Frontline workers say overtime is being 'forced' on emergency department staff at least three times per week, while clinicians say they are being forced to delay care, including routine surgery in young children and babies as young as six months old in parts of the state.
"We don't have staff", a Newcastle-based doctor, who works in the Hunter as well as the Western Sydney Local Health District, told the Newcastle Herald.
The John Hunter Hospital was already running at 110 per cent capacity pre-pandemic and things were only getting worse, she said.
"We don't have staff"- (Newcastle-based clinician)
"It's just bad and it's getting worse ... we were already overwhelmed and we are just going to become more overwhelmed."
Hunter New England Health has dodged questions about bed occupancy rates and staffing issues, saying "staffing numbers change daily".
Dr Paul Craven, Hunter New England Health COVID-19 response medical controller, said that as part of the pandemic preparedness strategy, emergency departments were "staffed accordingly to support the community."
Past the emergency ward, however, clinicians say routine surgeries are being delayed.
That meant people were at risk of complications which they wouldn't be facing if their surgeries took place on time, the doctor said.
"We don't have the staff. During the peak of the Delta wave, in western Sydney, a lot of our staff were redeployed to vaccination clinics.
"We had, at the peak, nearly 5500 children in the community (statewide) with COVID so every couple of days they required a phone call from a nurse or a doctor to assess their wellbeing so we had heaps of staff making phone calls, making home visits, doing administrations in the home, so all our staff were taken away from operating so we just didn't have staff to run theaters.
"We have now put that level of care onto GPs but in this omicron wave everyone is at home sick or they are a close contact."
In emergency departments, nursing staff are regularly working 'forced overtime' because no one is volunteering due to the sheer number of hours they have worked since the omicron wave began. Instead, a name is pulled out of a hat.
"Since omicron, it's been nuts," a Hunter-based nurse told the Newcastle Herald.
"It's everywhere, everyone's got it, even doctors whose kids have got it are being asked to come to work still, and take extra precautions.
"They are just so desperate for staff now the rules are getting more and more relaxed and you can understand why - they have got to staff these beds because the presentations are just going up and up and up and if you have a sick patient that has COVID, and you need a negative pressure room, you essentially need another nurse outside that room to run and get things.
"So, not only is everyone off but we have patients that are in isolation bays that we don't have enough nurses for."
The rising rates of COVID hospitalisations came on top of multiple ED resignations over the last 12 months, she said.
"And that's not just due to COVID ... but a lot of staff are burnt out. I think we are down about 10 full time staff at the moment in our ED alone."
"So you might start at 1.30pm thinking you are going home at ten, then someone calls in to say they can't make it - and then we are getting made to stay back until 7am the next morning.
"And there's a lot of presentations, a lot of very well people are showing up with COVID that don't really know where to get the swabs from, they don't really know how to look after themselves at home, and they just want to get checked out by a doctor when they don't need to."
Health authorities across the board have pleaded with the community to stay home, unless they actually need to go to hospital, including NSW Health Deputy Secretary Susan Pearce who warned on Wednesday there will be more challenging weeks ahead with NSW's emergency departments and the ambulance under "extraordinary pressure".
"Our emergency departments are not the place for a PCR test or a [rapid antigen] test," she said. "They are there to deal with people with a life-threatening emergency."
Dr Craven has also encouraged "only those with a serious injury or illness" to turn up at Hunter emergency departments.
"We encourage only those with a serious injury or illness, or those in need of emergency medical attention to present to our emergency departments," he said.
"The vast majority of people in our community who have returned a positive test result for COVID-19 do not require hospital care and can safely isolate at home. Almost 90 per cent of our current active cases fit this classification - rest, fluids and over-the-counter analgesics will relieve symptoms."
Acting president of the NSW Nurses and Midwives Association, Shaye Candish, said staffing issues had only been exacerbated by the increased number and complexity of COVID presentations.
In July, 500 Hunter-based ED clinicians and staff from supporting services signed an open letter outlining the issues to the chief executive, and called on the NSW government to introduce nurse-to-patient ratios on every shift, including a ratio of 1:3 in the ED.
"They were reporting things like nurses working 11 days straight including 18 hours on a single shift ... we've had this obvious explosion of cases that has just put an additional stress on the system," Ms Candish said.
"There were a number of deliberate decisions taken to try to get health workers off for a break so all of this has exploded at a time when the health system is at its absolutely worst in terms of resourcing.
"I think we need to start by having the government acknowledge that the hospital system is under pressure. Even today we had the NSW premier say the hospital system is in a good position. There is an absolute disconnect there."
Dr Craven said the Hunter's health facilities were designed to scale-up and down where required in response to the pandemic.
"Like everyone, our health care workers are not immune from exposure - and the number unavailable for work changes regularly.
"However, we've seen this impact decrease following NSW Health's revised risk management isolation guidelines for healthcare staff exposed to COVID-19."
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