From Birth To End Of Life, The NSW Government Is Neglecting Public Health

Nurses and midwives are sick of "excessive workloads and overtime" and feel they're making "heart-breaking decisions" due to understaffing.

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Despite Australia’s real reckoning with COVID-19 happening mere months ago, with 90,000 per day at the height of the Omicron pandemic in January, you’d be forgiven for thinking that after two years life almost seems normal again.

COVID infections have gone from being a speculative concept to one that has been physically experienced by many of us here in Australia, with most being lucky enough to experience illness and recovery from the comfort of home. However, anyone with recent experiences in the New South Wales public health staff can attest that the system is extremely ill.

While other sections of Australian life begin to show signs of recovery post-COVID, workers in public hospitals and aged care are reporting that they are working harder than ever before, while facing staffing woes and underpayment.

It begs the question: why are some of the most crucial areas that sustain a human life from birth to death being neglected in New South Wales’s pandemic response?

NSW Public Health Woes Start At Birth

Nurses and midwives across New South Wales participated in a general strike last week, protesting poor working conditions, bad pay, and systematic under-staffing that has caused chaos has led to staff leaving the profession entirely.

As nurses and marched down Downing street in Sydney, others gathered outside of their local hospitals, from the Central Coast to Wagga, to raise public awareness of the worsening conditions medical staff have faced during the pandemic.

Lucy* is a registered midwife and nurse working in public maternity ward on the south coast of NSW. A seasoned professional with over seven years under her belt, she told Junkee that she only got a sense of how bad things had gotten in public health after she moved to New South Wales in the midst of the pandemic.

Lucy says that staffing in the maternity ward she works in is currently approached through a “midwife to bed” ratio, that is decided roughly twelve hours in advance of her shift. This system is consistent with how the majority of New South Wales public health maternity wards are staffed, and doesn’t set a strict minimum requirement for how many patients must be attended to by a midwife.

“They just see it as beds, as workers to take care of a number of beds,” she told Junkee.

Staffing on a Lucy’s maternity ward is not solely comprised of midwifes — nurses are also regularly embedded on her ward. While, in a perfect world, this wouldn’t be cause for concern, Lucy says they are frequently rostered on to make up for low staffing numbers.

“Nurses are awesome, but they’re not midwives — it’s just not their scope of practice,” she said.

This can mean that someone who has just given birth is being taken care of by a nurse, who may not have experience in breastfeeding or post-natal care.

Additionally, Lucy says this “bed to midwife” ratio also doesn’t factor in the actual babies being born, and assumes midwives are working under the guise of both babies and parents being well. 

“If you’re looking at a broader maternity setting with higher rates of intervention, so higher rates of induction, higher rates of caesarean, higher rates of complex birth: we’re not always having well women well babies” Lucy told Junkee. 

The uncertainty of this staffing arrangement ultimately culminates in some nightmare scenarios — in one shift, Lucy arrived at work only to discover she was expected to help fourteen pregnant people with the pre-natal care of their babies, supported by one assistant in nursing; a ratio of two nurses for fourteen patients and their babies. 

According to Lucy, the current arrangement barely achieves the minimum requirements of care, and leaves out the provision of other models of care such as breastfeeding. “A woman is more than just her, just got that baby that she’s learning to care for, learning to breastfeed, as well as all her needs as well. So when you don’t have ratios you don’t have time to provide that parenting education and empowerment and don’t have time to establish breastfeeding with the woman,” Lucy told Junkee.

Lucy’s union is fighting for ratios of three nurses to one midwife, 24/7 across every shift in all urban and rural public hospitals in New South Wales. 

Nurses Say Understaffing Makes It “Almost Impossible” To Deliver Quality Care To Patients

Skye Romer has worked through the pandemic as an enrolled nurse at Prince of Wales Hospital in Randwick. While others were enjoying the summer holidays last Christmas, Skye was witnessing an explosion of COVID-19 case rock her workplace, as the Omicron worsened in December. One of the worst things she remembers is the heat.

Working in PPE for a full shift is not fun. It’s like you’re walking around in a plastic bag with your whole face covered. If you’ve got a 32-degree heat and you’re wrapped in plastic for eight to 10 hours, it’s excruciating – very uncomfortable. We’ve had staff that have nearly fainted on the ward because of the level of heat that they’re dealing with in their workplace.” 

One the most insidious threats that COVID poses to public hospitals is not just the virus itself, but the complex requirements it imposes on nurses at work. Skye says that COVID has even affected the once-simple processes of drinking water or taking bathroom breaks.

“If you’re doing your job correctly, and you’re wearing the full PPE, you can’t remove it. You’ve actually got to leave the ward to have a drink of water or use the toilet,” said Skye.  You can’t have a sip of water to keep going, to make sure you’re hydrated. You’ve gotta fully take all of your PPE off so that you’re not re-contaminating another area — go out, have a drink — so that’s another nurse that’s not on the ward — go and do that and come back to the ward, then put all the PPE back on. It’s just another job to the already huge list of things to do.”

Despite the rigorous screening measures hospital staff employ to vet patients before and during their stays in hospital, outbreaks are still a possibility. When a patient or staff member tests positive to COVID on a ward, it’s designated a ‘red zone’ and is closed. Skye says that the knock-on effect of this further hinders staffing rates across the whole hospital.

“Nurses and midwives are just sick of excessive workloads, excessive overtime, we’re missing breaks and you’ve got to make heart-breaking decisions and rushing the care you provide between patients while you’re constantly understaffed,” said Skye. “I know that within the community things may have opened up and calmed down in a lot of areas, but in the public health system we’re still very much in the midst of it.”

Almost a year ago, Skye was part of a union delegation comprised of nurses and midwives, which attempted to negotiate a better staffing system directly with representatives from the New South Wales government.

Their proposal for mandated staffing ratios was knocked back, in favour of a boost of 5000 of nurses and midwives, which a NSW health spokesperson said “far exceeds what is needed to deliver the ratios being called for by the nurses’ union”. The NSWNMA acknowledged that the extra staff would help boost numbers, but noted that “unfortunately, this is a mechanism proven to be fallible to management manipulation”.

“We know that without minimum nurse-to-patient ratios, nurses and midwives will continue to struggle to meet demand and maintain safe patient care,” the NSWNMA said in a statement.

Health Workers Say They’re Taking A Pay Cut Every Day They Show Up At Work

The Health Services Union, which represents health staff from paramedics to aged care workers, took part in a state wide strike last Thursday to protest the 2.5 percent wage cap on employees in the public service. The wages cap dictates that public service employees wage increases cannot exceed 2.5 percent, despite inflation figures which are currently at 3.5 percent.

Paramedic at Campbelltown Ambulance Station, Tess Oxley told Junkee that the health care workers are striking because the rising cost of living is now exceeding the 2.5 percent wages cap.

“What we’re actually doing every day that we turn up at work is taking a pay cut,” Tess told Junkee.

The situation is symbolic for Tess, who has fought daily to keep up with the constant flow of new challenges COVID presents to her work. Throughout tirelessly working amid pandemic, she says that she still hasn’t been able to process her changing world and the consequences it’s left on her.

“The sad thing is that even though things are getting better now, nothing’s actually gone away, and we’ve still not as health workers had a chance to stop,” said Tess. “It’s a massive massive change in our lives both at work and home, and we still haven’t had a chance to reflect on that.”    

Tess said that the stress of working as a paramedic over the two years is a constant pressure that has taken a toll on her personal relationships at home.

“I’ve become a lot more irritable, I’ve become very short with them and it’s also affected whether I feel safe going out and socialising, knowing that I’ve been treating COVID positive patients all week and I could give it to my family. Or if my family have been socialising with people, that I could catch it from them and give it to my high-risk patients when I return to work,” she said. 

The response that Tess keeps hearing from NSW Health is “we’re listening” — something that Skye and Lucy have also heard over and over again in their fields. Tess notes that despite the government’s supposed willingness to improve the conditions at her workplace, none of this goodwill has materialised into anything that made her situation any more bearable.

While Scott Morrison happily claimed in a recent promotional video that his government saved over 40,000 lives in the pandemic, health care workers like Tess at the frontlines of the crisis are having to fight tooth and nail to stop their salaries from being swallowed by the rising cost of living.

“This has affected all of us, We’ve all worked harder than we’ve ever worked before,” said Tess.

Looming Aged Care Crisis As The Federal Election Called

The announcement of a May 21 federal election comes after a survey conducted by Australian aged-care unions predicted a future staffing crisis, after one in five aged care workers stated they planned to quit their jobs within the next 12 months.

The survey cited that workers were physically and emotionally burnt-out after working additional, long shifts without adequate breaks and often without access to proper-fitting PPE.

While the pandemic has allowed some industries to directly profit from the disaster — such as the billionaire owner of Harvey Norman who pocketed $22 million in JobKeeper subsidies, while doubling the company’s profits — the public health sector that nurses human life from birth to death in New South Wales has been left to flounder. 

As the campaign to elect a new prime minister begins, irreparable damage has been done to the workers who, in sickness and in health, have carried us through this disaster.  

While the New South Wales government considers the demands of striking nurses, midwifes, and health workers after a month of industrial action, the sad truth is that it might take an election to see public health staff receive the compensation they deserve.

Charles Rushforth is a staff writer at Junkee. Follow him on Twitter.

*Indicates name changed out of respects for privacy