Hip and joint replacement surgeries in Gisborne stopped for two weeks in March after "safety concerns" were raised about staffing.
Hauora Tairāwhiti first said no surgeries were cancelled, it just didn't book patients for arthroplasty (joint) surgeries during that time.
However, it clarified after publication that four surgeries had been "deferred".
It said the impact on wait times had been minimal, after double the normal number of surgeries took place in April.
Hauora Tairāwhiti chief executive Jim Green said clinical staff in the orthopaedic department were concerned there were not enough nurses with the right qualifications and experience, to care for patients after joint replacements.
It came after the Covid-19 pandemic prompted some staff to "reconsider" their careers, he said.
A reconfiguration of Gisborne Hospital in response to the Covid-19 response in March last year prompted some nurses to retire, resign or move within the district health board, Green said.
Leading up to publication, Hauroa Tairāwhiti could not provide a number for how many nurses left the Orthopaedic Department, but said fulltime equivalent (FTE) staff numbers on the ward had been "relatively stable" this year with approximately 23 nurses.
During the reconfiguration, a "special area", or annex, was created at the hospital for people following joint replacements.
"The concern from the team was 'do we have enough people to staff that, to safely do surgery?', so we needed to make sure that was the case," Green said.
"We couldn't guarantee that."
The surgical team were still operating on other orthopaedic conditions over this time.
Concerns 'taken seriously'
Hauora Tairāwhiti surgical services group manager Lynsey Bartlett said when safety concerns were raised, the appropriate action was to stop planned joint surgery, review the safety issues and agree on a plan to remediate the areas of concern.
"It is important that clinical staff can raise safety concerns and that these are taken seriously," she said.
"Assuring patient safety is a priority. This is a standard process."
When the immediate concerns were resolved, surgery resumed.
Immediate remedial actions included planning and assuring the availability of staff to maintain the ward used for people who had had joint replacements, she said.
There was also a longer-term programme of work regarding the nursing workforce, leadership and a build project.
The impact of the hold on people waiting for joint surgery was minimal, Bartlett said.
Hauora Tairāwhiti had completed 114 arthroplasty surgeries since 1 July, 2020.
These were 36 more than planned, and reflective of the need in the community, she said.
In April, 16 people had joint replacements, which was double the usual number of planned arthroplasty surgeries.
"A huge thanks to our wider surgical teams for ensuring there was minimal impact on patients. They are to be commended for the effort taken to put agreed actions in place so the joint replacement surgery could resume," Bartlett said.
Covid-19 prompts reappraisal for some
Green said Covid-19 had prompted staff to think "where am I in my life and in my career?"
It wasn't unique to this ward but was something he had witnessed across the DHB.
"People have taken this opportunity to reconsider and think about where they're at with their stage of life.
"We've seen that as a feature and I know that it's a feature across the country."
It came as recruiting staff was an ongoing challenge.
"Clearly we're not able to recruit people from overseas as we have before. People are not tending to move around within the country as they have done before.
"So this is also a feature that is occurring across the country in getting enough people into the health system to make sure we've got staffing wherever we need it."
A surgical services report that came to Hauora Tairāwhiti's Hiwa i te Rangi advisory committee on 20 April highlighted the "safety concerns relating to staffing and facilities".
The report said two department meetings were held resulting in immediate remedial actions being taken and agreement on medium-term planning.
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