Exit signs

Increasing work pressure is forcing many experienced nurses and midwives to quit their jobs, a union survey finds.

Asurvey of NSWNMA members in public health suggests more than half intend to leave their current nursing and midwifery positions within the next five years.

The survey of workforce conditions, safety and wellbeing was conducted for the NSWNMA by the Rosemary Bryant AO Research Centre in mid-2022.

A total of 2305 nurses and midwives responded to the survey.

NSWNMA General Secretary Shaye Candish said the union commissioned the survey out of concern for its members’ health and wellbeing during the COVID-19 pandemic.

“A further reason was the risk of workers’ rights being neglected or abused due to system pressures aggravated by the pandemic,” she said.

“The current pressure NSW health services are under means there is a significant risk to the occupational and mental health of the health workforce.

“There are indications that a concerningly large number of staff are experiencing symptoms of fatigue, burnout, stress, anxiety, depression and posttraumatic stress.”

The survey showed 13.3 per cent of respondents intended to retire in the next five years.

Respondents were also asked when they intended to leave their current position.

A majority – 58.2 per cent – did intend to leave.

Of those who intended to leave their current position, 37.4 per cent planned to do so within the next 12 months.

Of those who intended to leave their current position, 22.2 per cent intended to get out of nursing, 36.3 per cent intended to stay in the profession and 41.4 per cent were undecided.

Over 400 respondents indicated that they had applied for other positions in the past six months. More than a quarter of them had applied for a position in another profession.

A total of 194 respondents were then currently working in a COVID-19 vaccination clinic or screening clinic. When asked how likely they were to return to the clinical setting, more than half (53.1 per cent) were either “not at all likely” or only “somewhat likely” to do so.

The report noted that nurses working in COVID-19 settings are “potentially highly experienced nurses whose skills and experience would be a loss for current generations of junior nurses and emerging nurse leaders should they not return.”

Incentives To Stay

Respondents planning to leave nursing were asked what would incentivise them to stay.

The top three responses were better pay, better workplace supports, and reduced workload.

Factors pushing members to leave the profession were associated with “the emotional drain of work”, “work–life conflict”, and an insufficiently supportive work environment, the survey found.

Other push factors were “associated with leadership” the survey noted.

“To this end, it is important that the healthcare system and services give consideration to supporting stronger representation (and visibility of representation) of nursing or midwifery leadership.” n

Key findings

13.3% of respondents intended to retire in the next five years

58.2% of respondents intend to leave their current position within five years.

37.4% of those planned to do so within the next 12 months

Of those who intended to leave their current position, 22.2 per cent intended to get out of nursing, 36.3 per cent intended to stay in the profession and 41.4 per cent were undecided.

The top three incentives to stay in the profession were better pay, better workplace supports, and reduced workload.

About the survey

The NSW public health sector workforce wellbeing survey was conducted during mid-2022.

Almost all survey respondents were NSWNMA members.

Of the 2305 nurses and midwives who responded to the survey, 88 per cent were women and 76 per cent were RNs.

Ages ranged from 18 years to 76 years and the mean age of respondents was 46.5 years.

More than one-third of respondents had caregiver responsibilities for children and one in five had other caregiver responsibilities at home.

The survey was conducted by the Rosemary Bryant AO Research Centre, which is a partnership between the University of South Australia, the Australian Nursing and Midwifery Federation (SA Branch), and the Rosemary Bryant Foundation. n

Read the report

https://www.nswnma.asn.au/wp-content/ uploads/2023/02/Impacts-of-COVID-19-andworkloads-on-NSW-nurses-and-midwivesmental-health-and-wellbeing_final.pdf

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 posttraumatic 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.”

Increasing Workload

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)

Working for multiple employers

Some respondents (n = 464) indicated they worked at more than one workplace. Of those who indicated they did, approximately one-third (n = 149) indicated they were asked to give up working at one of them.

Of these respondents, nearly two thirds (63.1%) indicated they gave up working at both workplaces. Only one-fifth (22.1%) sought advice on the situation and approximately one-quarter (26.8%) reported at the time, the situation was still not resolved.

said they did not receive appropriate education and training to do so.

Workplace Ratings

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) respondents, followed by managing workload, and access to and frequency of taking breaks.

· Access to workplace psychological or mental health support (69.8 per cent).

“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.

“Redeployment to ED and ICU without proper training, poor staffing, increased patient workload, being verbally abused by patients and relatives, feeling unsupported by executive.”

Respondents were asked to indicate if, 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 appropriated education and training (Figure 18) Nearly half of respondents (44.8%) had been asked to work outside of their usual scope of practice. Of those who had, approximately three-quarters (74.5%) indicated they did not receive appropriate education and training to do so.

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

The report noted that these concerns “are interrelated 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). n