducing ratios have suggested is a vested interest then let me be the one to diffuse the validity of that rebuttal by making it explicitly clear my position as not just an independent perspective on health system reform and transformation, but as an actual patient inhabiting and relying on that system every day since the age of 3.
Indeed, the dismissal of nurse and patient concerns were elevated to new heights of fantastical denialism each morning as NSW Premier, Dominic Perrottet fronted media and proclaimed our public health system was experiencing no burden that gumption and platitudes alone weren’t fit to remedy. This baseless optimism is a consistent, but inadequate pandemic management strategy that has crippled essential care for vulnerable communities, and snatched away the chance of respite for our already exhausted health care workers.
The failure to maintain adequate ratios of nursing staff to patients is unsafe for patients, leads to poorer health outcomes, and ultimately exhausts nursing staff - leading to high rates of burnout, and the loss of skilled staff. Even more so now that COVID has applied substantial pressure to the capacity of the system as a whole.
It is unreasonable to ask that on top of their responsibilities to patients, nurses are expected to spend what little time they have for themselves and their own well-being advocating alone to introduce legislative amendments designed to bolster the standards of a purportedly world-class health system. A health system that now cannot guarantee that there are enough nurses to ensure bed-bound patients can be assisted to mobilise to the bathroom before soiling themselves - something I have personally experienced.
Indignities like this occur, and patient care slips while our State Government demonstrates it is unwilling to engage in constructive dialogue to resolve a legitimate issue of patient safety and remove one of the most significant barriers to the delivery of high quality care we now face.
The onus has fallen to already exhausted staff, and the community of current and future users of our health system to advocate for the health and wellbeing of health care workers, and for the introduction of measures designed to support and improve the ability of those staff to deliver the kind of care we have come to expect. It is entirely unreasonable for this responsibility to have fallen to us, and is arguably a failure to uphold a fundamental duty of care to the public by state leadership, and one that continues to be neglected.
As it stands, the point of friction - and one of the most significant barriers to achieving that standard - is the unwillingness of our governing political representatives to sit down at the table and engage in a meaningful dialogue with health care worker and health consumer stakeholders, and work to support and resource them to do their jobs in a manner that is safe for them, and for us.
I have sat upright in my hospital bed countless times at night unable to sleep because of pain and discomfort - or the kind of inescapable and frustrating exhaustion that fades you without bringing you any closer to rest - while watching as few as three nurses care for a ward of 20 or more high complexity and acutely unwell patients as they push through their own visible exhaustion, energised only by their genuine desire to care for others.
Patients pick up on this unsettling feeling of exhausted patchwork care, refraining from using the nurse call buttons out of a desire to not be a bother amongst the long list of care tasks staff are grappling with, or forgoing basic needs and amenities as there are too few staff to care for them.
It erodes our confidence in nurses even though they are doing their utmost to provide the best care they’re capable of under the circumstances. They know it, and though they continue to turn up to work, that anger at the role government is now playing in actively impeding their ability to provide a standard of care they pride themselves on is growing.
I remember sharing an admission with a woman in her 70’s following a liver transplant. She was unable to mobilise, was in pain, and wanted to call her grandchildren but her phone was out of reach. Out of a fear she would be an annoyance in an environment of frantic understaffing she refrained from asking a nurse for help.
In the same way that vaccines alone are not enough to combat this rapidly evolving public health crisis, government insistence over the years on increasing bed capacity in hospitals without considering how best to staff them has left our health system, and the people who rely on it most, inexcusably vulnerable.
Not for a lack of effort and sheer willpower by our health care workers to keep the wheels of care rolling, the ‘gold standard’ state of healthcare in NSW has been dragged out into unforgiving waters by the tide of COVID - among a growing body count of the disabled, chronically ill, and elderly that have died under a Perrottet-Hazzard custodianship.
When patients are hesitant to ask for help out of a concern they’re adding more work for nurses by wanting to contact loved ones, or go without a shower for days because there aren’t enough staff to assist them (again something I have personally experienced) - when the safety and quality of essential care for existing patients with complex illnesses are compromised - then there is without question, as Minister Hazzard himself stated, “a need."
In the midst of a surge in COVID cases and the inevitable increase in hospitalisations that will follow, it is more important than ever that the NSW State government abandons it’s rhetoric and pointless posturing and takes health advice, and the safety and well being of those admitted to and working in our state health systems seriously. If they don’t, they will be responsible for crippling a world renowned public health system for the next decade to come.