The COVID-19 pandemic has inflicted a “huge and unprecedented” level of mental health trauma on nurses worldwide, according to a report published by the International Council of Nurses (ICN).


The International Council  of Nurses report said multiple studies in different countries show COVID-induced anxiety, stress, depression, burnout, psychological distress and PTSD 
have affected between 40 to 80 per cent of nurses.

Nurses in intensive care and coronary care have suffered the 
worst impact, according to the report titled Recover to Rebuild: Investing in the nursing workforce for health system effectiveness.

A co-author of the report, Scottish professor James Buchan, addressed the NSWNMA Annual Conference in Sydney in August.

He said the emotional toll on nurses was “immense”, with poor work/life balance, “moral injury” and a feeling of not being listened to.

International surveys showed over 
20 per cent of nurses said they intended to leave the profession.

“We are now beginning to see real evidence of (nurse) leaving rates growing post-pandemic,” said Professor Buchan, who is affiliated with the World Health Organization Collaborating Centre at the University of Technology Sydney.

“The National Health Service in England has more than 40,000 registered nurse vacancies, which is about 10 per cent – so one in 10 posts in the NHS is not filled. The retention rates are reducing and the turnover rates are increasing.”

WRONG EMPHASIS 
ON RESILIENCE

He said health organisations had failed to adequately protect and prevent harm to nurses, and had also wrongly emphasised a need for individual nurses to be resilient.

“We can’t just focus on emphasising resilience of individuals; we have to be looking at organisations’ duty of care, and their ability to reflect and respond to the growing concerns that are clearly there,” he said.

The incidence of industrial disputes and strikes in the health sector was up by 60 per cent internationally.

Strikes were a reaction to a failure to protect individual nurses from harm, historical undervaluing and funding, and concerns about patient safety.

“Governments and employers say they cannot afford to give pay rises and better conditions. The reality is, it is much more expensive to continue with the status quo.”

Professor Buchan said safe staffing was essential to rebuilding healthcare workforces severely affected by COVID-19.

“You need some sort of system in place where nurses can be confident that when they turn up at work, 
they are going to be in a safe 
working environment and patients will be safe.

“The second key point, I think, is having career structures with decent pay and the ability for nurses to progress up a career ladder if 
they wish.

“Australia needs to significantly increase the opportunities for nurse practitioners and other nurses.”

ETHICS OF FOREIGN RECRUITMENT

Professor Buchan said high-income countries such as Australia, the US and UK had failed to educate enough nurses of their own and were increasingly relying on international recruitment as a quick fix.

“There are serious ethical issues 
and health consequences when nurses are being actively recruited from countries that have too few nurses already.

“I’ve heard stories of a complete intensive care unit of nurses from Uganda moving en bloc to the UK … I’ve heard stories of Fiji losing a lot of its nurses (to Australia) and again, those cannot easily be replaced.”

Professor Buchan was asked if Australians had the right to dissuade nurses and midwives in poor countries from moving to Australia. to enjoy better working conditions that would benefit themselves and their families.

“We don’t have any right … the pre-eminent right should be that of the individual to move, assuming they’re free to do so and they have the right qualifications,” he replied.

He added, however, that governments of low-income countries had sometimes paid for nurse training on the proviso that nurses would work in their local health system for a period of time.

“That is not always being respected by recruiters, so it’s something we need to be monitoring.

“What we need to do beyond that is have bilateral agreements between recruiting countries and those we are recruiting from, to be clear that the nurses who move will get fair and equitable treatment – as that’s not always happening.”

If poor countries were being negatively impacted by international recruitment, then countries receiving migrant nurses needed to work with poor countries to improve their healthcare systems, he said.

RECRUITMENT ‘RED LIST’

He pointed to the World Health Organization code of practice on international recruitment, which includes a “Red List” of 
about 50 countries that should 
not be targeted for “active” international recruitment.

“The phrase ‘active recruitment’ gives a bit of an out in terms of how do you demonstrate the recruitment was active?

“Last year, the UK recruited about 6500 nurses from Red List countries … whether or not that was active recruitment or somehow all those 6,500 nurses made all the effort themselves is open to question.”

He said India and the Philippines were by far the biggest source countries for active recruitment.

“However, in both those countries most nurses pay for their own training and they do that with the intention of moving to earn more in other countries.

“So that dynamic is somewhat different, but in the Philippines there are concerns about their ability to meet their own healthcare demands post-COVID, when there are more Filipino nurses working in other countries than there are in 
the Philippines.”

Four steps to rebuild 
health services

The ICN report says solutions to rebuild health care workforces degraded by the pandemic include:

• adequate staffing levels
• attractive working conditions and pay, and career opportunities
• support for respite, health and wellbeing
• 
full participation in development and implementation of health-system rebuild strategies.