The management at the North Central Regional Health Authority (NCRHA) has been forcing nurses and midwifery staff to work alone on hospital wards.
So said president of the Trinidad and Tobago National Nursing Association (TTNNA) Idi Stuart.
Stating the action by the NCRHA is their response to the April 28 roll-out of phase two measures by the TTNNA, where nurses have been advised to perform their duties under a strict nurse-to-patient ratio, Stuart called on NCRHA chairman Dr Tim Goopeesingh to account for the alleged practice and operation within the authority.
NCRHA chairman: Dr Tim Goopeesingh
He said the TTNNA had advised its members, as well as all regional health authorities (RHAs) and the general public, that nursing and midwifery staff would step up action over wages by implementing a one-nurse-to-six-patient ratio at healthcare facilities across the country.
According to Stuart, the practice is in line with international standards and forms phase two of a plan aimed at triggering Government action to settle outstanding wage negotiations. Nurses, he noted, have been working on 2013 salaries—among the lowest in the public sector.
Speaking to the Express via phone yesterday, Stuart said since April 28 the NCRHA was the RHA he had received the bulk of complaints about.
He described the staffing situation at that authority as “horrendous”, and said nurses and midwifery staff “are being threatened by management, to basically work alone on the wards. And it is really placing the patient’s lives at risk”.
Stuart said the situation was expected, as the NCRHA has been the most severely short-staffed of all the RHAs, probably having less than half the numbers of nursing and midwifery personnel it needs to operate.
He said it was for this reason the NCRHA was heavily dependent on “pool” staff.
“On extra duty, which we call ‘pool’ because nurses are not paid overtime rates, we are paid a flat pool rate. So, with this action that we are pushing to make sure that every ward is properly staffed, management is pushing back and forcing nursing personnel to work alone,” Stuart said. “So, on a ward where it should have about three registered nurses, they have one or no registered nurses.”
Drawing attention to Caura Hospital, which falls under the NCRHA and handles mainly communicable diseases, Stuart said one nurse had been responsible for two wards at that location.
With respect to the Mt Hope Women’s Hospital, he said on Wednesday there were three midwives on duty to treat patients across the postnatal and antenatal wards, the birth department, as well as the Accident and Emergency Department.
He noted the Mt Hope Women’s Hospital is one of the larger maternity units in the country and is dedicated entirely to midwifery, maternal, and child care. In total, he said, there were six wards that the three registered midwives had to cover, adding they had to rely on students, “which we call pupil midwives”.
He added the practice could put mothers, unborn babies and neonates at risk.
Services disrupted
Stuart said on Tuesday a number of health institutions had to either reduce services or suspend operations until additional staff were diverted.
He identified the Barataria Health Centre, which falls under the North West Regional Health Authority (NWRHA), as one of the institutions severely impacted.
“There were no nurses on duty. So, they actually had to turn away patients and they had to send additional staff from other institutions to try to make up,” he said. “You had instances across Trinidad and Tobago, Trinidad in particular, where the nursing personnel are pushing back, particularly in the NCRHA and eastern regions and southwest. So, we have a number of complaints from members across Trinidad and Tobago.”
When the Express visited the Barataria Health Centre yesterday, staff said they were not allowed to speak with the media, but confirmed that while there were problems on Tuesday, operations returned to normal on Wednesday and remained so up to yesterday.
Asked to comment on the public’s reaction to the nurses’ plight, Stuart said the association was encouraged by the level of solidarity shown, noting a recent CCN TV6 poll indicated more than 75% of respondents supported the nurses’ position.
He said this reflected a growing public understanding of the link between staffing levels and patient care, and added that many citizens also recognised the long-standing concerns over outdated salaries.
The Express visited the Eric Williams Medical Sciences Complex, Mt Hope, yesterday and spoke with several people awaiting medical care. Most agreed with the TTNNA’s position, although many were unaware that a one-nurse-to-six-patient ratio had been implemented.
One patient, Sandra James, of Arima, said there were three nurses in her immediate family, and that it took all three more than a year after completing their degree programmes to gain employment. She said if nurses maintained the pressure, RHAs might be forced to hire more staff.
A man, who gave his name only as Thomas, stressed it was unfair for politicians to increase their salaries while denying nurses a pay raise. He said he was aware of the nurse-to-patient ratio implemented by the TTNNA and supported it.
Requesting anonymity, a woman said she was unaware of the measure, but agreed that reducing patient loads would ease the strain on nurses. She added that the benefits would extend beyond the workplace, as less-stressed nurses would be better able to care for their families at home.
Asked how long he expected phase two of the plan to continue, Stuart said the action would be indefinite.
“It is not expected to stop because this is actually the best practice. So unless the politicians come out and tell us that this is something that should not be practised in Trinidad and Tobago, we will continue,” Stuart said.
Stating that while the action began on Tuesday, the intention was for it to extend across all RHAs and for that reason the action would continue until it mushrooms into acceptable practice, Stuart said.
Efforts to contact the chief executive officers and chairs of both the NCRHA and NWRHA proved unsuccessful.
