Hospital authorities say they are looking at ways to better manage patient flow. Photo / 123rf
Five Bay of Plenty hospital wards operated over capacity for more than 100 days last year, and a union says the impact has nurses “at breaking point” at times.
Data received under the Official Information Act from Te Whatu Ora - Health New Zealand showed one medical/surgical ward at Tauranga Hospital recorded 242 days over capacity in 2022. This ward was set aside for overflow so was considered over capacity whenever it was used.
Two mental health wards overflowed on 102 and 129 days respectively, as did a surgical ward on 122 days.
A medical ward at Whakatāne Hospital recorded 194 days over occupancy.
Between them, the hospitals have 25 wards.
Te Whatu Ora said access to aged residential care beds could be a “significant” contributor to high ward occupancy. Other factors included older patients typically staying longer in hospital — significant for the Bay due to its aging population — fewer services on weekends and holidays, unplanned staff leave and vacancies.
The New Zealand Nurses Organisation (NZNO) said nurses were, at times, at “breaking point”, while the New Zealand Aged Care Association said wards “overflowing with patients” nationally was linked to underfunding.
Te Whatu Ora Hauora a Toi Bay of Plenty said it had overflow beds available and initiatives were under way to address pressures driven by demand, workforce constraints and capacity. Meanwhile, the national health authority said it was reviewing aged care service sector preparedness for rising demands.
Responding to the data, NZNO delegate Linda Logan said staff were “questioning why they are still in the nursing profession” due to hospital wards being over capacity.
Logan said she was based in Rotorua but she was “well aware” of these issues happening regionally and nationally as she was on a regional NZNO council and another committee.
She said many nurses were having health issues such as stress-related hypertension, palpitations and anxiety about going to work due to staff shortages and higher workloads.
Logan said nurses would “always put their patients first” and may forego using the bathroom or taking breaks “as it’s too busy to eat or drink”.
“We want to feel safe in our job areas to undertake the care our patient needs without the verbal abuse and frustration from patients who wait far too long for treatment due to us being short-staffed or not having enough resources.”
Logan said she believed more resources were needed and nurses should be “at the table” when looking at solutions.
In a media release, Aged Care Association interim chief executive Katherine Rich said it was hearing stories “almost daily” about wards “overflowing with patients”, long emergency department wait times and growing elective surgery wait times around New Zealand.
“This is all linked to aged care. Funding the aged care sector properly would improve the whole health system.”
Rich said aged care had been “chronically underfunded by successive governments”, resulting in a lack of capital investment in facilities.
Many providers had “no option” but to close beds - temporarily and permanently - meaning seniors stayed in hospital longer because they had “nowhere to go” if discharged.
Te Whatu Ora said the Bay of Plenty had 465 beds across 25 wards at Tauranga and Whakatāne Hospitals.
It said there were “overflow environments” that could be used in periods of high demand. Neighbouring wards were often used and beds could be placed in spaces such as treatment rooms and patient lounges fitted with oxygen.
Whakatāne Hospital had 10 extra beds that had “never been resourced as part of business-as-usual”. These beds were used ahead of treatment rooms and patient lounges. This led to the medical and surgical wards “looking like they are over capacity”.
The Tauranga “variable response” ward recorded as having 242 days over-capacity was “an additional ward, not included in usual capacity… [and] available for overflow ahead of using treatment rooms and patient lounges”. Whenever it was used, it was considered over capacity. Tauranga had another ward available for the same purpose.
Te Whatu Ora Hauora a Toi Bay of Plenty chief nursing officer Rosalind Jackson said hospitals were “very busy” as they balanced emergency and urgent care with doing “as much surgery as possible” to tackle waitlists.
“Our hospitals regularly operate at a high level of occupancy and occupancy can fluctuate from day to day – and even hour to hour – as patients are admitted and discharged.”
Jackson said initiatives were underway to address pressures driven by demand, workforce constraints, capacity and Covid-19. The initiatives focused on hospital flow, prioritising urgent care, and increasing regional coordination to deliver health services.
Jackson said the overall pressure on hospitals and wider partners made managing the flow of patients and freeing up space in the hospitals “challenging” but the district was committed to “safe staffing”.
“It is the cornerstone of appropriate care for our patients, families and whānau as well as the professional and personal wellbeing for those staff providing care.”
Jackson said recruiting and retaining staff was a priority alongside care capacity demand management - the process used to match available staff to patient care.
Te Whatu Ora primary, community and rural interim director Emma Prestidge said the review of aged care support services included assessing the state of services, considering alternative funding models and recommending ways to create a “sustainable system”.
Prestidge said Te Whatu Ora recognised the staffing challenges faced by aged residential care providers and it was important their nurses felt valued.
She said Te Whatu Ora had boosted funding to aged care providers specifically for increasing nursing pay. Aged residential care was one of five sectors prioritised to receive this additional funding to enable them to lift pay rates for about 5700 nurses from April 1, 2023.
Te Whatu Ora was also overseeing the care and support worker pay equity claim, addressing “historical sex-based discrimination of these important workers”.
Prestidge said a settlement would likely mean “significant benefits” for workers and the services people received.
She said Te Whatu Ora had established a $6 million pilot for districts to pay for initiatives that facilitated discharge from the hospital. Funds could be used to cover “exceptional costs” that sit outside what aged residential care providers were expected to meet.
It also had a carer support subsidy aimed at reducing “carer stress” — a “significant immediate cause” of people needing residential care. The subsidy provided financial assistance so the main carer could have a break.
Te Whatu Ora agencies worked with people needing aged residential care to find places that best met their needs. Home support resources were provided at a “high level” to keep people safe in their own homes until they found a suitable place, she said.
Megan Wilson is a health and general news reporter for the Bay of Plenty Times and Rotorua Daily Post. She has been a journalist since 2021.
The role was advertised as an 'intern cleaning position'.