Exhausted yet determined, nurses and midwives gathered in unison outside St George and Sutherland hospitals on Thursday, with raised placards and voices, demanding to be heard.
These were the scenes on September 1, when nurses and midwives joined state-wide strike action in a "fight for their patients".
Branch union members from the NSW Nurses and Midwives' Association rallied on the footpaths as part of a 24-hour strike.
A majority vote of the association's public sector members confirmed 94 per cent in favour of the strike, which started at 7am (morning shift), and ends on Friday morning.
Life-preserving services will be maintained during this time.
The industrial action is being taken as a result of members' unified concerns that wards have reached "crisis" point.
Sutherland Branch President, Colette Duff, says staff are "fed up". A nurse for more than 26 years and a registered nurse in the Emergency Department (ED) for more than five years, she says it's the worst she's ever seen.
"Every day people say to me 'I need to find something else to do, I don't know how much longer I can do this for,'" she said.
"A nurse told me it's not uncommon to have 11 patients with an Assistant in Nursing. She was almost in tears. They are getting abused by patients, and are under so much pressure."
She said the latest strike marked the fourth walk-out by branch members.
"The night shift is walking out. We're asking for ratios to be implemented across the system - 1:3 in emergency, 1:4 on the floor in ICU and we want mums to matter - for midwifery numbers to be counted properly," she said. "Three babies in a bed are counted as one patient."
Ms Duff said members were seeking the "same level of care" as St George Hospital.
"We are seeing as many people as St George but we have significantly less staff here," she said. "We are very short-staffed because we've had a huge number of people resign."
She says nurses are often lumped with extra work. "It's beyond what they're expected to do," she said. "If kitchen staff are sick, it gets put back on nursing.
"In the ED there are two very long halls, and it will be three nurses stretched across 13 beds. You could be down the other end of the department and you'll see someone get out of bed and they're about to fall - we've had an increase in falls, and there are delays in getting patients medication, in offloading beds.
"That means it's hard to tend to patients, and you can't do basic care. We get into nursing to provide care - it's not just about the technical skills, but occasionally being able to talk to somebody who's having a hard time, to get to know them, to build rapport with them.
"We need to give people a reason to come into the nursing profession by having a good workplace to work in."
St George Hospital branch association delegate, Kim Walker, says conditions continue to deteriorate and staff are exhausted from overtime shifts, including new graduates who become "deer in the headlights".
"Nurses are often doing the workload of two nurses as vacancies are left unfilled and those that are completely burnt out leave the profession all together," she said.
"New graduates completing their first year of work are reporting higher levels of stress as they find themselves with very little to no support as their education and support staff are forced into other roles to fill other essential roles."
She said midwives were also hit hard. "Each midwife is looking after six to eight mums as well as their babies on a shift. These babies need baby health checks, observations taken and if mum has had a c-section the babies need a lot more care while mum is in the post-operative period," she said.
"The fact that these babies aren't counted in the patient numbers is astonishing. The midwives are working incredibly hard to keep up with the demands of supporting and caring for new mums, often working through meal breaks and toilet breaks."
She said although ICU COVID-19 admissions were down because of strong community support of vaccinations, patients were still being admitted to the wards while infected.
"Nurses also need to take precautions to prevent the spread of the illness," Ms Walker said. "This is particularly difficult in the aged care wards where patients often have high care needs.
"We are feeling hopeless and abandoned. Mandated safe patient ratios across all areas of nursing will mean better quality care can be provided to the members of our community."
Union members are calling on Kogarah MP Chris Minns to "commit to supporting ratios."
"The leader of the opposition has stopped short at supporting staff to patient ratios in NSW despite the clear benefits ratios has had in Victoria and in QLD," Ms Walker said. "With so many hospital staff living and working in his electorate we want him to do better."
On August 25, the IRC ordered the association and its members to cease organising and refrain from taking industrial action.
A spokesperson for NSW Health said it engaged in extensive and ongoing discussions with the association.
"NSW Health recognises and is deeply thankful for the outstanding commitment and tireless efforts of our healthcare workers throughout the COVID-19 pandemic," the spokesperson said.
"All local health districts and NSW Ambulance will have plans in place to seek to minimise disruption or delays and to ensure people in need of emergency care continue to receive it.
"NSW Health will continue to work to mitigate potential impacts on patients, however some disruption and delays are expected, particularly as 1023 healthcare workers were in isolation as of August 26 either due to positive COVID-19 status, exposure to COVID-19, and/or whilst waiting a negative result.
"We thank all our patients and their families for their patience and understanding during this challenging time."
The IRC made a new award covering nurses and midwives at NSW Health on August 17. The award facilitated a three per cent increase to wages and conditions.
In June this year, the NSW Government announced a three per cent pay rise for every public sector worker across the state as part of an extra $4.5 billion spent on healthcare in the state budget. All healthcare staff were given a $3000 bonus as a 'thank you' for their work during the pandemic. The package is set to fund an extra 10,000 doctors, nurses and other health staff across the state.
