The NSW Nurses and Midwives' Association's says its Maitland members have "lost confidence" in the way that workloads are negotiated with hospital management and they "genuinely fear for patient safety".

"More issues have begun to surface in other parts of the hospital, while staff continue to be put under enormous pressure," the union's assistant general secretary, Judith Kiejda, said yesterday.

"It's a catalyst for error, or worse, an avoidable incident."

With a steady stream of passing motorists honking their horns and yelling out in support, Ms Kiejda said members were fatigued, burned out and feeling unsupported having raised their concerns repeatedly.

"After months of highlighting their concerns through the hospital's reasonable workload committee, without improvement, our members are understandably extremely disappointed with Hunter New England Local Health District for failing to step in and address the issues," Ms Kiejda said.

She said the Maitland protest was one of seven being organised by the union, with various state hospitals having a range of problems caused by under-staffing.

The president of the union's Maitland Hospital branch, registered nurse Jane Burton, said that even if a new hospital was being built at Metford, it was still at least three years away and the existing hospital "needs more nurses now".

Ms Burton said the Maitland nurses and midwives were raising three main concerns.

The first was under-staffing in the emergency department, where patient numbers were up by 9.5 per cent in the first three months of this year, and ambulance offloads were up by 13.2 per cent with only two bays for the ambulances to unload.

The second was the hospital's practice of using the maternity ward to house general medical and surgical patients, meaning maternity nurses were spending less time with their new mothers than they should because they were also treating surgical patients arriving without a surgical nurse.

The third was a nurse shortage in the acute and cardiac ward, where nurse to patient ratios were supposed to be no higher than one nurse for three patients, and they were running at one to four or higher.

The union says the best solution is for the state's hospital system is to adopt mandated minimum nursing ratios. It says the Coalition government has repeatedly rejected mandated minimums, which have been introduced by Labor in Victoria and Queensland.

"There is research to show that adopting these ratios is actually saving governments money, because they are spending less on overtime, to start with, and achieving better outcomes for patients," Ms Kiejda said.

She said the nurses were forced to protest in public because changes to NSW industrial laws meant they could not take their problems to the NSW Industrial Relations Commission.

State Maitland MP Jenny Aitchison was unable to make it to the protest but a staff member read out a letter of support on her behalf, saying she was with them "in spirit" having fought many battles together.

Ms Aitchison said Maitland was the fastest growing region outside of Sydney and needed more nurses and midwives to ensure patient safety.

The union was also recommending that rank and file union members not speak to the media at the protest after a former federal public servant, Michaela Banerji, lost her High Court case last week over a Twitter account she ran that frequently criticised the government.

Ms Banerji's lawyer, Allan Anforth, told the ABC that the decision would have far-reaching consequences.

"The implication is that for any employee-employer relationship, if the employee is critical of the employer's position on some politically relevant social issue, they can be sacked," Mr Anforth said.

Despite the union's concerns over the High Court case, the Maitland Hospital nurses who turned out for the protest were determined to make themselves seen and heard, with plenty of placards and signs and a lot of chanting.

A spokesperson for Health Minister Brad Hazzard said that despite the union claims of under-staffing, the NSW health budget was increasing annually, the 2019-20 figure being a record $26.7 billion.

"To put it in perspective, almost a third of the entire state budget is invested in health," the spokesperson said.

The spokesperson said the government would employ another 5000 nurses and midwives in this parliamentary term, describing it as " the largest workforce boost in the history of Australian healthcare".

It would result in higher nurse to patient ratios than the union was asking for.

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