TPCH Admits Its ICU Memo "Could Have Been Conveyed Differently”

NPAA has secured the withdrawal of a memo that threatened to end 12-hour shifts in the TPCH Intensive Care Unit, after members raised serious concerns about staffing, skill mix and patient safety.

What happened

 In August, TPCH management issued a memo raising the prospect of ending 12-hour shifts in the ICU, citing attendance levels and sick leave. On 16 September, the Executive Director of TPCH issued a new memo to the ICU nursing workforce confirming no decision has been made, or is under consideration, to end 12-hour shifts on that basis. It supersedes the August memo, acknowledges the earlier communication may have caused distress and could have been conveyed differently, and restates the obligation to consult under EB12 before any such change is proposed. 

How members made this happen

NPAA surveyed ICU members and the response was strong. Most said they would not stay in the unit under current terms if 12-hour shifts ended, particularly the most experienced staff. Members were clear that sick leave was not a behaviour problem. It reflected the unit running above funded capacity (24 to 27 beds occupied against 21 funded), a diluted skill mix, restricted overtime, cancelled education, difficulty securing annual leave, and the load on experienced nurses supervising staff not credentialled for the patients in front of them. Many raised patient safety directly.

On 21 August, NPAA put all of this, along with Metro North Health's own activity data, to the Chief Executive of Metro North Health and the Chief Nursing and Midwifery Officer.

 →  See our letter of 21 August to Metro North Health.

A response on 4 September confirmed no decision had been made but did not address staffing, skill mix or patient safety, and did not provide the documents requested. 

  → See TPCH's response of 4 September. 

NPAA wrote again on 11 September setting out every unanswered issue.

 → See our follow-up letter of 11 September.

The new memo followed.

What's not finished

The threat is gone, but the underlying conditions are not. The unit is still running above funded capacity, the skill mix is still diluted, overtime is still restricted, and education and annual leave remain difficult to access. NPAA has asked TPCH to confirm these are being treated as patient safety matters, and to set out what is being done, by whom and by when. A response is awaited.

NPAA has also raised a separate concern in writing: the new memo credits the unit with reduced unplanned leave over six weeks, but member feedback suggests some of that reflects staff attending work unwell under pressure. In a unit caring for transplant and mechanical support patients, that carries its own risk.

"KPIs are not patient care, and we will keep pressing for positive change," said NPAA President Kara Thomas.

Need support at work?

NPAA represents nurses and midwives across Australia on issues exactly like this one. If you're not yet a member, contact NPAA to find out how membership can support you at work.

Call the NPAA hotline on 1300 263 374 or email hotline@npaa.asn.au.