North Shore Hospital emergency department staff say chronic understaffing and unprecedented overcrowding have pushed the service beyond breaking point, with NZNO delegate Jean Classey warning patients and exhausted health workers are being placed at unacceptable risk.
More than 100 nurses, healthcare assistants and other emergency department staff have taken the extraordinary step of declaring their own state of emergency, writing directly to Health New Zealand chief executive Dr Dale Bramley demanding urgent intervention.
The picture painted by frontline staff is confronting.
North Shore’s ED has reportedly operated at up to 300 percent capacity, patients have been treated in corridors, triage waits have stretched to 90 minutes and some people have remained in the emergency department for more than 50 hours waiting for a hospital bed.
For Classey, a charge nurse and NZNO delegate, the crisis is no longer simply about an uncomfortable winter surge.
It is about whether nurses have enough people, space and resources to safely care for everyone arriving through the doors.
Patients cared for in corridors
The consequences of overcrowding are being experienced by some of the hospital’s most vulnerable patients.
Nurses have described elderly people being lined up in corridors without adequate privacy, while incontinent patients have sometimes remained in wet or soiled beds until staff can find somewhere suitable to provide care.
The nurses’ concerns also include delays to urgent heart scans, patients missing essential medications and staff attempting to monitor large numbers of people simultaneously across an overcrowded department.
North Shore and Waitākere hospitals together recorded almost 14,000 emergency department presentations during July, with Health NZ describing it as their busiest winter on record.
But staff reject any suggestion that winter demand alone explains the crisis.
Their letter argues the pressure was predictable and insufficient staffing has left the hospital poorly equipped to respond.
Nurses say 25 more FTE are needed
At the centre of the dispute is staffing.
North Shore ED nurses say Health NZ had identified the need for 25 additional nursing full-time equivalents, but recruitment has fallen well short of that figure.
Health NZ has since announced recruitment for 50 additional nurses across North Shore and Waitākere hospitals, including nine specifically for the North Shore emergency department.
A further centralised team of 10 nurses and 14 healthcare assistants is intended to provide additional flexibility across the hospitals during surges and unplanned staff absences.
North Shore ED staff say that response does not address the scale of the shortage they are experiencing.
They continue to seek the additional 25 nursing FTE they say are necessary to meet demand and provide safer care.
Health workers carrying the pressure
Behind the numbers is an increasingly serious workforce issue.
Emergency nurses are simultaneously treating their allocated patients, watching people waiting in corridors and waiting rooms, arranging assessments and treatments and responding to new emergencies arriving through the doors.
Experienced staff have described conditions as among the worst they have encountered during decades in nursing.
That raises concerns not only about immediate patient safety but about the longer-term sustainability of the workforce.
If experienced nurses become exhausted, leave emergency medicine or quit the profession entirely, already stretched departments face an even deeper staffing problem.
A question of dignity
The crisis also raises a more fundamental question about what patients should reasonably expect when they enter a New Zealand public hospital.
Emergency departments will always prioritise the most critically ill patients.
But treating elderly people in crowded corridors, struggling to provide privacy and leaving patients waiting many hours for appropriate hospital beds are not simply questions of efficiency.
They are questions of dignity.
For Māori and Pacific whānau, who already experience significant health inequities and barriers accessing healthcare, confidence that the public system will be there when it is urgently needed is particularly important.
An overwhelmed emergency department risks adding another layer of difficulty to an already unequal health landscape.
Frontline warning reaches the top
Health NZ says its winter planning has helped treat more people in the community and improve patient flow through hospitals, but acknowledges demand has been substantially higher than in previous years.
The nurses’ decision to write directly to the chief executive shows how far frontline concern has escalated.
This is no longer an internal staffing disagreement.
More than 100 health workers have collectively put their names behind a warning that they believe current conditions threaten both patients and staff.
For Jean Classey and her colleagues, the immediate demand is straightforward: North Shore Hospital needs enough nurses to safely care for the people arriving at its emergency department.
The bigger question now sits with Health NZ and the Government.
When frontline health workers declare their own emergency inside one of the country’s major hospitals, how bad do conditions have to become before emergency staffing itself is treated as an emergency?
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