WA’s frantic efforts to deal with one health crisis leaves another exposed - and our children may pay the price

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WA’s frantic efforts to deal with one health crisis leaves another exposed - and our children may pay the price

The state government is trying to ‘strike the balance’ between staffing vaccination clinics and hospitals as Delta strikes - but we just don’t have the nursing numbers that’s needed.

By Aja Styles

It’s a case of robbing Peter to pay Paul as West Australian nurses are being pulled away from child health services to bolster vaccination staff numbers in the prioritised fight against the deadly Delta strain gripping the nation.

Premier Mark McGowan warned on Wednesday that the threat from COVID-19 wasn’t over after news broke that a FIFO worker from FMG’s Cloudbreak site returned a weak positive test and it’s possible he was infectious in the community.

Clinical staff draw up COVID-19 vaccines at the Claremont Showgrounds vaccination clinic.

Clinical staff draw up COVID-19 vaccines at the Claremont Showgrounds vaccination clinic.Credit:Paul Kane

The pandemic has left the state government scrambling to find enough nurses to immunise adults quickly enough to protect against the latest strain, while also not leaving hospitals starved of those who will treat the COVID sick as the state lags behind the rest of the nation’s vaccine rollout.

The state’s Child and Adolescent Health Service (CAHS) shoulders the burden of the vaccine rollout when hospital presentations of child self-harm have risen between 214 to 403 per cent in the past decade and Perth Children’s Hospital is crying poor of qualified nurses.

Delta is also proving dangerous to children, with the Therapeutic Goods Administration recently approving the Pfizer vaccine in children aged 12 and over, and the Peter Doherty Institute for Infection and Immunity modelling suggests that vaccination of children is a priority.

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Nationally, Indigenous children and those with severe asthma and epilepsy, among other conditions, will be eligible as a priority for Pfizer vaccination on August 9.

There has been no state announcement regarding children yet, with WA ministers saying the vaccination of those in schools is a “live issue of discussion” between chief health officers nationally.

On Tuesday, Health Minister Roger Cook announced Pfizer would again be open to WA people aged 30 and over due to a boost in supply and nurses would be pulled from schools to help vaccination centres deal with the increased load.

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Twenty-four school nurses would help vaccinate about 70,000 recipients per week, up from 55,000, and assistants in nursing would replace more highly skilled registered nurses, according to the minister.

“There is a significant program of works going on at the moment to try to get our hospital and retired nurses back into the hospitals so that we can have those people available in our hospital care systems but make sure that we don’t draw people away from our vaccines,” Mr Cook said on Tuesday.

“So we’re trying to strike that balance.”

WA’s ‘School-Aged Health Service Review’ found mental health was the leading cause of concern and a priority for school nurses.

WA’s ‘School-Aged Health Service Review’ found mental health was the leading cause of concern and a priority for school nurses.Credit:CAHS report

But the withdrawal of nurses from schools will have a knock-on effect if the ‘School-Aged Health Service Review’ conducted by CAHS in 2019 is to be believed.

It found that “children and young people with chronic or complex health conditions including mental health and wellbeing, obesity, sexual health, diabetes and asthma” needed to be prioritised and given easy access to community health nurses (CHNs) in schools.

The nine key recommendations that were due to rollout at the start of 2020 identified “mental health issues as the greatest health and wellbeing concern” and the need to have highly skilled nurses in schools since “CHNs expressed concerns about their capacity to support young people experiencing mental health concerns, particularly where families cannot access specialist or acute services in a reasonable time frame”.

WAtoday also saw community child health nurses who monitor newborn development working shifts at the Claremont Showgrounds vaccination centre prior to the announcement.

Kwinana vaccination centre co-ordinator Debbie Rolls, who was previously a freelance neonatal clinical nurse to Fiona Stanley Hospital, said they were getting a lot more staff from CAHS after an “incredible” recruitment drive to the clinic since it opened in June.

“We’ve gathered staff from everywhere, but the majority of us actually came from Fiona Stanley – so we were running the vaccination clinic at Fiona Stanley and the Harry Perkins building,” she said.

CAHS looks after community health services for Aboriginal and refugee children, schools and immunisation; child mental health services; neonatal clinics; Perth Children’s Hospital; and Midland’s hospital and health hub.

“The state we are in is horrific, it’s a horror show, the worst I have seen it in 23 years.”

Mark Olson, ANF state secretary

Mr Cook admitted on Wednesday that CAHS staff within hospitals had been manning the vaccine clinics.

“Look originally it did; we had to staff a lot of our [vaccine] clinics with nurses that would have otherwise been practicing in the hospitals and we’ve been undertaking a program over the last few weeks of bringing other nurses into our vaccination clinics,” he said.

Child mental health numbers have been skyrocketing, with 7217 young people seen by the Child and Adolescent Mental Health Service in 2019-20, up from 6319 the year before.

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In February 2021, there were 1307 mental health inpatient admissions to WA hospitals of which 47 per cent were admitted via an emergency department. One mother in March told WAtoday of her struggle to get her son admitted to PCH for a severe psychosis because of a bed shortage.

Morale at PCH hit rock bottom in the wake of Aishwarya Aswath’s death in the hospital’s waiting room on April 3, with many nurses calling in sick or taking stress leave.

The Australian Nursing Federation reported that PCH had one nurse responsible for more than seven patients – when the safe ratio is one to four on a general ward – with no nurses available to assist in interventions or to make up a full resuscitation team, and no nurse in the waiting room over the weekend.

On Monday there were 290 admissions to PCH’s emergency department, almost double the 160 admissions usually experienced, with Mr Cook calling it a “tough gig”.

ANF state secretary Mark Olson said nurses were exhausted after unprecedented overtime and double shifts, while feeling scared and overwhelmed with guilt about not wanting to leave their colleagues to finish a shift.

“The state we are in is horrific, it’s a horror show, the worst I have seen it in 23 years,” Mr Olson said.

“We are in a state of emergency and the minister will have to start closing beds due to staffing shortages while he continues to promise more beds with no one to staff them.”

He told WAtoday that WA nurses were being robbed from one area to service another despite the government knowing for more than four years that its system was being crippled by soaring population numbers and “the tsunami of chronic disease”.

“Most of the problems we are seeing in the health system are exacerbated by underlying issues that have been expected over decades,” Mr Olson said.

“The issue is no one has done anything to counter them.”

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Mr Cook said they had integrated 100 nurses to PCH since April and he was fixing the problem by increasing the number of graduate nurses in hospitals from 700 to 1000 for this year and next as “the biggest intake in the state’s history”.

“This is part of Labor’s election commitment at the last election but also as part of a capacity surge, which the department is undertaking to continue to build out our nursing numbers,” he said.

Mr Cook said he would free up hospital nurses by utilising assistants in nursing – who have slightly lower level or different level of skills – in vaccination centres.

“All nursing staff, if they come into a COVID [vaccine] clinic, undertake a training course – which is on top of they’re already basic clinical studies – to deliver the vaccination safely,” he said.

Royal Perth Hospital staff told WAtoday that hospitals already had plenty of junior nurses and the huge gaps in the system were senior nurses, with not enough upskilling and an overabundance of graduates who felt undersupervised and underqualified from a lack of practical experience after being churned out by universities.

Mr Olson said while the state government was upping the placement of graduate nurses in hospitals there wasn’t the qualified staff to oversee them and those numbers barely covered the attrition rates from nurses retiring, having children or seeking less stressful work in other sectors.

“The whole thing is smoke and mirrors,” he said.

An RPH emergency department senior nurse confided to this WAtoday reporter there was also no “surge capacity” to deal with COVID-19, with everyone working at capacity every day just to manage the current cases coming in and have been for almost two years.

It then begs the question if, as Mr Cook suggests, WA “is in the blast zone of the pandemic”, what will happen when there’s no more nurses left to shift?

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