Health Analysis

We need to urgently talk about the nursing crisis in Australia

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Nursing is reaching breaking point due to the stress of COVID-19 and a disjointed healthcare system (Image via Pixabay)

The Coalition must do more to prioritise the health of nurses who are turning away from the profession at the worst possible time due to burn-out, stress and insufficient resources, writes Kylie Ward.

NURSING IS reaching breaking point due to the stress of COVID-19 and a disjointed healthcare system, which includes acute, primary and aged care sectors.

There is a major emotional and physical toll on nurses now – these signs are unmissable in a profession already under enormous pressure – and a rethink is desperately needed in how we support and provide nursing care in Australia.

As if that wasn't enough, nurses around Australia are reporting to Australian College of Nursing (ACN), 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 NZ nurses reported they had been either physically assaulted, verbally abused and/or subject to sexual innuendo, abuse or threats).

Harassment and intimidation of nurses in the workforce have become so regular that in some workplaces it is considered "just part of the job".

Recently, together with the Council of Presidents of Medical Colleges (CPMC), ACN released a statement condemning the escalation in workplace violence for nurses and doctors and called on everyone to support healthcare workers, who are doing an extremely difficult job day-in and day-out.

As a predominately female workforce – almost 90% – the issues of sexual assault against women echo loudly throughout our profession, as society grapples with the impacts of the #MeToo movement, the Brittany Higgins case and even the National Summit on Women's Safety hosted by the Federal Government recently.

From a professional perspective, the high rates of abuse sustained by the nursing profession have lasting impacts and many members of ACN report symptoms of trauma and post-traumatic stress syndrome. In January 2021, the World Health Organization confirmed the ‘mass trauma’ of healthcare workers, which was highlighted by International College of Nursing (ICN).

This needs to change. It needs to change now.

Nurses have informed me, in some sectors, that they get paid for the first three days of COVID-related isolation in the public health system. However, if they acquire the virus, nurses are expected to take sick leave for the remainder of their recovery. Many nurses are not permanent or full-time staff, but 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 – are left without a means to earn an income after virus exposure.  

Regular absences of clinical staff in client-facing health environments mean teams are short-staffed. Consequently, 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.

Nurses are turning away from the profession as a result.

Almost 400,000 Australian nurses today hold a science degree, possess highly technical training, valuable medical opinions and front-row expertise. They are effective trainers and are skilled in population and systemic thinking.

In March 2021, the ICN conducted global research in nurse shortages, finding 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, burn-out and stress are the factors driving that exodus.

The 2020 Aged Care Workforce Census reported that 29% of Australia's direct care workforce had left employment over the 12 months from November 2019 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.

Strategies to ease pressure

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 health care system. Governments and employers should be working to secure employment for all graduating nurses to provide a pipeline for workforce planning for 2022 and beyond.

Additional funding is needed for refresher courses for retired Registered Nurses (RNs) and Enrolled Nurses (ENs), as well as non-clinical active RNs, so they can supplement the workforce across Australia. This needs to be coupled with job certainty and tangible benefits. ACN has always championed overseas-trained eligible RNs provided with right-to-work visas in Australia. Skilled nursing migration enhances opportunity, diversity and care delivery to Australians.

Support and relief must be given to executives and senior directors who are dealing with burnt out and exhausted staff — they must be given resources to manage their teams and patients.

Current funding models exclude mental health nurses, nurse practitioners and RNs from accessing Medicare numbers to be paid for the work they do. This is having the greatest impact in rural and remote Australia, where community health care systems are often staffed by nurses who cover enormous areas.

We recommend a national summit to be sponsored by the Federal Government in collaboration with ACN, which is representative of all health care 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. 

Lastly, we ask all Australians to please consider the way fear, frustration and stress are expressed in clinical, aged care and community settings such as vaccination hubs — because this is having a major and lasting impact on the emotional and mental health of Australian nurses.

We appreciate the toll COVID-19 is taking on people — nursing is and has always been the "caring" profession – however, harassment, violence and intimidation of nurses and women in our society and workplaces are never okay. 

Adjunct Professor Kylie Ward is the CEO of Australian College of Nursing (ACN). She holds honorary academic appointments with five Australian universities. In 2020 Kylie was named in the Top 100 Health Voices for LinkedIn worldwide.

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We need to urgently talk about the nursing crisis in Australia

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