May 17, 2022

General

A burnt-out health workforce impacts patient care

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Throughout the pandemic, we’ve heard much about health-care worker burnout. But what we haven’t heard much about is its effects on patients.

Even before the pandemic, health workers were grappling with long hours, high workplace demands, staff shortages, and limited resources. The culture of health-care values selfless dedication and around-the-clock availability, yet this risks both health-care workers’ health and the quality and safety of patient care. The pre-existing cracks in the system have widened during the pandemic.

Our survey of more than 9,000 health-care workers during 2020 found 71% experienced moderate to severe burnout. And the workforce continues to experience the pressures of the pandemic.

What exactly is burnout?

The World Health Organisation says burnout results from chronic workplace stress that has not been successfully managed, and is characterised by:

  • feelings of energy depletion or exhaustion
  • increased mental distance from one’s job, or feelings of negativity or cynicism related to one’s job
  • reduced professional efficacy.

Burnout is linked to moral distress, which occurs when health-care workers feel they cannot deliver the care they are trained to provide. Our participants talked about the emotional distress they experienced as patients died alone, the deficiencies in aged care, and their worries about whether health-care resources would be rationed.

What are its consequences?

The sustained and prolonged stress of the pandemic is taking its toll. Clinician burnout and workforce shortages are linked, and they have been listed as the biggest threats to patient safety in the United States in 2022.

Staffing shortages lead to patients having to wait longer for health care, even in life-threatening emergencies with potentially fatal outcomes, or being turned away. Patients have long wait times just to be triaged in emergency departments, with some deciding to leave instead of wait.

A review of nursing studies reveals burnout, particularly emotional exhaustion, is associated with poorer quality and safety of care. This review cites studies finding nurses and patients negatively rate the care provided when nurses are burnt out; along with adverse outcomes including medication errors, patient falls, increased infections, and even increased mortality in one study.

A participant in our survey said:

I’m burnt out. The impact of COVID has affected my empathy. I feel like best practice is unachievable and that there are so many barriers to providing care.

Burnout has implications for the whole workforce. Health-care workers who are burnt out may reduce their hours of work, quit their jobs, or retire early. These unnecessary staff reductions contribute to workforce shortages, meaning less staff available to provide care to the patients and increased pressure on those clinicians left behind.

Health-care workers are not easily replaced and the education and training of our highly skilled workforce is a substantial investment in quality patient care. This is why we must ensure health-care organisations have strategies to support and promote staff well-being and retain their staff.

What has to happen to reduce burnout?

Even during times of crisis, burnout is not inevitable. Through our research we heard from health-care workers who felt connected, engaged, and able to do their jobs well despite the increased demands of the pandemic. The secret to avoiding burnout was not “individual resilience” – health-care workers are already a highly resilient group – nor tokenistic gestures of support.

One emergency department nurse in our survey told us her managers told staff to “watch [their] mental health” and threw them a pizza party, which she described as “the equivalent of throwing a Band-Aid over a haemorrhaging artery”.

Burnout is an occupational issue needing organisational change.
It requires a commitment from organisations and leaders to deliver safe, healthy and caring workplaces.

Practical supports to improve staff well-being include proactive strategies that ensure a work culture of respect and kindness, removal of stigma and feelings of guilt if staff need to take time off to support their mental health, and debriefing and peer support programs.

Frontline health-care workers in our survey asked for workload management strategies to reduce burnout, such as:

  • “compulsory leave days to prevent burnout” or “burnout leave”
  • sufficient staffing with “workload flexible hours to prevent burnout”
  • “prioritising leaving on time/taking leave to ensure health-care workers are well rested and avoid burnout”.

Staff also need workplaces free from patient and visitor abuse, so hospitals need to have good policies for preventing occupational violence.

The pandemic is not over yet, and it won’t be the last health crisis we face. We can’t afford to lose caring and dedicated health-care workers to burnout. Investing in safe and healthy workplaces is an investment in the quality of patient care.The Conversation

Karen Willis, Professor, Public Health, Victoria University, Victoria University; Jaimie-Lee Maple, Postdoctoral Research Fellow, Victoria University; Marie Bismark, Professor, The University of Melbourne, and Natasha Smallwood, Assoc Professor, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Nurses continue raising voices for a stronger future

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The incredible courage of nurses and their unwavering dedication to patient care is being recognised this International Nurses’ Day. As tens of thousands of aged care, public and private sector nurses celebrate, they are united behind the desperate need for governments to invest in nursing and deliver safe staffing.

Acknowledging the extraordinary sacrifices by nurses, the NSW Nurses and Midwives’ Association (NSWNMA) has urged the community to support calls for shift by shift nurse-to-patient ratios to be introduced into public hospitals, mandated staffing levels in aged care, and fair pay across the profession.

NSWNMA General Secretary, Brett Holmes, said it was time governments stepped up to support and protect the nursing workforce and adequately invested for the future.

“Nursing sits at the heart of our health care system and nurses’ voices deserve to be heard by the decision makers to ensure better health outcomes are achieved,” said Mr Holmes.

“Ask any nurse of any classification across the state what they want on International Nurses’ Day and the overwhelming majority all agree on the need for safe staffing and decent wages.”

NSWNMA Assistant General Secretary, Shaye Candish, said the vital role nurses play in providing care, compassion and comfort to patients and residents was unique, yet governments fail to match their work value.

“It’s widely acknowledged our health and aged care systems rely heavily on the proficiency of their nursing workforces,” said Ms Candish.

“The contribution nurses make to the wellbeing of our society is invaluable, and the depth of this has been on display throughout the global health pandemic that we still find ourselves in today.”

NSWNMA Councillor and aged care nurse, Jocelyn Hofman, said nurses deserved better support.

“As a registered nurse in aged care I want what is best for the residents in my care, and that is safe staffing. We need a federal government that will reform aged care now,” Ms Hofman said.

NSWNMA Orange Base Hospital Branch President, Grace Langlands, said rural and regional health had been neglected too long and patient care was continuing to suffer.

“We need people to understand nursing is a hard job, but it’s a rewarding job. We’re doing the best we can, but we really need more nurses and safe ratios,” said Ms Langlands.

NSWNMA Canowindra Memorial Hospital Branch President, Samantha Gregory-Jones, said nurses deserved safe workplaces and staffing ratios.

“We do all of this for our communities and our families, but we need the NSW government to recognise our claim for nurse-to-patient ratios and remember that we are amazing,” added Ms Gregory-Jones.

NSWNMA Prince of Wales Mental Health Branch Secretary, Skye Romer, said as advocates for patient safety, nurses were fighting to secure better health care for all.

“We’ve got a tough job and nursing isn’t for everyone, but we do it with dedication and empathy to give our patients and consumers the best possible outcomes. It’s time for the government to give us safe staffing ratios and stop taking our goodwill for granted,” Ms Romer said.

The NSWNMA is continuing to advocate for the introduction of nurse-to-patient ratios on every shift and for the wellbeing of all nurses and midwives across NSW.

“Nurses now need more”: ANMF calls for reform this International Nurses Day

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On this International Nurses Day (IND), the Australian Nursing and Midwifery Federation (ANMF) is asking us all to reflect and acknowledge the extraordinary commitment and dedication of our nurses working in health and aged care across the country – both their tireless work on the frontline throughout the ongoing COVID pandemic and their contribution to our health and well-being at every stage of life.

“On behalf of the ANMF, we wish all of our nursing colleagues a happy International Nurses Day. It’s a very special day for us, where we celebrate our profession’s acheivements and the impact of nurses on the lives of individuals, families and communities across the country,” ANMF Federal Secretary, Annie Butler, said today.

“Whether working in hospital EDs, in nursing homes, caring for those at the end of life or at the beginning, nurses play a crucial role in supporting our health wherever we are and whatever our need is. The community has rightfully acknowledged and applauded nurses for the amazing courage and compassion they demonstrated during the pandemic and the critical role they played in the fight against COVID, but – caring for all when they need it – is just what nurses do every day.

While applause is welcome, the fact is that nurses now need more, they need our full support for them to continue their work caring for us.

The theme of this year’s IND is ‘A Voice to Lead …Invest in Nursing and respect rights to secure global health’, bringing a focus to the real investment that is needed in the profession of nursing to secure global health, which must include protecting nurses’ rights, safety and well-being. Without this investment we risk seeing nursing shortages which will present a serious threat to our country’s health and must be addressed now.

In the lead-up the federal election, Ms Butler said the ANMF has called on our political leaders to commit to its five key priorities to improve health and aged care outcomes, including: a high-quality, well-funded health and maternity care system; a well-funded and regulated aged care system; a strong, valued post-pandemic healthcare workforce that is supported to work safely and effectively to deliver the best outcomes for all; gender equity in all Australian workplaces; and, action on the health impacts of climate change.

“It’s abundantly clear that despite the recent tragedies we have seen worldwide, nurses are leading the way to make the world a better place for patients and communities. But a key question remains, will the next Australian Government take action on what really matters for the health of all Australians? The ANMF encourages everyone to take a stand to actively make your voices heard for what is right and just in this Federal election,” Ms Butler said.

Nurses for nurses: Why a National Nurse and Midwife Health Service matters 

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The Federal Labor party has announced that, if they win government, they will implement a National Nurse and Midwife Health Service (NNMHS). This is a significant announcement aimed at improving the mental health of nurses and midwives across the country. 

But what’s it about, and why do we need it? 

Nurses and midwives’ mental health is a MASSIVE issue 

As COVID restrictions ease, there is still no end in sight for the nurses and midwives who are looking after thousands of Australians across a range of settings every day.  

Many nurses and midwives are close to breaking point – one survey of 7,800 Australian health care workers found 40 per cent had symptoms of post-traumatic stress disorder. It is estimated that one in five frontline workers, including nurses, are considering quitting their job because of the pandemic.  

The long established and successful Nursing and Midwifery Health Program in Victoria has been inundated with calls from nurses struggling with their mental health and wellbeing after working beyond exhaustion. But for nurses and midwives working in other parts of the country, a service like this isn’t available.  

Australia is already facing dire nursing shortages – we can’t afford to lose more nurses because of unnecessary burn-out. 

What is the National Nurse and Midwife Health Service? 

Under an Albanese Labor Government, nurses and midwives around the country who are concerned about their stress levels, feel exhausted or anxious, or who are struggling with their mental health, will be able to access a range of personalised and professional support services to help them manage their challenges.  

Federal Labor will set up the NNMHS across  States and Territories to provide free, confidential and independent support, delivered by nurses for nurses, with information, advice, treatment and specialist referrals. 

Local services will be based on the highly successful Nursing and Midwifery Health Program model already available in Victoria. Services will deliver holistic, case-managed support with a focus on early intervention so nurses and midwives can avoid unnecessary burn-out. 

The program will be open to enrolled and registered nurses, midwives and students. Federal Labor will work with the Nursing and Midwifery Health Program in Victoria and nurses and midwives around the country to establish services nationwide.  

Labor will commit $18.7 million to the National Health Service that will help keep nurses and midwives in the job, caring for Australians. 

How is it different to EAP? 

Most nurses and midwives in NSW have access to the Employee Assistance Program (EAP) which can assist with mental health support. However, the NNMHS goes beyond this to provide a specialised service to nurses and midwives. 

For example, NNMHS is run for nurses by nurses, meaning that those that whoever you speak to will have experience with the issues you may be dealing with. This is unlike the EAP program, which provides general support and is run by counsellors working across a range of sectors. 

Further, access to NNMHS is undertaken independently of your employer. This means that your employers aren’t privy to how many people access the service, or who may be accessing it. This is particularly important for nurses and midwives who may need to utilise the service while facing disciplinary action.  

Finally, the NNMHS goes beyond counselling services. Like Victoria’s program, the NNMHS will provide holistic and ongoing mental health support throughout your career – not just when you’re at your wits end. They can also provide specialist referrals where you need it.  

But it’s not ratios! 

That’s absolutely right. However, Anthony Albanese has announced the implementation of minimum staffing in aged care – the one area that they can mandate this for. Ratios in public hospitals are determined by state government, and we’ll have to keep the pressure up to achieve this important reform.  

You can find out more about the NNMHS here. 

Workforce shortages are putting NDIS participants at risk. Here are 3 ways to attract more disability sector workers

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Ahead of the upcoming election, Labor has promised a rigorous review of the National Disability Insurance Scheme (NDIS), focused on spending and administration, should it win office.

But workforce shortages present a danger to participants now. To ensure the stated ambitions of a market-based system in which NDIS participants can choose their own supports, Labor’s proposed review must focus on these pressing workforce issues.

Some NDIS participants aren’t having their most basic care needs met, such as assistance to get out of bed each day, because of a shortage of disability workers. Others cannot access assistive technology or other allied health assessments to achieve their goals for social or work participation.

Workforce solutions must focus on attracting a greater number of both international and local workers to the disability sector, while addressing the wage growth and career pathways currently lacking.

Early warnings ignored

Disability has historically been an employment sector that has been challenged by poor perceptions.

Low pay rates, a lack of career structure, supervision and mentoring, and a casualised workforce have limited both supply and growth.

Five years ago, the Productivity Commission warned that the disability workforce was growing too slowly to meet future demands of NDIS participants and their families. Since then, some NDIS participants have struggled to secure support workers, and have had difficulty accessing allied health workers such as physiotherapists, occupational therapists and speech pathologists.

Then came COVID

No-one could have foreseen the impact a pandemic would have on labour supply across all industries in Australia. With COVID cases surging, many workers have had to isolate.

This has been compounded by the international workforce supply to Australia having been completely shut off by border restrictions.

These multiple issues are now added to what was already causing both direct support and allied health workforce shortages, with the aged care and health sectors also competing for staff.

Policy responses so far inadequate

The Coalition government’s five-year NDIS national workforce plan, released last year, focuses on building capability of existing employment markets.

But it doesn’t address the need to increase the supply of disability and allied health staffing numbers, or include new or innovative ways to grow a quality workforce.

This means people with disability and service providers will continue to compete with other sectors trying to attract the same employees.

Without coordinated, supply-side government investment, the workforce growth issues will continue.

Add to this the fact there is currently no actual data on the number of workers in the NDIS.

Due to this data gap, to forecast workforce supply, the government uses modelling estimates from analysis of participant spending, using assumptions on the share of NDIS payments paid as labour costs.

But relying on actual spend is not accurate, as it does not base forecasting on the real demand, or factor in under-spending caused by lack of workforce supply.

Here are three things we can do now to attract a disability workforce and ensure appropriate support for people living with disability.

1. Increase strategic and skilled migration

We need a more targeted skilled migration program that includes a broader range of skilled visa categories, especially for the disability workforce skill shortages and rural and regional market supply gaps.

Both English-speaking and culturally and linguistically diverse groups will be important to attract into a growing and diverse disability workforce, for both direct support workers and allied health workers.

Government should increase migrant intakes for these skill categories.

2. Invest in new approaches to NDIS workforce development

The National Disability Insurance Agency (which runs the NDIS) has been investing in some small-scale pilot projects in areas with staff shortages. However, to date these projects have not been designed for replication, or scaled up to other areas.

More broadly, the Australian government has invested more than A$64 million in an NDIS Jobs and Market Fund – and previous to that an Innovative Workforce Fund – to support the growth of disability workers.

One example of this was the scaling up of mixed telehealth and face-to-face allied health student placements with NDIS participants. It aimed to attract students to work in the disability sector while studying, as well as preparing them for practice in the field.

The project also embedded disability lived experience within the education students received, employing NDIS participants to deliver education content. However, this program can’t be scaled up without supply-side investment.

A low-cost initiative for government would be to invest in NDIS-focused educator roles within universities. By investing in supervision programs, both face-to-face and telehealth services in allied health could be quickly expanded nationally.

This could not only ensure more disability workers, but provide employment for supervisors with disabilities. It would give students experience in the disability sector, give them paid work while they study, and they would graduate ready for NDIS practice.

3. Improve conditions for workers

Moving into the disability workforce needs to be a career pathway, with secure employment benefits and conditions that are competitive against other labour markets. This requires pay that recognises the value of education, training and experience, as well as access to a supportive workplace.

Equipping people with disability to manage and train their own workforce, while offering a safe employment environment, is also important to improve both NDIS participant experiences and worker retention.

Little progress has been made in addressing the disability workforce demand that exists, and competition from the health sector and an ageing population will only grow.

As Australians head to the polls, the incoming government is going to need strategies to ensure the growing disability workforce demand is met.The Conversation

Libby Callaway, Associate Professor, Rehabilitation, Ageing and Independent Living Research Centre and Occupational Therapy Department, School of Primary and Allied Healthcare, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pay battles expose Coalition’s contempt for wage justice

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Be it health care in NSW or aged care nationwide, Liberal/National governments are determined to keep wages low.

Liberal/National Party Coalition governments have a mean streak when it comes to fair pay in aged care.

In 2012, the Gillard Labor government committed $1.2 billion to address aged care workforce issues, including specific funding for wage increases.

However, in 2014 the Abbott government abolished the measure, despite warnings from the Aged Care Financing Authority. Instead, it told aged care providers to bring in more temporary migrant workers.

Fast forward to 2022 and another federal Coalition government is displaying a similar contempt for wage justice.

The Fair Work Commission (FWC) is currently considering a union application for a 25 per cent wage increase for aged care workers. Aged care employers have told the FWC they also support a pay rise but haven’t specified how much.

Labor leader Anthony Albanese says his government will also make a submission to the FWC supporting a pay increase if Labor wins the election.

The Morrison government alone refuses to support a permanent pay rise. Instead, it hopes aged care workers will be satisfied with two one-off payments of $400.

This is a rejection of the aged care royal commission’s call for higher wages in the sector last year.

As Labor frontbencher Bill Shorten said, “If Mr Morrison was fair dinkum, he’d turn up at the Fair Work Commission, the independent umpire of wages, and support increasing the base rate per hour. If we don’t do that, we’re going to see a flight of aged care workers into hospo, into retail, into Bunnings, and nothing ever changes.”

In NSW, Scott Morrison’s counterparts in Macquarie Street have shown a similar disregard for wage justice for nurses and midwives.

The NSW Coalition Government gave nurses and midwives an insulting 0.3 per cent increase in the first year of the pandemic and a 1.5 per cent pay rise in 2021.

As NSWNMA General Secretary Brett Holmes said, “Not only is this offer disrespectful of our hardworking members, but it also sends a message to any nurses and midwives entering the public health sector that they are not valued by their employer.”

Such paltry increases also make no economic sense.

A study by the Centre for Future Work at the Australia Institute found that blocking pay rises for essential workers “is not just morally questionable – it’s also a major economic mistake”.

“The motivation for public sector wage austerity seems more ideological than fiscal or economic. Our research shows these arbitrary pay freezes are both unfair and economically counterproductive,” said Dr Jim Stanford, the lead author of the study.

Even the Reserve Bank of Australia says improved wages remain central to any recovery from the pandemic.

For years, the Reserve Bank governor, Philip Lowe, has said wages growth in Australia needs to “have a three in front of it” for spending to pick up and our economy to prosper.

Dr Andrew Charlton, a key economic adviser for the Rudd government when it crafted its stimulus package in response to the Global Financial Crisis, said keeping wages low is “precisely the opposite direction economic policy needs to be headed to achieve the government’s goal of supporting economic recovery.”

Where the parties stand on WAGES

Labor promises to:

make a submission to the Fair Work Commission supporting a pay increase for aged care workers if it wins government

legislate to criminalise wage theft – the deliberate underpayment or non-payment of wages, which disproportionately impacts young people, women, overseas students and migrant workers. A 2019 report estimated the underpayment of Australian workers’ entitlements at $1.35 billion per year including $220 million in “healthcare and social assistance”

ensure that workers employed through labour hire companies receive no less than workers employed directly.

The Greens support:

raising the minimum wage to at least 60 per cent of the full-time adult median wage so workers can afford to meet their basic needs

giving workers the right to engage in industrial action, including the right to strike, consistent with international law and not limited to artificially restricted bargaining periods

giving workers the right to engage in collective bargaining on any matter relevant to their social, economic and environmental interests.

Coalition:

The Coalition government imposed a 12-month pay freeze on federal government employees in 2020.

Its latest wage policy is to ensure that Commonwealth public sector wage rises do not exceed wage rises in the private sector.

The Liberal and National parties promise to continue “tackling union lawlessness and thuggery”.