Australia: Scared nurses' secret evidence of intimidation from public hospital bureaucrats

The bullying of nurses by hospital management is so rife that about a third who gave evidence at the State Government's inquiry into hospitals chose to do so in secret, fearing retribution if they publicly revealed their stories. Some nurses were too afraid even to be seen seated at the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals, said Bob Whyburn, a lawyer employed by the NSW Nurses Association support nurses who gave evidence.

The nurses union was so concerned about nurses refusing to come forward due to fears of intimidation by management that it employed Mr Whyburn to attend every one of the 34 sitting days. "Roughly a third gave evidence in closed session and it's likely that a lot of them did because of fear of retribution, because that was expressed by the others in open hearings," Mr Whyburn told the Herald. "In some hospitals we went to the nurses were so concerned about what might occur if they did give evidence that they didn't even come along and listen to any evidence that was given. They were frightened to be even seen near the commission." Mr Whyburn said at one hearing at Westmead Hospital, three senior managers reserved the front row and stared down witnesses during their evidence. "The three of them stayed there all day and scowled."

Marguerite Cullen, who has been a nursing unit manager for almost 30 years, told the inquiry at Westmead on April 10 that nurses who spoke up inevitably experienced "payback". Some nurses cried because of the way they were treated by managers and felt "totally demoralised", she told the inquiry. She also told the inquiry some nurses were too afraid to attend. "They said, 'It's not worth my job. It's not worth it. The repercussions if I went down there would be too much,"' she said. "They are too intimidated. I find that quite distressing."

Besides bullying and poor morale, nurses complained of poor workplace conditions - heavy workloads, double shifts and wards staffed by too many junior nurses. Some cried while giving evidence. They also complained about a lack of consultation when NSW Health issued directives that affected their work practices.

The Nurses Association's submission to the inquiry reported widespread frustration and fatigue. Nurses described their hospitals like a "war zone" or being "in the trenches". "When people become nurses they know it is hard work . but they don't know it is unsafe, that you don't get a break and you are not supported," one nurse said. "Some shifts feel out of control."

The submission recommended an overhaul of policies to prevent and resolve bullying and harassment, saying NSW Health had failed to address a "culture of fear and intimidation embedded throughout the public health sector".

The Minister for Health, Reba Meagher, has been forced in Parliament to defend the Health Department's response to bullying, particularly at Royal North Shore Hospital. A study conducted by the University of Sydney on behalf of unions for the inquiry showed that 60 per cent of nurses said they were exhausted at work and, within the previous 12 months, 60 per cent had seriously considered leaving. The inquiry has concluded and the commissioner, Peter Garling, SC, is due give his recommendations by July 31.

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Australia: Ambulance bureaucrats block use of heart-saving system

Sadly, it's just the sort of thing you expect from socialized medicine. Paperwork trumps people every time

When John Plant felt his chest tighten on the drive to work two months ago, he thought his life was over. Less than 70 minutes later, the storeman was in an intensive care unit with a stent in his heart. He was lucky. The ambulance that responded to his emergency in Minchinbury was one of hundreds in Sydney fitted with a system called ETAMI, or early triage for acute myocardial infarction. It allows patients to be taken directly to one of two major hospitals, bypassing all smaller facilities, and getting vital treatment more than an hour earlier, saving lives and limiting damage to the heart muscle.

But more than 70 per cent of Sydneysiders are missing out because the NSW Ambulance Service has instructed most of its staff not to use ETAMI. It believes 12-lead electrocardiogram (ECG) machines, used to diagnose patients, should be operated only by highly trained paramedics and that junior staff should not be required to manage cardiac arrest patients for the additional time it takes to transport them to one of the major hospitals.

The instructions have angered cardiologists. "We know that the quicker a person is treated, the higher their chance of survival," the director of cardiac services at Westmead Hospital, Pramesh Kovoor, said. "But not everyone who calls an ambulance will get the same treatment and that's unfortunate because I don't believe it requires a paramedic to operate it."

For an ETAMI trial carried out between 2004 and 2007, 20 ambulances were fitted with 12-lead ECG machines capable of sending results by mobile phone to the emergency departments at Westmead or Royal North Shore hospitals. The study, in the European Heart Journal, found about 1500 patients were delivered directly to Westmead's coronary care unit during that time, with 73 per cent on the operating table within 60 minutes and 66 per cent having angioplasty within 90 minutes, compared with 2 per cent of people taken to community hospitals.

A spokeswoman for NSW Health said the results of the trial were still being analysed and the NSW Ambulance Service would issue a statement on the matter within weeks. For Mr Plant, 58, from Sadleir, in Sydney's south-west, the quick treatment meant only five days in hospital and a second chance at life.

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