Wednesday, November 04, 2009


My hospital had a town hall today. The hospital's further expansion plans were shown. I took the opportunity to ask if there was any plans to increase the staff strength, especially the nursing staff, given the increase in number of rooms.

The DON did not look happy about receiving the question. Her reply was that we will increase nursing staff strength only if there is an increase in occupancy. At the moment, the average occupancy rate is around 60-70%. Thus, there was no need to increase the staff strength. She added that on an adhoc basis, bank staff and agency nurses could be called in.

Of course I did not mention it, but IMHO that is a management wool-over-staff's eye. My hospital had a policy that adhoc staff can only be called-in if planned one shift in advance. Consider the common scenario where a shift started with staff to cater only to 50% occupancy. This happens when staff are told to take their public holiday leave because the ward census is low. Then the occupancy jumps to 90-100% due to a sudden surge in admission and/or acuity [see here on HDU intents]. Due to hospital policy and the urgency of the matter, one cannot suddenly call for bank or agency staff. Given the poor levels of inter-ward collaboration, existing staff on-duty are unlikely to be transferred from a more lax ward to the busy ward. What, then, is the impact on the quality of nursing care? What of the risks that nurses are exposing our license to?

As it is, based on my calculations, each SSN and SN at my ward can only take 7 days-off per year for MC, training and other leave (excluding annual leave). The calculations assume that new SNs are equivalent to experienced SNs in skills, e.g. newbies like myself and SN RB. Otherwise we would need SNs to work double-shift or ENs to act as SNs to cover the staff shortfall [Note: which often happens currently]. Given that the expansion represent 12.5% increase in my ward's maximum capacity (and we currently often take patients overflowed from the other wards), the DON's reply instructed me clearly to leave this hospital ASAP!

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