15% of NSW nurses and midwives suffer post-traumatic stress “at a clinical level”
Work-related exhaustion and disengagement – key indicators of burnout – are major causes of post-traumatic stress.
About 15 per cent of nurses and midwives in NSW public healthcare facilities are suffering post-traumatic stress at a clinical level, the Rosemary Bryant AO Research Centre survey of NSWNMA members found.
The survey reinforces a growing body of literature indicating that healthcare workers are at real risk of post-traumatic stress symptoms and post-traumatic stress disorder (PTSD).
The survey sought to gauge the possible extent of post-traumatic stress and workplace factors that may contribute to it.
It assessed post-traumatic stress using a Department of Veteran Affairs checklist.
“Results indicated that while the majority did not have post-traumatic stress at a clinical level, there was still a sizeable proportion (approximately 15 in every 100) who did,” the survey report said.
“There were a number of organisational factors that contributed to this; in particular, concerns regarding workload, skill mix and staffing levels, as well as job demand and lack of availability of job resources important to the working environment for nurses and midwives.”
The report said there was a “strong, positive relationship between the two measures of burnout – exhaustion and disengagement – with PTSD”.
The survey results “showed that the higher the burnout, the higher the proportion of people with post-traumatic stress scores above the clinical cut-off”.
“People with post-traumatic stress were also more likely to have a poorer quality of life.”
The survey report notes that PTSD requires a psychological diagnosis from a qualified health practitioner.
The report adds: “While this research used a validated instrument to explore the presence of symptoms of PTSD among the nursing and midwifery cohort, it is not valid to conclude that these people have PTSD; rather that they have expressed symptoms of PTSD at a level that, according to the publisher of the instrument, are comparable to others who have been diagnosed with PTSD.”
Survey respondents were asked to indicate how their workload had changed during the pandemic.
The vast majority (90.1 per cent) said it had either slightly, moderately or significantly increased. Very few (4.5 per cent) said their workload had decreased.
Respondents were asked whether, as part of the pandemic response, they had been asked to work outside of their usual scope of practice – and, if so, whether they received appropriate education and training to do so.
Nearly half of respondents (44.8 per cent) had been asked to work outside of their usual scope of practice.
About three-quarters (74.5 per cent) said they did not receive appropriate education and training to do so.
Survey respondents were asked to rate their workplace across a range of areas related to policies and procedures. Ratings were scored on a six-point scale from “very poor” through to “excellent”.
Ability to deploy more staff was the policy and procedure that nurses and midwives rated most poorly.
The top five areas where organisational policies and procedures were frequently rated fair, poor or very poor were:
- Ability to deploy more staff if required (86.7 per cent)
- Access to alternative accommodation to stay between shifts (80.4 per cent)
- Debriefing processes (79.7 per cent)
- Managing staff abuse (73.1 per cent)
- Access to workplace psychological or mental health support (69.8 per cent).
Respondents were also asked to rate their level of concern about seven factors related to work and personal/family life at the height of the 2021 lockdown.
The seven factors were:
- My physical health
- My psychological wellbeing
- Keeping my family or people I live with safe
- Managing my workload
- Staffing levels
- Skill mix
- Access to and frequency of taking breaks.
Results showed that staffing levels and skill mix were the factors of most concern to respondents, followed by managing workload, and access to and frequency of taking breaks.
“Personal factors were not rated at as high levels of concern based on frequency response analysis,” the survey reported.
Across five of the seven factors, perceptions of concerns had improved from lockdown to the time of completing the survey.
These changes were “significant, yet modest” the survey found.
However, for staffing levels and skill mix, perceptions of concern had “significantly worsened”.
“It is evident in the results that perceptions of adequate staffing levels is poor and that it has declined over the course of the pandemic,” the survey found.
Staffing was the area most in need of improvement, the survey reported.
Other areas identified as needing improvement including addressing skill mix and being able to access paid leave.
The report noted that these concerns “are inter-related and associated with the lack of staff”.
Other policies and procedures identified as needing improvement include debriefing processes and managing staff abuse.
Respondents also reported they were “moderately, very or extremely concerned” about the following:
- The welfare of my colleagues (68.6 per cent)
- Having access to paid leave (61.4 per cent)
- Managing the personal needs of my family/the people I live with (53.9 per cent).
‘The higher the burnout, the higher the proportion of people with post-traumatic stress scores above the clinical cut-off.’