Hundreds of ICU nurses across NSW have signed an open letter to Premier Gladys Berejiklian warning the hospital system is "in crisis" and demanding the standard ratio of one nurse to each patient in ICU be guaranteed.
The warning follows confirmation that NSW hospitals may be forced to set up makeshift ICU wards in surgical operating theatres and require staff to care for more than one ICU patient at a time.
The number of Covid patients in ICUs is expected to triple in the coming weeks.
When the overall number of ICU patients, including both Covid and non-Covid patients, reaches more than 926, NSW Health has confirmed it will declare a "Code Black" that signals "demand for critical care services significantly exceeds organisation-wide capacity".
But in an open letter to Berejiklian obtained by news.com.au, hundreds of nurses have urged the government not to abandon the standard ratio of one nurse to every ventilated patient.
"Given the chronic unsafe staffing conditions, exacerbated by Covid-19, we cannot deliver the care you expect us to provide and the level of critical care our patients rightly deserve," the letter warns.
"We are extremely concerned about our ability to provide safe nursing care under the current staffing levels afforded by the NSW government to ICUs around this state.
The open letter signed by ICU nurses across NSW. Photo / news.com.au
"Never before has there been such a crucial time in NSW where ICUs should be properly staffed to avoid preventable patient outcomes.
"We urge you and your government to urgently fix the ICU staffing crisis. It cannot wait."
The dramatic intervention in the debate by ICU nurses follows the Premier's repeated claims that the system is under pressure but can withstand the surge.
On Monday, the NSW government released new modelling by Melbourne's Burnet Institute which predicts hospitalisations will peak at over 3400 in October.
The Burnet Institute's Professor Margaret Hellard confirmed to news.com.au on Monday that she had prepared predictions on the statewide peak of cases but it was up to NSW Health to release it.
However, NSW Health confirmed late on Monday night that it would not be releasing the taxpayer-funded modelling in full, including the prediction on the statewide peak of daily cases.
"From time to time NSW Health obtains Covid-19 related modelling," a spokesperson said.
"After public discussion around the capacity of the state's ICU resources to cope with the current outbreak, the NSW government asked NSW Health to collate modelling to do with ICU capacity. That modelling was released today."
Health workers in Sydney. Photo / NCA NewsWire
The modelling the NSW government is prepared to release predicts a peak in daily case numbers at 2000 a day, but only in local government areas of concern. It does not say how much the daily cases will peak at across the state.
The signatories to the nurses' letter warn that they have a professional obligation to provide safe and professional care and must raise these issues with management.
"Our workforce's health and safety is constantly being placed at risk both physically and mentally," the letter states.
"We do not want to be harmed just for attending work. We do not want to see our patients die from understaffing.
"It is our professional view that ICUs were in crisis prior to the current Covid-19 pandemic.
"The added demands of the pandemic, testing capacity and surging admissions are forcing our clinical workforce to the brink, placing our registration at risk on every shift and compromising patient care."
The letter also calls for additional breaks to remove and put on PPE safely and a buddy system to ensure the correct protocols are not skipped due to fatigue.
One ICU nurse who spoke to news.com.au raised concerns that some hospitals plan to bring in physiotherapists to help in the ICU, a strategy she described as "completely insane".
"They can't give medications, manage IVs or dialysis, invasive monitoring," she said.
"All they can do is help with basic nursing jobs. We are running low on some essential stock items. All of these things compound the stress and anxiety.
"We get texts from the manager begging us to do overtime and extra shifts every day. There are not enough nurses. I say to people all the time: having lots of ventilators is fine and dandy, but you need trained ICU nurses to manage them. They aren't like turning on a washing machine."
NSW Nurses and Midwives' Association secretary Brett Holmes told news.com.au the threat to reduce staff-to-patient ratios was alarming.
"This represents what baseline ICU staffing levels should have been in normal operating circumstances, but we know these professional standards of one-to-one care for ICU patients were not consistently being met prior to the pandemic," he said.
"We have raised concerns about critical care staffing levels and the need for ACCESS nurses in ICUs with the Ministry of Health for some time.
"After they shoulder the burden of this current crisis, our members do want to sit down with the Premier and Health Minister to discuss their concerns first-hand and seek assurances that a one-to-one nurse to patient ratio is mandated for critical care patients."
