Nurses and midwives are hurting. Working a double shift or extra hours has become the norm, and two days off in a row is considered a luxury. They are digging deep, trying to provide patients with safe care but are constantly arriving at work to find their emergency department, ward or maternity unit is short staffed yet again.

Patient care under these conditions is being compromised and it is taking a toll because as trained clinicians, nurses and midwives want to give everyone the best care possible – but currently they can’t. What they are increasingly describing is psychological injury, an experience of knowing the right actions to take ethically but being systemically constrained from doing so.

Our state health minister has previously dismissed this as hyperbole. That somehow nurses and midwives are immune to suffering trauma themselves, when in fact they often experience it in the form of guilt from letting their patients down. This has been compounding, shift after shift, removing their sense of job satisfaction and motivation to practice.

So much so, over half of almost 3,000 public sector nurses and midwives we surveyed late last year indicated they intend on leaving their current role within the next five years and of those, over 20 per cent plan to leave the profession entirely. Many told us they are fatigued or burnt out and around 15 in every 100 reported post-traumatic stress symptoms at a clinical level.

This precious workforce is now feeling acutely overworked.

As activity and elective surgery levels in public hospitals continue to surge, the prevalence of psychological harm amongst health workers has also grown. A study from last November into psychological injury claims to the NSW workers’ compensation system revealed a rapid rise, with nurses and midwives highly impacted. Stress and anxiety were the most common injuries, accounting for two-thirds of cases.

An NSW Auditor-General’s review into the health, safety and wellbeing of nurses and junior doctors in late 2020 also found ‘the Ministry had not dedicated sufficient resources to assess systemwide health and safety data and develop initiatives to address statewide risks, in particular risks to nursing staff’.

Despite this growing evidence, governments have failed to intervene effectively or have opted for an ‘individual resilience’ approach, placing the burden of a broken health system back onto the distressed nurse or midwife – the individual with the least control over their working environment to change their situation.

Nurses and midwives are still being told to “be more resilient” or “find a less stressful role”, once again increasing their anxieties about work and prompting them to seek alternative employment.

This cannot continue. Rather than trying to normalise the trail of destruction that COVID-19 has left so far, a system-wide solution-driven focus is needed.

We must see improvements in working conditions, as well as urgent investment in services, such as robust physical and mental health supports, job control, and childcare.

One area in critical need of reform is staffing. Nursing and midwifery staffing levels have declined over the course of the pandemic, with many senior clinicians leaving or opting for less demanding roles that offer more job control. Those remaining at the bedside are required to fill these gaps through increased overtime and increased responsibility. Early career staff are suffering the loss of their experienced peers most, missing out on mentorship and support, and adding to the stress and expectations being placed upon them.

Plugging staffing gaps with first-year new graduates is not the answer, it is a band-aid solution and not sustainable. Given Australia also has one of the highest rates of graduate nurses per capita, the issue is less about local supply and more about retaining valuable experience across the workforce.

Shaye Candish is the General Secretary of the NSW Nurses and Midwives’ Association