Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Introduction and Environment
reduction in beds was understandable and understood. As a high
percentage of admissions to Gisborne Hospital are acute, the hospital has
a very variable occupancy in the medical and surgical wards. Average
occupancy may be low in a month when staff have had to tightly manage
available beds for numerous days in the month.
Further, Gisborne Hospital had previously not experienced the tight
management of beds and elective admissions required every day that has
been accepted practice in most other hospitals in New Zealand and
overseas for many years. For these reasons the number of beds in the
reconfigured medical/surgical floors is higher than the statistical analysis
showed was required.”
3.6 After working on the SFIU concept since 1 March 1998, management
modified the proposal and adopted a dual floor inpatient service in April 1999,
in response to the concerns expressed by clinical staff. THL said that this was
an example of management being responsive, despite strong pressure to retain
the single floor concept to maximise financial savings. This change in
direction required further changes to the nursing structure plans, which were
well under way.
Nursing leadership
3.7 Up until August 1999 the Group Manager (Hospital) (Ms Rachel Haggerty)
and the Director of Nursing (Mr Dan Madden) worked together on the ward
and nursing restructuring projects, with input from Clinical Directors. The
Group Manager (Hospital) appointed the Director of Nursing as project team
chair for the Nursing Professional Structure Review.
3.8 When the Group Manager (Hospital) left THL in August 1999, the Director of
Nursing, Mr Madden, was duly appointed to that position and became the new
Group Manager (Hospital). He took up the new position immediately.
3.9 It took eleven months for a new Director of Nursing to be appointed in July
2000. The Clinical Nurse Educator resigned on 14 January 2000, and at the
end of October 2000 that position was still unfilled (although it has since been
filled). Nurses were therefore without professional leadership (other than
through the Nursing Reference Group) at a critical time.
Changes to the nursing structure
3.10 Charge Nurse positions were replaced in a restructuring exercise in 1998 by
Nurse Unit Managers and Clinical Nurse Leaders (CNLs). Clinical Nurse
Leaders provided clinical co-ordination and leadership at a local (ward) level.
Nurse Unit Manager positions were created to manage the surgical and the
medical services. In September 1999 Clinical Nurse Leaders were to be
replaced by Clinical Nurse Specialists.
3.11 A special project, the Surgical and Adult Medical Service Nursing
Professional Structure Review, was put in place in October 1998 with the
purpose:
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