Blacktown Hospital nurses and midwives still fighting, say understaffing puts health at risk

Nurses and Midwives at the embattled Blacktown Hospital in Sydney are continuing protests against their employer, again voicing frustration at understaffing and what they see as a disregard for patient safety.

Staff and members of the NSW Nurses and Midwives’ Association (NSWNMA) Blacktown Hospital Branch gathered outside the hospital on Monday, the latest in a long line of action which saw nurses walk off the job in November as well as 20 obstetricians threaten to resign en masse over issues in maternity services.

“Midwives have demanded staffing numbers be increased for over a year now, and management have finally agreed that the service is understaffed,” said union general secretary Brett Holmes.

“Even now that our members are at breaking point, these new positions still aren’t being advertised and there is no timeframe for when the Local Health District intends to start hiring the additional 15 midwives that our members have won by standing up for their community."

The issues at Blacktown hospital came to a head this year with the news that four newborn babies had died at the hospital over the previous 18 months, and staff say that these deaths could have been avoided had staff concerns been headed.

Anna, a midwife who is a member of the NSWNMA Blacktown Hospital Branch, told Nursing Review that staff numbers, conditions and morale at the hospital have been going down slowly over the last few years.

"Blacktown local government area is a growing area, there's a lot of new estates popping up. So we noticed a trend where a lot of these young couples, young families were moving into the area and coming to have their babies at Blacktown. And we could feel that we were getting busier," she said.

"And so in 2018 we did a Birth Rate Plus which measures how much workload we were doing. And then from that, we did see a pattern that we have been getting busier."

Since 2015, births at Blacktown Hospital have increased 52.3 per cent, while staffing has risen 11.5 per cent over the same period, based on those figures.

Nearby Westmead hospital has 10 midwives rostered every shift for on average 13.7 deliveries every 24 hours compared to Blacktown, which has 11.5 births every 24 hours with seven midwives rostered.

And the union says that staff are often rostered on for shifts totalling 64 hours over seven days, despite 56 hours being the maximum allowed.

"And then they ended up closing half of the maternity ward, which puts more strain on them in the long run. Because although we are getting more women, a lot of these women have a lot of more complex things that they need to stay in hospital longer for. But the birthing unit doesn't close. Mums are coming into labour, we can't stop. So it would fill up in birthing unit, but then the mums who have had babies in the birthing unit can't go up to the maternity ward because there's a limited number of beds," Anna said.

Anxiety and burnout are symptoms of this increased workload Anna and her colleagues experience, and the recent action is a last resort so they feel like their voices are being heard, she says.

"We wanted them to see how frustrated we have been that we get overworked, we get asked to do overtime. You get text messages on your day off, 'Can you come in and do a shift? We're short staffed'.

"And then you start burning out because you can't say no. Because you know that if you say no and no one comes in to fill in that spot, then your colleagues are short-staffed and they're going to get stressed and burn-out. And we know how busy it is, so you feel bad for them. But then if you are coming in on your days off, then how is that caring for yourself really?"

"And we all do it. We all do it because you don't want to leave anyone feeling run-down. And the mums and babies that come through, we know if you have two midwives down in the birthing unit, every midwife on the floor is going to have two or three women for that shift. And what care do the mums and babies get? You get your midwife for like five, 10 minutes every hour, which isn't enough for a first-time mum really. They don't have that support."

Anna says that she routinely skips breaks or simple things like going to the toilet or grabbing some water due to the high workload and that the job has, at times, taken a mental toll.

"I would get anxiety. I would check the day sheet for the next day to check if I was in charge, so I could mentally prepare myself for what's to come. And then I thought, that's not normal, is it? To have that pre-work stress that you have to mentally prepare yourself because you're not going to get your morning tea, you're not going to get your lunch or dinner break. You probably won't get to the toilet because there's stuff to do," she says.

The staff at Blacktown hospital can't work out why their concerns are going unheard, as ultimately this is about patient health and safety.

"If you speak to any of the women that come through the antenatal clinic, a lot of the time they do feel like they're just a number. Because especially with COVID, they don't see the doctor for that long. They see them for five, 10 minutes and they're rushed out the door. And they could have been waiting an hour to see that doctor, only for a very quick consult and then they're out the door," Anna said.

"So they're not getting the support they need, especially these first-time mothers, often the immigrants, their families are overseas. This is such a disservice to them that is so frustrating. And it's like, are we just a machine that you just get them in, get them out? Where's the care?

"And you feel it, you feel how strained everyone is. And you come into work, you try and be cheerful for the women, you try and be happy as much as possible, but it's just like you're putting on a front when you're around them because you don't want them to see how much pressure you are under."

Blacktown Hospital has said it will hire more midwives after an inquiry was launched into obstetrics in the Western Sydney Local Health District, but the union and its members say this is not enough.

“Not only does the 15 FTE fall short of what’s required, but the midwives and the community are still being made to wait," said Holmes.

And in the meantime, the staff who have spoken out and taken industrial action in recent months have felt blowback from hospital management. Union members have been blamed for harming the hospital's reputation, Anna says, and therefore making it harder to hire extra staff.

"I don't think it's anything selfish, it's really just so we can service the community better," Anna says.

"If we do have more midwives, then the customer satisfaction, which is a lot of what the managers are concerned about, the customer's experience is there. So it's really to everyone's benefit if we have more staff."

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