Emergency department staff and management at Dunedin Hospital met again today over growing concerns patients are at risk of dying while they wait for treatment.
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Dunedin Hospital nurse Anne Daniels said staff were at breaking point and do not feel they were being heard.
She said current staffing levels do not meet the huge demand the department is experiencing, meaning patients are not being seen within specified triage times.
"We are carrying the emotions and the psychological scars of our inability to do the job that we have trained to do."
She said staff were asked daily to take on extra hours or return to work to do overtime.
"We have hit the wall, we are exhausted, we can't do it anymore."
Last week, Daniels, who has been a nurse for 40 years, lodged a provisional improvement notice (Pin) with the Southern District Health Board.
The notice, an action under the Health and Safety at Work Act, requires a workplace to display the notice and take steps within eight days to address the safety issues raised or face possible further action.
Following a provisional meeting this morning, Daniels said she felt the DHB had listened to the concerns that had been raised.
"I believe that the organisation and the main leadership team have heard us, and they're doing everything in their power to work with us in collaboration and I get a real sense of hope from that."
A formal response was received from leadership this afternoon.
A report tabled at a Southern District Health Board meeting on Tuesday found one Dunedin Hospital ward was regularly understaffed by 20 percent or more between July 2018 and October 2020.
Daniels said emergency departments were seeing patients with more complex needs, including specialty patients referred from GPs.
"They come into the ED where they wait for many, many hours to be seen by the specialty patients, which causes bedlock."
She said, on top of that, there is a growing number of high acuity patients, with patients much sicker than they used to be when they arrive in the ED.
The patients with most serious need due to a potential loss of life (triage one) were seen immediately, with triage two patients seen within 10 minutes.
"We are not meeting that at all, so these are patients who are possibly having a heart attack or a stroke, they are not being seen within the prescribed times and in our terms, time is brain or time is heart muscle so we are putting these patients at absolute risk.
"We are not getting the traction we need, we are not being heard by the people who can make decisions without changing the way we work and the numbers of staff that we need, where they need to be."
It resulted in what was called "moral injury", where health professeionals went home knowing they had been unable to do the job they were supposed to.
She said requests for changes were first made back in March.
"We have been signaling to our team leaders that both nurses and doctors are hanging on by their fingernails.
"But it's got to the point where we can no longer hang on and the changes that our leadership team has requested absolutely need to be be put in place and they're quite complex."
It required separating the ED patients and those needing to be seen by a specialist, so space in the department wasn't taken up with a non-ED patient.
Daniels said the emergency department at Dunedin Hospital was one of many around the country facing the same issues.
"I believe wards are falling over in hospitals as well and the whole system needs to change."
She said more resources were needed in the community to help people to stay well so they didn't need hospital treatment as frequently.