Anaesthetists and trainee registrars at Canberra Hospital fear patient safety is being compromised because senior experienced nurses can no longer assist anaesthetists due to a change to their scope of practice.
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A letter to Chief Minister Katy Gallagher reveals senior anaesthetists and trainee anaesthetic registrars are "alarmed and frustrated" at alleged decisions by Canberra Hospital administration and the ACT Health Directorate that staff say have interfered with their ability to provide safe patient care during anaesthesia for surgery.
"We, as patient advocates, stress that the quality of care we provide to patients is compromised by these decisions and the failure to collaborate with medical practitioners for this purpose warrants your attention," the lettersaid.
The letter claims anaesthetists are being assisted by nurses who lack the "clinical experience to provide safe and adequate care" to patients.
It also alleges highly experienced enrolled nurses have been deemed "unsuitable" to assist anaesthetists because of their lack of university qualification and a concern it would have them working outside of their "scope of practice".
"It is our view the clinical experience of these enrolled nurses is more valuable than their lack of formal qualification. These nurses save lives and their loss compromises patient care further, particularly after hours when staffing, and therefore experience, is limited."
ACT chief nurse Veronica Croome confirmed there had been a change to enrolled nurses' scope of practice.
She said enrolled nurses, like any health professionals, had to legally abide by their scope of practice and working outside of it put their registration at risk.
"It has come to our attention that there are some enrolled nurses within the anaesthetic department who can't fulfil the scope of practice required in anaesthetics because their scope is limited in relation to the administration of some forms of medications.
"There are medications which enrolled nurses legally cannot administer and they are certain scheduled medicines, which may, on occasion, need to be used in the administration of an anaesthetic and the hanging of blood and blood products.
"The issue for the anaesthetic department here is that on occasion they might require the nurse in attendance to administer both of those things, particularly in an emergency or after hours, and the scope of practice for the enrolled nurse does not allow them to fully function in the way that keeps their registration safe.
"The solution is to replace those enrolled nurses with health professionals who can fulfil that role and, typically, that would be a registered nurse or an assistant to an anaesthetist."
Ms Croome said registered nurses had either completed a three-year qualification within a hospital setting or a bachelor of nursing degree, while enrolled nurses may have "done anything from a hospital certificate many years ago that would have just simply been on-the-job training, up to what we now describe as a diploma in nursing and that program of study is 18 months long".
She said an enrolled nurse would need to undertake further education at a vocational level to be a qualified anaesthetic assistant.
"Those programs are available in limited educational institutions across Australia, not in the ACT, and I have explored with CIT the opportunity to run such a program and we're looking at a few issues at the moment in relation to whether or not that's possible."
Ms Croome said as chief nurse she had an obligation to ensure staff worked safely and within their scope of practice.
Ms Croome has spoken to the enrolled nurses, the head and deputy head of anaesthetics and met with a representative group of anaesthetists.
"What came out of those meetings was certainly a way forward in relation to employing registered nurses to fulfil this role as well as exploring opportunities for the additional piece of education, which is the assistant to the anaesthetist qualification," she said.
She said rostering of nursing staff was also being examined so the "right types of nurse are available with the right qualifications and the right registrations to ensure they can adequately work with the anaesthetist to deliver safe care".
A senior anaesthetist at the Canberra Hospital, who did not want to be identified, confirmed the concerns outlined in the letter. They said the issue needed to be addressed urgently, saying nurses who assisted anaesthetists played an extremely important role and it was crucial they had the appropriate experience and skill.
