Currently Resident Doctors work rosters including seven nights in a row and twelve days in a row. The RDA believes this roster is unsafe for patients and unsafe for the doctors.
We are seeking:
- DHB commitment in our collective agreement to replace seven nights in a row with maximum of four nights in a row followed by three days off AND
- DHB commitment in our collective agreement to move from 12 days in a row followed by 2 days off to rosters with a maximum 10 days in a row with four days off.
The RDA has suggested an implementation period (of the safer rostering process) of two and a half years. The DHBs would be divided into 4 groups with the last group to have rosters implemented no later than 1 June 2018. On August 17 DHBs refused to commit to safer rosters for resident doctors prompting the NZRDA to launch the Safer Hours campaign.
What are Resident Doctors?
Resident Doctors, also known as House Officers, Registrars or Resident Medical Officers (RMOs) are registered medical practitioners and range in experience from first year qualified doctors to those with more than 12 years’ experience.
Resident Doctors range from doctors in their first year out of medical school to Registrars training in a specialist field such as surgery or pediatrics. Resident Doctors are rostered to work between 40 and 65+ hours a week but frequently work substantially more hours to provide necessary care and support to patients in public hospitals.
They work primarily in the public sector and are employed by all 20 DHBs. We have more than 3,500 Resident Doctors working in New Zealand.
The NZRDA stands for New Zealand Resident Doctors’ Association – or the RDA for short. The RDA (established in 1985) is the only organisation in New Zealand solely representing the interests of RMOs. The RDA looks after and promotes the interests (within the health sector and wider community) of its members including the negotiation and enforcement of RMOs terms and conditions of employment.
Who are the employers?
The employers are the 20 District Health Boards (DHBs) in New Zealand represented in negotiations by their agent DHBSS (DHB Shared Services).
What is the DHB’s position?
Employers have rejected all our safer roster claims in preference for the status quo. They wish to continue with the status quo i.e. working on rostering at a local level.
The employers also do not want a definitive end point to this process; specifically they do not want a maximum of 4 nights or 10 days (with 4 days off) as the default position where another alternative cannot be agreed i.e. no agreement means no change.
The problem with that is after 4 years of this approach only 13 out of 144 identified rosters have been entirely fixed, and only 49 partially (either the 12 days or the 7 nights) fixed. 82 remain unaltered.
Why are we running 0ur campaign now?
Put simply increasing workload and service demand has forced the RDA to request that DHBs commit to safer rosters. The workload and intensity of the work Resident Doctors do has increased over the years due to a number of contributing factors such as advancing technology, increasing patient load and the increasing presence of compounding illnesses.
We have sicker patients than in the past and we do more to help each one of them than was possible in the past. In the past we might have got some rest, even a nap whereas today we are full on all day and all night. Current rosters do not take into account the effect this increase in workload and complexity of care our patients need from us.
There is no recognition that with higher and more complex workloads RMOs can simply not sustain working the same long hours for continuous periods.
The personal hazards of working these types of rosters are well demonstrated – fatigued doctors are a risk to themselves, their patients and those around them. The following facts are from a recent fatigue survey of resident doctors:
- 1162 report being so fatigued from working long hours they were worried a clinical mistake had been made;
- 821 report being so concerned by a potential mistake they have made whilst on duty, they have called back to the hospital to ask someone to check up;
- 939 report having almost fallen asleep at the wheel when driving home;
- 275 report actually falling asleep at the wheel driving home after working these hours.
How many unsafe rosters are there?
We have been working on these rosters at a local level for some 4 years now and acknowledge some have improved. We have had success with some DHBs – current rosters at Tairawhiti and Northland DHBs are in line with the proposed process. Of the 145 rosters across the DHBs:
- 12 have resolved both issues;
- 1 DHB has resolved the 12-day issue (but not the nights);
- 65 night rosters have been resolved (without resolving the 12 days);
- 66 rosters have had no improvement applied to them at all.