R U OK? Day on Thursday ended fittingly with a community forum at Tenterfield School of Arts where the mental health and well-being of Tenterfield Hospital nursing staff was strongly in focus. The consensus was that they're far from OK.
Nurses were reduced to tears when the capacity crowd gave them a standing ovation, demonstrating the community's support for calls for staff increases to combat the stressful work environment.
Mayor Peter Petty chaired the panel comprising deputy mayor and Tenterfield Care Centre chair Greg Sauer, MP Janelle Saffin, Hunter New England Health Tablelands Manager Catharine Death, Glen Innes Health Service Manager Cathryn Turner, NSW Nurses and Midwives' Association Organiser Jo-Anne McKeough and Tenterfield Hospital Manager Tony Roberts.
Backlash over an earlier HNEH decision to reduce staffing levels to two nurses per shift led to that decision being reversed. Recruitment difficulties in the face of multiple resignations, however, have led to a strong reliance on agency staff even to meet that level.
Ms Death agreed that this is an expensive way to staff the hospital, but a statewide shortage of suitable nurses is being keenly felt. She said she will take suggestions of offering incentives for nurse recruits to relocate to Tenterfield back to a management meeting on Friday, along with other feedback from the meeting.
Mr Roberts said the equivalent of 2.7 permanent full-time positions is being advertised, locally and on Seek and the NSW Health website, with no relocation allowance and on award rates and terms.
The gathering was told only three registered nurses remain at Tenterfield Hospital, and one of them resigned this week. It is feared that the current situation has 'poisoned' the work environment to the extent that potential recruits are turned off and that agency staff fulfil their contract, if that, and don't want to return.
There were reports of many missed meal breaks and difficulty even finding time for a toilet break, long waits in emergency while staff were busy elsewhere, nurses lifting heavy patients single-handedly, and returning home at the end of a shift exhausted and fraught.
There is an apparent disparity between work conditions dictated by hospital policy and the reality of nurses wishing to provide optimum care for their patients.
"You're not going to walk off on a meal break when there's an ambulance backing into the bay," recently-retired nurse Colin Chevalley said.
It is feared the situation will become even worse when the hospital's refurbished emergency department (ED) reopens, due to its isolation from the general wards.
Despite Ms Death's assurances that Tenterfield is an important part of the HNEH network, many felt it was instead the end of the line. It's location on the state border exacerbates the problem due to the administrative time consumed in arranging cross-border transfers.
Speaking from the audience, Councillor Bronwyn Petrie said the statistics are skewed anyway as many people take themselves over the border in a crisis, preferring the Queensland hospital system.
Ms McKeough said history shows that when a new ED opens it's like "honey to bees" as far as walk-ins are concerned, and three nurses per shift is the absolute minimum.
"It's a small amount of money to keep you (the community) safe," she said.
"The argument that you can't staff for 'what it' is fundamentally flawed. The Australian Defence Force doesn't go to war every week, but they staff like they are."
Mr Roberts said one of those 'what if' scenarios happened last Friday as the fires descended, and that the response from staff was outstanding.
"It makes you proud to know these people," he said.
Ms Sauer suggested making Tenterfield a Level 3 hospital (it's currently Level 2) with more facilities so that fewer cases need to be transported to a larger hospital, thereby making it easier to recruit and retain staff.
"Inter-hospital transfers are probably the biggest issue in rural area, and something we're working on," Ms Death said.
Ms Saffin and Mr Petty support the three-nurses-per-shift position and will lead a lobby group to make representation to NSW Health Minister Brad Hazzard in that regard.
Ms Death promised the audience that HNEH is looking at staffing, security and other issues with the new $1.4 million ED about to open and said there's more work to be done. She said NSW Health is a large organisation that needs statistics and procedures in order to operate.
She committed to taking the community's suggestions to management and returning with a response.
Speaking to the Star following the forum, Ms Death said the numbers don't indicate the staff increase but she will look at it again.
"We take very seriously what was said here tonight. Tenterfield is not the end of the line, it's very important."
She said after consultation with management she will return to the hospital and will work with the mayor and with the Primary Health Network on the broader issues, to bring all the players together.
This multi-discipline health cooperative will include not only HNEH amd PHN but GPs, the ambulance service, and aged care services for a more coordinated approach to serving the community's health needs.
Here's the full content of the forum...