When the Premiers discuss budget cuts to essential services, as they’re currently doing with our fire and emergency services, they hasten to add that cuts “won’t affect front line staff” – don’t worry, people, it’s not the teachers, nurses, midwives, fire fighters, police, ambulance officers you see in the classroom/at the bedside/on the street that we’re affecting, just the bloated layers of non-essential, invisible, minimally qualified office dwellers. You won’t notice they’re gone, promise.
I know in my profession, without support staff we’re at best slowed, at worst unable to do our work because support staff tasks still need to be done. Our “non-essential” support staff include ward support (who run specimens to the lab, pick up equipment, perform routine cleaning), isolation cleaners (who prepare rooms after patients with infectious conditions have been transferred or discharged), and ward clerks (who answer the phone, manage enquiries, input patient data, order stores, liaise with supply to order stores and equipment, and with enginneering to fix equipment and address issues like blocked toilets).
None of that is work that can be left undone, and all of it affects patient flow, patient care, and the smoothness of my shift.
To take a typical example – when we have no ward clerk and I’m in charge I’m unable to spend any significant time supporting floor staff because I have to answer the phone, transfer calls, liaise with other departments (like theatre and radiology), electronically transfer and discharge patients, call engineering because a pan flusher no longer has hot water, and order meals.
Each of these tasks takes a couple of minutes, but the phone alone rarely stops ringing. I already have a phone – the resource phone, which bed flow use to give me new patients, ED use to handover those patients, the consultant uses to tell me we’re getting a transplant, and bank use to let me know they can only replace my eight-hour-shift experienced but sick nurse with a six-hour agency nurse who’s newly qualified, in a different register, and hasn’t worked in Melbourne before.
If I’m juggling phone calls I can’t expedite bed flow – for a start, I can’t talk with nurses who have empty beds about their new patient. Of course, it’s rarely that straightforward, because around 30% of the time accepting a new patient means moving at least one other patient and/or patient assignment – the new patient’s coming out of ICU, or is seriously ill, or is dying, or is having a transplant, or has a transmissible disease, all of which means s/he needs a single room. That usually means shifting a patient from a single room – first I have to identify which patients can be moved (because they’re not seriously ill, disruptive, dying, or in need of isolation for medical reasons), and where they can go to.
Then I explain this to the nurses who will be involved in the move – taking the new patient, or accepting the transferred patient. One of then explains the move to the patient – often the person in the room is accommodating, but often they want to stay put, which is understandable, but that means the person in charge (in this case me) needs to explain that in public hospitals single (not private) rooms are allocated based on need, not preference of private insurance, or length of tenancy. If I don’t want this move to affect the rest of the patient’s stay, or even to cause them to self-discharge, I need to demonstrate resolve combined with empathy.
I can’t do that with a phone ringing every other minute, so I give the phone to a colleague while I go in to settle down the evictee – that means one of the ward nurses can’t perform her or his work, because every set of observations or medication administration or student supervision or patient interaction is interrupted by the phone.
Frontline staff can’t do frontline work without adequate, experience, competent support staff. Cuts to staff and resources that have been externally identified as non-essential directly affect the capacity for frontline staff to function effectively, and that has knock-on effects for the public we serve. I’m not saying there are no systems without inefficiency or fat, though I suspect in most cases we’re pretty close to bone already. But claims by premiers that frontline providers will be unaffected are at best naive and simplistic, and willfully misleading.