Time for action
Governments must act to address critical care nursing shortages .
By Margaret Fry
With the Covid-19 pandemic highlighting the shortage of nurses , including critical care nursing , governments need to act now to implement measures to ensure there are enough nurses in hospitals to supply quality healthcare and avoid poor patient outcomes .
The reasons for the shortfall of nurses are complex and include ever-increasing demand for hospital healthcare .
There has been an increase in hospital admissions and a 7 per cent annual increase in emergency department presentations since 2019-20 . In 2020- 21 , over 8.8 million people presented to emergency departments .
Other longer-term factors have pushed up demand for critical care nurses , including the increasing burden of disease due to an ageing population , and improved survival rates from chronic diseases , including cancer .
Total numbers of full-time equivalent nurses have been rising at 4.3 per cent a year since 2014-15 . There are now 432,885 practising registered and enrolled nurses across Australia and , as of September 2021 , another 2,277 nurse practitioners who are legally entitled to autonomously assess , diagnose and manage a range of patient conditions in line with their scope of practice .
Even so , the Federal Government has predicted there will be a shortfall of approximately 85,000 nurses by 2025 , and 123,000 nurses by 2030 .
This will result in significant service gaps , sub-optimal care for patients and the potential for a rising number of adverse events in hospitals .
Hospitals are being forced to increase triage , deciding who and who does not receive care due to an inability to roster nurses to clinical areas .
In addition , the nursing staff shortage may lead to an increase in the lengths of stay in clinical areas such as emergency departments , something that may compromise the timeliness , efficiency and appropriateness of patient care .
Several factors are leading to this shortfall . Since the Covid-19 pandemic began , many Sydney hospitals have been unable to recruit nurses , resulting in a deficit of permanently employed nurses . Those who remain are becoming overworked and burnt out due to ongoing shortages .
Nurses are also being redeployed to the Covid-19 response , away from other crucial areas and elective surgery .
Shortages of nursing staff may increase the rate of adverse events and near misses in hospitals as the quality of care and patient safety is compromised , leading to greater patient dissatisfaction . The risk of nursing staff shortages can also negatively influence the organisational culture of care and push up nurse dissatisfaction , leading to burnout and poor retention .
No single policy will remedy the projected shortfall of nurses able to meet service demands .
The use of unregulated workers in aged care settings , for example , has led to significant adverse events , poor outcomes and sub-optimal care . These workers need to be regulated by state and federal governments to optimise care and patient safety .
Nurse practitioners need to be empowered to operate more independently to manage a range of patient conditions . Legislation needs to be revised to expand nurse practitioners ’ scope , for example , nurses are unable to sign work certificates as under the law only doctors are authorised to sign these forms .
The federal government also needs to increase Medicare rebates for care by nurse practitioners to give rural and regional nurses a greater scope of practice . This would improve access , timeliness and equity of care across Australia .
A prolonged and persistent effort is needed to address the nursing shortfall and educate people about nursing careers and thus to stimulate greater output of trained and skilled nurses .
Governments need to devise strategies to minimise nursing curriculum creep to ensure integration and a coherent relevant education program . We need to encourage postgraduate study , such as the Master of Advanced Nursing and Graduate Certificate in Critical Care and postgraduate training should be funded by governments .
The process of defining nursing ratios for all critical care areas such as emergency departments should be mandated by governments , which would support a reasonable patient load and factors in acuity and not simply patient numbers formalised .
The government should consider incentivising rural and regional placements for nurses , as it does for other medical staff .
There also needs to be better defined career pathways for nurses and greater time for transition to practice programs that support an environment of learning overseen by experienced senior nursing clinicians .
Researchers also need to explore strategies to increase diversity and the number of men in nursing .
Only by introducing such strategies now will the nursing shortage be alleviated . ■
Margaret Fry is a researcher , clinician , supervisor and teacher in the School of Nursing and Midwifery at UTS .
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