Patients at Maitland Hospital missed out on more than 4000 hours of care over four years, according to NSW Ministry of Health records.
Staffing data between 2019 and 2022 obtained by the NSW Nurses and Midwives Association through freedom of information laws, shows there were 4223 nursing hours missed at the hospital.
That's double what the Calvary Mater in Newcastle - a facility that operates under a public-private partnership - missed during the same period.
Maitland Hospital performed worse than Cessnock Hospital, which had 440 missed nursing hours, and Belmont Hospital, which had 357 hours. John Hunter Hospital - a significantly larger facility - had just 234 hours missed.
On top of this, Maitland Hospital nurses say they are failing a NSW Ministry of Health requirement to complete a basic health check on every patient during each hour of their shift.
NSW Nurses and Midwives Association Maitland Branch delegate Kathy Chapman said patients were receiving just over half the nursing time they should be in 24 hours and that meant the hospital was also failing the government's 6 Nursing Hours Per Patient Day system (NHPPD).
But Regional Health Minister Bronnie Taylor maintains the hospital is "fully funded to meet the needs of the community".
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NSW Health pointed to challenges during the COVID-19 pandemic, higher patient demand, industrial action and unexpected staff absences to explain the missed nursing hours.
"COVID-19 and the flu have had a particularly significant impact, with thousands of NSW Health staff unavailable every day throughout 2021 and 2022, either through illness or isolation," a spokeswoman said.
The spokeswoman said NHPPD compliance - which is the amount of time a patient receives face-to-face care from a nurse within a 24-hour period - was improving with an extensive and ongoing recruitment drive, a record intake of new nursing and midwifery graduates in 2023, workforce strategies and less pressures from COVID-19.
She said that system "enabled hospitals to increase staffing where needed to ensure safe and effective care" and providing staff above the agreed minimum had been commonplace throughout the COVID-19 pandemic.
"Where Local Health Districts determine that increased hours are required due to clinical need they are being provided," she said.
'Most patient's don't even get that'
Ms Chapman said the missed nursing hours validated their concerns. She said shift modelling showed each patient received 1 hour and 3 minutes of face-to-face nursing care from a Registered Nurse or an Endorsed Enrolled Nurse on a morning shift where the nurse had 6 patients to look after.
She said that time increased to 1 hour and 35 minutes on a morning shift when the nurse had 4 patients - though she has never seen happen - and a patient was given 1 hour and 13 minutes of care by a nurse on an afternoon shift with five patients.
"Most patients don't even get that," she said.
"I'm angry they aren't acknowledging there's a problem, these figures prove that there are too many patients and not enough nurses."
Ms Chapman said the hourly check, called Rounding, takes 10 minutes per patient and when they have 6 patients - which is most of the time - that's the whole hour allocated.
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She said that left no time for other duties like giving medication, checking vital signs and responding to a declining patient, so nurses were always cutting corners.
She said patient buzzers and bed alarms are often going unanswered, nurses are completing paperwork during their breaks and they are staying after their shift to finish their duties.
The mathematics doesn't add up
"It's mathematically impossible to do Rounding and all of the other work that you need to do. If you've got 6 patients and it takes 10 minutes per patient to do the Rounding check that's the whole hour taken up for every hour of your shift," Ms Chapman said.
"Rounding is important, but at the same time, where is the time for administering medications, paper work, meal breaks, complex patient hygiene, documentation and checking ward drugs and other equipment?".
A Hunter New England Health spokeswoman said Rounding played an important role in "supporting the delivery of timely, quality and safe healthcare" and was "a system of providing holistic and contemporary nursing care during the course of usual patient care".
"Rounding is not an additional interaction with a patient on the hour," she said.
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"This means that a planned task such as administering medications or taking observations becomes the opportunity to undertake intentional patient Rounding."
Ms Chapman said the workload was even worse with nurses went on a break. She said nurses were split into teams of 2 at the start of a shift and when their team member had a break the other nurse was responsible for their patients as well as their own.
A nurse could look after 12 patients over a 50 minute period, and there wasn't enough time to care for each one of those patients properly, she said.
Certain medications require two nurses to sign off before it can be administered, so that's taking a nurse away from her patients too, she said.
Call for action
"Often you've got one patient who might need you for an hour, so you can see how patients deteriorate because in that time you can't get to the other 5 patients to do Rounding and their buzzers are still ringing.
"Patients deserve more than just 10 minutes an hour with their nurse. The next state government needs to do something about this urgently."
The association launched a case in the Supreme Court earlier this month against the state of NSW for widespread and repeated staffing breaches of the Public Health System Nurses' and Midwives' (State) Award in hospitals across NSW.
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Liberal candidate for Maitland Michael Cooper said a re-elected Coalition government would employ an extra 10,000 hospital staff over four years, though recruitment remained a challenge. It is not know how many would come to Maitland. The party has also promised free parking at the hospital.
Labor MP Jenny Aitchison has promised a safe staffing policy on a shift-by-shift basis - a minimum of one nurse to 3 patients in the Emergency Department and one nurse to 4 patients in the general ward.
The policy would be rolled out within six months, if elected.
Labor would employ 1200 extra nurses across NSW within 4 years but couldn't say how many could come to Maitland.
