Nurses have called for indemnity amid fears Canberra Hospital's emergency department may be pushing them to breach professional standards by seeing most patients based on waiting time not need.
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The concern has led the nurses' union to call for an urgent review of the hospital's triage system to ensure it meets practice standards of a registered or enrolled nurse.
It comes as the ACT's public hospital ED waiting times for the majority of patients remain among the nation's worst.
Australian Nursing and Midwifery Federation ACT secretary Jenny Miragaya, writing in a letter to an ACT Health deputy director-general on June 17, said the federation had been advised by ED management three months earlier that patients "allocated to categories three, four and five on the [Australasian Triage Scale] will be seen based on their time of arrival".
Ms Miragaya said this left nurses at risk of being notified to their regulator, the Nursing and Midwifery Board, where their actions would be considered against federal Health Department guides and those of a recognised nursing body which called for care based on clinical urgency not "administrative or organisational need".
"The ANMF seeks clarification as to how ACT Health will support and indemnify the individual nurse employee who, in working as directed by the employer ... has breached their professional obligation."
An ACT Health spokesman provided the first written response to the letter on Friday, saying category-three to category-five patients – who make up 90 per cent of emergency presentations – were treated at Canberra Hospital using a procedure that divided them into two streams, for those likely to be admitted to hospital and those with less acute conditions.
"Streaming is designed to promote efficiencies in care and manageable units for senior staff to supervise," he sad.
"It allows for patients who may only require a simple, quick treatment to be seen before patients of a similar triage category who may need more complex and lengthy treatment."
Patients from any of the three categories could sometimes be assessed in the first stream.
"ACT Health had not directed, or put any pressure on staff within the ED to prioritise National Emergency Access Target timelines ahead of triage timelines of categorisation," he said.
The latest results for the National Emergency Access Target (NEAT), now discontinued as a formal federal measure, showed 62 per cent of ACT public hospital ED patients had a length of stay of four hours or less in the half-year to December, similar to the national average for major metropolitan hospitals but below the overall national figure.
The latest Australian Institute of Health and Welfare report showed the ACT had the worst waiting times ranking for urgent (category-three) patients (with only 50 per cent treated within the required 30 minutes), the worst ranking for non-urgent (category-five) patients, and the second-worst ranking for semi-urgent (category-four) patients.
All category-one patients were seen immediately, and 83 per cent of emergency (category-two) patients, one point above the national average.
Australian Medical Association ACT president Elizabeth Gallagher said she was not aware of the nursing federation's concerns, but clinical need was always the most important issue in patient care.
