Response to patient death after ramping outside of Adelaide hospital

The tragic deterioration and subsequent death of a patient ramped outside Flinders Medical Centre unfortunately reflects another avoidable failure of the health care system in South Australia.

The College of Emergency Nursing Australasia (CENA) expresses our sincere condolences to the patient’s family.  CENA is deeply concerned that patient safety at Flinders Medical Centre has been severely compromised, and that despite promises by SA Health to improve timely access to emergency care, patients continue to be put at risk through policies that create overcrowded emergency departments that are unable to meet patient needs.

Emergency staff, while trying to provide safe, high-quality care, are overburdened by system inadequacies, which places staff under significant additional stress and puts patients at risk.  CENA maintains its stance that the growing community requires additional acute care capacity.


Comment on Report of the Auditor General – Performance of Tasmania’s four major hospitals in the delivery of Emergency Department services


CENA comment on Report of the Auditor General – Performance of Tasmania’s four major hospitals in the delivery of

Emergency Department services

 May 2019

Last month the Auditor General released a report on the Performance of Tasmania’s four major hospitals in the delivery of Emergency Department services.  The report can be found at this link

CENA believes that there are many positive aspects to the healthcare model in Tasmania, however, as with any healthcare system, there are opportunities for improvement and several items raised in the Auditor-General’s report are certainly in harmony with concerns previously raised by the College of Emergency Nursing Australasia (CENA) and its members. The CENA Tasmanian branch has previously made a submission to the Legislative Council’s Inquiry into Acute Health Services in Tasmania (which echoes many similar points raised in this current report by the Tasmanian Audit Office) and are looking forward to the Legislative Council’s final report. All four major public hospitals in Tasmania are facing the same challenges such as access block, ED crowding, ambulance ramping, increasing patient acuity, reduced access to other services such as mental health and difficulty with recruitment and retention of nursing staff – and these challenges also impact on the emergency care that can be provided in the smaller district hospitals and other services.

CENA supports the position of the Australasian College for Emergency Medicine in relation to the Auditor General’s report and agree that engagement with both nursing and medical leaders will be critical to improving patient outcomes. Any sustainable changes to be made to improve access to emergency care and ultimately improve the Tasmanian health care system will require a long-term nonpartisan commitment from all key stakeholders.

As the peak professional organisation representing emergency nurses in Australia, CENA is committed to working with the key stakeholders to drive improvement. CENA believes it is important to continue to hold our healthcare system to high operational and practice standards that protects emergency nurses, doctors, administrative and support staff and other healthcare workers and ensures ongoing safety, improvements and outcomes for patients and the communities we serve. Emergency nurses have always been and continue to be committed to providing safe and high-quality patient care despite the current challenges of the health care system.

For additional information please contact CENA.

03 6231 2722

Please click HERE to read the CENA Statement

Please click HERE to read Submission to the Legislative Council Government Administration

Support for Ratios for Aged Care

The College of Emergency Nursing Australasia (CENA), the peak professional association representing emergency nurses, unequivocally supports the Australian Nursing & Midwifery Federation’s campaign for Ratios for Aged Care. Residential aged care services provide care to one of our most vulnerable populations and the current nurse-to-resident ratios are woefully inadequate.

There is clear evidence that better levels of nurse staffing result in better patient outcomes and decreased risk of death and harm. The lack of nurse staffing in aged care not only places residents at risk of suboptimal care it also results in moving residents to emergency departments as aged care staffing does not enable nurses assess and manage residents who suffer clinical deterioration or an event such as a fall at their facility.

CENA Executive Director, Dr Julia Morphet highlights that “transferring older persons to emergency departments places them at unnecessary risk of harm”. “Movement to an unfamiliar environment is distressing for many older persons and their families and can cause delirium which is associated with increased risk of death.” “Being in an emergency department places older persons at higher risk of falls, pressure injuries, and unnecessary test and invasive procedures.”

CENA endorses that older persons deserve the best possible care which is not possible in the 2.86 hours of nursing care per day currently provided to residents. Nurse staffing in aged care warrants urgent attention and legislated nurse-to-resident ratios: make them law now.


Further information:

Dr Julia Morphet, Executive Director

College of Emergency Nursing Australasia

Response to the death of Remote Area Registered Nurse Gayle Woodford – the need for safer workplaces no matter the location

The College of Emergency Nursing Australasia is saddened by the news of Registered Nurse Gayle Woodford’s death. The College sends its condolences to the family, friends and colleagues of Gayle.

The death of Gayle Woodford has highlighted the need for improved security and protection of all nurses.

Mr Shane Lenson, Executive Director for the College of Emergency Nursing Australasia says, “violence towards nurses is not isolated to any one speciality or setting. In Australian Emergency Departments, physical and verbal abuse is a daily occurrence. Nurses dedicate their professional lives to caring for people who are injured and unwell. All nurses should be able to assist those requiring health care without the fear of violence and abuse.”

“Nurses who work alone are at increased risk of violence, and must be protected. Duress alarms and working in pairs have been shown to reduce violence in healthcare.”

A petition ( has over 70,000 signatures calling for an abolishment of single nurse posts in Australia and requesting a mandate for two responders to attend all after hours call outs in rural and remote communities. The College adds its support to the petition.

One Australian nursing blog, (@TheNursePath), written by emergency nurse Ian Miller has encouraged “ALL nurses to pay tribute to Gayle Woodford and support our Remote Area Nurses by wearing a simple bandage on their upper arm.” This is to occur on the Tuesday 29th of March.

Social media has erupted (#‎GaylesLaw) from Australian nurses who are saddened by the loss of Gayle. Additionally, many nurses are sharing on social media their stories of being vulnerable to violence and abuse in their workplaces.

Health service managers in rural, remote and metropolitan areas must engage in a review of their strategies to keep nurses safe as a matter of urgency.


Further information:

Mr Jamie Ranse, Associate Executive Director, CENA

Nurse Staffing Standards for South Australia Emergency Care Settings

Nurse Staffing Standards for South Australia Emergency Care Settings

The College of Emergency Nursing Australasia has released a statement to its national membership outlining the required nursing staffing standards for South Australian Emergency Care Settings, both rural and metropolitan.

This statement is in response to the concerns from the South Australian Branch of the College relating to the proposed changes to the healthcare system through the Government of South Australia’s Transforming Health initiative.

Ms Karen Hammad, President for the South Australian College of Emergency Nursing Australasia says the changes “will have a significant impact on Emergency Departments within the state. his may subsequently lead to increased waiting times.”

Ms Hammad says “There are increased workload pressures on nurses working in SA EDs. This is complicated by the state government’s proposed changes to healthcare.”

Mr Shane Lenson, Executive Director for the College of Emergency Nursing Australasia says “Australian EDs are facing an increase in patient attendances, during 2013-2014 over 19,700 patients per day nationally. It is widely agreed that patient presentations to the ED will continue to increase”.

According to a study by Professor Christine Duffield, a Professor of Nursing and Health Services Management, EDs are experiencing a more complex patient case load, increasingly presentations of patients with multiple comorbidities, and have increasing presentations of patients with rates of chronic disease and acuity and are we now have a more culturally diverse patient population.

Ms Karen Hammad, President for the South Australian College of Emergency Nursing Australasia says “There are numerous system wide issues particularly relating to in-patient capacity which impact directly on the ability to move admitted in-patients in the ED to in-patient treatment areas. This results in access block and an inability to treat patients in a timely manner when they present to the emergency department. This in turn has a direct impact on the South Australian Ambulance Service (SAAS) who is often required to ramp patients as EDs are unable to accommodate patients in an appropriate clinical space within the ED”.

SA has 16 designated EDs, 13 in the public sector and three in the private sector. These departments vary greatly with regards to size, patient profiles, number of attendances and staffing making it difficult to develop a one size fits all approach to nurse staffing. Additionally nurses are working in a variety of emergency care settings across the state.

The College is calling on the Government of South Australia to consider a model which takes into account the unique nature of emergency nursing work while acknowledging variation across all emergency care settings in SA.

Mr Lenson states that “it is essential for EDs to have adequate nursing roles to support the timely and efficient assessment and management of emergency patients. EDs should consider roles such as clinical support roles, adequately trained team leaders, mental health nurses. These roles should be supported by other nursing roles such as: nursing directors, trauma nurse coordinators, patient flow coordinators, nurse managers, clinical service coordinators, nurse educators, research nurses, equipment nurses, discharge nurses, and disaster nurses”.

A full position statement can be located HERE

Click HERE to listen to Karen being interviewed on ABC radio

Further information:

Mr Jamie Ranse, Associate Executive Director, CENA,


Release date:

8th March 2016

Hospital Security Action Plan

Emergency departments have the highest incidence of violence in healthcare, and up to 90% of emergency department staff have experienced some form of violence in the careers.1, 2 However, surveys have demonstrated that up to 70% of incidences of violence go largely unreported.3, 4 In Australia, emergency nurses have the highest risk of being victims of violence, second only to security staff.1 All staff, patients and visitors have the right to an environment that is safe from acts of violence. The College of Emergency Nursing Australasia welcomes the commitment by the Minister for Health to improve security in all NSW emergency departments.

Roundtable Delivers Hospital Security Action Plan

Action Plan arising from Security Roundtable

Wayne Varndell | National Board Director | NSW State President


  1. Kennedy, M., Violence in emergency departments: under-reported, unconstrained, and unconscionable. The Medical Journal of Australia, 2005. 183(7): p. 362-365.
  2. Australasia College for Emergency Medicine. Policy on violence in emergency departments. 2011 [cited 2015; Available from:
  3. Hogarth, K.M., Beattie, J., and Morphet, J., Nurses’ attitudes towards the reporting of violence in the emergency department. Australasian Emergency Nursing Journal, 2015. In print. Link:
  4. Lau, J.B.C., Magarey, J., and McCutcheon, H., Violence in the emergency department: A literature review. Australian Emergency Nursing Journal, 2004. 7(2): p. 27-37. Link:

Release of the Australian and New Zealand Resuscitation Councils Resuscitation Guidelines

The College of Emergency Nursing Australasia is pleased to support the newly released guidelines from the Australian and New Zealand Resuscitation Councils, collectively known as ANZCOR. Mr Shane Lenson, Executive Director of CENA said “Emergency nurses, alongwith our colleagues in paramedicine, emergency medicine, intensive care nursing and intensive medicine, are a vital and highly skilled link in the chain of survival.”

“Emergency nurses are committed to achieving the best possible outcomes for victims of cardiac arrest and their families by ensuring timely and evidence based care both during and after cardiac arrest.”  Mr Lenson also called for the public to take a greater role in resuscitation, stating “We know every second matters in cardiac arrest and it is essential that everyone knows what to do when someone collapses. CENA strongly supports public training in CPR and Basic Life Support and any attempt at resuscitation is better than no attempt”

Further information:

Mr Shane Lenson, Executive Director, CENA, (03) 6231 2722

Release date:

13th January 2016

Download CENA ANZCOR Media Release

International Emergency Nurses Day 2015

Wednesday 14th October, 2015 is International Emergency Nurses Day.

The 13th International Conference for Emergency Nurses was held in Brisbane this month. At the conference a number of nurses and emergency departments were acknowledged for their exceptional contribution to emergency care.

  • Emergency Department of the Year: Dandenong Emergency Department, Victoria
  • Emergency Nurse of the Year: Sarah Cornish, Clinical Nurse Educator, Western Health, Victoria
  • Julie Finucane OAM Medal for Leadership in Emergency Nursing: Di Crellin, Nurse Practitioner, Royal Children’s Hospital, Victoria.

The College of Emergency Nursing Australasia (CENA) would like to acknowledge the work of all emergency nurses who dedicate their professional lives to caring for people during times of emergent injury and illness.

Mr Shane Lenson, Executive Director of CENA said that “at hospitals throughout Australasia, nurses are involved in the emergency care of people. Additionally, emergency nurses assist in the care of people in many other contexts such as rural and remote environments. Emergency nurses are an integral part of the overall health service.”

Mr Lenson states “Emergency nursing is a unique and specialised area of clinical practice. The Australian emergency care population comprises people from all age groups, socioeconomic and cultural backgrounds. Emergency nurses provide care of patients which ranges from minimal intervention to life saving, advanced life support.”

Further information:

Mr Jamie Ranse, Associate Executive Director, CENA,


Treat us equally: South Australians with mental illness getting a raw deal

The Royal Australian and New Zealand College of Psychiatrists (RANZCP), the Australasian College for Emergency Medicine (ACEM), and the College of Emergency Nursing Australasia(CENA) have joined together to highlight the plight of Mental Health patients left stranded in Adelaide’s Emergency Departments (EDs).

Every day, doctors and nurses represented by the three Colleges, are appalled by waits for acute mental health beds: leaving patients languishing in EDs for days. Even for the sickest group of patients, those needing Psychiatric Intensive Care Unit beds, waiting for 4 days is common.

“Lengthy ED stays are not tolerated for patients with severe physical illnesses, and should not be tolerated for acutely ill mental health patients who deserve equitable access to hospital beds. This is discriminatory,” RANZCP South Australian Branch Chair Dr Michelle Atchison says.

The chair of the Emergency Psychiatry Advocacy Group, Dr Megan Brooks says: “EDs are designed for the rapid assessment of patients. They are not somewhere that anyone would wish to stay for days on end. In an ED, acutely disturbed mental health patients are subjected to continuous noise and light, constant scrutiny by a guard, and share a toilet and shower with 20-30 other patients. Fundamentally, there is no basic human dignity or privacy. In this completely non-therapeutic environment: physical and pharmacological restraint is often required.

“SA Health mandate that patients with physical illness should move out of the ED to a ward bed within 4 hours. Why is it acceptable that Mental Health patients wait 4 or 5 days?”

College of Emergency Nursing Australasia SA Branch President, Ms Karen Hammad, says the prolonged presence of these very unwell mental health patients places additional strain on already overcrowded EDs and further reduces the ability of the nurses and doctors in EDs to care for all their patients.”

When compared to all other Australian states SA has the lowest number of acute MH beds per head of population for those aged 18-65.

To meet the national average SA requires a further 43 acute beds for patients aged 18-65.

For media queries contact:

Christine Gounder or +61 3 9601 4940

Emergency nursing care provided despite problems with Emergency Department access

There has been considerable media attention given to the difficulties of providing care to
patients in overcrowded emergency departments. In particular, concerns have been raised
regarding the increased demands for emergency care services resulting in ambulance
patients being transferred to trolleys in emergency department corridors and perceptions
about the care that they then receive.

The College of Emergency Nursing Australasia (CENA) deems that caring for patients on
trolleys in emergency department corridors and in unapproved treatment spaces is
unacceptable. Hospitals and health services should view the inability to allocate a patient to
staffed, equipped treatment spaces within the emergency department as a serious adverse

CENA reassures the public that specialist emergency nurses assess every patient who
attends the emergency department through the triage process, and that emergency nurses
provide assessment and care to all patients, irrespective of their location within the
emergency department.

“Emergency nurses are committed to providing safe and high quality emergency care, and
typically do so in challenging working conditions. Equity of access to emergency care is
fundamental to emergency nursing. Nursing resources are distributed according to patient
needs, not where the patient happens to be physically located within the emergency
department” said CENA Executive Director, Lee Trenning. “The College and its members
work collaboratively with our medical and paramedic peers to facilitate appropriate care for
patients presenting to emergency department by ambulance, including those patients for
who there is a delay in accessing the emergency department”.

CENA encourages the public to continue to lobby Governments for timely access to
emergency care and for an integrated health system where ambulance, emergency and
inpatient services can provide the best possible care to the communities that they serve