10 September 2021

Abuse, stress, overwork: nursing is in crisis

Comment COVID-19 Nursing

Nursing, already under pressure, is reaching breaking point because of the pressures of covid-19 and a disjointed healthcare system, including the acute, primary and aged care sectors.

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.

If you’re one of the 400,000 Australian nurses of today, you probably hold a science degree, possess highly technical training, have valuable medical opinions and front-row expertise, are an effective trainer, and are skilled in population and systemic thinking. But you won’t be treated accordingly.

Nurses around Australia are reporting to the Australian College of Nursing higher than normal levels of occupational violence over the past 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 subjected to sexual innuendo, abuse or threats (1).

Harassment and intimidation of nurses in the workforce has become so regular that, in some workplaces, it is considered “just part of the job”.

As a predominately female workforce (2) (90%), the issues of sexual assault against women echoes 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 this week 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 a lasting impact 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, a situation highlighted by the International College of Nursing (ICN) (3).

This needs to change. Today.

Nurses have informed me, in some sectors, they get paid for the first three days of an 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, but are rather casual, part-time or working as agency nurses, and 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.  

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.

As a result, nurses are turning away from the profession.

In March 2021, the International College of Nursing (ICN) conducted global research in nurse shortages and found 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. (4)

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 2020 (5) and there were almost 10,000 vacant roles in aged care alone. That was before the current extended lockdowns in Victoria and New South Wales. 

While the issues are challenging, there are strategies that can be put in place to ease the pressure.

First, 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 because of 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.

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 (6).

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 Australians.

Support and relief must be given to the executives and senior directors who are dealing with burnt-out and exhausted staff – they must be given the support and resources they need to manage their teams, and their patients.

Current funding models exclude mental health nurses, nurse practitioners and registered nurses 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, sponsored by the federal government in collaboration with the Australian College of Nursing, that is representative of all the 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. 

And finally, 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 those of you who are patient, and who express kindness and gratitude – it means so much. We are, and have always been, the caring profession, so we appreciate the toll covid-19 is taking on people. However, harassment, violence and intimidation of nurses and women in our society and workplaces will never be okay.   

Adjunct Professor Kylie Ward is CEO of the Australian College of Nursing


References:

  1. https://www.stuff.co.nz/national/health/121473761/nurses-added-to-proposed-law-which-imposes-minimum-prison-sentences-for-assaults-against-healthcare-workers
  2. 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.
  3. https://www.icn.ch/news/covid-19-pandemic-one-year-icn-warns-exodus-experienced-nurses-compounding-current-shortages
  4. https://www.icn.ch/news/covid-19-pandemic-one-year-icn-warns-exodus-experienced-nurses-compounding-current-shortages
  5. https://www.health.gov.au/resources/publications/2020-aged-care-workforce-census
  6. 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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