?Falling over in a screaming heap?: overworked staff quit under-resourced NSW regional hospital

One of New South Wales' major regional hospitals had to source its own triage tent, is sending Covid tests six hours away due to a lack of space for its own diagnosis machine, and has had positive patients wait 30 hours to be transferred to a designated hospital for those with the virus.

Doctors at the Tweed hospital, which is 1km from the Queensland border in northern NSW and serves a hinterland that includes Byron Bay, are even donning personal protective equipment to drive home, in their own cars, asymptomatic Covid-positive patients because taxis won't take them.

Kristin Ryan-Agnew, president of the local branch of the Nurses and Midwives Association and a senior nurse at the hospital, said local Covid cases were tripling daily, much faster than the 5o% growth in new cases reported for NSW as a whole on Wednesday.

As a result of increased presentations to Tweed's emergency department, nurses were doing "double shifts every day" with one day off before resuming the toil. "They're going to fall over in a screaming heap," she said. "They will not be able to manage."

Eighteen staff, many of them senior, have resigned since December out of a roster of about 150, citing burnout and the better conditions offered over the border.

Queensland offers $1,800 a year for nurses' education, a Covid bonus - both absent in NSW - and higher wages, Ryan-Agnew said.

"They were really top-notch, really good quality staff, and they can walk up to the Gold Coast and they'll just completely snaffle them."

As Guardian Australia reported on Wednesday, nurses at Lismore Base hospital - the destination for Tweed's Covid patients needing treatment - are also struggling to cope with a surge in medical needs.

The Tweed hospital is buckling under spiking demand for care and a lack of trained staff and appropriate equipment. A senior manager, for instance, had to phone around themselves and then purchase the triage tent prior to Christmas after months of pleading to the health department, Ryan-Agnew said.

The tent, though, remains far from adequate, with no toilet, forcing potentially Covid-positive patients - and anyone waiting for PCR testing to cross the border - to traipse through the main hospital lobby.

"You can have people with heart conditions, sick kids, elderly, frail, all sitting there waiting to be seen, and you've got a potential Covid patient walking through the waiting room," Ryan-Agnew said.

Patients with chest and severe abdominal pain, septic children and adults should be in beds not a tent without nursing care, staff said. Earlier this week, one Covid patient had to wait 17 hours before being transferred to Lismore, while another patient had to wait 30 hours before being moved on Wednesday.

The nurse manager shares office space and air-conditioning with two beds set aside for Covid patients with no air-locked space for changing PPE.

"We have bottles of hand sanitiser sitting on top of overflowing bins, flapping Covid tent flaps compromising PPE," another staff member, who requested anonymity, said.

"We also continue to struggle getting adequate PPE and supplies, certain masks run out, no hair coverings and no disposable blood pressure cuffs."

A Northern NSW Local Health District spokesperson said a "transportable treatment area" had been set up to treat Covid-positive patients without serious illness so they didn't need to enter the hospital.

"As with any month in a large organisation there has been some staff turnover, however, this is not different [from] other months or years," the spokesperson said.

"These positions have been filled with new staff, casual staff, and any potential shortages can also be filled with staff between wards and facilities.

"Our workforce across northern NSW has been increased and upskilled, with more than 265 staff attending surge training in intensive care, emergency care and immunisation specialties to provide additional capacity if needed.

"We regularly review our stocks and supply chains of resources, including PPE and pharmacy items, to ensure adequate supplies."

According to Ryan-Agnew, some of Tweed's problems were partly self-inflicted.

Pathology North, the department's regional pathology unit, offered to supply Tweed with a BD MAX machine used to conduct Covid tests on the spot. That would save sending the results three times a day for what can be a six-hour journey.

"We just needed the scientists to use it because you have to have doctors to be able to read the results," Ryan-Agnew said, but the hospital management refused to set aside space to house it. "We still don't have the BD MAX. That's been argued for months and months and months."

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