A nursing shortage at Wairarapa and Hutt hospitals means nurses are sometimes "rationing" their care to patients.
When patient numbers are high, and extra nurses are not available, patients may not be bathed or changed, have their hair brushed, or their pillows arranged. Families are increasingly having to step into the breach.
The medical floor at Hutt Hospital, and the medical surgical ward at Wairarapa Hospitals, are the areas where nursing supply frequently does not meet demand, according to an operational services monthly report tabled at a meeting of the DHBs' joint health advisory committee in Masterton on Friday.
A section of the report, written by executive director of nursing and midwifery Helen Pocknall, says the nurse-to-patient ratio "remains extremely tight" at both hospitals.
At times, they had to use "care rationing", she said, when essential care was prioritised over patient comfort. Essential services included giving medication, monitoring intravenous fluids, taking observations and dressing wounds, but did not include "giving them a wash".
Yesterday Ms Pocknall said: "As nurses we like to deliver what we call comfort cares to our patients, make sure they're as comfortable as possible . . . [but] if you haven't got enough hours, some of that stuff doesn't get done.
"Sometimes you'll find [families] will assist with some of those comfort cares . . . we don't say to parents, well we expect you to give your child a wash - it's more of a partnership.
"Comb my mother's hair, do her teeth, those sorts of things, perhaps rearrange her pillows for her."
She said people without family were not disadvantaged. "It's not an expectation, but quite clearly it's appreciated."
Nursing Council chief executive Carolyn Reed defended care rationing, while accepting that it was not a perfect scenario. It was important that every patient's medical needs were prioritised before non-essential tasks, she said.
"Our role is about public safety and obviously I think care rationing is not ideal - it's nurses taking some control, ensuring the patients are kept safe and making sure their health needs are being met."
Ms Pocknall said rationing was happening more now for several reasons, including unusually high patient numbers, and an increase in nurse sick days over winter.
Another reason was a decrease in the pool of casual nurses, particularly at Hutt Hospital, where a new operations centre was distributing casual nurses better, so there were fewer available on call.
The "tight financial situation" across the DHBs was also a factor, she said. "Everybody's been closely monitoring needing to bring in extra [casual] staff, because it . . . increases your costs quite significantly."
Medical wards were particularly affected because the work there was "heavy, laborious nursing". Many nurses preferred post-surgical care, for example.
It was a paradox that graduate nurses were struggling to find jobs while there was a nursing shortage in many hospitals, she said.
The problem was that graduates needed experience before stepping into demanding roles, and the health sector nationwide was looking at better ways to address this.
The DHBs were also working to reduce the care rationing problem, Ms Pocknall said.
A care capacity demand management programme had been set up to analyse data around staffing and better allocate nurses to high-demand periods. It is due to report back in 12 months.
In the meantime, nurses at Wairarapa and Hutt hospitals were sometimes "frustrated" by not being able to give patients everything they needed, she said.
"We've got all these health targets to meet . . . many probably would be saying that doesn't necessarily help us to do the job that we want to do."
Comfort care 'best part of job'
While nursing shortages may mean patient comfort sometimes takes a back seat at Hutt and Wairarapa hospitals, Masterton-based nursing students Kerry Dalziell and Dinah Bowie say it has been one of the most rewarding aspects of their first clinical placement.
"Basic care is basic to all nursing. Feeding, washing, communication, assisting with day-to-day living - it's part of [it] all," Ms Dalziell, 45, said.
She and Ms Bowie, 48, are on a placement at Metlifecare's Wairarapa Village aged-care facility in Masterton. Caring for elderly people had been an eye-opener and a good grounding in their chosen career, Ms Dalziell said.
"With a lot of other [types of nursing] you get a patient in and out, but here you get to build a relationship with the patient."
Ms Bowie said: "I've really appreciated being here because they're training us in that basic care - [they] are amazing people."
There is high demand for places on Ucol's bachelor of nursing course at its Wairarapa campus, where the two women are in their first year.
However, despite hospital staffing shortages, many graduates cannot find work because they lack experience, according to Stephenie Orchard, the Masterton nursing programme leader. Nursing degrees mitigated this with an extensive clinical placement programme but there was no substitute for on-the-job mentoring, she said.
"You can't fill the wards with inexperienced nurses . . . It's a bit of a vicious circle."
Fiona Samuel, the nursing manager at Wairarapa Village, said she found students from Ucol's Masterton campus "outstanding", but the high demand for degree places could not solve the nurse shortage.
"Your first year out is a really big development year, you're not experienced enough to just go for it. You need support."