Nursing: a profession under "enormous stress"
Nursing, already under pressure, is reaching breaking point due to the pressures of COVID-19 and a disjointed healthcare system, including the acute, primary and aged care sectors. We must act now to protect our nurses and healthcare; the time has come for a national reckoning on nursing in Australia.
Australian nurses cannot continue to work under the extreme pressure they are currently operating under — the impacts are mounting.
The almost 400,000 Australian nurses — the largest and most trusted health professionals in the country1 — are a constant presence in every one of our major life milestones, national emergencies and global crises.
The nurse of today holds a science degree, possesses highly technical training, valuable medical opinions and front-row expertise, is an effective trainer, and is skilled in population and systemic thinking.
Importantly, there is also a major emotional and physical toll on nurses.
For too long there has been a reliance on the ‘giving and goodness’ of nurses — however, there is not an endless bucket of personal resources to draw upon, to keep the profession fronting up to do the job, whether that be in policy, research, in hospitals, in the community, in academia, politics and across the aged care and disability sectors.
And now the signs are unmissable for a profession under enormous stress.
We desperately need a rethink about how we support and provide nursing care in Australia.
Nurses around Australia are reporting to the Australian College of Nursing higher than normal levels of occupational violence over the last 20 months. This comes off the back of unacceptably high levels; in 2019, up to 10% of nurses reported they had been either physically assaulted, verbally abused and/or subject to sexual innuendo, abuse or threats2.
Harassment and intimidation of nurses in the workforce has become so regular that, in some workplaces, it is considered ‘just part of the job’. When I was establishing myself as a nurse, I also experienced harassment and violence, but we didn’t have the language or understanding to know we didn’t have to tolerate it. This outdated and damaging mentality of workplace culture needs to end, and it is the reason I am championing as loudly as I can in my role.
As a predominately female workforce3 (90%), the issues of sexual assault against women echo loudly through our profession, as society grapples with the impacts of the Me Too movement, the Brittany Higgins case and even the Women’s Safety Summit hosted recently by the federal government. For nurses, the topic of domestic and family violence as well as occupational violence is front of mind.
From a professional perspective, the high rates of abuse sustained by the nursing profession have deep, lasting impacts and many members of the Australian College of Nursing report symptoms of trauma, post-traumatic stress syndrome and vicarious trauma. In January 2021, the World Health Organisation confirmed the ‘mass trauma’ of healthcare workers, which was highlighted by the International College of Nursing (ICN)4.
This needs to change. Today.
The pressure on the nursing profession is mounting on a day-to-day level, when nurses are required to isolate from their family and friends after being exposed to COVID-19 at work.
Nurses have informed me, in some sectors, they get paid for the first three days of that isolation in the public health system; however, if they acquire the virus, they are expected to take sick leave for the remainder of their recovery. Many nurses are not permanent or full-time staff, rather casual, part-time or working as agency nurses, who are often not entitled to sick leave. This vulnerable group of workers — most often women — is left without a means to earn an income, after virus exposure.
The regular absences of clinical staff in client-facing health environments means teams are short-staffed, or managers, clinical nurse consultants and nurse educators — all vital for the coordination, oversight and safety of health systems — are pulled off their work and asked to be clinically facing. This leaves these nursing experts to work extensive hours each day, as there is no back fill for their roles.
Nurses are turning away from the profession as a result.
In March 2021, the International College of Nursing (ICN) conducted global research in nurse shortages one year on from the World Health Organisation (WHO) declaring COVID-19 a pandemic. They reported that nearly one in five of the National Nursing Associations surveyed reported an increase in the number of nurses leaving the profession, and 90% of them are “somewhat or extremely concerned” that heavy workloads, insufficient resources, burnout and stress are the factors that are driving that exodus.5
The 2020 Aged Care Workforce Census reported that 29% of their direct care workforce had left their employment over the 12 months from November 2019 to November 20206 and there were almost 10,000 vacant roles in aged care alone. That was before the current extended lockdowns both Victoria and New South Wales are experiencing.
The ICN reports: The world entered the pandemic with a shortfall of up to six million nurses and an additional four million expected to retire by 2030, which puts the global nursing workforce under an intolerable strain. ICN says large numbers of experienced nurses are leaving the profession or considering calling time after the pandemic, which should be a wake-up call for governments to invest in nursing jobs, education, and leadership before it is too late7.
Whilst the issues are challenging, there are strategies that can be put into place to ease the pressure, to support nurses and nursing care in Australia.
Firstly, we need to immediately support the graduating class of 2021. Right now, thousands of third-year nursing students are at risk of being ineligible to graduate this year as they are struggling to obtain clinical placement hours required of their three-year tertiary degrees due to disruptions to the healthcare system. It is estimated almost 20,000 nurses across Australia are due to graduate, in their final semester. This workforce will make a tremendous contribution, with adequate support, to all healthcare sectors. Governments and employers should be working to secure employment for all graduating nurses to provide a pipeline for workforce planning for 2022 and beyond.
We need additional funding for refresher courses for retired Registered Nurses and Enrolled Nurses, as well as non-clinical active Registered Nurses, so they can supplement the workforce across Australia. This needs to be coupled with job certainty and tangible benefits to them for coming back into the workforce8.
The Australian College of Nursing has always championed overseas trained eligible Registered Nurses provided with Right to Work VISAs in Australia. Skilled nursing migration enhances opportunity, diversity and care delivery to those living in Australia, and nursing has long been considered a profession that can take you around the world.
Support and relief must be given to the Executive Directors, Directors of Nursing, and other senior workforce executives who are dealing with tired, burnt out and exhausted staff — they must be given the support and resources they need to manage their teams, and patients. The complete transformation of health systems to deal with the impacts of COVID-19 have largely landed on their shoulders, and they need practical support, people, funds and the go-ahead to overcome policies and procedures not suited to the current challenges.
Funding models are outdated and exclude Mental Health Nurses, Nurse Practitioners and Registered Nurses from accessing Medicare numbers in order to be paid for the work they do. This is having the greatest impact in rural and remote Australia, where community healthcare systems are often staffed by nurses who cover enormous areas. Your postcode should not determine your health outcomes in the 21st century, but in Australia it does.
We recommend a national summit to be sponsored by the federal government in collaboration with the Australian College of Nursing which is representative of all the healthcare systems — including aged care and disability — so a national action plan for a sustainable and supported nursing workforce can be established, prioritised and actioned — in light of the pending crisis.
Finally, and most urgently, we ask all Australians to please consider the way fear, frustration and stress is expressed in clinical, aged care and community settings, for this is having a major and lasting impact on the emotional and mental health of Australian nurses. We thank and acknowledge those of you who are patient, express kindness and gratitude, it means so much. We are, and have always been, the caring profession so we appreciate what toll COVID-19 is taking on people, but harassment, violence and intimidation of nurses and women in our society and workplaces will never be okay.
3 86% of Aged Care Nurses are female: https://www.theweeklysource.com.au/almost-10000-vacant-roles-and-37-np-and-rn-turnover-in-just-12-months-2020-aged-care-workforce-census/ and 89% of Australian nurses are female: Australian Government Job Outlook, “Registered Nurses”, www.joboutlook.gov.au.
8 In 2020, the Australian College of Nursing secured federal government funding to deliver 3,000 refresher courses to non-clinical RN. The Australian College of Nursing invested an additional $500,000 to extend the refresher course to Enrolled Nurses.
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