Patient on suicide watch not given recommended supervision due to understaffing, says nurse

A patient on suicide watch was not given the recommended one-to-one supervision due to understaffing, says a nurse who has just ended a 20-year career at Hutt Valley hospital.

A Hutt Valley nurse and health and safety representative has contacted the Herald about the unsafe working conditions that contributed to her resignation after 20 years.

Hutt Valley Hospital health and safety rep Mary-Ann Coervers resigned last month, citing safe staffing and poor management as key reasons behind her departure.

Nurses were burnt out and stressed, and patients receiving inadequate care due to a lack of safe rostering, she said.

As the health and safety representative Coervers issued a Provisional Improvement Notice (PIN) in May this year.

Hutt Valley DHB confirmed the PIN was received, and base staffing increased as a result.

Coervers said the PIN followed a night that was 14 hours understaffed, in which two nurses were in charge of up to 25 patients, and a suicidal patient could not be supervised as per the recommendations from a psych registrar.

“We had a suicidal patient that was assessed by a psych registrar who said he needed one-to-one minding,” she said.

“One-to-one minding means there’s one nurse that looks after him and not after any others – to keep eye contact at all times, even if he goes to the toilet.

“You need to be in contact with that patient all the time and it was not provided.”

Coervers, who worked in the Burns and Plastics Unit, said it was not the only time staffing issues prevented them from providing adequate care.

“The DHB has dodged bullets one after another,” she said.

“The bell would be going for such a long time that by the time you got there [patients] were busting to go to the toilet.”

“Or they were in such pain that if you got there 20 minutes earlier you would have been able to be on top of that pain.”

A PIN is a written notice issued to a person or organisation asking them to address a health and safety concern in the workplace.

Capital and Coast and Hutt Valley DHBs Director of Provider Services Joy Farley confirmed they received a PIN in regards to safe staffing across two shifts in the Burns and Plastics Unit at Hutt Hospital on May 17.

She said the DHB identified mitigations to support specific shifts, such as additional nurse cover and the availability of duty nurse managers and a nurse educator.

Base staffing was increased from 34.30 to 37.77 full-time equivalent roles within the Burns and Plastics Unit.

Farley said processes were in place to review each shift and assess the support required.

“The operating procedure guides are applied and closely monitored to ensure any future risk is assessed and minimised,” Farley said.

The DHB would not comment on the specific allegation that a patient on suicide watch was not provided one-to-one supervision, but stressed no further action had been highlighted by Worksafe.

“The PIN was referred to Worksafe for review and no further action was taken,” Farley said.

“Worksafe cancelled the PIN in June 2021 and did not highlight any actions for the DHB.”

Coervers said the PIN had resulted in a meeting but she had not felt like her concerns were heard.

A senior nurse employed at Hutt Valley Hospital, who the Herald has agreed not to name, supported Mary-Ann’s account, and said she had not seen PINs used in this way in all her years working at the hospital.

“We’ve been absolutely under the hammer since about January – emergency departments have been overwhelmed, hospitals have been short of beds.”

“This is the first time really that nursing as a workforce have worked through their health and safety reps in the hospitals and had PINs created.”

A PIN was also issued at Wellington emergency department in July due to overcrowding and security, and the nurse said she was aware of a number of others throughout the country.

“I’ve probably been put in more unsafe situations at work in this year than ever before,” she said.

“It just compounds because we’re already short-staffed, you’re constantly working under those conditions, nurses are becoming stressed, they’re looking for something that’s less stressful in the way of a job – so they leave.

“That makes us more short-staffed and so it goes.”

As well as being overworked and exhausted, nurses were constantly having to make judgment calls on how to prioritize care, exacerbating the stress, she said.

“If one of those decisions happens to be wrong or something turns to custard, then it’s our registration that’s on the line, it’s not the DHB.”

She said she was aware of several “close calls”.

Safe staffing had been a key concern that drove the nursing profession to strike nationwide earlier this year.

Last month the NZNO accepted an offer from DHBs, following 15 months of negotiation, which included a contractual obligation to enforce safe staffing.

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