WA health authorities launch investigation into ‘dangerous’ triple shift worked by emergency department nurse

An under-pressure hospital has apologised after an emergency department nurse was asked to work a “dangerous” triple shift — which included a 22.5-hour block with only an hour break. In a 40-hour period between May 23 and May 25 at Albany Health Campus, the agency nurse clocked 29.5 hours on duty, performing general ED tasks and working in a one-on-one paediatric setting. Her workload included managing a young patient overnight — because of her specialist skills in paediatric care — before the child was taken to Perth via the Royal Flying Doctor Service. The nurse started work at 3.30pm on May 23, finishing later than expected at 11.30pm to assist with resuscitation. She then returned to work at 9am on May 24, only taking an hour break at 5pm before continuing to work until she finally finished the next day at 7.30am. The extreme workload is understood to have been caused by miscommunication between day and night managers and prompted internal meetings and outrage about fatigue management in the WA nurses’ union. Australian Nurses Federation boss Janet Reah labelled triple shifts “dangerous and outrageous”, adding the case highlighted the strain staff shortages imposed on WA’s health system. “Triple shifts are a disgraceful ‘solution’ to a problem that has been ignored for years,” the union state secretary said. “In high-risk settings, the outcomes are more likely to be catastrophic for not only the patient and their family but the nurse, their family and their colleagues. “The more double shifts we are asking our already tired and overworked nurses to do increases the likelihood of adverse events for which nurses have historically been thrown under the bus,” she said. Ms Reah called for an end to extreme hours and an overhaul of fatigue management in health care. “In any other industry, getting staff to work 18, 22 or 24 hours is considered negligent,” she said. An Albany nurse, who wished to remain anonymous, said staff received texts or verbal notifications about shortages asking for people to work overtime. “It isn’t that uncommon that we would do overtime and then have to adjust our shift hours,” she said. “We get texts probably every second day to say that they’re short,” they said. The nurse said, however, no text callouts were made on the evening of May 24. She called for better rostering and the upskilling of all nurses so that tasks could be delegated to more people rather than a select few with specialist skills. “We need to see an overhaul in policy in the public health sector to prevent nurses needing to take stress leave and robust and transparent fatigue management policies to prevent these situations (from) ever happening again. “This practice needs to be stopped immediately and should definitely be investigated.” Ms Reah said she hoped to meet with new Premier and former health minister Roger Cook in the coming weeks, adding she would raise the issue. Agency nurses work transiently across multiple facilities through a third-party provider, allowing flexible schedules with higher pay for individuals and providing a stopgap for hospitals with shortages. Their contracts can often range from two weeks to three months. WA Country Health Service executive director Evelyn Quinn labelled the incident “extremely rare” and said it shouldn’t have happened. “A shift of this length is an extremely rare occurrence for Albany Health Campus and shouldn’t have happened,” she conceded. She assured the union that fatigue management and staff well-being were “at the forefront of everything we do to enable us to care for our patients”. It comes after Fiona Stanley Hospital intensive care unit nurses pulled a 24-hour shift on May 17 due to “exceptionally high numbers of very sick admissions and unplanned staff sick leave”. The hospital claimed the two nurses had volunteered to stay back, had taken an extended break, worked in non-patient-facing roles, and took regular breaks. UnionsWA acting secretary Lisa Judge said it was the responsibility of employers to provide safe environments for staff. “Working people often feel pressure from employers to agree to work longer hours than is healthy for them or the public they serve,” Ms Judge said. “This is why a properly funded WorkSafe Commission supported by strong laws and elected workplace health and safety representatives supported by their union are so important.” Research Fellow at Curtin’s Future of Work Institute Micah Wilson said fatigue in the workplace could impair someone’s ability to process emotions and increase the risk of human error. “Basically, fatigue reduces our ability to process information efficiently,” Dr Wilson said. “When fatigued, people are slower to make decisions, make poorer decisions, and can have difficulties with emotional regulation, memory, and attention. “Research has also shown fatigue impairs our ability to adapt to rapidly changing circumstances, which is critical in unexpected crisis situations. “I’d expect most bio-mathematical models — which are tools that we use to estimate fatigue risk based on work schedules — would tell us that a work schedule like (the Albany nurse’s) would increase the risk of fatigue-related performance impairment. “A key concern for me is how much restorative sleep and recovery could actually be obtained in the limited rest opportunities of that work schedule (the Albany nurse’s). “Additionally, if this is not uncommon, I would have concerns about staff developing chronic sleep debt or burnout, which are both associated with other long-term negative health impacts.”