Our Crisis Model of Care is a plan to put us in the best position possible to be able to deal with all potential impacts of the COVID-19 pandemic on the health service and our staff.
There is a need to establish workforce models that will be able to respond to the both the anticipated increase in demand, the associated increase in personal leave and the limited number of nurses and midwives.
A crisis nursing/midwifery model of care and staffing profile for each surge level at Western Health has been developed to provide safe patient care and ensure that staff workloads are controlled as much as possible.
We have been actively recruiting for months now to build staffing capacity, and to date Western Health has recruited hundreds of additional nurses. There is no cap on the number of nurses that we are recruiting – we are trying to get as many staff to join our team to weather any COVID-19 storm that may come our way. We have also introduced a new COVID Vaccination Graduate Program, where we recruited an additional 220 graduates onto our team. This is great, however the demand for nursing has never been as high, with nurses actively involved in all aspects of the COVID-19 pandemic management – including vaccination, contact tracing and testing. Combined, these take many hundreds of people to undertake these vital roles – and the majority are nurses.
We need to keep on vaccinating, as vaccination is our way out of this pandemic. Similarly testing and contact tracing are essential to identifying and managing outbreaks.
Central to Western Health’s Crisis Model of Care 2021 is having the right people, with right skills, in the right place at the right time.
Many of the roles being undertaken by nurses in these roles can be undertaken by others at the moment, and therefore over the past months Western Health has been actively employing hundreds of additional COVID-19 support roles including:
- Registered Undergraduate Students of Nursing (RUSON)
- Registered Undergraduate Students of Midwifery (RUSOM)
- Allied health students
- Paramedic students
- Personal Care Attendants.
These roles are an ‘emergency authorised’ workforce that are able to be trained to work in the COVID Vaccination Hub and administer vaccine under the delegation and supervision of a nurse.
Our wards:
Western Health’s Crisis Model of Care will see our nurses working in the Vaccination Hub be progressively redeployed into our wards and clinical departments when required.
There will be continuous monitoring to ensure that this is undertaken in a balanced way, with the right timing, to ensure that our wards and clinical departments are kept safe whilst we continue to vaccinate our community.
We are working with these staff to educate and support them to make this change, and will put them on supernumerary time initially to help them get settled.
We have already enacted the first 3 phases, with groups of these nurses progressively moving from the COVID Vaccination Hub into our wards.
Please take these new staff under your wings, and be kind to them. They will have varying experience in working in the ward environment, but they are here to help and will fit in quickly with some support and guidance. We are all in this together.
Our specialty areas:
Nurses with post-graduate qualifications have been identified, and training is being provided to nurses with previous experience in ICU and ED, to be able to refresh their skills and knowledge.
Additionally ward nurses that have volunteered to help out in ICU and/or ED are being given training and inducted to working in the ICU and ED (within their scope of practice) to support our critical care and emergency nurses.
Crisis Model of Care:
We had a Crisis Model of Care in 2020, and thankfully the additional nurses that we employed was able to meet demand. Unfortunately in 2021 the modeling predicts that the COVID-19 demand is going to be much higher, within an environment where the workforce is already stretched. Once lockdown is lifted, this will likely lead to significantly more COVID cases as the unvaccinated population and the small percentages of vaccinated population need hospital care. We have seen this occur overseas.
Our Crisis Model of Care is planning for the worst, and we hope that it will not need to be implemented. If it does need to be implemented, it will likely evolve on a ward/department basis – dependent upon the volume and nature of any surge in demand/activity and the levels of personal leave from nurses/midwives. Only in the worst case scenario will this need to be implemented across the whole health service. If it needs to be implemented, changes will only be in place for the period of time required to manage the pandemic. The Crisis Model of Care has included consultation, including presentation to ANMF.
The model comprises 3 phases:
- Surge 1 – Hospital Vacancy requests (excludes Vaccination and testing hubs) remain below 204 per day
- Surge 2 – Hospital vacancy rates (excludes Vaccination and testing hubs) are between 205 and 249 per day&/or clinical demand/activity dictates that additional beds are needed beyond what can be achieved through business as usual processes.
- Surge 3 – Hospital vacancy rates are above 250 per day &/or clinical demand/activity dictates that additional beds are needed substantially beyond what can be achieved through business as usual processes.
Western Health intends to ensure that all reasonable efforts are made prior to adjusting a ward/department’s status to an elevated surge level.
The possible implications and strategy for the surge levels are:
- Surge 1
Maintenance of Safe Patient Care Act staffing requirements through business as usual processes. Hospital vacancy requests are less than 204 per day, acuity is manageable & replacement of personal leave is achievable with either bank, pool or agency staff. - Surge 2
The vacancy request is above 204 per day, together with increased demand & clinical acuity may mean that very limited nurses/midwives are available to meet demand. Western Health would be forced to implement measures to ensure that patients continue to receive care.
One of the options during Surge 2 if to change to 12 hour shifts for some of our staff to decrease the overlap time for double staffing therefore maximises staff social-distancing, increases the hours of direct care reducing pressure on night duty staff and maintains nursing/midwifery ratios for day and nights as long as possible. The changes also increase ‘downtime’ for staff to assist with well-being and rest between blocks of shifts.
We would look at optimising staff, which would decrease supernumerary time and we may need to look at shift times decreasing.
In this instance non-clinical nurses/midwives would be reassigned to clinical roles where possible.
- Surge 3 – may mean that no nurses/midwives are available to meet demand or cover vacancies. Western Health would be forced to implement measures to ensure that patients continue to receive care.
Unfortunately, ratios may need to reduce to 1:6, 1:6, 1:8 across acute wards. If this needs to occur, we would attempt to send a COVID support worker to work under the nurses’ delegation and supervision so our teams have the same number of people (where a nurse/midwife is not available). This would including RUSON, RUSOM and PCA roles in wards, and ward nurses in ICU and ED.
Staff would be working to top of scope, and delegating any aspects of their role that can be safely assigned to other roles (including members of the COVID-19 Support Staff). Any delegated task would be undertaken under the supervision of the Registered Nurse/Midwife.
No role would be asked to work outside of their scope of practice or educational preparation.
Education:
To support this, education programs have commenced in:
- Delegation and supervision
- ICU refresher/re-induction
- ED triage/induction
- Ward refresher/re-induction
- HDU programs for assigned wards
We have all experienced the pressure that COVID-19 can place of health systems. Western Health is planning for the worst and hoping that we never have to use these measures. Our plan aims to maintain:
- a safe workplace,
- the best possible skill-mix of staff to ensure that the best possible care is provided to our patients,
- staff workloads, through the provision of supports and resources,
- the well-being of our staff and teams.
It is possible that we may be asked to work harder, longer, in a different way and sometimes out of our comfort zone. This will require flexibility and resilience. This model of care will ensure that our colleagues working clinically are supported. Experienced staff will support those in the early years in our professions, as we always do.
Thankfully this year we are not seeing our nurses and midwives being infected by COVID-19 within our hospitals. Vaccination, PPE and air handling really is making a difference.
The Directors of Nursing and Midwifery and the Nursing & Midwifery Executive stand tall with you, and will be here for all of our nurses and midwives however hard it gets. We stand together. We are committed to ensuring that we support our amazing nurses and midwives through this period of COVID surge, and doing whatever we possibly can to keep workloads achievable and patient care safe.
If you have any queries do not hesitate to talk to you manager or Director of Nursing & Midwifery.