Lack of staff, lack of beds lead to ED crisis.

Inadequate numbers of clinical staff and overwhelming numbers of patients presenting at emergency departments (EDs) throughout the country are leading to unsafe working conditions and low morale for nurses. Many hospitals have hit gridlock or "code red" in recent weeks, as patient numbers outstrip available beds and nurses to cope with the influx.

Christchurch Hospital ED has been in the media spotlight recently, following a report into the death of Dean Carroll, who was treated and discharged from the ED the day before his death in April. Although the report concluded there did not seem to have been any negligence on the part of nursing and medical staff, it noted that overcrowding and the ED environment made treating him "challenging" for all concerned. It recommended the department needed to be bigger to accommodate approximately 65 trolley patients. There are presently 48 beds, including the observation area.

Clinical nurse co-ordinator of Christchurch Hospital ED and chair of NZNO's College of Emergency Nurses, Justin Moore, described the situation nationally as "dire", particularly during the tough winter months. "In Christchurch, we have about 210 presentations each day. The major problem is that patients aren't moving through to inpatient beds because of the tack of staff in other areas and the lack of beds on occasions. The ED is frequently acting as a backup area to inpatient areas. However, no extra nurses are rostered to care for the overload. Even at 6am, there could be 15 patients waiting for inpatient beds.

"There are real safety issues when nurses try to move through with a crash trolley and find they have to move three people just to get through. People keep working, despite these conditions, often going without meal breaks and working overtime, because they are loyal to their colleagues. People are considering leaving, however, and stress levels are rising."

A similar crisis is occurring at North Shore Hospital, where the occupancy rate sits at 100 percent, with 140 presentations a day in the ED and 57 beds. This makes the risk of gridlock an ever present reality, says NZNO organiser Theona Wright. Patients are often spending 24 or more hours in the ED because there are no ward beds available. Staff are attempting to cover up the nursing shortages by continually doing extra shifts, adding to their stress and ill health. There are plans to open 25 more beds across Waitemata District Health Board (DHB). However, with at Least 60 full-time equivalent vacancies at the DHB, actioning these plans is difficult. Urgent meetings between NZNO delegates and staff and management to resolve the situation are continuing, says Wright.