Frontline medical staff shortage at crisis levels in regional NSW communities

Underresourced rural health centres are using kitchen staff to “keep an eye” on aged care residents so nurses can help out with emergencies elsewhere in the facility.

Kitchen staff at rural health centres were “commonly” being asked to “keep an eye” on aged care residents to allow nursing staff to help out with emergencies.

Paramedics were also being called to help medical staff treat patients at rural hospitals’ emergency departments while “burnt out” and “exhausted” nurses were doing double shifts.

A lack of staff had also led to situations where frontline physicians were working solo for up to 32 hours straight while caring for more than 100 emergency department patients.

The revelations were made at an NSW Upper House inquiry into health and hospital services in rural, regional and remote areas of the State.

Tumbarumba multi-purpose centre nurse Kristyn Paton revealed how it was “common” for nurses at local rural multi-purpose sercvices (MPS) to rely on aged care nurses during emergencies.

Combining health care services such as an emergency department, medical ward and aged care, MPCs are regarded as a rural “one-stop-shop”.

Ms Paton, who was representing the NSW Nurses and Midwives’ Association, said while kitchen staff had basic life support training, they were not nurses.

“If we had an emergency, we’ve got the registered nurse, say myself and my supportive nurse, which is an enrolled nurse,” she said.

“I would take the staff from the residential aged care first, which is one enrolled nurse and assistants in nursing, so once they’re taken off the floor over there, there is nobody to look after 28 aged care residents.

“So kitchen staff then just keep an eye.”

Upper House MP Walt Secord. Picture: NCA NewsWire/Dylan Coker

Responding to a question from Upper House MP Walt Secord, Ms Paton said there was no policy on using kitchen staff as “minders”, but that it had come about out of necessity.

Rural Doctors Association NSW president Dr Charles Evill, a locum and relieving doctor who had worked in 28 rural towns, told the inquiry that staff shortages in the bush were critical.

Describing some of the conditions in hospitals that he had worked in as “completely unsustainable”, Dr Evill recalled a stint Casino Hospital where he was the sole doctor in charge of more than 100 patients over two days.

“I spent a weekend in Casino, on my own, looking after the wards and the departments – 105 emergency patients over two days,” he said.

“You sit in the emergency department and you keep seeing them as they come in. They are triaged by the nurse. Your sort them out.

“You see the urgent ones as quickly as you can. But I couldn’t leave the department for 32 hours out of 48.”

Dr Evill said there had been some improvements at the hospital, with locums now working “12 hours on, 12 hours off”.

He said he was often called to areas where the local doctor was finding a situation “too difficult” or had left, and blamed local health bureaucrats for not being supportive when help was called for.

Health Services Union’s Gerard Hayes. Picture: NCA NewsWire/Bianca De Marchi

He said there were “serious issues” within NSW Health administration in providing clear policy for local health managers to manage staff, leading to situations such as Lismore Base Hospital where a lack of nurses had left a brand new intensive care unit designed unable to be used.

Instead, the unit was being used as a Covid vaccination centre with staff operating out of the old unit, he said.

Health Services Union secretary Gerard Hayes told the inquiry that paramedics in the bush were often called on help medical staff in the hospitals.

“The pressure on paramedics now is intense,” he said.

State opposition health spokesman Ryan Park said the extreme pressure doctors, nurses and paramedics were under in the bush contributed to staff not wanting to work in rural communities.

“When you hear a frontline physician giving evidence that he has at times had to work 32 hours straight, caring for over 100 patients because of a lack of staff, it is clear that we have a health and hospital system in crisis across our rural towns and villages,” Mr Park said.

Describing the scale of understaffing in the bush as “dire”, nurses union general secretary Brett Holmes called for “shift-by-shift”, nurse-to-patient ratios.

“Postcodes shouldn’t define the healthcare a community receives and there is a crisis across rural and remote healthcare delivery,” he said.

“We need safe staffing, adequate skills, and safe working conditions in all health settings to tackle this crisis.”

A NSW Health spokesperson said the department acknowledged the concerns raised by those who made submissions to inquiry, while noting how the State government had increased its health workforce since 2011 by 24,614 full-time equivalent positions.

“Since 2011, the NSW Government has built or upgraded more than 130 hospitals and health facilities across the State - a further 80 projects are currently underway and more than two-thirds of those are in rural and regional areas,” the spokesperson said.

“A further 8300 frontline staff are being added over this term, with 45 per cent going to the regions.”