Many staff in our cross-border community live in NSW and work in Victoria. While we were not exposed to the mass numbers of COVID patients our metropolitan counterparts were dealing with until later in the outbreak, our cross-border lives meant we were dealing with our own unique stressors.
Changes to the way the border crossing was managed during the pandemic introduced a range of environmental stressors that impacted staff personally and had severe workforce implications. Almost twenty per cent of our nursing staff at any one time have a NSW address. The different rules in the different states, including when and who could cross the border, meant staff living in NSW were constantly hampered by limited childcare and schooling; frequent permit applications; lengthy transport times to and from work; long wait times at COVID testing clinics; pending PCR delays and limited access to community support services.
The dreaded permit check supervised by the police force and the Australian army was time-consuming and exhausting, not only for us but also for our tired and impatient children who were traveling with us after being collected from childcare or school. Wait times meant the usual twelve-minute drive to or from home became an hour, making car picnic snacks a must.
The local Aboriginal Yorta Yorta community residing on Cummeragunja Reserve on the NSW side of the Murray River struggled to even gain permits to cross the border as there is no postcode assigned to this area of land. This limited their access to healthcare and items essential for daily living. Fortunately, Aboriginal Liaison Services was able to organise a minibus and this proved to be a great help.
The first COVID case was not reported in Echuca until September 2020, almost six months after the virus was introduced into Australia. The government listed numerous exposure sites of various levels, and everyone isolated as per recommendations as no-one wanted to be ‘the one’ who brought COVID to town!
The workforce implications of the isolation requirements and other restrictions that were in place were significant. The capacity of medical staff to rotate through regional hospitals became limited and overall staffing availability was thrown into chaos. Face-to-face education was sacrificed and delays in patient interhospital transfers became the new norm.
This had a substantial impact on our day-to-day nursing and healthcare. We could still transfer COVID patients who presented to emergency to the larger regional hospital, but we became banked up with the non-COVID patients we could now no longer transfer to metropolitan or tertiary hospitals because those hospitals were full and ramped with ambulances.
We had the same nurse-to-patient ratios on the medical ward as before: one to five in the morning, one to six in the afternoon, and one to ten overnight. This was already higher than in the city, but now our patients were much sicker than usual. Some were staying with us for a week or more—before COVID they would have been transferred to a larger hospital in two or three days. We did our best to manage this by moving the sickest patients to the high dependency unit where the ratios were better.
PPE was also a contentious topic. We understood that the need and demand for PPE in metropolitan hospitals was far greater, but we had questions of our own: ‘Will the virus spread like wildfire throughout the hospital and local towns?’ ‘Will we be provided with adequate PPE and an appropriate supply given the statewide shortage?’ ‘It is highly unlikely my patient has COVID, but they’ve buzzed for a glass of water or I need to quickly drop in their meal tray—should I fully gown up?’
Palliative and hospital-in-the-home services were affected and our community suffered just like everywhere else because of the restrictions on visiting and the social distancing requirements. However, for small towns along the Murray River access to these services was now reduced to a bare minimum.
The snap lockdown on New Year’s Eve as we welcomed in 2021 had an enormous impact on staff and staffing. The announcement that the border would be closed was made at midday. People were told to return to their place of residence or be stuck for two weeks. It was holidays and every camper and visitor—and there were many—all immediately hit the single-lane road to cross the bridge causing numerous unavoidable traffic jams, even on the back roads.
We escalated our plan of action to make sure we could continue to provide safe staffing levels. We needed strategies to get the evening staff home and the night duty staff to work on time, not just nursing, medical and midwifery staff, but also administration, corporate services and security.
One staff member came across by boat. Another sat in traffic, bumper to bumper, for four hours. Many were late. Rostering to shuffle shifts around was challenging. Nurse unit managers and senior leaders worked on the floor to help maintain our staff-patient ratios.
Living on the border during COVID had a major impact on our hospital operations and on the personal lives of healthcare staff. We didn’t have the same resources as our metropolitan counterparts yet, like them, we adapted and put ourselves at risk to care for others. We learnt the true importance of family, not only for our own emotional wellbeing but for our patients—and we got through testing times because of the help and support we gave to each other.