North Shore Hospital report - New Zealand Doctor

Health and Disability CommissionerTypical duties for the after-hours on-call medical house officer is that he or she isresponsible for admitting some patients, and for patients on two medical wards, twogeriatric wards, and one psychogeriatric ward from 4pm to 10pm during the week,and 8am to 10pm in the weekends. The wards have between 34 and 36 beds, whichcan mean that the on-call house officer is responsible for the welfare of 140 patients.Weekend workloads are more difficult to manage than the late shifts during the week,because the patients have not been seen by the teams on routine ward rounds andtherefore the normal management of diagnostic test requests, such as blood tests, havenot been completed.Nursing serviceNursing position numbers are reviewed every year. The number of establishedpositions, particularly in the adult health service, is said by the DHB to be similar tothat of other hospitals in the region and nationally.According to the Associate Director of Nursing, in the latter half of 2007 (and into2008) North Shore Hospital had 340 budgeted nursing positions but 59 vacancies,representing a 17% vacancy in the inpatient wards of the Adult Health Services.Occupancy at North Shore Hospital was at 100% over much of this period. During thewinter months and at other peak times in 2006/2007, it was common for averagestaffing levels in the wards to be one nurse to six to seven patients (or more) duringthe day and 12 patients at night.Waitemata DHB said the high volume of patients, the impact on the budget of latereplacement when staff left, the removal of some support roles in late 2005/06, andthe slow filling of vacancies owing to a regional shortage of nurses, all impacted onNorth Shore Hospital during the period examined in this inquiry.Nursing leadership and supervisionThe DHB submitted that for some years it has had a robust nursing structure whichsupports nurses to fulfil their professional responsibilities. However, it alsoacknowledged that some ―tweaking‖ may be needed.In 2007 (as now), Waitemata DHB‘s Director of Nursing and Midwifery had overallresponsibility for professional leadership, workforce planning and professionalsystems, and reported to the Chief Executive. Additionally, each service, such asAdult Health services, had its own Associate Director of Nursing (or Midwifery)responsible for professional leadership, workforce planning and professional systemswithin their service.There are, in total, seven nurse/midwife professional leaders. They do not have lineauthority, but are part of the service management teams and can influence and leadprofessional issues. Their key responsibility is overseeing nursing practice.There are also a number of Nurse Consultants at the corporate and service level,providing professional support and development, and there are Charge Nurse/MidwifeManagers on each ward who are responsible for managing the systems, processes andworkforce in the ward or unit. They report to Unit Managers for operational issues.12April 2009