Waikato Hospital has been issued with a provisional improvement notice (PIN) by staff who claim the emergency department (ED) there is critically unsafe.
Newshub revealed on Tuesday night that Waikato Hospital had just experienced its worst day ever for ramped ambulances on Monday with at least 12 backed up, unable to unload sick patients due to the ED being full.
Five status 2 seriously ill patients were among those waiting up to four hours to be taken inside the crammed ED.
The New Zealand Nurses Organisation said it has supported the issuing of a PIN to Waikato Hospital ED on Wednesday in response to health and safety concerns arising from unsafe staffing levels.
A PIN legally requires an employer or service provider to address a health and safety issue before a certain time - in this case within nine days - and is a powerful step employees can take through their health and safety representative.
Registered nurse Janferie Dewar, who is a health and safety representative in the ED, issued the notice "because severe staff shortages and unreasonable and unmanageable workloads have made the ED critically unsafe, and led to increased sick leave, burn out and resignations."
Dewar said the notice represents the views of Waikato Hospital's ED workers, but that more than 150 staff across the hospital have signed a document in support of the notice - ranging from nurses to health care assistants, students, cleaners, paramedics and doctors.
A spokesperson for Health Minister Ayesha Verrall told Newshub she is "unimpressed" to learn of Monday's severe 'ramping' incident at Waikato.
"Te Whatu Ora takes matters such as this very seriously, and I will be seeking information from officials to ensure it is being handled appropriately," she said.
Hato Hone St John said anything over a 30-minute wait time to clear patients from an ambulance into the emergency department is declared as 'ramping'.
Deputy chief executive of ambulance operations Dan Ohs told Newshub Monday was a tough day with ambulances around the country waiting to get into EDs for a total of 204 hours. On a normal winter's day, they'd be 'ramped' for a total of 130 hours nationally.
"In Waikato it's probably the worst day we have ever seen. We spent 60 hours sitting at Waikato Hospital," said Ohs.
Dewar said three letters of recommendation have been sent to Te Whatu Ora Waikato management since April this year, but health and safety for staff in the ED has still not been addressed.
"Despite ongoing meetings with management nothing significant has changed even though the ED is almost in code red by default. We're at the point now where staff have had enough," said Dewar.
Waikato management team has until August 11 to comply with the Provisional Improvement Notice's recommendations.
Te Whatu Ora responds
Te Whatu Ora interim lead of hospital and specialist services in Waikato Michelle Sutherland acknowledged the pressures the emergency department staff are under and thanked them for the "tireless work they continue to do for their patients during this busy period".
Sutherland said Waikato Hospital's ED is fully recruited at the moment for medical staff and healthcare assistants, and almost fully for nursing staff.
"Despite this, we know our team are still under a lot of pressure at the moment. This is being driven by sustained high presentations and high level of occupancy across the hospital – which also affects our team in ED," Sutherland said.
She said the safety of the hospital staff is of "paramount importance and our top priority".
"We recognise that emergency departments are busy and challenging for staff at times of high demand, and that our clinicians are working hard to see and treat patients in the quickest time possible while ensuring patient safety."
Sutherland said Waikato Hospital has been working with ED management and staff to improve patient flow, prioritise urgent care, and improve regional coordination.
"Both to improve the experience our patients have at Waikato ED, and to ease pressure on our staff."
Sutherland said there is a comprehensive plan in place to manage expected surges in demand during busy periods.
"Which includes using modelling data to anticipate these periods of high demand as best we can," Sutherland said.
"Our whole-of-system business continuity approach aims to effectively and safely respond to the ongoing health challenges that increase the demand for our emergency departments and inpatient beds."
Sutherland again acknowledged that many staff are experiencing "considerable pressure at this time and we are committed to doing everything we can to work with our people and improve the situation every day".
She said Te Whatu Ora will engage with WorkSafe to support its response to the PIN submission.
