tag:theconversation.com,2011:/id/topics/nurses-6864/articlesNurses – The Conversation2023-11-15T01:05:04Ztag:theconversation.com,2011:article/2172882023-11-15T01:05:04Z2023-11-15T01:05:04Z‘I was told to return to work as soon as I regained consciousness.’ Why only a third of assaulted nurses report it to police<figure><img src="https://images.theconversation.com/files/559003/original/file-20231113-19-g682an.jpg?ixlib=rb-1.1.0&rect=22%2C0%2C7326%2C4902&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-nurse-suffering-headache-1369626374">Shutterstock</a></span></figcaption></figure><p>Violence <a href="https://theconversation.com/violence-against-nurses-is-on-the-rise-but-protections-remain-weak-76019">against nurses is pervasive</a>. They are <a href="https://oem.bmj.com/content/76/12/927">more likely to experience physical violence</a> than any other health-care professionals. Violence against nurses occurs in the context of <a href="https://www.un.org/en/observances/ending-violence-against-women-day">violence against women</a>, with <a href="https://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx">87.5% of Australia’s nursing workforce</a> identifying as women. </p>
<p><a href="https://doi.org/10.1016/j.colegn.2023.08.003">Nurses report</a> being punched, hit, struck, having objects or body fluids thrown at them, being kicked, grabbed, spat on, threatened, pushed, slapped, strangled, scratched, bitten, or sexually assaulted by patients. These actions are assault, which is a crime. In recent years Western Australia, Queensland, South Australia and Northern Territory have <a href="https://search.informit.org/doi/epdf/10.3316/informit.075234270376929">implemented tougher penalties</a> for those who assault nurses on the job as a deterrent.</p>
<p>But nurses don’t feel empowered or supported to report these crimes and patients are not being held accountable for their actions. Harsher penalties alone aren’t enough to protect nurses.</p>
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Read more:
<a href="https://theconversation.com/doctors-are-being-sexually-harassed-at-work-this-needs-to-stop-214264">Doctors are being sexually harassed at work. This needs to stop</a>
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<h2>Unhelpful responses from employers and police</h2>
<p>We surveyed 275 nurses as part of <a href="https://doi.org/10.1016/j.colegn.2023.08.003">our research</a>. About 83% had been assaulted by patients. Around a third of the nurses in our study reported experiencing more than one form of assault. </p>
<p>But only about one in three assaulted nurses report attacks to the police. Nurses say the support they receive from their employers and police is generally poor, and they feel discouraged from proceeding with the reports they do make. Nurses said:</p>
<blockquote>
<p>I felt like the decision was taken away from me and my management didn’t do anything in support of me. </p>
<p>I did not pursue charges as [there was] pressure from police to drop charges and no further support from my department in doing so.</p>
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<a href="https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="nurse stands with hand in front of her to say stop" src="https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559001/original/file-20231113-17-8n46yr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Violence and assault is often minimised as ‘part of the job’.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-african-american-doctor-woman-2023569635">Shutterstock</a></span>
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<h2>Assaults still seen as ‘part of the job’</h2>
<p>Nurses in our study spoke about how they see assaults as “part of the job”. As one said:</p>
<blockquote>
<p>I was told to return to work as soon as I regained consciousness […] I had to look after the same patient because ‘there aren’t enough staff to replace you, and this is part of nursing […] There is only four hours left of your shift. Then you can go home and sleep it off’.</p>
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<p>Another nurse said assaults were common:</p>
<blockquote>
<p>[…] this sort of treatment from patients happens often and no one reports it. There’s this sort of culture that you just move on and get over it […] I have been physically and sexually assaulted a few times over the last year but not reported to police as I feel like I’m wasting time and resources and my claim isn’t important enough.</p>
</blockquote>
<p>This self-limiting culture appears to be longstanding, and reinforced by substandard responses from their employer and police.</p>
<h2>Nurses don’t report based on misconceptions</h2>
<p>In <a href="https://doi.org/10.1016/j.colegn.2023.08.003">our research</a> nurses thought patients who are intoxicated or have a mental illness wouldn’t satisfy the requirement of a guilty mind (<em><a href="https://www.alrc.gov.au/publication/traditional-rights-and-freedoms-encroachments-by-commonwealth-laws-ip-46/12-strict-and-absolute-liability/a-common-law-principle-2/">mens rea</a></em>) required for conviction. Or that, they have to be physically hurt for assaults to be seen as an offence. </p>
<p>But patients who are intoxicated or have mental illness can be held accountable.</p>
<p>In legal terms, neither intoxication or mental illness <a href="https://www.legislation.gov.au/Details/C2023C00283">equate to a lack of capacity</a> to know what is right or wrong. And to say someone cannot be held responsible for their actions due to mental illness, can be seen as stigmatising or unjust. It is not up to a nurse, employer or police to decide a person’s mental capacity. Every person is to be presumed of “sound mind” unless proven otherwise during prosecution. </p>
<p>Another misconception is that nurses have to be physically hurt for assaults to be reported. As one nurse said:</p>
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<p>I didn’t think that it was worth reporting it to the police as there was no visible harm done to me.</p>
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<p>Harms from assault can be physical, emotional or psychosocial (impact on one’s thought and how they interact with others). However, <a href="https://www.legislation.gov.au/Details/C2023C00283">assault is not characterised by its impact, but rather the act itself.</a> A patient can be guilty of assault if they physically attack a nurse or if they threaten to do so.</p>
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Read more:
<a href="https://theconversation.com/aged-care-staff-urgently-need-training-to-report-and-prevent-sexual-assault-169734">Aged care staff urgently need training to report and prevent sexual assault</a>
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<h2>Benefits of reporting to the police</h2>
<p>Laws help set standards of what is right or wrong in society. To enforce the law, nurses must first report and make a statement to the police, so charges can be laid against a patient who commits violence. Police can then present this evidence to a prosecutor, who makes a decision if there is sufficient evidence for conviction.</p>
<p>Reporting to the police could have far-reaching impacts including:</p>
<ul>
<li>enforcing a culture of respect and safety, improved staff retention and wellbeing<br></li>
<li>helping patients learn their rights to seek health care must be balanced with nurses’ rights to a safe workplace</li>
<li>setting a consistent standard of acceptable behaviours in society that includes health-care settings.</li>
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<p>Many nurses have been assaulted by patients, but only few are reporting to the police. Employers and authorities must work together to empower and support nurses to report assaults. It is through this collective effort that we can hold patients to account, and ultimately keep nurses safe from harm. </p>
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Read more:
<a href="https://theconversation.com/paramedics-have-one-of-australias-most-dangerous-jobs-and-not-just-because-of-the-trauma-they-witness-149540">Paramedics have one of Australia's most dangerous jobs — and not just because of the trauma they witness</a>
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<img src="https://counter.theconversation.com/content/217288/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>C.J. Cabilan received funding the PA Research Foundation to conduct this research. She currently serves as the Director of Occupational Violence Prevention and Management for Canberra Health Services. The views described in the article are her own based on evidence.</span></em></p>Nurses say violence is treated as ‘part of the job’ or believe patients can’t be held accountable for their assaults if they are intoxicated or distressed.C.J. Cabilan, Adjunct Lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2135542023-11-06T05:40:20Z2023-11-06T05:40:20ZA 4-day week might not work in health care. But adapting this model could reduce burnout among staff<figure><img src="https://images.theconversation.com/files/557212/original/file-20231102-15-bi7e32.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2995%2C1576&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-stress-depression-man-on-hospital-2265615149">PeopleImages.com - Yuri A/Shutterstock</a></span></figcaption></figure><p>The COVID pandemic saw a <a href="https://www.sbs.com.au/news/article/burnt-out-australias-hospital-system-struggling-to-cope-amid-covid-19-wave-healthcare-workers-warn/lru94oiaj">mass exodus</a> of health-care workers across developed countries, exacerbating an existing <a href="https://www.afr.com/politics/no-answers-to-huge-problem-of-healthcare-worker-exodus-20230307-p5cq5o">health-care staffing crisis</a>. </p>
<p>In Australia, turnover rates among hospital staff <a href="https://www.oracle.com/au/human-capital-management/cost-employee-turnover-healthcare/#:%7E:text=In%202022%2C%20turnover%20rates%20for,to%2094%25%20at%20nursing%20homes.">reached nearly 20%</a> in 2022. Hospital waiting lists in Victoria alone ballooned to <a href="https://www.theage.com.au/national/victoria/cash-alone-won-t-fix-hospital-staffing-woes-20230414-p5d0fa.html">80,000 in 2023</a>.</p>
<p>The <a href="https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf">United States</a> and the <a href="https://www.theguardian.com/society/2023/mar/26/nhs-england-staff-shortages-could-exceed-570000-by-2036-study-finds">United Kingdom</a> have faced similar staffing issues.</p>
<p>Efforts are underway globally to <a href="https://www.education.gov.au/higher-education-funding/commonwealth-grant-scheme-cgs/20000-additional-commonwealth-supported-places">educate new health professionals</a> and boost the <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/government-cuts-red-tape-for-overseas-trained-doctors">skilled migration of doctors</a>.</p>
<p>However, retaining existing staff is a paramount strategy. </p>
<p>The pandemic accelerated the exploration of more flexible work arrangements, while the idea of a four-day work week is continually gaining traction. Could this be a solution to improve the retention of burnt out staff in the health-care sector?</p>
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Read more:
<a href="https://theconversation.com/health-worker-burnout-and-compassion-fatigue-put-patients-at-risk-how-can-we-help-them-help-us-191429">Health worker burnout and 'compassion fatigue' put patients at risk. How can we help them help us?</a>
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<h2>Burnout</h2>
<p>Health-care professionals have historically experienced <a href="https://www.mayoclinicproceedings.org/article/S0025-6196(18)30938-8/fulltext">high levels of burnout</a>. </p>
<p>The strain of balancing demanding work schedules, including long hours and shift work, with family responsibilities, can lead to work-family conflicts. Also, the nature of the profession means staff are often exposed to traumatic situations such as patient deaths, further elevating stress levels. COVID has intensified the issue of <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2021.750529/full?hidemenu=true">burnout in health care</a>. </p>
<p>Burnout commonly leads <a href="https://www.forbes.com/sites/debgordon/2022/05/17/amid-healthcares-great-resignation-burned-out-workers-are-pursuing-flexibility-and-passion/?sh=5c4314507fda">health-care workers to resign</a>, and also contributes to <a href="https://www.emerald.com/insight/content/doi/10.1108/01437721011050594/full/html?casa_token=nr9ADuU_NwcAAAAA:GpDmtyeG9mgabwrsADWwebyIQhYePpc4ZgM2Cu9VfPOsP7VQUEo5cyJhPriWp7yqA2B3HBYW-WAOPRfNF-zdlywoomCPN5Z_6FPFYc2F9hZx3-UIrPwm">early retirement</a>. </p>
<p>For those who remain in the profession, burnout <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025619616001014">negatively affects productivity</a>, including increasing the likelihood of perceived <a href="https://jamanetwork.com/journals/jama/article-abstract/203249">medical errors</a>. </p>
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<img alt="A nurse attends to a patient's IV drip." src="https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557213/original/file-20231102-25-oc7b5i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Staff shortages are a big issue in the health-care sector.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hospital-ward-professional-black-head-nurse-1985507474">Gorodenkoff/Shutterstock</a></span>
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<h2>Rise of the four-day week</h2>
<p>A four-day work week is based on the so-called 100-80-100 arrangement, where 100% of productivity is achieved in 80% of the time with 100% of pay. So that might mean working Monday to Thursday, but getting paid a full wage, and with an expectation that you’ll produce as much in four days as you did in five.</p>
<p>In a pilot study by Cambridge University and <a href="https://www.4dayweek.com">4 Day Week Global</a>, <a href="https://www.cam.ac.uk/stories/fourdayweek">71% of participants reported</a> feeling less burnt out, while there was a 57% fall in staff resignations. These outcomes <a href="https://sloanreview.mit.edu/article/how-far-reaching-could-the-four-day-workweek-become/">are similar to results</a> from trials in Belgium, Spain, Japan, Australia, and New Zealand. </p>
<p>But the execution of a four-day work week in health care comes with unique challenges. The model has primarily been trialled in office and corporate environments, where a five-day work week, totalling 35-40 hours, is conventional. </p>
<p>For many health-care workers, especially nurses, longer hours and shift work are the norm. Nurses are often expected to work on public holidays, and may have to work for <a href="https://www.healthstaffrecruitment.com.au/news/nurse-working-hours-in-australia/">six or seven consecutive days</a> before having a few days off, instead of the standard five days on, two days off. </p>
<p>Also, many health-care services, such as hospitals and aged care facilities, require staffing seven days a week. It’s imperative any restructured work arrangements are designed to ensure continuous, adequate staffing.</p>
<p>Consequently, a direct transition from a five-day to a four-day work week might not be immediately logical or applicable.</p>
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Read more:
<a href="https://theconversation.com/4-day-work-week-trials-have-been-labelled-a-resounding-success-but-4-big-questions-need-answers-201476">4-day work week trials have been labelled a ‘resounding success’. But 4 big questions need answers</a>
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<p>Instead, this model should be conceptualised more broadly for health care, focusing on reducing and optimising working hours, and addressing the specifics of rostering and workforce planning in the industry. </p>
<h2>Applying this model to health care</h2>
<p>The focus should be on achieving greater productivity through reducing stress and burnout. Although shifting to a four-day work week won’t necessarily be practical, there should be an emphasis on shorter hours, guided by the 100-80-100 model.</p>
<p>The application of this model within health care would vary. For example, specialist physicians work <a href="https://labourmarketinsights.gov.au/occupation-profile/specialist-physicians?occupationCode=2533#:%7E:text=Around%2079%25%20of%20people%20employed,(44%20hours%20per%20week).">50 hours a week on average</a>, so applying the model would reduce their work week to 40 hours.</p>
<p>Shift design, particularly <a href="https://link.springer.com/article/10.1007/s10729-022-09613-4">for nurses</a>, should focus on ways to reduce fatigue and in turn burnout. This might include scheduling shifts at a consistent time of day for individual staff members, implementing shorter shifts, and rostering reasonable consecutive working days (instead of seven or more days in a row before getting a day off).</p>
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<img alt="Four people working around a table in an office." src="https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557214/original/file-20231102-21-q9g8oq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Trials of a four-day work week have shown positive results in corporate settings.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/office-colleagues-having-casual-discussion-during-1791564398">Jacob Lund/Shutterstock</a></span>
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<h2>The benefits</h2>
<p>Reducing the hours worked and optimising shift rostering could help to alleviate stress, burnout and work-family conflict for health-care workers. All this is likely to improve staff retention.</p>
<p>Any reduction in staff turnaround would save on direct costs associated with hiring new staff. The cost to replace a highly specialised health-care professional can reach up to <a href="https://www.oracle.com/au/human-capital-management/cost-employee-turnover-healthcare/">200% of their annual salary</a>. </p>
<p>Also, implementing shorter shifts – for example shifts lasting four or eight hours instead of 12 – may <a href="https://upaged.com/blog/healthcare-organisations-workplace-flexibility/">increase the uptake of</a> shift times that are usually hard to fill. Measures like shorter shifts could also appeal to part-time workers or those who have retired.</p>
<p>Finally, reducing burnout and absenteeism will improve productivity among staff. This will indirectly lower costs and benefit public health.</p>
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Read more:
<a href="https://theconversation.com/a-burnt-out-health-workforce-impacts-patient-care-180021">A burnt-out health workforce impacts patient care</a>
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<h2>Some challenges</h2>
<p>As it can take a <a href="https://ipractice.nl/en/symptoms/burnout/treatment-and-recovery/#:%7E:text=How%20Long%20Does%20Burnout%20Last,or%20periods%20of%20stagnant%20recovery.">few months</a> to a <a href="https://www.wellics.com/blog/how-long-to-recover-from-burnout">few years</a> to recover from burnout, once any changes are implemented, the benefits would take time to be seen. </p>
<p>And reducing working hours as well as other changes to rostering will initially be difficult given current staff shortages in the sector. </p>
<p>Hopefully, measures such as migration incentives and subsidised training for health-care professionals will bolster the workforce and make bridging this gap a little easier.</p>
<p>Although the implementation is not straightforward, changes to working arrangements in the health-care sector could have an even greater positive impact than in other industries.</p><img src="https://counter.theconversation.com/content/213554/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nataliya Ilyushina receives funding from the ARC Centre of Excellence.</span></em></p>The COVID pandemic has exacerbated staff shortages in health care. We need to think about how we can better retain staff in this sector.Nataliya Ilyushina, Research Fellow, Blockchain Innovation Hub, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104252023-09-13T18:40:20Z2023-09-13T18:40:20ZSolving Canada’s shortage of health professionals means training more of them, and patients have a key role in their education<figure><img src="https://images.theconversation.com/files/547848/original/file-20230912-7671-ly0s9f.jpg?ixlib=rb-1.1.0&rect=131%2C186%2C5013%2C3523&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A fundamental component for training health-care professionals is interacting with patients and families.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/solving-canadas-shortage-of-health-professionals-means-training-more-of-them-and-patients-have-a-key-role-in-their-education" width="100%" height="400"></iframe>
<p><a href="https://www.ctvnews.ca/health/canadians-worried-about-the-state-of-provincial-health-systems-poll-1.6248713">Eighty-six per cent of Canadians</a> are worried about their health-care systems. Health-care professional organizations like the <a href="https://www.cma.ca/about-us/what-we-do/press-room/health-care-groups-call-premiers-make-canadas-collapsing-health-system-their-top-priority#:%7E:text=%22Canada%27s%20health%20care%20system%20is%20in%20crisis.%20While,only%20added%20fuel%20to%20an%20already%20raging%20fire.">Canadian Medical Association</a> and the <a href="https://www.casn.ca/2022/11/casn-releases-nurses-education-in-canada-statistics-report-2020-2021/">Canadian Association of Schools of Nursing</a> are sounding the alarm about the severe shortage of health-care providers. This shortage is contributing to Canada’s health-care crisis. </p>
<p>Canada urgently needs more trained health-care professionals. While they may not know it, everyone in Canada can play a key role in educating future health-care providers. </p>
<p>Each encounter that health-care students have with patients, families and communities helps them develop real-world understanding of the various needs of the diverse Canadian population.</p>
<h2>Canada’s shortage of health-care workers</h2>
<p>The House of Commons Standing Committee on Health’s March 2023 report titled <a href="https://www.ourcommons.ca/Content/Committee/441/HESA/Reports/RP12260300/hesarp10/hesarp10-e.pdf">Addressing Canada’s Health Workforce Crisis</a> explored and substantiated this shortage of health-care professionals. This report primarily focused on physicians and nurses. Canada anticipates a shortfall of <a href="https://www.canada.ca/en/employment-social-development/news/2023/06/canada-is-addressing-current-and-emerging-labour-demands-in-health-care.html">78,000 physicians</a> by 2031, and <a href="https://www.canadian-nurse.com/blogs/cn-content/2023/04/17/solutions-to-tackle-nursing-shortage#:%7E:text=A%202019%20analysis%20predicted%20a,care%20(OECD%2C%202022).">117,600 nurses</a> by 2030. </p>
<p>Other professions are also sounding the alarm of practitioner shortages, including <a href="https://www.ourcommons.ca/Content/Committee/441/HESA/Reports/RP12260300/hesarp10/hesarp10-e.pdf">dental professionals, medical laboratory specialists, occupational therapists</a> and <a href="https://www.longwoods.com/audio-video/longwoods-breakfast-series/Youtube/9588">pharmacists</a>. </p>
<p>In addition to these predictions, there are significant concerns about keeping the care providers we currently have. A 2022 report from the <a href="https://nursesunions.ca/wp-content/uploads/2022/11/CHWN-CFNU-Report_-Sustaining-Nursing-in-Canada2022_web.pdf">Canadian Federation of Nurses Unions</a> found that 94 per cent of nurse respondents showed signs of burnout, and over half wanted to leave their current job. Other health professions have raised similar concerns. </p>
<h2>Addressing the shortage</h2>
<p>There is no quick fix to these complex problems, and Canada is responding in a variety of ways. This includes recruiting <a href="https://www.canada.ca/en/employment-social-development/news/2022/12/government-of-canada-launches-call-for-proposals-to-help-internationally-educated-professionals-work-in-canadian-healthcare.html">internationally trained</a> practitioners, funding strategies to improve <a href="https://www.canada.ca/en/health-canada/news/2023/04/government-of-canada-announces-support-to-help-address-workforce-challenges-and-retention-in-nursing-field.html">retention</a> and increasing <a href="https://www.universityaffairs.ca/news/news-article/provincial-budget-round-up-2023-highlights-for-the-university-sector/">educational seats</a> to train more future health-care providers. </p>
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<img alt="A woman in scrubs shakes hands with a man using a wheelchair in front of two other people in scrubs" src="https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547868/original/file-20230912-5779-i19k0y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Each encounter that health-care students have with patients, families and communities helps them develop real-world understanding of the various needs of the diverse Canadian population.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>These responses are being created from <a href="https://www.canada.ca/en/health-canada/news/2022/11/health-canada-announces-coalition-for-action-for-health-workers.html">federal</a>, provincial (such as <a href="https://novascotia.ca/news/release/?id=20221114001">Nova Scotia</a>) and local levels. However, these strategies are not quick fixes and efforts may not be successful. </p>
<p><a href="https://www.cbc.ca/news/health/financial-perks-doctor-recruitment-1.6548194">Retention efforts</a> have not been as effective as anticipated, as financial incentives do not appear to have the same influence they might have had in the past. International recruitment is fraught with <a href="https://theconversation.com/the-ethics-of-recruiting-international-health-care-workers-canadas-gains-could-mean-another-countrys-pain-208542">ethical concerns</a> and complex processes applicants need to work through in order to become licensed to practice.</p>
<h2>Education investments</h2>
<p>Significant provincial investments are being announced to create more seats in education programs for health-care professional students. The <a href="https://edmontonjournal.com/news/politics/alberta-to-expand-seats-in-health-care-education-with-200-million-over-three-years">Alberta government</a> is investing $72 million for 3,400 new seats in a variety of health-related training programs and $20 million for the creation of 120 new physician seats. </p>
<p><a href="https://globalnews.ca/news/9448757/additional-seats-saskatchewan-health-care-training-programs/">Saskatchewan</a> is adding 550 health-care provider education seats. <a href="https://news.umanitoba.ca/manitoba-government-announces-80-physician-training-seats-to-be-added/">Manitoba</a> announced an investment of $200 million for 2,000 health-care professionals, including 80 new physician seats and four <a href="https://news.gov.mb.ca/news/index.html?item=56297">respiratory therapy</a> students. </p>
<p><a href="https://www.universityaffairs.ca/news/news-article/provincial-budget-round-up-2023-highlights-for-the-university-sector/">Other provinces</a> are also investing in a variety of ways such as educational program grants to expand enrolment in Ontario, and student financial support in Prince Edward Island.</p>
<p>While increased training opportunities can increase the future workforce, having more students also requires additional resources and learning opportunities. Education for health-care professionals varies by the type of provider, and can range from certificate programs to graduate degrees. </p>
<h2>How Canadians can help</h2>
<p>We are a team of interdisciplinary researchers who teach health-care professionals in their foundational training. We know that despite significant differences in health-care education programs, one fundamental component for all learners is interacting with patients and families. </p>
<p>That means all Canadians play an essential part in educating future health-care providers. With more students enrolling, Canadians will have even more engagement with students in health-care settings.</p>
<p>Most health-care education programs include public interaction. Some public members purposefully engage. For example, some become guest speakers in classes, and share personal experiences with illness and health care. But more commonly, people engage with health-care professional students while looking after their health needs. </p>
<p>Canadians can anticipate interacting with students in common health-care spaces such as pharmacies, physiotherapy clinics, dental clinics, public health clinics, doctor’s offices, hospitals or outpatient clinics. But students may also be found in less expected places such as food banks, non-profit community organizations, schools and community settings. </p>
<p>Members of the public may feel less inclined to interact with students. This can be due to the perceived increased time it takes, worries about students’ knowledge or abilities, or because they might feel that they <a href="https://doi.org/10.1016/j.ijnurstu.2018.04.010">don’t have anything to contribute</a>. However, it is important for Canadians to know about the benefits of these interactions for both students and patients.</p>
<h2>What Canadians can teach health-care professional students</h2>
<p>Research has identified that student encounters with public patients and family members contributed to the development of their <a href="https://doi.org/10.1007/s10459-022-10137-3">communication</a>, <a href="https://doi.org/10.1080/0142159X.2019.1652731">compassion and empathy skills</a>. It also helped decrease stigma towards traditionally stigmatized groups and conditions, such as those with <a href="https://doi.org/10.1111/1440-1630.12205">mental illness</a>. </p>
<p>Interacting with the Canadian public also increased students’ ability to <a href="https://doi.org/10.1111/j.1365-2850.2011.01858.x">use appropriate language</a> and <a href="https://doi.org/10.1111/j.1365-2850.2012.01955.x">work with patients</a>. It enhanced their <a href="http://dx.doi.org/10.1136/bmjopen-2020-037217">self-confidence</a> and their motivation in caring for the public.</p>
<h2>How does this impact Canadians?</h2>
<p>While these interactions benefit student learning and will help contribute to a larger health workforce, they have also been found to benefit the public. </p>
<p>Research has found that student encounters can increase a patient’s <a href="https://doi.org/10.1111/inm.12021">sense of empowerment</a> to participate in their own health with shared decision-making. Additionally, there is a potential for the improvement of overall <a href="https://doi.org/10.1007/s10459-022-10137-3">health outcomes</a> of patients. One study found patients were more knowledgeable and better able to <a href="https://doi.org/10.1016/j.japh.2021.08.014">manage their own medications</a> after engaging with student practitioners.</p>
<p>The shortage of health professionals in Canada, and globally, is of sincere concern. To address this, it is essential that we increase the number of professionals being trained. This requires the Canadian public’s assistance as they encounter more health-care professional students. </p>
<p>Investing your time in interacting with students has benefits for the students and for you. Canadians can all play a part in building the future health workforce we desperately need. As health-care professionals, we thank you for the important role you play in educating and shaping our students and future health workforce. </p>
<p><em>Bryn Keogh co-authored this article. She is an undergraduate student at the University of Calgary in communication and media studies and received an Alberta Innovates Summer Research Studentship.</em></p><img src="https://counter.theconversation.com/content/210425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Each encounter that health-care students have with patients and families helps them understand real-world patient needs. That means all Canadians have a role in educating future health-care providers.Lisa McKendrick Calder, Associate Professor, Nursing, MacEwan UniversityEleftheria Laios, Educational Developer, Queen's University, OntarioKerry Wilbur, Associate Professor and Executive Director, Entry-to-Practice Education, Faculty of Pharmaceutical Sciences, University of British ColumbiaLorelli Nowell, Associate Professor and Assistant Dean of Graduate Programs, Faculty of Nursing, University of CalgaryWhitney Lucas Molitor, Associate Professor and Program Director, Occupational Therapy Department, University of South DakotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2113982023-08-22T12:25:59Z2023-08-22T12:25:59ZMost US nursing homes are understaffed, potentially compromising health care for more than a million elderly residents<figure><img src="https://images.theconversation.com/files/542411/original/file-20230811-21-ml692x.jpg?ixlib=rb-1.1.0&rect=0%2C23%2C7959%2C5266&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nursing homes in poorer neighborhoods tend to have more critical staffing issues.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-male-care-worker-helping-woman-off-bed-with-royalty-free-image/1433524154?phrase=nursing+home&adppopup=true">10'000 Hours/Digital Vision via Getty Images</a></span></figcaption></figure><p><em>More than 80% of U.S. nursing homes <a href="https://thehill.com/changing-america/well-being/longevity/3809450-more-than-8-in-10-nursing-homes-face-staffing-shortages-survey/#:%7E">reported staffing shortages</a> in early 2023. SciLine interviewed <a href="https://nursing.nyu.edu/directory/faculty/jasmine-travers">Dr. Jasmine Travers</a>, a gerontological nurse practitioner and assistant professor of nursing at New York University Rory Meyers College of Nursing, and asked her how the shortage affects health care for nursing home residents, if nursing homes in poorer neighborhoods have been hit harder by the shortages, and what can be done to fix the problem.</em></p>
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<figcaption><span class="caption">Dr. Jasmine Travers discussed the impact when nursing homes are short-staffed.</span></figcaption>
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<p><em>Below are some highlights from the discussion. Answers have been edited for brevity and clarity.</em></p>
<p><strong>Who lives in nursing homes in the United States?</strong></p>
<p><strong>Jasmine Travers:</strong> There are 15,000 nursing homes with approximately <a href="https://oig.hhs.gov/reports-and-publications/featured-topics/nursing-homes/">1.2 million residents</a>. That population can range in age, although most commonly it’s those 65 years of age or older.</p>
<p><strong>What is the current state of nursing home staffing?</strong></p>
<p><strong>Jasmine Travers:</strong> In 2001, the Centers for Medicare & Medicaid Services proposed minimum staffing standards. They indicated that total nursing hours should be <a href="https://doi.org/10.1177/1178632920934785">4.1 hours per resident per day</a>. And that’s including the registered nurse, the licensed practical nurse and the certified nursing assistants. Only 25% of nursing homes were found <a href="https://doi.org/10.1111/jgs.17678">to be meeting those total nursing hours</a> in 2019.</p>
<p><strong>How did the COVID-19 pandemic affect nursing home occupancy and staffing?</strong></p>
<p><strong>Jasmine Travers:</strong> Occupancy levels hovered at about 80% prior to the pandemic. During the pandemic, occupancy went down to a low of 67%. By the end of 2022, those levels <a href="https://www.statista.com/statistics/1223881/occupancy-rate-of-certified-nursing-facilities-in-the-united-states/">had gone up to 72%</a>. </p>
<p>Lower occupancy levels can be a significant issue. Higher occupancy brings in more revenue to the nursing homes. With lower occupancy and less revenue coming in, then that’s a decrease in financial support that the nursing home needs to run their day-to-day activities.</p>
<p><strong>How does nursing home staffing affect the quality of care and health outcomes for residents?</strong></p>
<p><strong>Jasmine Travers:</strong> A number of studies show that when staffing is low, <a href="https://doi.org/10.1177/1178632920934785">emergency hospitalization visits</a> increase. Some of these visits could have been addressed by care provided in the nursing home setting. We also see increased instances of <a href="https://doi.org/10.1016/j.jamda.2004.12.003">pressure ulcers</a>, <a href="https://doi.org/10.1093/geronb/55.5.S278">urinary tract infections</a>, <a href="http://dx.doi.org/10.14283/jnhrs.2020.24">falls</a> and <a href="https://doi.org/10.1080/08959420.2011.532011">deficiency citations</a> – issued when a nursing home does not <a href="https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter08-10.pdf">meet a certification minimum standard</a>. </p>
<p>When nursing homes are understaffed, that means there might not be a sufficient number of certified nursing assistants to, for example, answer call bells. That might translate to residents sitting in their beds needing help for longer periods of time. </p>
<p>In those instances, if a person doesn’t have someone to get them out of bed, sometimes they might try to get up themselves. And when they do that, they could be at risk of falling. Or if they stay in bed and they’re soiled, they’re at increased risk for urinary tract infections or pressure ulcers. </p>
<p><strong>What can be done to alleviate nursing home staffing challenges?</strong></p>
<p><strong>Jasmine Travers:</strong> Areas that are socioeconomically deprived or that lack good transportation, housing and schools are less <a href="https://doi.org/10.1111/jgs.17990">desirable places to work</a>. </p>
<p>Just recently, the Centers for Medicare & Medicaid Services released an announcement that they are going to allow for those in pediatric specialties to receive loan reimbursements and loan forgiveness <a href="https://www.hhs.gov/about/news/2023/06/09/hhs-announces-new-15-million-loan-repayment-program-strengthen-pediatric-health-care-workforce.html">for working in underserved areas</a>. A similar program for those working in nursing homes would likely increase staffing. </p>
<p>I’d also like to see improved wages and benefits and more investment in retention efforts to keep the people who are already working in nursing homes working there.</p>
<p>One of the biggest issues when it comes to staffing is turnover. People will stay when the work environment is changed. And when people stay longer, they know their residents more. That consistency translates to better quality of care.</p>
<p>Watch the <em><a href="https://www.sciline.org/health-medicine/nursing-home-staffing/">full interview</a></em> to hear more.</p>
<p><em><a href="https://www.sciline.org/">SciLine</a> is a free service based at the nonprofit American Association for the Advancement of Science that helps journalists include scientific evidence and experts in their news stories.</em></p><img src="https://counter.theconversation.com/content/211398/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jasmine Travers receives funding from Robert Wood Foundation and the National Institutes of Health. </span></em></p>Reduced staffing means nursing home residents make more unnecessary trips to the hospital.Jasmine Travers, Assistant Professor of Nursing, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082652023-07-14T13:04:49Z2023-07-14T13:04:49ZThe NHS relies on nurses from poorer countries to fill jobs – here’s how to tackle this problem<figure><img src="https://images.theconversation.com/files/536882/original/file-20230711-2328-m8ypho.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6144%2C3456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-american-nurse-holding-digital-tablet-2056112471">DC Studio/Shutterstock</a></span></figcaption></figure><p>Recent <a href="https://www.bbc.co.uk/news/world-africa-65808660">media reports</a> have highlighted the issue of nurses coming to the UK to work for the NHS from poorer countries with their own nursing shortfalls. This is a problem because when nurses leave countries that already have workforce shortages, healthcare in those countries inevitably suffers.</p>
<p>The World Health Organization (WHO) has identified <a href="https://www.who.int/publications/i/item/9789240069787">more than 50 countries</a> where exporting nurses is putting their healthcare systems at risk. The WHO advises that in these countries, international recruitment should only take place if very carefully managed.</p>
<p>While we would not criticise any person who is looking for a better life for themselves and their family, nurses are often trained at taxpayers’ expense to meet the pressing healthcare needs in their own countries. </p>
<p>So is there a better way?</p>
<h2>Not a new trend</h2>
<p>It’s important to see this phenomenon in its <a href="https://doi.org/10.1258/jrsm.2010.100222">historical context</a>. Britain has been recruiting nurses from its former colonies since the 1940s. Some of the original Windrush passengers 75 years ago were nurses and midwives <a href="https://blog.nationalarchives.gov.uk/ena-clare-sullivan-a-jamaican-nurse-aboard-the-empire-windrush/">from Jamaica</a> who had been invited to work in the newly-created NHS to meet workforce needs.</p>
<p>According to the <a href="https://www.nmc.org.uk/globalassets/sitedocuments/annual_reports_and_accounts/2022-annual-reports/international-joiners-data-report-2021-2022.pdf">Nursing and Midwifery Council</a>, the countries that the UK recruits the most nurses from post-Brexit are India, the Philippines, Nigeria, Zimbabwe, Ghana, Kenya and Nepal. </p>
<p>Some 91% of the overseas nurses registered to practice in the UK in 2021-2022 came from these seven countries. Four of these countries (Nigeria, Zimbabwe, Ghana and Nepal) are on the WHO’s safeguarding list. </p>
<p>Countries such as the Philippines and India – where the majority of internationally trained nurses in the UK come from – have a “surplus” of nurses, insofar as they train more nurses than they can employ with the intention that those nurses will work elsewhere. The Philippines in particular is economically dependent on the remittance of expatriate citizens, <a href="https://www.tandfonline.com/doi/abs/10.1080/14747731.2022.2153492">including nurses</a>. </p>
<p>Nonetheless, both the Philippines and especially India have very low levels of nurses <a href="https://data.worldbank.org/indicator/SH.MED.NUMW.P3">per capita</a>, according to data from the World Bank. This is even more of an issue <a href="https://core.ac.uk/download/pdf/303923116.pdf">in rural areas</a>. Given this, and the underdeveloped state of their <a href="https://core.ac.uk/download/pdf/303923116.pdf">healthcare systems</a>, recruiting nurses even from these countries is not a straightforward ethical proposition.</p>
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Read more:
<a href="https://theconversation.com/its-like-being-in-a-warzone-aande-nurses-open-up-about-the-emotional-cost-of-working-on-the-nhs-frontline-194197">'It's like being in a warzone' – A&E nurses open up about the emotional cost of working on the NHS frontline</a>
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<p>This is not a uniquely British situation. Of the OECD countries, the UK is similar to New Zealand, Switzerland and Australia where <a href="https://www.oecd-ilibrary.org/social-issues-migration-health/international-migration-and-movement-of-nursing-personnel-to-and-within-oecd-countries-2000-to-2018_b286a957-en">at least 20%</a> of the nursing workforce is trained elsewhere.</p>
<p>Even Japan, a country that has traditionally been wary of immigration, is now recruiting nurses from <a href="https://www.researchgate.net/publication/265260791_Globalization_of_Care_and_the_Context_of_Reception_of_Southeast_Asian_Care_Workers_in_Japan">Indonesia and the Philippines</a>. This means that the UK is in competition with other rich countries for nurses and other healthcare workers.</p>
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<img alt="A male nurse of Indian appearance with a senior female patient." src="https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536885/original/file-20230711-29-w0cmgy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many nurses in the UK are originally from India.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-indian-male-medical-nurse-consults-2093439340">The Imagineers/Shutterstock</a></span>
</figcaption>
</figure>
<h2>What’s the solution?</h2>
<p>The obvious long-term solution, featured in the recent <a href="https://www.england.nhs.uk/publication/nhs-long-term-workforce-plan/">NHS workforce plan</a>, is to train more nurses in the UK. However, this is not as simple as funding additional places at university for students to study nursing. Student nurses need supervised practice as part of their education, and the NHS has <a href="https://www.nhsemployers.org/articles/expanding-placement-capacity">a limited capacity</a> to absorb students, especially given the pressure the system is under. </p>
<p>It takes at least three years to train a nurse, and longer before they can take on complex roles like advanced nurse practitioner. Around the world, there is also a shortage of nursing lecturers (notably <a href="https://www.aacnnursing.org/news-data/fact-sheets/nursing-faculty-shortage">in the US</a>). </p>
<p>While there is not yet firm evidence of such a shortage in the UK, the nursing lecturer workforce, like the wider nursing workforce, is ageing, with many <a href="https://www.nmc.org.uk/about-us/reports-and-accounts/registration-statistics/">set to retire</a> in the coming years. </p>
<p>In the short term, the policy intervention that will be most effective is for the NHS to retain more of the nurses that it already has. The easiest and quickest way of doing this would be to pay nurses more and give them better working conditions, including improved professional development and training. </p>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/35669147/">own research</a> supports this. We ran a development programme for late-career nurses and the participants talked about “feeling energised” by the programme.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nhs-nurses-pressures-taking-toll-on-compassion-and-kindness-our-new-study-shows-84315">NHS nurses: pressures taking toll on compassion and kindness, our new study shows</a>
</strong>
</em>
</p>
<hr>
<p>The UK government has reached agreements with <a href="https://www.gov.uk/government/publications/memorandum-of-understanding-between-the-uk-and-nepal-on-the-recruitment-of-healthcare-workers">Nepal</a> and <a href="https://www.gov.uk/government/publications/uk-and-india-collaboration-on-healthcare-workforce-framework-agreement">India</a> that aim to allow the UK to recruit healthcare workers from these countries but without damaging their healthcare systems. They are currently frameworks for the development of more detailed policy but do not contain specific targets for recruitment numbers. </p>
<p>Given global economic inequalities, and <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">ageing populations</a> in the world’s richer countries, some movement of nurses from poorer countries to richer countries is inevitable, at least in the short term. </p>
<p>But there are measures that richer countries can take to manage this process ethically, not least a strong commitment to the existing nursing workforce in terms of pay, working conditions and development.</p><img src="https://counter.theconversation.com/content/208265/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A strong commitment to improving things for the existing nursing workforce in the UK is essential to addressing this issue.Stephen Timmons, Professor of Health Services Management, University of NottinghamJoy Spiliopoulos, Research Associate, SAPPHIRE research group, Department of Health Sciences, University of LeicesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085422023-07-11T21:02:29Z2023-07-11T21:02:29ZThe ethics of recruiting international health-care workers: Canada’s gains could mean another country’s pain<figure><img src="https://images.theconversation.com/files/536865/original/file-20230711-21-kbh5nf.jpg?ixlib=rb-1.1.0&rect=269%2C417%2C4223%2C2580&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Recruiting health workers from countries on the World Health Organization’s safeguard list without robust and reciprocal benefits for the countries sending them does not meet ethical standards. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Canadians know we are facing a health workforce crisis, from the <a href="https://doi.org/10.1503/cmaj.1096049">estimated 6.5 million who do not have a primary care provider</a>, to those waiting months for <a href="https://www.camrt.ca/wp-content/uploads/2023/05/HHR_crisis_radiology_news_release_May_30_2023_FINAL.pdf">medical imaging</a> and hours in <a href="https://doi.org/10.1503/cmaj.230719">emergency rooms</a>. While the World Health Organization (WHO) declared the COVID-19 <a href="https://www.who.int/europe/emergencies/situations/covid-19">Public Health Emergency</a> over in May 2023, Canada’s health workforce crisis has no end in sight. </p>
<p>As researchers with the <a href="https://www.hhr-rhs.ca/en/">Canadian Health Workforce Network</a>, we see the roots of this crisis in <a href="https://www.policyschool.ca/wp-content/uploads/2021/12/HC5_Improved-Health-Care_Bourgeault.pdf">poor workforce planning</a> and the inadequate integration of <a href="https://doi.org/10.1186/s12960-022-00748-7">immigrant health workers</a>. The consequences of poor planning are evident, as are the <a href="https://doi.org/10.1177/08404704221095129">ethical ramifications</a> of solving our problems through global recruitment.</p>
<h2>Canada’s health workforce crisis is more than a national issue</h2>
<p>The Canadian Academy of Health Sciences and the Royal Society of Canada established an <a href="https://rsc-src.ca/en/programmes/canada%E2%80%99s-role-in-global-health-rsccahs-expert-panel">expert panel</a> to assess Canada’s role in global health and identify opportunities for Canada to “be true to its announced values of equity, human rights, and global citizenship.” </p>
<p>One way to promote Canadian health leadership is to align practices with the WHO’s <a href="https://www.who.int/publications/i/item/wha68.32">Global Code on the Practice of International Recruitment of Health Personnel</a>. This voluntary code was agreed to by all member states in 2010. Its key principles are ethical recruitment, a commitment to planning and international co-operation.</p>
<ul>
<li><p>Ethical practices include discouraging active recruitment from countries listed on the WHO’s health workforce support <a href="https://www.who.int/publications/i/item/9789240069787">safeguards list</a>, which identifies “countries with the most pressing health workforce needs related to universal health coverage.”</p></li>
<li><p>Robust health workforce planning strategies include strengthening health workforce data and implementing plans with a goal of health workforce sustainability and self-sufficiency. Robust data can ensure policies and planning are evidence-based, and document the impact of international recruiting on health systems. The goal should be sustainable, self-sufficient health workforces, including appropriate education, training and retention policies.</p></li>
<li><p>International co-operation between source and destination countries includes technical assistance and financial support to ensure benefits are mutual.</p></li>
</ul>
<h2>Why is the WHO Code important to reflect upon now?</h2>
<figure class="align-center ">
<img alt="Health workers in scrubs and white coats wearing face masks" src="https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536871/original/file-20230711-20-4r06r2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Recruiting and integrating internationally educated health personnel is part of proposed solutions to Canada’s health worker crisis.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Recent Canadian health workforce reports identify the recruitment and integration of internationally educated health personnel (IEHPs) as part of the solution to the health worker crisis. The Parliamentary Standing Committee on Health held hearings on addressing Canada’s health workforce crisis, and the top four recommendations from its <a href="https://www.ourcommons.ca/DocumentViewer/en/44-1/HESA/report-10/">March 2023 report</a> all referenced IEHPs:</p>
<ul>
<li>greater collaboration between all levels of government and relevant stakeholders to streamline the process to recruit from countries that are known to train more health workers than they need domestically; </li>
<li>to provide more residency positions for international medical graduates; </li>
<li>expand pathways to <a href="https://www.mcc.ca/about/route-to-licensure/">qualifying for a licence to practice medicine in Canada</a> (licensure) for international physicians who have already completed their residency; and </li>
<li>support expedited pathways to licensure and practice. </li>
</ul>
<p>The <a href="https://cahs-acss.ca/assessment-on-health-human-resources-hhr/">Canadian Academy of Health Sciences</a> report also offers “pathways forward to ease the health workforce crisis,” including improving the integration of IEHPs.</p>
<h2>Provincial recruiting strategies</h2>
<p>Sub-national governments are also focused on international recruitment and integration. In British Columbia, <a href="https://www.healthmatchbc.org/Moving-to-BC/Immigration">Health Match BC</a> is assisting health professionals to immigrate, and <a href="https://news.gov.bc.ca/releases/2023HLTH0001-000013">legislation</a> now makes it easier for internationally educated nurses to work in the province. </p>
<p><a href="https://www.alberta.ca/health-workforce-strategy.aspx">Alberta</a> developed a health workforce strategy that includes attracting IEHPs. <a href="https://www.saskatchewan.ca/residents/moving-to-saskatchewan/live-in-saskatchewan/by-immigrating/saskatchewan-immigrant-nominee-program/browse-sinp-programs/applicants-international-skilled-workers/international-healthcare-worker-eoi-pool">Saskatchewan</a> launched an international health worker pool for <a href="https://www.canada.ca/en/immigration-refugees-citizenship/services/immigrate-canada/provincial-nominees/works.html">Provincial Nominee Program</a> candidates. <a href="https://healthcareersmanitoba.ca/buildyourfuturemb/">Manitoba</a> started recruiting health-care workers directly from the Philippines. </p>
<p>Ontario has both made it easier for health workers <a href="https://news.ontario.ca/en/release/1002650/new-as-of-right-rules-a-first-in-canada-to-attract-more-health-care-workers-to-ontario">from other provinces</a> to practice there, and also directed its licensing bodies to streamline integration processes for immigrants in the province with a <a href="https://www.cbc.ca/news/canada/toronto/college-temporarily-register-international-nurses-1.6555165">nursing or medical credential</a>.</p>
<p><a href="https://montreal.ctvnews.ca/quebec-on-track-to-recruit-1-000-nurses-from-french-speaking-countries-1.6339396">Québec</a> launched an international recruitment drive to hire over 1,000 French-speaking nurses in February 2022. </p>
<p><a href="https://www.cbc.ca/news/canada/new-brunswick/health-care-workers-new-brunswick-nurses-1.6736196">New Brunswick</a> partnered with Vitalité Health Network to send nurse recruiters to Senegal and Ivory Coast (countries on the WHO’s safeguard list). <a href="https://www.saltwire.com/atlantic-canada/news/nova-scotia-recruits-65-refugees-from-kenya-for-continuing-care-work-100810963/">Nova Scotia</a> has recruited 65 refugees from Kenyan refugee camps who will be employed in the continuing care sector. <a href="https://www.gov.nl.ca/releases/2022/exec/1103n02/">Newfoundland and Labrador</a> has launched a mission to recruit nurses directly from India.</p>
<h2>How compatible are these practices with the WHO Code?</h2>
<p>Recruitment and integration efforts have seen provinces develop novel and seemingly ethical plans to recruit IEHPs and provide them a pathway to practice in Canada. However, recruiting health workers from countries on the WHO’s safeguard list without robust and reciprocal benefits for the countries sending them fails the ethical test. </p>
<p>Merging employment and refugee selection channels also suggests ethical concerns beyond health workforce issues, since refugee systems are based on the <a href="https://freemovement.org.uk/briefing-is-labour-mobility-for-skilled-refugees-a-good-idea/">vulnerability individuals</a> face, not their occupational compatibility.</p>
<p>The absence of health workforce planning discussions is notable. Canada’s ability to approach self-sufficiency is limited by its lack of robust plans, and by the lack of data to support planning. This includes how <a href="https://doi.org/10.1186/s12960-022-00748-7">immigration fits into the health workforce</a>. The proposal to establish a <a href="https://www.canada.ca/en/health-canada/news/2023/03/statement-from-the-minister-of-health-and-minister-of-mental-health-and-addictions-and-associate-minister-of-health-on-the-coalition-for-action-for.html">Centre of Excellence on health worker data</a> can begin to address these gaps.</p>
<p>Siloed responses from health and international development government ministries means we miss opportunities to support international co-operation and <a href="https://www.balsillieschool.ca/wp-content/uploads/2022/12/Global-Skills-Mobility-Partnerships-ZAJ-RF-RH-LLB.pdf">develop integrative solutions</a> to health workforce issues beyond Canada’s own international recruitment efforts.</p>
<p>We encourage greater attention to these different facets of the WHO Code as national, provincial and territorial governments seek to address their present and ongoing health workforce challenges. This approach would be more in keeping with Canada’s role on the global stage than is presently the case.</p><img src="https://counter.theconversation.com/content/208542/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Margaret Walton-Roberts receives funding from SSHRC. She is affiliated with Canadian Health Workforce Network.</span></em></p><p class="fine-print"><em><span>Ivy Lynn Bourgeault receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council of Canada. Through the Canadian Health Workforce Network, she has received funds from Health Canada and Service Canada.</span></em></p>Recruiting internationally educated health workers is a key part of Canada’s proposed solution to the health worker crisis. But there are ethical questions about recruiting from foreign countries.Margaret Walton-Roberts, Chair professor, Geography and Environmental studies, Wilfrid Laurier UniversityIvy Lynn Bourgeault, Professor, School of Sociological and Anthropological Studies, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1993862023-02-09T22:44:03Z2023-02-09T22:44:03ZHealth-care worker strikes in the United Kingdom: Are there lessons for Canada’s health crisis?<figure><img src="https://images.theconversation.com/files/509279/original/file-20230209-22-e2n15h.jpg?ixlib=rb-1.1.0&rect=36%2C7%2C4787%2C3196&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nurses of the University College Hospital protest in London on Feb. 6, 2023. The walkout is part of a wave of health worker strikes and demonstrations in recent months.</span> <span class="attribution"><span class="source">(AP Photo/Frank Augstein)</span></span></figcaption></figure><p>It is a “season of strikes” for health-care workers in the United Kingdom. Nurses and ambulance workers employed within the National Health Service (NHS) in England, Wales and Northern Ireland conducted <a href="https://www.reuters.com/world/uk/britain-faces-largest-ever-healthcare-strikes-pay-disputes-drag-2023-02-05/">the largest strike</a> in the organization’s history on Feb. 6, 2023, after initiating strikes in December 2022. </p>
<p>Nurses, ambulance workers and physiotherapists will continue their industrial action this week. Junior doctors <a href="https://www.reuters.com/world/uk/uk-junior-doctors-vote-strike-action-england-union-says-2023-01-20/">are set to follow</a> after voting in favour of strike action this month. </p>
<p>Media attention to these labour disputes by <a href="https://www.cbc.ca/player/play/2151515715974">Canadian</a> and <a href="https://time.com/6233694/nurses-strike-nhs-rcn-hospitals/">international</a> news outlets has been intriguing. Health workers strike with <a href="https://accountabilityresearch.org/publication/heroes-on-strike-trends-in-global-health-worker-protests-during-covid-19/">regularity</a> around the world, particularly in the COVID-19 era. Why, then, is there so much interest in these particular strikes? </p>
<h2>Holding up a mirror</h2>
<p>One reason is the context in which these strikes are occurring; the U.K. is facing <a href="https://www.cbc.ca/news/world/britain-strike-uk-labour-unrest-1.6733623">labour disputes across multiple sectors</a>, underscoring a broader and deeper crisis in government-labour relations in the country.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People holding signs reading 'Fair Pay for Nurses' and 'Staff shortages cost lives'" src="https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509285/original/file-20230209-26-32jg0n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Demonstrators hold up placards in support of a strike by nurses outside St. Thomas’ Hospital in London on Dec. 20, 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Alastair Grant)</span></span>
</figcaption>
</figure>
<p>The global attention may also be affected by their unprecedented nature: <a href="https://www.rcn.org.uk/Get-Involved/Campaign-with-us/Fair-Pay-for-Nursing/Strike-hub/Strike-locations#:%7E:text=For%20the%20first%20time%20in,act%2C%20our%20strike%20action%20continues.">U.K. nurses had never gone on strike</a> in their century-long history as organized labour. Scale also plays a role, as strikes extended to a large part of the country.</p>
<p>But another reason motivating international interest might be that the strikes in the U.K. hold up a mirror to other parts of the world, including Canada, reflecting the discontent of our own health workers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/patient-aggression-and-physician-burnout-the-makings-of-a-human-resources-crisis-in-health-care-175017">Patient aggression and physician burnout: The makings of a human resources crisis in health care</a>
</strong>
</em>
</p>
<hr>
<p>The labour concerns motivating this crisis — <a href="https://accountabilityresearch.org/wp-content/uploads/2022/04/ARC-Accountability-Note_Health-Worker-Protests_WEB.pdf">staffing shortages, pay, benefits, working conditions, repeated waves of COVID-19, burnout</a> — are occurring around the world in different types of health-care systems. This suggests there is something fundamentally askew with health workforce policy globally. How, then, might the situation in the U.K. provide lessons about the health-care crisis unfolding in Canada? </p>
<h2>Protests in Canada</h2>
<p>In the U.K., health workers are demanding pay increases that account for inflation, as well as policies to address staffing shortages and underinvestment in the health-care system. These concerns bear conspicuous similarities to recent demonstrations from health workers across Canada. </p>
<p>Between 2021 and 2022, according to the <a href="https://acleddata.com/">Armed Conflict Location & Event Data Project</a> database of protests and political violence, there were over 150 discrete demonstrations by Canadian health workers in every Canadian province. </p>
<p>Some of the higher profile events included protests against <a href="https://ottawa.ctvnews.ca/ottawa-health-care-workers-protest-to-repeal-bill-124-1.5878016">Bill 124</a> which would have limited pay increases in Ontario, protests against <a href="https://calgary.ctvnews.ca/alberta-unions-rally-against-health-care-cuts-and-privatization-1.5176108">underinvestment and privatization of health services</a> in Alberta, and <a href="https://bc.ctvnews.ca/nurses-rally-to-highlight-crisis-in-b-c-health-care-system-1.6098097">the shortage of family physicians and nurses</a> in British Columbia. </p>
<p>While the structure of Canadian health care might not result in a national protest similar to the ones in the U.K., the shared DNA across events in Canada is undeniable. These protests are clear manifestations of the deeper crisis in Canadian health care, fuelled by underinvestment, staffing shortages and attrition, burnout and repeated waves of COVID-19 and other respiratory illnesses. </p>
<p>These concerns echo demands from health workers around the world. An <a href="https://accountabilityresearch.org/publication/heroes-on-strike-trends-in-global-health-worker-protests-during-covid-19/">analysis of global health worker protests</a> in the first year of the pandemic found that the vast majority of protests focused on remuneration and working conditions, such as insufficient or unpaid wages, risk allowances and job security. Clearly, health policy was not aligned with public declarations of health workers as heroes and warriors. </p>
<h2>Short-term solutions don’t solve long-term problems</h2>
<p>Many of the frustrations voiced by health workers in Canada, the U.K. and other countries <a href="https://www.who.int/publications/i/item/9789241511131">predate the pandemic</a>. Health workers have long drawn attention to problems of underinvestment and austerity through strikes and demonstrations. </p>
<p>Yet, health system leaders continue to address only the most immediate fires that need to be put out, rather than the underlying issues impacting health service availability and access. Not enough attention has been paid to the unintended consequences of using shorter-term solutions to address the workforce crisis. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A crowd of protesters with signs supporting fair pay for nurses" src="https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509287/original/file-20230209-22-c6660h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses of the University College Hospital protest in London on Feb. 6, 2023.</span>
<span class="attribution"><span class="source">(AP Photo/Frank Augstein)</span></span>
</figcaption>
</figure>
<p>For example, travel or contract employment have become <a href="https://www.vox.com/22936455/travel-nurses-health-care-covid">a lucrative option</a> for nurses in the United States and Canada frustrated with their working conditions and seeking more flexibility. But, hiring these nurses comes at <a href="https://www.cbc.ca/news/canada/edmonton/alberta-dependent-on-contract-nurses-1.6735424">a high cost</a> to hospitals and creates lingering discontent in the workforce due to pay and benefits imbalances between travel nurses and staff nurses in the same facilities. </p>
<p>Recruiting nurses from low- and middle-income countries is another solution; yet, this approach results in <a href="https://www.cbc.ca/news/health/canada-international-nurses-poorer-countries-worried-1.6655231">labour shortages in low- and middle-income countries</a>, where migration is an attractive option for skilled nurses due to workforce and system challenges in their own contexts.</p>
<p>The U.K. health worker protests echo problems here in Canada and elsewhere. More importantly, they are a harbinger of forthcoming labour disputes and systemic collapse if our health systems continue to be characterized by austerity, underinvestment and neglect of health worker voices. </p>
<p>Reform is urgently needed to address these challenges in a manner that pays heed to workers’ concerns, looks long term at workforce planning (and its consequences) and prioritizes sustainable investment in health systems. The costs of not seriously engaging with this type of reform are clear for all to see, across the pond.</p><img src="https://counter.theconversation.com/content/199386/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Veena Sriram receives funding from the Social Sciences and Humanities Research Council of Canada and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Sorcha A. Brophy receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p>U.K. health worker protests echo issues in Canada. They are also a harbinger of future labour disputes and systemic collapse if austerity, underinvestment and neglect of health workers continue.Veena Sriram, Assistant Professor, Global Health Policy, University of British ColumbiaSorcha A. Brophy, Assistant Professor, Department of Health Policy and Management, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1968322022-12-22T06:56:02Z2022-12-22T06:56:02ZNurses: attracting more men to the profession could help with talent shortage<p>Seldom has the state of the NHS workforce been more in the public consciousness. A global survey of nurses undertaken by the consultancy firm <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/around-the-world-nurses-say-meaningful-work-keeps-them-going">McKinsey</a> in the summer of 2022 highlighted the perilous state of the sector. The survey, which was conducted in France, Singapore, Japan, the US, Australia, Brazil and the UK, found that around one in four nurses was considering leaving the profession. Central to this desire was the burnout that was caused by being overworked and understaffed.</p>
<p>It’s a situation that has been widely discussed in the UK as a result of the <a href="https://www.bbc.co.uk/news/health-64029578">first-ever strike</a> by members of the Royal College of Nursing in England. Data from <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies-survey/april-2015---september-2022-experimental-statistics">NHS Digital</a> reveals that there are over 133,000 unfilled vacancies across NHS England, with about one in three of these vacancies for registered nurses. The extent of the crisis is underlined by the fact that this figure has grown by 19% on the same period last year.</p>
<p>The huge number of unfilled vacancies has led to an understandable call for a renewed focus on recruiting new nurses into the NHS. It’s an effort that would be greatly helped if the sector was as attractive to men as it is to women. Indeed, official <a href="https://www.rcn.org.uk/congress/congress-events/male-nurses#:%7E:text=There%20are%20currently%20over%20690%2C000,jobs%20in%20the%20United%20Kingdom.">data</a> from the Nursing and Midwifery Council shows that just 11% of registered nurses in the UK today identify as men. </p>
<h2>Gender stereotypes</h2>
<p>This matters in a number of ways. First, men can often suffer from discrimination when applying to or working in stereotypically female roles. Indeed, <a href="https://dx.doi.org/10.1111/irel.12318">research</a> has shown that men receive about 40% fewer requests for interviews when applying for jobs in female-dominated sectors. </p>
<p>These gender-based stereotypes <a href="https://dx.doi.org/10.1177/0956797620929297">emerge</a> as early as five years of age, with children associating certain professions with men and others with women – and they are incredibly hard to shift. To do so will require a rethink about how nurses are portrayed both in the media and in communication between the industry and the wider public.</p>
<p>We have seen in <a href="https://dx.doi.org/10.1187/cbe.19-12-0266">attempts</a> to increase the number of women studying science, technology, engineering and mathematics (Stem) subjects, and participating in those industries, that having a strong supply of role models significantly increases participation by women. Just as those efforts have had to confound the stereotype that science and engineering were male disciplines, so too do we need a concerted effort to show that men can thrive as nurses as well.</p>
<p><a href="https://www.brown.edu/Departments/Economics/Faculty/Glenn_Loury/louryhomepage/teaching/Ec%20237/Akerlof%20and%20Kranton%20(QJE)%202000.pdf">Research</a> shows that going against gender norms carries a social and emotional cost, but whereas there has grown to be less stigma associated with women when they perform “men’s” jobs, the same is not the case when men perform “women’s” jobs. This is confounded by the <a href="https://nursinglicensemap.com/blog/male-nurses/">stereotyping</a> often associated with male nurses as either effeminate or homosexual (or failed doctors). </p>
<p>Not only is the healthcare sector facing a chronic skills shortage today, but it is also <a href="https://www.bls.gov/ooh/healthcare/home.htm">estimated</a> that the number of jobs in the sector will grow by 13% by 2031. While there has been a justifiable focus on Stem subjects as underpinning the jobs of tomorrow, jobs in healthcare promise to be more important than ever due to the ageing society and general trend towards greater spending on healthcare. If the industry is to meet those needs, it cannot afford to overlook half of the population.</p>
<p>The successful efforts to increase female participation in Stem point to several approaches that could be adopted to do likewise for male participation in health-related roles. </p>
<p>For instance, healthcare organisations and universities should actively target men for vacancies and training opportunities. This should be done in conjunction with providing more positive male role models. The potential of this was highlighted by a recent NHS campaign, called <a href="https://www.england.nhs.uk/2019/02/young-male-nursing-applicants-surge-after-we-are-the-nhs-recruitment-campaign/">We are the NHS</a>, which resulted in a record number of male school leavers applying to be nurses. The campaign was backed by actor Charles Venn, who plays a nurse in the BBC series Casualty.</p>
<p>It’s an outcome that needs to be built upon, with investment to back up such campaigns. For instance, in the US, <a href="https://www.aamn.org/scholarships">The American Association for Men in Nursing</a> offers scholarships for men who have embarked on a career in nursing, but while this is encouraging, it is not at the same level as the financial support offered to Stem-related projects.</p>
<p>Getting more men into nursing has clear benefits for both the NHS and for society as a whole, but achieving it will require a truly national effort. We’ve shown what’s possible with the drive to get more women into Stem. Now we need to replicate that to ensure men feel that nursing is a career for them.</p><img src="https://counter.theconversation.com/content/196832/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Zografia Bika currently receives EU funding from the Interreg France (Channel) England Programme (2018-2023) called 'Increase Valorisation Sociale' ('social value' in French) that offers micro-enterprise and employment-support services to those furthest from the labour market, who are often 'invisible' and face various complex barriers to work.</span></em></p><p class="fine-print"><em><span>Adi Gaskell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is a huge and growing number of unfilled nurse vacancies in the NHS. But there is a solution.Adi Gaskell, Senior Research Associate, University of East AngliaZografia Bika, Professor of Entrepreneurship, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1951552022-12-02T13:42:01Z2022-12-02T13:42:01ZNurses’ attitudes toward COVID-19 vaccination for their children are highly influenced by partisanship, a new study finds<figure><img src="https://images.theconversation.com/files/498352/original/file-20221130-6065-agmvaq.jpg?ixlib=rb-1.1.0&rect=49%2C36%2C8130%2C5408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As of Nov. 30, 2022, 62.5% of children and adolescents are unvaccinated against COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-putting-band-aid-on-patients-arm-after-covid-royalty-free-image/1340701756?phrase=nurses%20covid%20vaccines&adppopup=true">South_agency/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Children of nurses who identify as Republican are less likely to receive a COVID-19 vaccination compared with children of nurses who identify as Democrat, according to our recently published study in the <a href="https://doi.org/10.1007/s10900-022-01167-4">Journal of Community Health</a>. </p>
<p>We surveyed more than 1,000 nurses in South Dakota in June and July of 2022. Of those, 298 participants reported having children 5 to 17 years old. We asked this group about the vaccination status of their children and found that the children of nurses who identified as Democrats had a 13% higher probability of being vaccinated compared with the offspring of nurses who identified as Republican. </p>
<p>The timing of our survey only allowed us to measure the vaccination intention of parents of children from 6 months to 4 years old, since authorization of COVID-19 vaccines for that age group occurred just days before the survey. Of the 123 nurses who reported having children 6 months to 4 years old, those who identified as Democrats had a 14% higher probability of intending to vaccinate their children compared to self-identified Republicans. </p>
<p>Additionally, we found that those nurses who received a COVID-19 booster dose were more likely to vaccinate their children. On the other hand, gender, education and type of nursing credential had no effect.</p>
<h2>Why it matters</h2>
<p>Since the start of the COVID-19 pandemic, vaccination for children has been a <a href="https://www.vox.com/the-highlight/23438552/covid-vaccine-refusal-hesitancy-politics-polarization-pandemic-mandates">contentious issue</a>. In our study, we found that polarization among nurses split along political party lines in a similar fashion to the general public. </p>
<p>Despite the wide availability of safe and free COVID-19 vaccines for children and adolescents in the U.S., vaccination rates for people under age 18 are lower than for adults. As of Nov. 30, 2022, more than 60% of children <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/children.html">remain unvaccinated</a>. </p>
<p>Though children tend to be more resilient to COVID-19, there are still significant risks. The Centers for Diseases Control and Prevention has reported <a href="https://data.cdc.gov/NCHS/Deaths-by-Sex-Ages-0-18-years/xa4b-4pzv">more than 1,500 deaths of children under 18</a> from COVID-19, as of late November 2022. And children are <a href="https://doi.org/10.1038/s41598-022-13495-5">susceptible to “long” COVID</a> symptoms as well.</p>
<p>Nurses – and other health care workers – are at the forefront of efforts to contain COVID-19. They also advise patients who are deciding whether to vaccinate themselves and their families. Our study shows that among nurses, political partisanship appears to influence their attitudes toward vaccinating their own kids.</p>
<p>Public health officials are striving to boost COVID-19 vaccination rates. Yet the politicization of the pandemic continues to hinder these efforts. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two nurse protesters stand near a street holding up signs arguing against vaccine mandates, with a large group of protesters in the background." src="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses protesting the Biden administration’s vaccine mandate, which has since been suspended, in Michigan in July 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/protesters-holding-placards-expressing-their-opinion-while-news-photo/1234168497?phrase=nurses">SOPA Images/LightRocket via Getty Images</a></span>
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</figure>
<p>Increasing vaccination rates among children will also protect the <a href="https://www.hhs.gov/immunization/basics/work/protection/index.html">most vulnerable members of society</a>, such as older adults and people with weakened immune systems. Nevertheless, some parents continue to resist vaccinating their children.</p>
<p>Our study shows that parents make COVID-19 vaccination decisions for the entire family. We found that nurses who received a booster dose of a COVID-19 vaccine are more likely to vaccinate their children and adolescents. However, the nurses who haven’t received a booster dose are far less likely to vaccinate their children. </p>
<h2>What other research is being done</h2>
<p>Our findings align with other research carried out by ourselves and others that shows the strong influence of partisan self-identification on COVID-19 attitudes and behaviors. </p>
<p>Other studies we’ve done show that Republicans are less likely than Democrats to <a href="https://doi.org/10.1111/ssqu.13147">receive a COVID-19 vaccination</a> and are less likely to <a href="https://doi.org/10.1177%2F1532673X221118888">support mandatory COVID-19 vaccination</a>. We also found that nurses who identify as Republican are less likely to receive a <a href="https://doi.org/10.1016/j.ajic.2022.11.014">COVID-19 booster dose</a>.</p>
<p>Our study joins a growing body of work that seeks to explore the factors behind COVID-19 vaccine hesitancy among health care workers. Other studies have linked <a href="https://doi.org/10.1001/jamanetworkopen.2021.21931">race and ethnicity</a>, as well as <a href="https://doi.org/10.3390/vaccines9111358">trust</a> in government, physicians and pharmaceutical companies, to the attitudes of health care workers toward COVID-19 vaccination.</p>
<h2>What’s next</h2>
<p>Given the politicization of the pandemic and the erosion of trust in authorities, it’s important that messages encouraging the vaccination of children <a href="https://theconversation.com/covid-19-vaccines-for-children-how-parents-are-influenced-by-misinformation-and-how-they-can-counter-it-173212">come from trusted sources</a>. </p>
<p>Our previous research suggests that <a href="https://doi.org/10.1080/03623319.2022.2049557">religious leaders</a> can help encourage compliance with COVID-19 prevention measures. In the future, we plan to investigate whether endorsements from trusted community leaders could convince parents to vaccinate their children.</p><img src="https://counter.theconversation.com/content/195155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nurses who identify as Democrats have a significantly higher likelihood of having their children vaccinated against COVID-19 than those who identify as Republicans.Filip Viskupič, Assistant Professor of Political Science, South Dakota State UniversityDavid Wiltse, Associate Professor of Political Science, South Dakota State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1914292022-10-05T03:13:09Z2022-10-05T03:13:09ZHealth worker burnout and ‘compassion fatigue’ put patients at risk. How can we help them help us?<figure><img src="https://images.theconversation.com/files/488199/original/file-20221005-25-pyxbmk.jpg?ixlib=rb-1.1.0&rect=11%2C5%2C3888%2C2598&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/tired-female-african-scrub-nurse-600w-1766425187.jpg">Shutterstock</a></span></figcaption></figure><p>The toll of COVID on our health-care workers has been <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00764-7">brutal</a>, with many saying they want to quit their jobs. </p>
<p>The World Health Organization <a href="https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb--without-immediate-action--health-and-care-workforce-gaps-in-the-european-region-could-spell-disaster">says</a> burnout, coupled with an ageing workforce, is a “ticking time bomb” that could lead to “poor health outcomes across the board, long waiting times for treatment, many preventable deaths, and potentially even health system collapse”. </p>
<p>The Royal Australian College of General Practitioners’ just released annual survey reported some <a href="https://www.racgp.org.au/general-practice-health-of-the-nation-2022/executive-summary">three-quarters of GPs</a> say they feel burnt out.</p>
<p>With burnout <a href="https://360info.org/the-research-on-reducing-health-worker-burnout/">characterised</a> in part by a “depersonalisation” or a sense of detachment, it can be tough to care for others. “Compassion fatigue” can set in. So how can we help health workers so they can continue to help others?</p>
<h2>A worldwide workforce shortage</h2>
<p>Workforce <a href="https://www.nursingreview.com.au/2021/10/no-nursing-workforce-shortage-in-australia-but-why-it-doesnt-it-feel-like-it/">projections predict</a> health workforce shortages worldwide. Retention is a major factor and burnout the major contributor. During the pandemic, studies from the United States and Singapore reported unprecedented turnover in the health-care sector, and again burnout was the <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00764-7">biggest factor</a>. </p>
<p>In Australia, a <a href="https://www.unimelb.edu.au/__data/assets/pdf_file/0004/4085194/katelyn_mannix_report.pdf">report</a> found that during the first wave of COVID, nurses experienced high rates of anxiety and depression. COVID disruptions meant less access to social supports. Less social support affects a person’s ability to cope. </p>
<p>Workplace culture was seen as negative. There were safety concerns about working with patients with COVID. A fear of transmitting the virus to their families and friends led to increased anxiety. There was inadequate, inappropriate and often <a href="https://pubmed.ncbi.nlm.nih.gov/36177495/">limited</a> or unavailable personal protective equipment (PPE) for health-care workers and carers. When it was available, workers felt PPE and physical distancing constraints prevented them providing the compassionate care required. </p>
<p>Health-care workers experienced increased violence and aggression from patients and the public when enforcing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9195416/#:%7E:text=According%20to%20the%20International%20Committee,before%20the%20COVID%2D19%20pandemic">government-mandated restrictions</a>. They also faced significant increases in <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00764-7">workloads</a>. </p>
<p>New models of care were introduced, often with little preparation or training. Staff shortages resulted from COVID isolation and staff were <a href="https://pubmed.ncbi.nlm.nih.gov/34864791/">redeployed</a> to areas of high need in health care, which left shortages in other areas.</p>
<p>Health-care workers also identified a lack of support from leadership and organisational culture compromised their <a href="https://onlinelibrary.wiley.com/doi/10.1111/jan.15442">psychological safety</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="tired doctor" src="https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488200/original/file-20221005-16-ra8m36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A large proportion of health-care workers are considering quitting.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/tired-doctor-mask-dark-background-600w-96933794.jpg">Shutterstock</a></span>
</figcaption>
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Read more:
<a href="https://theconversation.com/moral-injury-what-happens-when-exhausted-health-workers-can-no-longer-provide-the-care-they-want-for-their-patients-185485">Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients</a>
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<h2>Burnout and clinical mistakes</h2>
<p>The <a href="https://www.smh.com.au/national/nsw/the-doctors-sleeping-under-desks-because-they-re-too-tired-to-drive-20220922-p5bk5i.html">Australian Medical Association</a> reports almost half the junior doctors in New South Wales are overworked and exhausted, and burnout could be putting patients at risk. Of 1,766 doctors surveyed, 76% reported making a fatigue-induced clinical error. </p>
<p>A <a href="https://www.nytimes.com/2022/09/29/health/doctor-burnout-pandemic.html?unlocked_article_code=NpRnXp_u852yYbGnEE6G-iDynSZtnYygVMInJkl63qF_7LMp4RszuR0t2AaN_dWDmJjBGdeu7Envy2WAFOltDNV9FUueEx1bEA9B8aod6bn7gLeMxGwEAUi36kcP4UC3uoQrA31xciJA0Luelh4WgyiLUvKRH53bdn5D44SL2hj956DIjhEUYhsfNw11NuDueyXrE_ig2aTtfJkyeGD5KSWADwz6IpRmAl72JpDNWyXNY6LBbD_ZHnko1WWHWRH89iBr9mSZy_agLovQC5aQD89ucBse9aSfXzoeunIBP92H1TidpHMi75bAyl9OzluJfBIM6WzrATkvKSYKzHGsoQ&smid=share-url">US study reported</a> increases in physician burnout was associated with increased medical errors and worse patient outcomes. </p>
<p>And <a href="https://pubmed.ncbi.nlm.nih.gov/35493392/">an international study</a> reveals nurses reporting “missed care”, “care at improper times” and “unfulfilled care” due to excessive job demands.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-burnt-out-health-workforce-impacts-patient-care-180021">A burnt-out health workforce impacts patient care</a>
</strong>
</em>
</p>
<hr>
<h2>When caring for others is too much</h2>
<p>“<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924075/">Compassion fatigue</a>” means health-care workers are unable to carry out their roles. Compassion fatigue can result from repeated exposure to others’ suffering in high stress environments and the constant giving of self. </p>
<p>It leads to complete physical and emotional exhaustion, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924075/">depleting health-care</a> workers of their ability to cope. Crucially, it disconnects them from their patients, making unable to be empathetic and provide compassionate care. Usual coping strategies aren’t effective and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924075/">negative coping strategies</a> such as alcohol or substance abuse can follow. Ultimately, workers feel a diminished sense of satisfaction in their work and burnt out. </p>
<p>Health-care workers can mitigate against compassion fatigue by <a href="https://pubmed.ncbi.nlm.nih.gov/30462717/">making time for themselves</a>, enforcing work boundaries, and creating a better work-life balance. </p>
<p>Strategies such as mindfulness meditation have been shown to be <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2020.01683/full">effective</a>. So have employer <a href="https://pubmed.ncbi.nlm.nih.gov/30884198/">support programs</a> such as counselling services and advocating for organisations to provide healthy and nurturing workplaces. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1574315232926711808"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-health-care-leaders-can-foster-psychologically-safer-workplaces-190745">How health-care leaders can foster psychologically safer workplaces</a>
</strong>
</em>
</p>
<hr>
<h2>Rejecting the health hero narrative</h2>
<p>Compassion fatigue and burnout also occur when <a href="https://theconversation.com/burned-out-heroes-why-bedside-nurses-should-not-have-to-be-martyrs-to-be-valued-184505">health-care workers are not valued</a>. </p>
<p>During the pandemic, health-care workers have been increasingly portrayed as angels and heroes, who appear to be able to swoop in and save the day. Nurses and other health-care workers have <a href="https://doi.org/10.1080/10376178.2020.1827964">argued this narrative</a> is outdated and fails to recognise their complex roles. </p>
<p>Instead of being given hero status, nurses and other health-care workers are seeking opportunities to highlight the <a href="https://sigmapubs.onlinelibrary.wiley.com/doi/10.1111/jnu.12591">complex skills</a> and compassion required to undertake their roles. This could prove transformative for media reports, fictional <a href="https://onlinelibrary.wiley.com/doi/10.1111/jan.12244">portrayals</a> of doctors and nurses on screen, and even how hospitals and health centres represent health-care workers in recruitment and retention campaigns.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nurses-dont-want-to-be-hailed-as-heroes-during-a-pandemic-they-want-more-resources-and-support-167763">Nurses don't want to be hailed as 'heroes' during a pandemic – they want more resources and support</a>
</strong>
</em>
</p>
<hr>
<h2>A time to re-evaluate</h2>
<p>The pandemic has brought the <a href="https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb--without-immediate-action--health-and-care-workforce-gaps-in-the-european-region-could-spell-disaster">predicted shortages</a> in the health-care workforce into sharp focus. The role of burnout and compassion fatigue are <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2207252">important factors</a>. </p>
<p>While resilience is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448586/">key protective factor</a> – and one that health-care workers are encouraged to develop – it isn’t enough. Health-care leaders have an ethical and legal obligation to ensure all workers have access to work environments that are psychological safe and free from violence and aggression. And health needs to be adequately resourced so patient care is prioritised and workloads are safe. </p>
<p>After all, if we don’t care for our health workforce, who will care for us?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/overseas-recruitment-wont-solve-australias-aged-care-worker-crisis-189126">Overseas recruitment won't solve Australia's aged care worker crisis</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191429/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Burnout and ‘compassion fatigue’ can compromise patient safety and signal health worker exhaustion. And they are a ticking time bomb for health care.Sue Dean, Lead Lecturer Practitioner, Nursing, Faculty of Health., Southern Cross UniversityDeb Massey, Associate Professor, Faculty of Health, School of Nursing, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1907452022-09-27T20:21:39Z2022-09-27T20:21:39ZHow health-care leaders can foster psychologically safer workplaces<figure><img src="https://images.theconversation.com/files/486635/original/file-20220926-26-578e68.JPG?ixlib=rb-1.1.0&rect=134%2C143%2C2694%2C1895&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Building safer workplaces requires leaders who understand how years of resource constraints, unhealthy work environments, abuse from patients and a pandemic have contributed to overwhelming burnout and job dissatisfaction among workers.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>Every day it seems the Canadian health-care staffing crisis worsens, with <a href="https://www.nytimes.com/2022/09/14/world/canada/nurse-shortage-emergency-rooms.html">emergency room closures</a>, <a href="https://theconversation.com/with-family-doctors-heading-for-the-exits-addressing-the-crisis-in-primary-care-is-key-to-easing-pressure-on-emergency-rooms-189199">not enough family doctors</a> and <a href="https://www.wellesleyinstitute.com/wp-content/uploads/2020/09/Waiting-for-Long-Term-Care-in-the-GTA.pdf">long wait times to get into long-term care</a>. </p>
<p>At the core are health-care workers who are physically and mentally burnt out from the unsafe work environments they’ve been asked to work in for years, which were made remarkably worse during COVID-19. </p>
<p>Health-care leaders have a key role to play in developing psychologically safer workplaces to support the well-being of our health-care workers. Building safer workplaces requires leaders who understand how years of resource constraints, unhealthy work environments, <a href="https://doi.org/10.1186/s12913-020-05084-x">abuse from patients</a>, and <a href="https://doi.org/10.3389/fpubh.2021.750529">the pandemic</a> have contributed to the overwhelming burnout and job dissatisfaction evident among workers.</p>
<h2>Physically and emotionally unsafe</h2>
<p>Even before the COVID-19 pandemic, Canadian health-care workers were experiencing <a href="https://www.cma.ca/sites/default/files/2018-11/nph-survey-e.pdf">burnout and depression</a>. The pandemic has worsened already poor working environments, exposing them not only to a life-threatening virus, but <a href="http://doi.org/10.1001/jama.2021.2701">mounting physical and verbal abuse</a>, <a href="https://www.cma.ca/sites/default/files/2022-08/NPHS_final_report_EN.pdf">increasing rates of burnout and depression</a>.</p>
<p>It is not surprising, then, that health-care workers are leaving the profession in greater numbers, <a href="https://www.cbc.ca/news/canada/nurses-canada-overtime-pandemic-burnout-1.6545963">further exacerbating the working conditions for the remaining health-care workers</a>. </p>
<figure class="align-center ">
<img alt="A paramedic in a face shield wearing a neon yellow jacket walks past patients on gurneys in a hospital corridor" src="https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=524&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=524&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486636/original/file-20220926-21-w3atsc.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=524&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The challenges are not limited to one group of health-care workers, or one type of workplace; personal support workers, nurses, physicians, paramedics working in hospitals, long-term care, primary care clinics and emergency services are all reporting burnout.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>The challenges are not limited to one group of health-care workers, or one type of workplace; personal support workers (PSWs), nurses, physicians, paramedics working in hospitals, long-term care, primary care clinics and emergency services are all reporting higher levels of stress. <a href="https://clri-ltc.ca/files/2021/02/PSW_Perspectives_FinalReport_Feb25_Accessible.pdf">PSWs working in long-term care report</a> physically and emotionally unsafe work environments, insufficient staff-to-patient ratios and disrespectful work environments.</p>
<p>We know that <a href="https://www.mentalhealthcommission.ca/wp-content/uploads/drupal/Workforce_Psychological_Safety_in_the_Workplace_ENG.pdf">psychological health and safety in the workplace</a> is directly tied to productivity, retention, absenteeism, workplace conflict and the overall operational success of the workplace. Canadian health-care leaders, managers and supervisors are exceptionally placed to help health-care organizations build work environments where staff feel supported and safe. </p>
<figure class="align-right ">
<img alt="An outdoor sign reading 'Hiring PSWs - many shifts - benefits'" src="https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486638/original/file-20220926-879-z9tmaw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">PSWs working in long-term care report physically and emotionally unsafe work environments, insufficient staff-to-patient ratios and disrespectful work environments.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<p>Our research team was recently funded by the <a href="https://mentalhealthcommission.ca">Mental Health Commission of Canada</a> to examine the facilitators and barriers that health-care organizations face in creating safe work environments. We surveyed and interviewed <a href="https://mentalhealthcommission.ca/resource/exploring-two-psychosocial-factors-for-health-care-workers/">hundreds of health-care workers from across disciplines, workplaces and provinces</a>. Here’s what they told us: </p>
<ul>
<li><p>There is much focus placed on health-care workers building resiliency, but without giving them the time and space to do so. Organizations can help by protecting time off for workers. </p></li>
<li><p>Health-care workers have told us that long-term organizational resources such as wellness champions, ethicists and effective health benefits for all health-care workers (for example, benefits that cover counselling services) would help support their well-being. </p></li>
<li><p>Appropriate and transparent operational policies and procedures related to clinical care and/or human resources that pervade an entire organization help to develop a fair and safe working climate. Managers can further support their workers by ensuring those policies and procedures are consistently applied and followed.</p></li>
<li><p>Organizations should seek out and support effective, compassionate and authentic leaders. Developing health-care leaders who are skilled and rise to the job in their stressful environments is critical and should be cultivated and rewarded. Managers have also been through the wringer over the past several years and need to be supported by their organizations. </p></li>
<li><p>Fewer than 50 per cent of health-care workers in our study reported working in an ethical climate. For example, many health-care workers do not have access to the necessary supports to work through ethical dilemmas. This is a great place for health-care organizations to focus; cultivating an ethical work environment can demonstrate to its employees that they want to protect them from moral distress. </p></li>
<li><p>Health-care workers have told us that transparency and effective communications are critical and increase trust in their leaders. </p></li>
</ul>
<p>The future of our health system is dependent on recruiting and retaining passionate, hardworking and highly skilled health-care workers. Every health-care worker, in ever workplace, across every province needs an organization that values and prioritizes their psychological health and safety. For the full report please visit: <a href="https://mentalhealthcommission.ca/resource/exploring-two-psychosocial-factors-for-health-care-workers/">MHCC – Exploring Two Psychosocial Factors for Health-Care Workers</a>.</p><img src="https://counter.theconversation.com/content/190745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The future of our health system depends on recruiting and retaining passionate and highly skilled health-care workers. It’s essential to build work environments where they feel supported and safe.Angela Coderre-Ball, Assistant Professor (Adjunct), Family Medicine, Queen's University, OntarioColleen Grady, Associate Professor, Family Medicine, Queen's University, OntarioDenis Chênevert, Professor and director of healthcare management hub, HEC MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1889842022-08-28T20:04:58Z2022-08-28T20:04:58ZThe physio will see you now. Why health workers need to broaden their roles to fix the workforce crisis<figure><img src="https://images.theconversation.com/files/481019/original/file-20220825-16-wo9502.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1917%2C1077&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/qvFlxrDSyXU">Andrik Langfield/Unsplash</a></span></figcaption></figure><p><em>This article is part of The Conversation’s series looking at Labor’s jobs summit. Read the other articles in the series <a href="https://theconversation.com/au/topics/jobssummit2022-125921">here</a>.</em></p>
<hr>
<p>The greatest workforce challenge Australia faces is in health, an issue that will likely be with us for another decade.</p>
<p>Shortages of health workers reduce access to care, increase waiting times and reduce patient safety. They can even <a href="https://qualitysafety.bmj.com/content/28/8/609">increase avoidable deaths</a>.</p>
<p>However, we don’t need the upcoming <a href="https://treasury.gov.au/employment-whitepaper/jobs-summit">Jobs and Skills Summit</a> to solve this problem. There is already low-hanging fruit to pick.</p>
<p>We need to broaden the scope of practice for some health workers, engage in better workforce planning, and reform how existing and new resources are deployed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/general-practices-are-struggling-here-are-5-lessons-from-overseas-to-reform-the-funding-system-188902">General practices are struggling. Here are 5 lessons from overseas to reform the funding system</a>
</strong>
</em>
</p>
<hr>
<h2>Health workers burnt out and leaving</h2>
<p><a href="https://grattan.edu.au/news/how-to-tackle-burnout-among-healthcare-workers">Burnt-out health workers</a> leaving the workforce are a key driver of a rise in <a href="https://www.seek.com.au/employer/market-insights/healthcare-pulse-report">job vacancies</a> across Australia.</p>
<p>While much of this is due to the unprecedented nature of COVID, Australia has had problems staffing its health-care system <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook46p/HealthWorkforce">for years</a>. The workforce shortage is particularly acute in rural and remote regions. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1521974048825438208"}"></div></p>
<p>The natural response is to throw money at the problem but the Australian government has little spare cash. Its budget deficit is projected to be more than <a href="https://budget.gov.au/2022-23/content/bp1/download/bp1_2022-23.pdf">A$800 billion</a> by 2025-26. State governments are also cash-strapped.</p>
<p>More immigration of skilled health workers may also have limited success. Australia will be competing with countries including New Zealand, Canada, the United States and the United Kingdom, which are looking to fill their own health worker <a href="https://www.health.org.uk/publications/nhs-workforce-projections-2022#:%7E:text=Workforce%20shortages%20were%20the%20single,on%20staff%20wellbeing%20and%20absence">shortages</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/despite-what-political-leaders-say-new-zealands-health-workforce-is-in-crisis-but-its-the-same-everywhere-else-187256">Despite what political leaders say, New Zealand's health workforce is in crisis – but it's the same everywhere else</a>
</strong>
</em>
</p>
<hr>
<h2>Health workers could take on more roles</h2>
<p>Health worker registration, along with standards and protocols, are essential for ensuring safe and effective care. However, this also stops health workers taking on new roles typically performed by others.</p>
<p>The potential for broadening health workers’ roles has been discussed for <a href="https://www.pc.gov.au/inquiries/completed/health-workforce/report/healthworkforce.pdf">more than two decades</a>. There has been some progress. Pharmacists now administer some vaccines, which was traditionally the domain of GPs and nurses.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pharmacist giving vaccine in upper arm of seated female customer" src="https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/480698/original/file-20220824-25-n9cfmt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Pharmacists now give some vaccines, once the domain of GPs and nurses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/paris-france-december-20-2021-vaccination-2097845026">Victor Joly/Shutterstock</a></span>
</figcaption>
</figure>
<p>A broader scope of practice for some health workers <a href="https://www.pc.gov.au/research/completed/efficiency-health/efficiency-health.pdf">can increase</a> people’s access to care, create more job satisfaction for the health worker, and lead to more efficient health care. It could also help the health-care system respond better and quicker to future pandemics or large-scale reform.</p>
<p>Overall, peak organisations and specialist colleges have effectively protected their turf. This may have resulted in <a href="https://www.pc.gov.au/research/completed/efficiency-health/efficiency-health.pdf">more expensive care</a> for the public and the government because it has stopped less-costly health workers from delivering care.</p>
<p>We are now faced with a more serious problem. A broader scope of practice for some health workers is needed to secure <em>timely</em> access to care. That stronger message will help government bash through future turf wars.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-rivalries-between-doctors-and-pharmacists-turned-into-the-turf-war-we-see-today-122534">How rivalries between doctors and pharmacists turned into the 'turf war' we see today</a>
</strong>
</em>
</p>
<hr>
<h2>New roles for paramedics, pharmacists, physios</h2>
<p>Health workers in other countries are becoming more flexible in the scope of tasks they perform.</p>
<p>The UK’s National Health Service <a href="https://www.nuffieldtrust.org.uk/files/2017-01/reshaping-the-workforce-web-final.pdf">has</a> “extended roles”, such as nurses being more involved in managing chronic diseases. There are also “advanced roles”, which require a master’s degree in advanced practice. One example is allowing advanced nurse practitioners to manage people with mental health issues in the community, under the guidance of a psychiatrist. </p>
<p>Australia is also starting to think differently. The ten-year <a href="https://www.health.gov.au/sites/default/files/documents/2022/03/national-medical-workforce-strategy-2021-2031.pdf">National Medical Workforce Strategy</a> released in 2021 seeks to re-balance from sub-specialisation to a more generalist workforce to improve access to care. The hope is to create more GPs and specialists with additional skills, such as emergency care, and other select specialist skills.</p>
<p>There are opportunities to expand the roles of paramedics, especially in rural and remote regions without enough GPs and nurses. </p>
<p>Paramedics <a href="https://bmcmedicine.biomedcentral.com/track/pdf/10.1186/s12916-021-02019-z.pdf">have evolved</a> from delivering emergency care to managing chronic disease, mental health and social care. Additional paramedic education to understand diagnostic tests, prescribe some medicines and deliver wound care could increase patients’ access to health care.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1561006398674276354"}"></div></p>
<p>Physiotherapists could be the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478452/">first point of contact</a> for musculoskeletal conditions. They could give steroid injections and refer patients to orthopaedic specialists.</p>
<p>Pharmacists could also take a greater role, administering medicines over the counter rather than requiring a prescription from GPs. </p>
<p>Sexual health is one area. Allowing women to access the oral contraceptive pill without a prescription would be <a href="https://pubmed.ncbi.nlm.nih.gov/31069781/">cost effective</a> with minimal risk. Viagra requires a prescription in Australia but is sold over the counter <a href="https://www.bbc.com/news/health-42155489">in the UK</a>.</p>
<h2>How do we fund this?</h2>
<p>Any health workforce reform to address shortages must ensure quality and safety are maintained and provide at least as good an experience to patients compared to current practice.</p>
<p>It must also be accompanied by supportive funding models. </p>
<p>Nurse practitioners provide a good example. They were <a href="https://www.researchgate.net/publication/291764586_A_Historical_Review_of_the_Nurse_Practitioner_Role_in_Australia/link/5eaa049345851592d6abaf98/download">introduced in Australia in 1998</a> to fill doctor shortages, allowing registered nurses with additional education to diagnose, perform procedures and prescribe drugs – within tightly defined parameters.</p>
<p>Today, <a href="https://consultations.health.gov.au/health-workforce/nurse-practitioner-10-year-plan-survey/supporting_documents/Nurse%20Practitioner%2010%20Year%20Plan%20Consultation%20Paper.pdf">most</a> nurse practitioners work in public health, particularly emergency departments.</p>
<p>More nurse practitioners aren’t in private practice for a number of reasons, including <a href="https://consultations.health.gov.au/++preview++/health-workforce/nurse-practitioner-10-year-plan-survey/supporting_documents/Nurse%20Practitioner%2010%20Year%20Plan%20Consultation%20Paper.pdf">restricted access</a> to Medicare and pharmaceutical item numbers.</p>
<p>With appropriate funding models, expanding nurse practitioner roles could substantially increase access to care and <a href="https://www.health.gov.au/sites/default/files/documents/2021/03/cost-benefit-analysis-of-nurse-practitioner-models-of-care.pdf">reduce health-care costs</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-could-do-so-much-more-with-its-nurse-practitioners-17693">Australia could do so much more with its nurse practitioners</a>
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</p>
<hr>
<h2>We need better planning</h2>
<p>Health workforce shortages are an endemic, multifaceted, cross-jurisdictional problem. COVID has amplified shortages, but poor planning and limited government investment are mostly to blame.</p>
<p>There is an under-supply of specialists in some areas, and oversupply of specialists in others. <a href="https://www.health.gov.au/resources/publications/national-medical-workforce-strategy-2021-2031">Redistributing</a> the health workforce, from metropolitan regions to rural and remote regions, would fill some shortages. </p>
<p>Australia also needs another independent agency such as Health Workforce Australia. This was <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/bd/bd1314a/14bd077">established</a> to support workforce reform initiatives in 2009 but abolished in 2014. </p>
<p>Roles of a new agency should include independently identifying workforce needs across the health-care system, helping coordinate investment in education and training, and providing evidence for broadening workforce scope, retention and reform. </p>
<h2>What policies would we need?</h2>
<p>The health-care system must also reform to reduce waste and redeploy valuable resources more effectively. </p>
<p><a href="https://www.oecd.org/health/health-systems/Empowering-Health-Workforce-Digital-Revolution.pdf">Digital health</a> and other technology advancements offer opportunities to improve workplace productivity, alongside reorganisation of care models. </p>
<p>Reducing bureaucracy and better allocating administration tasks to non-clinical staff can also create more time for clinical care.</p><img src="https://counter.theconversation.com/content/188984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Henry Cutler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The greatest workforce challenge Australia faces is in health, an issue that will likely be with us for another decade. Here’s one way to fix it.Henry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1848292022-08-11T23:18:12Z2022-08-11T23:18:12ZGetting more men into nursing means a rethink of gender roles, pay and recognition. But we need them urgently<figure><img src="https://images.theconversation.com/files/474236/original/file-20220715-11-w83sqo.jpg?ixlib=rb-1.1.0&rect=0%2C70%2C6720%2C4396&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Demand for health care is soaring as the population ages, medical treatments become more widely available and more people live with chronic and complex illnesses.</p>
<p>However, there is global <a href="https://www.who.int/health-topics/health-workforce#tab=tab_1">shortage of health professionals</a> – and the pandemic has only accentuated the trend. Overwork, burnout and stress are causing nurses to <a href="https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce">leave in droves</a>. </p>
<p>The World Health Organization <a href="https://www.who.int/news-room/fact-sheets/detail/nursing-and-midwifery">estimates</a> we’ll need a further 9 million nurses worldwide by 2030. According to the International Council of Nurses, the figure is closer to <a href="https://www.icn.ch/sites/default/files/inline-files/ICN%20Policy%20Brief_Nurse%20Shortage%20and%20Retention_0.pdf">13 million</a>.</p>
<p>Part of the solution is to recruit and retain more men in nursing. This would help address workforce shortages and could, over time, reduce the industry gender pay gap as the existence of men in nursing becomes more normalised. </p>
<p>And as jobs dry up in traditionally male-focused industries – such as mining and manufacturing – work in health care should be an <a href="https://nurse.org/articles/Male-Nurses-And-The-Profession/">attractive option</a> for men, providing job security, career opportunities and salary. </p>
<p>But attracting men to the profession won’t be without its challenges. It will require a serious society-wide rethink around gender roles, compensation and recognition for the importance of nursing work.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477275/original/file-20220803-26-98lqfz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The reasons for the low number of men in nursing are complex and multifaceted.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fixing-the-aged-care-crisis-wont-be-easy-with-just-5-of-nursing-homes-above-next-years-mandatory-staffing-targets-184238">'Fixing the aged care crisis' won't be easy, with just 5% of nursing homes above next year's mandatory staffing targets</a>
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<hr>
<h2>Why are there so few men in nursing?</h2>
<p>Caregiving is <a href="https://link.springer.com/article/10.1186/s12960-019-0406-0">feminised</a> in society and health care, and the nursing profession has strong female foundations. This has established a trajectory and a culture that has kept the representation of men to <a href="https://www.acn.edu.au/nurseclick/men-in-nursing-why-its-okay-for-men-to-care">around</a> <a href="https://www.bbc.com/news/uk-scotland-48125231">10%</a> in many high income countries.</p>
<p>This is despite fervent efforts by many in the industry to achieve the <a href="https://www.bls.gov/cps/cpsaat11.htm">equity of gender representation</a> you see in most professions. </p>
<p>The reasons are complex and multifaceted. Men in nursing are often portrayed negatively in <a href="https://www.truthaboutnursing.org/media/films/meet_the_parents.html#gsc.tab=0">media and movies</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/24001311/">Stereotypes</a> abound. </p>
<p>And some men in nursing face <a href="https://journals.lww.com/ajnonline/Citation/2006/02000/Men_in_Nursing__Still_Too_Few__Discrimination_and.16.aspx">discrimination</a> from patients and staff, underpinned by false assumptions women are better suited to the role. Many people still <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4228905/">underestimate</a> the capacity of men to undertake personal care tasks.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/nuf.12504?casa_token=0fSzo6BonEQAAAAA%3AuEbtIqONQ7FdzpbrezYLGoIEKLH37CbOan7R0n33MG4vBGplDO0PlJ4kcjEIHhp1hXlxKlEqCgEd">Research</a> also shows low male participation can stem from reticence by career counsellors to recommend nursing as a career.</p>
<p>A recent Australian <a href="https://www.health.gov.au/sites/default/files/documents/2019/12/topic-2-nursing-as-a-career-choice.pdf">report</a> shows the dominance of women in the nursing workforce may hinder some men from considering nursing as a career, particularly those for whom masculinity is central to their identity. So we must work to undo the perception nursing is a feminine job – it is not.</p>
<p>Negative perceptions around the prestige of nursing and its perceived status in the community may hinder some men’s interest in nursing as a career.</p>
<p>Good role modelling is important. Many educational institutions and supporters such as <a href="https://nursing.jnj.com/">Johnson & Johnson</a> are working hard to in present <a href="https://nursing.gwu.edu/improving-mens-health-battling-stereotypes">positive images</a> of men in nursing and normalise that men can be great nurses too.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/WikQz4J9B7U?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Source: JHU.</span></figcaption>
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<h2>Retaining men in the workforce and addressing the ‘glass escalator’</h2>
<p>Many <a href="https://www.who.int/publications/i/item/9789240003279">regulatory</a> and professional bodies are monitoring the participation of men in nursing. Some organisations offer incentives. For example, <a href="https://www.aamn.org/">The American Association for Men in Nursing</a> offers scholarships, awards and training to attract and retain men in the profession.</p>
<p>It is important to recognise some barriers for men come from within the nursing profession itself. </p>
<p>Some in the nursing workforce perceive that men are on a career “<a href="https://journals.lww.com/naqjournal/Abstract/2021/10000/Going_Up___Exploring_the_Phenomenon_of_the_Glass.6.aspx#:%7E:text=The%20%E2%80%9Cglass%20escalator%E2%80%9D%20refers%20to,to%20upper%20levels%20of%20leadership">glass escalator</a>”. Unlike a “glass ceiling”, which inhibits career progression, the “glass escalator” allows men to be fast-tracked up the nursing workforce to higher positions in an effort to retain them.</p>
<p>This can cause some to <a href="https://journals.lww.com/naqjournal/Abstract/2021/10000/Going_Up___Exploring_the_Phenomenon_of_the_Glass.6.aspx#:%7E:text=The%20%E2%80%9Cglass%20escalator%E2%80%9D%20refers%20to,to%20upper%20levels%20of%20leadership">perceive</a> male participation in nursing as a negative, which reduces inclusion. </p>
<p>But this glass escalator phenomenon, which can occur in <a href="https://www.spglobal.com/esg/csa/yearbook/articles/gender-equality-workplace-going-beyond-women-on-the-board">other industries</a> too, can only be overcome if male participation in the workforce is normalised. </p>
<p>And it is critically important to look at the structural, gender-driven factors that inhibit women embracing leadership roles. </p>
<p>It’s also worth noting women in the health and caregiving sector face a larger gender pay gap than in other economic sectors. A joint report by the International Labour Organization and the World Health Organization found: </p>
<blockquote>
<p>Women in the health and care sector face a larger gender pay gap than in other economic sectors, earning on average of 24% less than peers who are men […] Within countries, gender pay gaps tend to be wider in higher pay categories, where men are over-represented. Women are over-represented in the lower pay categories.</p>
</blockquote>
<p>Although this differential is not easily explained, it does reflect the value society ascribes to caregiving. If women are over-represented in the lower pay categories (which tend to focus more on personal care tasks) that suggests society ascribes low value to caregiving tasks, and over-representation of women in caregiving helps to further “feminise” caregiving.</p>
<p>It is highly likely these factors conspire to dissuade men and boys from getting started in nursing and undertaking caregiving roles within the profession.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/477278/original/file-20220803-25-gs9o51.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We urgently need more men in nursing.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Time for action</h2>
<p>We urgently need more men in nursing. </p>
<p>Not only does this make good sense for health care, as it presents opportunities for engagement with men, but also good sense for our society and economic productivity. Investment in education and job creation in the health and social sectors <a href="https://www.who.int/teams/high-level-commission-on-health-employment-and-economic-growth/recommendations">could improve</a> health outcomes, shore up global health security, and boost inclusive economic growth.</p>
<p>Perhaps most importantly, robust health care systems should be representative of the populations they serve. The workforce in any industry should be drawn from a range of perspectives, including gender and culture. </p>
<p><hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-saints-or-monsters-pop-cultures-limited-view-of-nurses-107696">Friday essay: saints or monsters, pop culture's limited view of nurses</a>
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</p><img src="https://counter.theconversation.com/content/184829/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia Davidson is Vice Chancellor and President of the University of Wollongong and is Dean Emerita at the Johns Hopkins School of Nursing. She has previously received funding from the National Health & Medical Research Council, Australian Research Council, National Heart Foundation, NSW Cancer Institute and National Institutes for Health in the United States. </span></em></p><p class="fine-print"><em><span>Caleb Ferguson works for the School of Nursing, University of Wollongong, NSW, Australia. He receives funding from the National Health & Medical Research Council, and has received funding from the Stroke Foundation and Heart Foundation.
</span></em></p><p class="fine-print"><em><span>Jason Farley works for Johns Hopkins University School of Nursing. He receives funding from the National Institutes of Health, Baltimore City Health Department, and the Centers for Disease Control and Prevention. </span></em></p>Research shows low male participation in the nursing workforce can stem from many sources, including reticence by career counsellors to recommend nursing as a career.Patricia Davidson, Vice-Chancellor, University of WollongongCaleb Ferguson, Associate Professor, University of WollongongJason Farley, Professor, Infectious Disease-Trained Epidemiologist and Nurse Practitioner, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1842422022-06-03T03:33:17Z2022-06-03T03:33:17ZEmergency departments are clogged and patients are waiting for hours or giving up. What’s going on?<figure><img src="https://images.theconversation.com/files/466875/original/file-20220603-18-8dxkiz.jpg?ixlib=rb-1.1.0&rect=56%2C69%2C3948%2C2420&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/sydney-nsw-australia-january-26-600w-1916848787.jpg">Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.aihw.gov.au/reports-data/myhospitals/intersection/activity/ed">25,000 people</a> visit hospital emergency departments across Australia every day. Many of them are reporting waiting for hours to be seen. Some <a href="https://www.abc.net.au/news/2022-06-01/victorian-hospitals-emergency-department-crisis/101111452">give up</a> and leave, only to have their condition deteriorate. </p>
<p>“Ambulance ramping” – where ambulances queue outside hospitals to hand over patients – has become more common and means some people wait long periods before they even arrive at emergency. </p>
<p>Of the <a href="https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care">8.8 million</a> presentations at emergency departments each year, one in three people wait more than four hours to be treated and admitted to a ward for further care, or to be discharged.</p>
<p>Our fragile public health system and its staff need urgent attention before emergency departments can recover.</p>
<h2>Not a new problem</h2>
<p>Demand for urgent hospital care is increasing Australia-wide, placing prolonged strain on the acute care services provided by emergency departments. But demand has been building over decades, not months.</p>
<p>According to the <a href="https://www.aihw.gov.au/reports-data/myhospitals/intersection/activity/ed">Australian Institute of Health and Welfare</a>, the number of people presenting at public emergency departments increased by 3.2% on average each year from 2014–2019, mostly due to an ageing population that is experiencing more complex health issues. </p>
<p>Perhaps surprisingly – and despite ups and downs in some cities over shorter periods – overall demand on emergency departments <a href="https://www.aihw.gov.au/reports-data/myhospitals/intersection/activity/ed">decreased</a> during the peak COVID period as people chose to stay home or were in lockdown. Volumes have only recently recovered to normal levels. </p>
<p>Two key issues stand in the way of people getting emergency care. </p>
<p>First, the public health system is already at capacity, so even small increases in demand send it into gridlock. </p>
<p>Second, with more and more staff unable to work due to illness, including COVID infection, burnout and now influenza, there are not enough staff to look after patients. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1525278391796396032"}"></div></p>
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Read more:
<a href="https://theconversation.com/hospital-emergency-departments-are-under-intense-pressure-what-to-know-before-you-go-169098">Hospital emergency departments are under intense pressure. What to know before you go</a>
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<h2>No slack in the system</h2>
<p>Emergency departments are in the business of preparing for the unexpected, whether it’s a surge in COVID infections or mass injuries from natural disasters, large-scale accidents or a terrorist attack.</p>
<p>The surge becomes magnified when the event also affects health-care staff or facilities, taking away care capacity as demand increases. We are currently facing an early influenza surge, with rates around what’s typically seen in late <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm/$File/flu-04-2022.pdf">June</a>. </p>
<p>Systems can cope with unexpected events by allowing “slack” or holding excess capacity in normal times. Unfortunately, our health-care systems have been stripped of excess capacity. <a href="https://theconversation.com/remind-me-how-are-hospitals-funded-in-australia-177915">Cuts</a> in the name of efficiency have been implemented by successive governments, without fully appreciating the implications on health-care supply in times of need. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1529809106533588992"}"></div></p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-private-health-insurance-rebate-has-cost-taxpayers-100-billion-and-only-benefits-some-should-we-scrap-it-181264">The private health insurance rebate has cost taxpayers $100 billion and only benefits some. Should we scrap it?</a>
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<h2>Working harder comes at a cost</h2>
<p>During COVID, extra capacity was created by ambulance and hospital staff working faster and longer. Longer term, this results in burnout. </p>
<p>Because burnout is harder to see than ramped ambulances, it’s less likely to make the evening news – but it’s a more critical and complex problem.</p>
<p>Around <a href="https://9now.nine.com.au/today/more-than-twenty-thousand-critical-care-nurses-quit-amid-pandemic-stress/87af0657-b43b-4be7-975b-8ff418234397">20,000 Australian nurses</a> left the profession in 2021, many citing <a href="https://www.acn.edu.au/post/we-need-to-urgently-address-the-nursing-crisis-in-australia">stress and abuse</a> suffered on the job. </p>
<p>Around 8% of <a href="https://theconversation.com/paramedics-have-one-of-australias-most-dangerous-jobs-and-not-just-because-of-the-trauma-they-witness-149540#:%7E:text=A%20national%20Australian%20study%20of,have%20anxiety%20and%2027%25%20depression">paramedics</a> suffer post-traumatic stress disorder, twice the average for Australian workers. Almost one third are diagnosed with depression. </p>
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<strong>
Read more:
<a href="https://theconversation.com/bad-for-patients-bad-for-paramedics-ambulance-ramping-is-a-symptom-of-a-health-system-in-distress-169528">Bad for patients, bad for paramedics: ambulance ramping is a symptom of a health system in distress</a>
</strong>
</em>
</p>
<hr>
<h2>Just add beds?</h2>
<p>The addition of “more beds” sounds like a practical solution – but hospital beds rely on staff (particularly nurses) to take care of the patients in them.</p>
<p>Addressing hospital staff shortages is less straightforward. There is a long lead time to train additional nurses and we can’t rely solely on importing them from overseas. New Zealand is already concerned we’re going to take many of its nurses to help our <a href="https://www.abc.net.au/news/2022-04-12/new-zealand-aged-care-labor-election-opposition-nurses/100983882">aged care sector</a> and other countries are competing for skilled hospital staff.</p>
<p>In an attempt to relieve pressure, governments want to divert those with less severe illnesses or injury away from emergency departments to urgent care centres or 24-hour GPs. This may improve access to care for some patients, but it may not substantially reduce emergency demand. <a href="https://www.bhi.nsw.gov.au/data-portal">New South Wales data</a> shows surprisingly few people went to emergency when they could have gone to a GP. </p>
<h2>Improving flow</h2>
<p>The long-term solution to emergency department blockages is to increase throughput. </p>
<p>Imagine the hospital as a bathtub, and the patients as the water streaming into the bath. Increasing the bath size is a temporary fix. If you can’t turn off the tap, it will quickly fill. We need to work on the drainage system – increasing the size of the drain and unblocking any pipes that are clogged. </p>
<p>Hospitals have a duty of care to discharge patients to a safe environment. To quicken hospital discharges, we need more community capacity to house people with disability, people with mental health conditions who need supported care, older people who can no longer live alone without assistance, and homeless people. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="hospital staff at busy work station" src="https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466876/original/file-20220603-12-aoc3q5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Addressing the shortage of health-care workers is a complex process.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/news-photo/india-wells-rn-and-ed-opnum-and-ed-mcgregor-ed-registrar-news-photo/1359053648?adppopup=true">Getty/Lisa Maree Williams</a></span>
</figcaption>
</figure>
<h2>Working with patients</h2>
<p>Processes often follow a “one size fits all” model, yet patients are diverse in their preferences and needs. Some groups have more complex needs, which mean they may spend longer in the emergency department. </p>
<p>We know, for example, emergency departments perform worse for older adults with multiple health conditions, people who have a disability or mental health condition, people who are Aboriginal and/or Torres Strait Islander, or who come from a culturally and linguistically diverse background.</p>
<p>We are about to embark on a <a href="https://thepulse.org.au/2022/05/04/2-8-million-to-reduce-emergency-wait-times-in-western-sydney-hospitals/">project</a> with three large Sydney hospitals. We will work with patients, clinicians and community groups to co-design emergency care improvements and reduce wait times. Examples might include strengthening connections between GPs and the emergency department, and greater use of technology to streamline care pathways and help patients navigate the journey. </p>
<p>For now, everyone can help alleviate stress on emergency departments by taking better care of their health, addressing problems early with their GP, and taking advantage of immunisation programs such as for COVID and influenza.</p><img src="https://counter.theconversation.com/content/184242/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robyn Clay-Williams receives funding from the Medical Research Future Fund and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Henry Cutler receives funding from the Medical Research Future Fund, National Health and Medical Research Council and the Australian Healthcare and Hospitals Association</span></em></p>Adding more beds won’t fix emergency department pressures. Neither will one-size-fits-all processes. But improving patient flow and addressing staff shortages might.Robyn Clay-Williams, Associate Professor, Macquarie UniversityHenry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1804972022-04-02T05:45:34Z2022-04-02T05:45:34ZLabor’s plans for aged care are targeted but fall short of what’s needed<figure><img src="https://images.theconversation.com/files/455725/original/file-20220401-25-bbb91w.jpg?ixlib=rb-1.1.0&rect=2%2C0%2C995%2C660&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-older-woman-caring-female-doctor-451107376">Shutterstock</a></span></figcaption></figure><p>In his <a href="https://anthonyalbanese.com.au/media-centre/budget-reply-2022">budget reply speech</a> this week, opposition leader Anthony Albanese promised a plan to fix the “crisis in aged care”. </p>
<p>Labor’s aged care package includes 24/7 registered nurses for all residential care facilities, better pay for aged care workers, more care, better food for residents, and greater accountability for providers. </p>
<p>The immediate cost of Labor’s commitments is estimated at <a href="https://theconversation.com/anthony-albanese-offers-2-5-billion-plan-to-fix-crisis-in-aged-care-180419">A$2.5 billion over four years</a>, not including better pay for workers. </p>
<p>That cost is likely to be up to <a href="https://www.smh.com.au/national/we-must-act-aged-care-body-calls-for-4b-annual-wages-injection-20220313-p5a47l.html">A$4 billion per year</a>, depending on the <a href="https://www.fwc.gov.au/hearings-decisions/major-cases/work-value-case-aged-care-industry">Fair Work Commission’s decision</a> later this year. The commission is considering <a href="https://www.theguardian.com/australia-news/2020/nov/12/more-than-200000-aged-care-workers-seek-25-pay-rise-in-landmark-australian-case">aged care worker unions’ case</a> for a 25% pay increase. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1509623059371773962"}"></div></p>
<p>But while Labor’s announcements are worthy initiatives, they stop short of the comprehensive plan we need for reform. </p>
<h2>What’s the problem?</h2>
<p>The Commonwealth <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/agedcarebeds">took responsibility for aged care from the states</a> 25 years ago. </p>
<p>It then centralised, privatised, commodified and marketised it to drive efficiency and manage its spending, but at the cost of quality and accountability.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/quality-costs-more-very-few-aged-care-facilities-deliver-high-quality-care-while-also-making-a-profit-178022">Quality costs more. Very few aged care facilities deliver high quality care while also making a profit</a>
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</em>
</p>
<hr>
<p>The results are there for all to see. Increasingly, larger “big box” institutions are riddled with loneliness, poor quality care and isolation from friends, family and the community. </p>
<p>Those who don’t want to go into residential aged care, face year-long waiting lists for home and community care. </p>
<p>The <a href="https://agedcare.royalcommission.gov.au">Royal Commission into Aged Care Quality and Safety</a> comprehensively documented the problems with the current system. </p>
<h2>Labor’s aged care announcements</h2>
<p>Labor’s initiatives in the budget reply are best seen as a downpayment focused on the problems in residential aged care identified by the commission. </p>
<p>The broader structural directions for policy are yet to be addressed. This includes:</p>
<ul>
<li>the balance between residential and home care, as Australians increasingly choose the latter</li>
<li>market management and stewardship, as too much emphasis falls on cost and profit for providers and not enough on quality and outcomes for residents</li>
<li>the balance between public and private financing, because better care will cost more.</li>
</ul>
<figure class="align-center ">
<img alt="Older man sits in a wheelchair in his bedroom." src="https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455889/original/file-20220402-25-ny5xi8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older Australians increasingly want to stay in their own home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-sitting-on-wheelchair-alone-1012812838">Shutterstock</a></span>
</figcaption>
</figure>
<p>But Labor’s initiatives for residential care are cleverly targeted.</p>
<p>Staff make up about <a href="https://www.stewartbrown.com.au/images/documents/StewartBrown---FY19-Aged-Care-Financial-Performance-Survey-Report.pdf">70% of residential aged care costs</a>. One way of reducing costs and improving profits is to employ low paid unskilled workers on casual and flexible part time arrangements. </p>
<p>Not surprisingly, this has made aged care unattractive for workers. Quality has suffered and it is increasingly hard to get staff.</p>
<p>Another way to cut costs is to reduce living expenses for aged care residents. On average, one-third of homes <a href="https://theconversation.com/why-is-nursing-home-food-so-bad-some-spend-just-6-08-per-person-a-day-thats-lower-than-prison-120421">still spend under $10 on food</a> for <a href="https://www.smh.com.au/national/report-questions-where-10-a-day-aged-care-food-budget-is-being-spent-20220325-p5a7v9.html">each resident per day</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-is-nursing-home-food-so-bad-some-spend-just-6-08-per-person-a-day-thats-lower-than-prison-120421">Why is nursing home food so bad? Some spend just $6.08 per person a day – that's lower than prison</a>
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</em>
</p>
<hr>
<p>There is little doubt aged care will struggle without a better paid and more skilled workforce, including <a href="https://theconversation.com/our-ailing-aged-care-system-shows-you-cant-skimp-on-nursing-care-115565">a greater role for nurses</a>. </p>
<p>In 2015, <a href="https://theconversation.com/nearly-2-out-of-3-nursing-homes-are-understaffed-these-10-charts-explain-why-aged-care-is-in-crisis-114182">it was estimated</a> each resident in aged care got about 168 minutes of care a day. </p>
<p>Labor is promising Fair Work wage increases for staff, 215 minutes of care for each resident and round-the-clock nursing support. </p>
<h2>What’s in the budget for aged care?</h2>
<p>The government promised little new for aged care in its 2022 budget, apart from a continuation of its response to the recent royal commission’s recommendations. </p>
<p>However there is a <a href="https://theconversation.com/when-aged-care-workers-earn-22-an-hour-a-one-off-bonus-wont-help-176136">one-off bonus of A$800</a> and additional funding for training and to embed pharmacists in aged care facilities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-budget-2022-spends-a-little-on-favoured-interest-groups-but-misses-a-chance-for-real-reform-179835">Health budget 2022 spends a little on favoured interest groups but misses a chance for real reform</a>
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<hr>
<p>While COTA (Council of the Ageing), which represents older Australians, <a href="https://www.cota.org.au/news-items/reflections-on-the-federal-budget/">largely endorsed the government’s budget</a> and its response to the royal commission, the Australian Aged Care Collaboration, representing major providers, has been <a href="https://lasa.asn.au/news/aged-care-budget-2022-initial-response">much more critical</a>, particularly of the government’s lack of commitment to lift the pay for aged care workers. </p>
<p>In contrast, both <a href="https://www.cota.org.au/news-items/cota-welcomes-labor-commitment-to-aged-care-reform/">consumer</a> and <a href="https://lasa.asn.au/news/aged-care-budget-in-reply-response-2022/">provider</a> organisations have been supportive of Labor’s budget initiatives for aged care.</p>
<p>In general, the aged care sector has <a href="https://www.smh.com.au/politics/federal/hopes-raised-and-dashed-in-aged-care-response-20220216-p59x0w.html">criticised the government’s response</a> to the aged care crisis as anaemic: too little, too slow and too late (particularly in relation to COVID). </p>
<p>Throughout the pandemic, there have been repeated calls for the Aged Care Minister, Richard Colbeck <a href="https://www.smh.com.au/politics/federal/who-is-richard-colbeck-the-low-profile-minister-in-the-middle-of-a-covid-crisis-20200828-p55qdu.html">to be sacked</a>.</p>
<figure class="align-center ">
<img alt="Empty corridor of a large aged care facility." src="https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/455887/original/file-20220402-62186-kj80a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The government’s response to COVID in aged care was widely criticised.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/corridor-elderly-care-facility-1579445854">Shutterstock</a></span>
</figcaption>
</figure>
<p>None of this was helped by the royal commission’s inability to present a coherent, unified and consistent blueprint. </p>
<p>Not surprisingly, the government cherry-picked an incremental, piecemeal path of least resistance from the commission’s recommendations to shore up, rather than reform, the current system. </p>
<p>A key line in opposition leader’s budget reply speech for aged care was: “we will bring the principle of universal, affordable and quality service to Child Care and to Aged Care”.</p>
<p>Aged care reform remains unfinished business for Labor. It made a start this week but more needs to come. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-aged-care-workers-earn-22-an-hour-a-one-off-bonus-wont-help-176136">When aged care workers earn $22 an hour, a one-off bonus won’t help</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/180497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hal Swerissen is a non executive director of the Murray PHN</span></em></p>Aged care reform remains unfinished business for Labor. It made a start this week but more needs to come.Hal Swerissen, Emeritus Professor, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1711022021-12-13T13:25:27Z2021-12-13T13:25:27ZThe US doesn’t have enough faculty to train the next generation of nurses<figure><img src="https://images.theconversation.com/files/434267/original/file-20211128-17-elh123.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7935%2C5238&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some nursing programs had to turn away students because of a shortage of faculty and clinical sites. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-attending-to-patients-needs-during-covid-19-royalty-free-image/1257336821"> FatCamera/E+ Collection via Getty Images</a></span></figcaption></figure><p>Despite a national <a href="https://theconversation.com/amid-a-raging-pandemic-the-us-faces-a-nursing-shortage-can-we-close-the-gap-149030">nursing shortage in the United States</a>, over <a href="https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/24802/2020-survey-data-student-enrollment">80,000 qualified applications were not accepted at U.S. nursing schools</a> in 2020, according to the American Association of Colleges of Nursing. </p>
<p>This was <a href="https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage">due primarily</a> to a shortage of nursing professors and a limited number of clinical placements where nursing students get practical job training. <a href="https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage">Additional constraints</a> include a shortage of experienced practitioners to provide supervision during clinical training, insufficient classroom space and inadequate financial resources.</p>
<p>Although the 80,000 <a href="https://www.ncsbn.org/LTL_Fall2021.pdf#page=17">may not account</a> for students who apply to multiple nursing schools, it clearly suggests that not all qualified students are able to enroll in nursing school. </p>
<p>I am a nurse researcher, <a href="https://health.usf.edu/nursing/faculty-staff/directory/raynaletourneau">professor of nursing</a> and founding director of <a href="https://health.usf.edu/nursing/partnerships/wires">WIRES</a>, an office at the University of South Florida that focuses on the well-being of the health care workforce. I’ve found that the nursing shortage is a complex issue that <a href="http://healthworkforcestudies.com/news/state_of_the_nursing_workforce_paper.pdf">involves many factors</a> – but chief among them is the shortage of faculty to train future nurses.</p>
<h2>Growing demand for nurses</h2>
<p>There are not enough new nurses entering the U.S. health care system each year to meet the country’s <a href="https://www.bls.gov/ooh/healthcare/registered-nurses.htm">growing demand</a>. This can have serious consequences for <a href="https://psnet.ahrq.gov/primer/nursing-and-patient-safety">patient safety</a> and <a href="https://doi.org/10.1093/restud/rdaa082">quality of care</a>. </p>
<p>Nationally, the number of jobs for registered nurses is <a href="https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-6">projected to increase by 9% between 2020 and 2030</a>. </p>
<p>Some states project an even higher demand for registered nurses because of their population and their needs. Florida, for example, will need to <a href="https://projectionscentral.org/Projections/LongTerm?AreaName=&AreaNameSelect%5B%5D=12&Name=nurse&items_per_page=10">increase its number of registered nurses by 16%</a> over the next decade.</p>
<p>The U.S. Bureau of Labor Statistics estimates there will be about <a href="https://www.bls.gov/ooh/healthcare/registered-nurses.htm">194,500 openings</a> for registered nurses each year over the next decade to meet the demands of the growing population, and also to replace nurses who retire or quit the profession. This means the U.S. will need about <a href="https://www.bls.gov/ooh/healthcare/registered-nurses.htm">2 million new registered nurses</a> by 2030.</p>
<p>In addition to a shortage of registered nurses, there is also a shortage of nurse practitioners. Nurse practitioner is identified as the <a href="https://www.bls.gov/emp/images/growing_occupations.png">second fastest-growing occupation</a> in the next decade, after wind turbine technicians, with a projected increase of 52.2%. Nurse practitioners have an advanced scope of practice compared with registered nurses. They must complete additional clinical hours, earn a master’s or doctoral degree in nursing, and complete additional certifications to work with specific patient populations. </p>
<p>The COVID-19 pandemic has exacerbated the <a href="https://nursing.osu.edu/news/2021/09/23/new-study-examines-association-between-nurses-well-being-workplace-wellness">health and wellness problems of the nursing workforce</a>. Despite these problems, student enrollment in nursing schools <a href="https://www.aacnnursing.org/News-Information/Press-Releases/View/ArticleId/24802/2020-survey-data-student-enrollment">increased in 2020</a>. The pandemic has not turned people away from wanting to pursue a career in nursing. However, without enough nursing faculty and clinical sites, there will not be enough new nurses to meet the health care demands of the nation. </p>
<figure class="align-center ">
<img alt="Women in red scrubs hold signs encouraging people to get vaccinated" src="https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436725/original/file-20211209-23-1m60ltq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Student enrollment in nursing schools increased in 2020 amid the COVID-19 pandemic.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/indiana-university-nursing-students-hold-signs-encouraging-news-photo/1235910444">Jeremy Hogan/SOPA Images/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<h2>Need for more nursing faculty</h2>
<p>Currently, the national <a href="https://www.aacnnursing.org/Portals/42/News/Surveys-Data/2020-Faculty-Vacancy-Report.pdf">nurse faculty vacancy rate is 6.5%</a>. This is slightly improved from the <a href="https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage">2019 rate of 7.2%</a>. More than half of all nursing schools <a href="https://www.aacnnursing.org/Portals/42/News/Surveys-Data/2020-Faculty-Vacancy-Report.pdf">report vacant full-time faculty positions</a>. The highest need is in nursing programs in <a href="https://www.aacnnursing.org/News-Information/News/View/ArticleId/25043/data-spotlight-august-2021-Nursing-Faculty-Shortage">Western and Southern states</a>. </p>
<p>Nursing education in clinical settings requires smaller student-to-faculty ratios than many other professions in order to maintain the safety of patients, students and faculty members. Regulatory agencies recommend at least one faculty member to <a href="https://www.ncsbn.org/ga_chapter410.pdf">no more than 10 students</a> engaged in clinical learning.</p>
<p>The faculty shortage is also affected by the fact that many current nursing faculty members are <a href="https://doi.org/10.1016/j.outlook.2017.03.003">reaching retirement age</a>. The percentage of full-time nursing faculty members <a href="https://www.nursingoutlook.org/article/S0029-6554(16)30314-1/fulltext">aged 60 and older</a> increased from roughly 18% in 2006 to nearly 31% in 2015. </p>
<p>The American Association of Colleges of Nursing reports the <a href="https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage">average ages</a> of doctorally prepared nurse faculty members at the ranks of professor, associate professor and assistant professor were 62.6, 56.9 and 50.9 years, respectively.</p>
<p>[<em>More than 140,000 readers get one of The Conversation’s informative newsletters.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140K">Join the list today</a>.]</p>
<p>Another factor that contributes to the nursing faculty shortage, and the most critical issue <a href="https://www.aacnnursing.org/Portals/42/News/Surveys-Data/2020-Faculty-Vacancy-Report.pdf">related to faculty recruitment</a>, is compensation. The salary of a nurse with an advanced degree is much higher in clinical and private sectors than it is in academia. </p>
<p>According to a survey by the American Association of Nurse Practitioners, the <a href="https://www.aanp.org/about/all-about-nps/np-fact-sheet">median salary of a nurse practitioner</a>, across settings and specialties, is $110,000. By contrast, the AACN reported in March 2020 that the <a href="https://www.aacnnursing.org/news-information/fact-sheets/nursing-faculty-shortage">average salary for master’s-prepared assistant professors</a> in nursing schools was just under $80,000. </p>
<figure class="align-center ">
<img alt="Two people wearing face masks and scrubs fill a syringe" src="https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436726/original/file-20211209-104971-1unb5cz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A registered nurse, at right, helps a nursing student prepare a dose of the COVID-19 vaccine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/western-university-of-health-sciences-master-nursing-news-photo/1300409969">Will Lester/MediaNews Group/Inland Valley Daily Bulletin via Getty Images</a></span>
</figcaption>
</figure>
<h2>Fixing the faculty shortage</h2>
<p>Innovative strategies are needed to address the nursing faculty shortage. The <a href="https://www.congress.gov/bill/116th-congress/house-bill/728">Title VIII Nursing Workforce Reauthorization Act of 2019</a> was a start. The act provides funding for nursing faculty development, scholarships and loan repayment for nurses, and grants for advanced nursing education, nursing diversity initiatives and other priorities.</p>
<p>The Build Back Better Act that <a href="https://www.congress.gov/bill/117th-congress/house-bill/5376">passed the U.S. House of Representatives</a> in November 2021 includes funding to help nursing schools across the country recruit and retain diverse nursing faculty and enroll and retain nursing students. The act is now before the U.S. Senate.</p>
<p>In addition to national strategies, individual states are addressing the shortage at the local level. Maryland, for example, awarded over <a href="https://mhec.maryland.gov/Pages/6-3-20.aspx">$29 million in grants</a> to 14 higher education institutions with nursing programs in Maryland to expand and increase the number of qualified nurses.</p>
<p>Finally, offering faculty salaries comparable to those in clinical settings may attract more nurses to use their expertise to train and expand the next generation of health care workers.</p><img src="https://counter.theconversation.com/content/171102/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rayna M. Letourneau receives funding from philanthropic supporters to build programs to recruit and retain competent nurses and nursing students into the profession. </span></em></p>The US has a growing demand for nurses. Yet nursing schools are turning away many qualified candidates.Rayna M. Letourneau, Assistant Professor of Nursing, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1677632021-11-12T13:35:55Z2021-11-12T13:35:55ZNurses don’t want to be hailed as ‘heroes’ during a pandemic – they want more resources and support<figure><img src="https://images.theconversation.com/files/430377/original/file-20211104-13-k52yd1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The COVID-19 pandemic has left many nurses feeling burned out, and its long-term effects on the profession are unknown.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nurse-takes-care-of-a-patient-infected-with-covid-19-in-the-news-photo/1235124543">JEFF PACHOUD/AFP via Getty Images</a></span></figcaption></figure><p>Nurses stepped up to the challenge of caring for patients during the pandemic, and over <a href="https://www.theguardian.com/us-news/ng-interactive/2020/aug/11/lost-on-the-frontline-covid-19-coronavirus-us-healthcare-workers-deaths-database">1,150 of us have died from COVID-19</a> in the U.S. As cases and deaths surge, nurses continue working in a broken system with <a href="https://oig.hhs.gov/oei/reports/oei-06-20-00300.asp">minimal support and resources</a> to care for critically sick patients, many of whom will still die.</p>
<p><a href="https://scholar.google.com/citations?user=ZUV-5awAAAAJ&hl=en">We</a> <a href="https://www.up.edu/academics/faculty-profiles/chloe-littzen.html">are</a> nurses and nurse scientists who <a href="https://repository.arizona.edu/handle/10150/660275?show=full">study nurse well-being</a> during the COVID-19 pandemic. One of our studies, which asks <a href="http://tiny.cc/COVIDDisclosure">health care workers to share voicemails</a> about their experience providing care during the COVID-19 pandemic, is ongoing. What we have found across our studies is that nurses are struggling, and without help from both the public and health care systems they may they leave nursing altogether. </p>
<p>To help you understand their experiences, here are the five key takeaways from our studies on what nursing has been like during the COVID-19 pandemic.</p>
<h2>1. Calling nurses ‘heroes’ is a harmful narrative</h2>
<p>Nurses demonstrated that they will do almost anything for their patients, even <a href="https://khn.org/news/these-front-line-workers-could-have-retired-they-risked-their-lives-instead/">risking their own lives</a>. As of the end of December 2020, <a href="https://www.icn.ch/news/covid-19-effect-worlds-nurses-facing-mass-trauma-immediate-danger-profession-and-future-our">more than 1.6 million health care workers</a> worldwide had been infected by COVID-19, and nurses make up the largest affected group in many countries. </p>
<p>For this, <a href="https://doi.org/10.1016/j.ijnurstu.2021.103887">nurses have been hailed as heroes</a>. But this can be a dangerous label with negative consequences. With this hero narrative, expectations of what nurses should do become unrealistic, such as working with <a href="https://repository.arizona.edu/handle/10150/660275?show=full">inadequate resources, staffing and safety precautions</a>. Consequently, it becomes normalized for nurses to work longer hours or extra shifts without consideration for how this may affect them personally. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="ICU nurse at computer with hand over their masked face." src="https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The hero narrative surrounding nurses could exacerbate burnout.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakLouisianaHospital/dbff33d1da064b099139239d6b727dc7">AP Photo/Gerald Herbert</a></span>
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</figure>
<p>This ultimately could result in nurses’ leaving the profession because of burnout. A survey conducted by the American Association of Critical-Care Nurses of over 6,000 ICU nurses found that <a href="https://www.aacn.org/newsroom/hear-us-out-campaign-reports-nurses-covid-19-reality">66% of respondents were considering leaving nursing</a> as a result of their care experiences during the pandemic. Similarly, we found that <a href="http://hdl.handle.net/10150/660275">67% of nurses under 30</a> are considering leaving their organizations within the next two years.</p>
<p>The nurses in our studies put the needs of their patients and society above their own. This is how one young nurse described their experience caring for COVID-19 patients without any safety guidance: “There was a palpable tenseness being there … nobody knew what was going on or what was expected. There was no real protocol yet. If a patient was admitted and you had to take care of one, you kind of felt like you were being thrown to the wolves as an experiment.”</p>
<h2>2. Nurses lack adequate resources or support</h2>
<p>Nurses have cared for patients despite working in <a href="https://www.osha.gov/coronavirus/hazards">hazardous work environments</a>. While some health care organizations have offered <a href="https://www.nbcnews.com/business/business-news/rural-hospitals-losing-hundreds-staff-high-paid-traveling-nurse-jobs-n1279199">increased pay to travel nurses</a>, or contracted temp nurses to address staffing shortages, that offer hasn’t been extended to their full-time staff. Many organizations instead require overtime and don’t provide adequate resources, <a href="https://www.who.int/news/item/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide">such as personal protective equipment</a> or <a href="https://www.wsj.com/articles/high-pay-for-covid-19-nurses-leads-to-shortages-at-some-hospitals-11630253483">support personnel</a>, for safe patient care. This has left many nurses feeling unappreciated, undervalued and unsafe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health care workers huddled at an ICU nursing station at night." src="https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inadequate institutional support during the pandemic left nurses working long hours in hazardous conditions.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/several-healthcare-workers-working-in-the-icu-of-the-san-news-photo/1306877903">Alvaro Calvo/Stringer via Getty Images News</a></span>
</figcaption>
</figure>
<p>As one nurse from our study explained: “Lack of resources, lack of staffing, lack of getting all our concerns addressed, things like that. Those are very draining, especially when we’re supposed to provide patient care and do a good job. … All the drama from work and things like that, those don’t help. If anything, it just makes the environment more toxic and unbearable, definitely, and at one point, it will start affecting … your mental health and your physical health, even your spiritual health.”</p>
<h2>3. Nurses lost trust in health care organizations</h2>
<p>Nurses said they struggled with <a href="http://hdl.handle.net/10150/660275">rapidly changing policies and procedures</a>. Even when they were given information about these changes, many health care organizations weren’t transparent about the reasons behind them and expected nurses to just roll with the punches. </p>
<p>Even worse, some health care organizations gaslit nurses for being concerned for their own safety. One young inpatient nurse, for example, described frustrations with lack of communication from management: “They just weren’t telling us much of anything. We have three managers and seven clinical coordinators on our unit. There were definitely enough people to be sending emails and to be giving updates, but they were so unsure as well that they just kind of opted for radio silence, which was really frustrating and made the whole situation more challenging. When they were giving us information, a lot of it was, you guys are overreacting. You don’t need to wear N95s all the time.” </p>
<p>The safety sacrifices nurses have made for their organizations and patients has led to severe mental health consequences. In <a href="https://doi.org/10.1097/01.NUMA.0000752784.86469.b9">one study</a> of 472 nurses in California, 79.7% reported anxiety and 19% met the clinical criteria for major depression.</p>
<p>Another nurse in our study had a similar experience: “Our policies were changing so rapidly that oftentimes anesthesia would have a different understanding [of the policy], the doctors and residents would have a different understanding, and nursing would have gotten a different email always within like a half-hour. It was extremely frustrating. It was very, very stressful.”</p>
<h2>4. Nurses experience morally traumatic events</h2>
<p>Nurses have been exposed to a substantial amount of <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp">moral injury</a>, which occurs when they witness, perpetuate or fail to prevent something that contradicts their beliefs and expectations. </p>
<p>Not only have nurses seen a high volume of deaths every day, but they have also been placed in morally difficult situations due to resource shortages, such as <a href="https://www.usnews.com/news/us/articles/2021-08-31/oxygen-supplies-grow-precarious-amid-covid-surge">oxygen supplies</a>, <a href="https://www.miamiherald.com/news/coronavirus/article254289313.html">ECMO machines</a> that support heart and lung function, and <a href="https://www.nytimes.com/2020/11/27/health/covid-hospitals-overload.html">hospital beds and staff</a>. Even more routine aspects of care, such as basic hygiene, <a href="https://dx.doi.org/10.1111%2Fjan.15013">were neglected</a>, further contributing to nurse moral distress.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse hunched over with head in hands." src="https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=513&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=513&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=513&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=645&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=645&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=645&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The moral injury that nurses sustain can take a toll on their mental health.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakOregon/e91d8625b38846e5869cbbd8b47b557c">AP Photo/Hanin Najjar</a></span>
</figcaption>
</figure>
<p>One nurse in our study described their experience of moral distress in making life support decisions for patients: “We were told very early on … if this person needs a ventilator, they are not going to get it. So, in a way, we were determining code status without really consulting the patient, which to me is very problematic and unethical.”</p>
<h2>5. Nurses are frustrated by the public’s not taking the pandemic seriously</h2>
<p><a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html">Masks</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html">vaccines</a> are proven to help prevent the spread of COVID-19. Yet some Americans <a href="https://www.bbc.com/news/world-us-canada-53477121">still refuse to mask</a>, and, as of Nov. 1, 2021, <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-by-race-ethnicity/">only 67% of the population</a> has received at least one dose of the vaccine.</p>
<p>According to the CDC, 92% of COVID-19 cases and hospitalizations, and 91% of COVID-19-related deaths, were among individuals who were <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm">not fully vaccinated</a> between April and July 2021. Conversely, only 8% of COVID-19 cases and 9% of deaths were among fully vaccinated individuals. </p>
<p>Nurses care for patients regardless of vaccination status. Unfortunately, what the public may not realize is that their decision to decline vaccination or masking has serious consequences not only for nurses, but also their friends and community members. When hospital systems are overwhelmed with unvaccinated COVID-19 patients, there may be limited staff or resources to help those who need <a href="https://www.wsj.com/articles/hospitals-swamped-with-delta-cases-struggle-to-care-for-critical-patients-11630661403">care for other medical emergencies</a>. This is a frustrating experience for nurses who find themselves unable both to care for every patient in need and to protect people from contracting COVID-19.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="ICU nurse hugging sister of patient who had just died." src="https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses not only see a large number of COVID-19 deaths firsthand, they may also need to provide comfort for those left behind.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakLouisianaHospital/39bcdab213ec4d41a51627e74aa4b3e1">AP Photo/Gerald Herbert</a></span>
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</figure>
<p>A nurse in one of our studies recalled having to chase after an unvaccinated pregnant person with COVID-19 who attempted to leave the ICU against medical advice, despite the risk that she might infect other people: “This was so early [in the pandemic], we didn’t know how far [the virus] would travel. So I’m, like, is she going infect the staff in the lobby? Are there people down there? You know, she’s just going to go home and give this to her newborn. And … her husband looked at me and said, you know, basically Western medicine isn’t real and this isn’t real and I’m, like, OK, this is real. And I’m, like, you’re going to give it to your newborn and your five kids.”</p>
<h2>How you can help nurses</h2>
<p>As the pandemic continues to overwhelm hospitals and communities across the U.S., its effects on nurses need to be carefully considered. Exhausted and demoralized nurses are <a href="https://www.nbcnews.com/health/health-news/u-s-hospitals-hit-nurse-staffing-crisis-pandemic-rages-n1278465">already quitting or retiring</a> at alarming rates.</p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-newsletter-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Only time will tell what long-term effects the COVID-19 pandemic will have on the nursing profession. But the public and health care organizations can step up to help nurses now by increasing access to mental health support and providing adequate resources, safe working conditions and organizational transparency during times of immense change. And everyone can help by protecting themselves from COVID-19 through masking and vaccination.</p><img src="https://counter.theconversation.com/content/167763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Rainbow receives funding from the National Institute of Occupational Safety and Health, National Council of State Boards of Nursing Center for Regulatory Excellence, The University of Arizona College of Nursing, and HRSA. The study described in this piece was unfunded.</span></em></p><p class="fine-print"><em><span>Chloé Littzen receives funding from the Sigma Theta Tau International Beta Mu Chapter of the University of Arizona.</span></em></p><p class="fine-print"><em><span>Claire Bethel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exhausted and demoralized nurses are leaving the profession at alarming rates as the COVID-19 pandemic drags on.Jessica Rainbow, Assistant Professor of Nursing, University of ArizonaChloé Littzen, Assistant Professor of Nursing, University of PortlandClaire Bethel, Adjunct Instructor of Nursing, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1693062021-10-24T12:25:31Z2021-10-24T12:25:31ZHow regulatory agencies, not the courts, are imposing COVID-19 vaccine mandates<figure><img src="https://images.theconversation.com/files/427874/original/file-20211021-27-udafb.JPG?ixlib=rb-1.1.0&rect=0%2C0%2C5599%2C3729&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dr. Nili Kaplan-Myrth, an Ottawa family doctor who hosted several pop-up COVID-19 vaccination clinics, speaks in Ottawa in August 2021 during JabaPalooza, a rally calling on Ontario to adopt a provincial COVID-19 vaccine mandate.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-regulatory-agencies--not-the-courts--are-imposing-covid-19-vaccine-mandates" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic has undoubtedly <a href="https://theconversation.com/creating-new-social-divides-how-coronavirus-is-reshaping-how-we-see-ourselves-and-the-world-around-us-137485">reshaped how we perceive ourselves</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/19460171.2021.1963793?journalCode=rcps20">the social world around us</a>. It has more recently transformed the <a href="https://www.scc-csc.ca/judges-juges/spe-dis/bm-2013-05-27-eng.aspx">business of governance</a> in western democracies like Canada.</p>
<p>The crisis has modified how the law is applied to society and redefined who decides the exceptions to the rules that our society must now adhere to. </p>
<p>The decisions of medical health-care professionals like <a href="https://www.health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/guidance_proof_of_vaccination_for_businesses_and_organizations.pdf">doctors and nurse practitioners</a> are now far more legally and politically significant than before, since they’re determining who is exempt from following new vaccination laws and mandates.</p>
<figure class="align-center ">
<img alt="A doctor wearing a head covering and a mask adminsters a vaccine to a woman." src="https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427873/original/file-20211021-19-1nxsou7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Dr. Stephen Lee from Toronto’s Michael Garron Hospital administers a Moderna vaccine at a mobile vaccination site outside a mosque in Toronto in April 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young</span></span>
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<p>Because of the implications that immunization exemptions have on public health, regulatory bodies like the <a href="https://www.cpso.on.ca/">Ontario College of Physicians and Surgeons</a> and the <a href="https://www.cno.org/">College of Nurses of Ontario</a> are playing a more significant role than they have previously in holding doctors and nurses accountable.</p>
<p>Under the current pandemic circumstances and new immunization laws, the decisions of administrative and regulatory agencies are likely to have a much greater impact on society than the courts.</p>
<h2>Vaccine passport rules</h2>
<p>Ontario’s <a href="https://news.ontario.ca/en/backgrounder/1000780/new-requirement-for-proof-of-vaccination-in-certain-settings-frequently-asked-questions">vaccine mandate</a> took effect on Sept. 22, 2021, requiring vaccine passports to access <a href="https://ontariosuniversities.ca/wp-content/uploads/2021/09/PSE-Guidance-Framework.pdf">various public-</a> and <a href="https://ontariosuniversities.ca/wp-content/uploads/2021/09/PSE-Guidance-Framework.pdf">private-sector</a> facilities. </p>
<p>Canadians over the age of 12 who remain unvaccinated face a difficult decision: receive a government-approved COVID-19 vaccine or accept the consequences.</p>
<p>Canadians face more than just missing out on public social gatherings as institutions move towards more restrictive measures. Failing to comply with vaccine mandates may also result <a href="https://toronto.ctvnews.ca/employees-who-refuse-to-be-vaccinated-can-be-fired-lawyer-1.5615552">in the loss of jobs</a> and being forced to withdraw from educational programs. </p>
<p>Additionally, Canadians who are not fully vaccinated by Nov. 30 will be unable to travel from <a href="https://www.canada.ca/en/transport-canada/news/2021/10/mandatory-covid-19-vaccination-requirements-for-federally-regulated-transportation-employees-and-travellers.html">Canadian airports or railways.</a> </p>
<p>Although the vaccination requirements <a href="https://toronto.ctvnews.ca/ontario-s-proof-of-vaccination-requirement-could-eventually-be-made-voluntary-for-businesses-sources-1.5622432">could eventually become voluntary</a>, they currently require compliance.</p>
<figure class="align-center ">
<img alt="Travellers wearing face masks wait in line at an airport." src="https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427878/original/file-20211021-13-1bsh6g2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Travellers wait in line to check in for a flight to Manila at Vancouver International Airport in Richmond, B.C., in July 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
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<h2>Exception to the rules</h2>
<p>The only alternative to restrictive government mandates is to obtain a medical exemption that can only be verified by a doctor or nurse practitioner. </p>
<p>While considerations for human rights-based exemptions are not entirely precluded or disregarded, in Ontario, the province’s Human Rights Commission has found vaccination requirements <a href="http://www.ohrc.on.ca/en/news_centre/ohrc-policy-statement-covid-19-vaccine-mandates-and-proof-vaccine-certificates">generally permissible</a> under its human rights code.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-covid-19-vaccinations-be-mandated-short-answer-yes-151958">Can COVID-19 vaccinations be mandated? Short answer: Yes</a>
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<p>This has left much of the power to determine exemptions from new health and safety measures almost exclusively in the hands of doctors and nurse practitioners.</p>
<p>While medical exemptions are <a href="https://www.cbc.ca/news/canada/ottawa/vaccine-medical-exemption-ottawa-1.6172055">considered rare</a> and presumably granted in <a href="https://www.cbc.ca/news/canada/new-brunswick/covid-19-vaccine-medical-exemption-1.6183944">exceptional circumstances</a>, <a href="https://toronto.ctvnews.ca/ontario-s-top-doctor-says-medical-exemptions-to-covid-19-vaccine-being-granted-too-frequently-1.5611874">Ontario’s Chief Medical Officer of Health said he’s heard reports suggesting</a> they are being granted too frequently. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A doctor stands outside her medical clinic, arms crossed." src="https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=451&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=451&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=451&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427884/original/file-20211021-15-p8dbla.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Dr. Memoona Butt of Calgary says some patients have demanded vaccination exemptions based on misinformation or unverified information.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh</span></span>
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<p>There has also been a <a href="https://www.theglobeandmail.com/canada/article-as-vaccine-passports-kick-in-doctors-see-a-rise-in-medical-exemption/">growing demand</a> on doctors for exemptions from those who are vaccine-hesitant even though they <a href="https://health.gov.on.ca/en/pro/programs/publichealth/coronavirus/docs/vaccine/medical_exemptions_to_vaccination.pdf">don’t actually qualify</a>.</p>
<p>What remains unclear is whether doctors will meet the demands of unqualified exemption requests. <a href="https://www.cbc.ca/news/canada/toronto/patrick-phillips-covid-19-misinformation-college-1.6191906">Some doctors</a> have already shown a willingness to oppose the mandates <a href="https://www.cbc.ca/news/canada/toronto/ontario-doctors-covid-1.6214950">and grant illegitimate exemptions.</a></p>
<h2>Can doctors be held accountable?</h2>
<p>Despite rigid ethical standards and <a href="https://www.cpso.on.ca/Physicians/Your-Practice/Physician-Advisory-Services/COVID-19-FAQs-for-Physicians">policy directives and guidelines</a> provided in Ontario by the Ontario College of Physicians and Surgeons on immunization exemptions, doctors exercise a great deal of discretion when it comes to their practices. </p>
<p>This level of discretion, while necessary in many cases, may allow physicians to make medical decisions according to their own political beliefs and not according to objective medical standards.</p>
<p>The problem with exercising discretion when it comes to COVID-19 policies is that it grants physicians who oppose vaccine mandates a tremendous opportunity to circumvent the law. </p>
<p>While the rule of law does not require all people to be treated identically, it does require applying the same standards to all people in similar circumstances. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-proposal-to-reduce-vaccine-exemptions-while-respecting-rights-of-conscience-110467">A proposal to reduce vaccine exemptions while respecting rights of conscience</a>
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<p>Under these circumstances, physicians may potentially <a href="https://www.lawnow.org/the-rule-of-law-what-is-it-why-should-we-care/">violate laws</a> by not giving the same considerations or applying the same standards to people in similar circumstances.</p>
<p>In other words, they may allow some patients to avoid vaccine mandates by providing illegitimate immunization exemptions to unqualified people.</p>
<p>Holding doctors accountable, while not entirely impossible, will be quite challenging. Since a system has not yet been established to <a href="https://winnipeg.citynews.ca/video/2021/10/05/ontarios-top-doctor-says-vaccine-exemptions-being-given-out-too-often/">track or validate exemptions</a>, the process for reviewing them is unclear.</p>
<h2>Tribunals as accountability institutions</h2>
<p>The Ontario college traditionally oversees and regulates the medical health-care profession. Disciplinary actions were once handled internally by various committees, but the college established its first independent <a href="https://opsdt.ca/">discipline tribunal</a> on Sept. 1, 2021. The tribunal is responsible for adjudicating allegations of professional misconduct or incompetence of Ontario physicians.</p>
<p><a href="https://doi.org/10.1111/j.1754-7121.1987.tb00063.x">Tribunals</a> are in many ways like courts. They follow particular legal procedures, conduct hearings and play an important role in <a href="https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/7/index.do">interpreting and applying the law.</a></p>
<p>However, unlike courts, tribunals are designed to adjudicate matters and regulate the administration of particular public policy areas such as <a href="https://doi.org/10.1111/capa.12275">immigration and refugee policy</a>. Due to <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2880154">their expertise</a>, tribunal members are responsible for holding public officials accountable for their actions.</p>
<p>Tribunals are designed to function as institutions of accountability, but achieving that goal is easier said than done.</p>
<p>The timely move by the college towards establishing an independent, arms-length adjudicatory board is an indication of the legally and politically heightened role of doctors. It also signals the <a href="https://www.annualreviews.org/doi/abs/10.1146/annurev.polisci.11.053006.183906">increasing trend of judicialization</a> of our politics. </p>
<p>However, rather than the courts, administrative agencies such as the newly created Ontario Physicians and Surgeons Discipline Tribunal will be on the front lines when holding doctors accountable in their application of the law.</p>
<h2>Heightened role of regulatory bodies</h2>
<p>Like other provinces across Canada that have <a href="https://www.bnnbloomberg.ca/across-canada-vaccine-passports-are-a-patchwork-here-s-what-that-looks-like-1.1647710">implemented similar COVID-19 immunization policies</a>, there has been a lot of concern over the <a href="https://www.ctvnews.ca/health/coronavirus/do-vaccine-mandates-violate-canadians-charter-rights-1.5569971">potential violation of rights</a> and <a href="https://www.cbc.ca/news/canada/calgary/firefighters-lawsuit-ahs-vaccine-mandate-alberta-1.6211066">civil liberties</a> associated with the new health and safety measures. </p>
<p>Arguments by vaccine mandate opponents citing the Canadian Charter of Rights and Freedoms <a href="https://policyoptions.irpp.org/magazines/septembe-2021/charter-arguments-will-not-likely-help-vaccine-mandate-opponents/">are unlikely to succeed</a>, so pandemic-related legal battles will more likely be handled by regulatory bodies and administrative tribunals.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/canadian-colleges-and-universities-can-mandate-covid-19-vaccination-without-violating-charter-rights-166640">Canadian colleges and universities can mandate COVID-19 vaccination without violating Charter rights</a>
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<p>The decisions made by discipline tribunals and others, like the Labour Relations Board that handles <a href="https://toronto.ctvnews.ca/ttc-asks-labour-relations-board-to-declare-illegal-strike-action-over-low-employee-compliance-with-vaccine-policy-1.5604603">employee compliance with vaccine policies</a>, will therefore play a crucial role in restructuring a post-pandemic society. </p>
<p>For now, the COVID-19 pandemic has cast a bright light on the role of regulatory organizations and administrative agencies and how they mediate the relationship between the state and society. In the post-pandemic area, more attention should be paid to the decisions they make.</p><img src="https://counter.theconversation.com/content/169306/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Said does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The decisions of medical health-care professionals like doctors and nurse practitioners are more legally significant than ever before since they are determining vaccination exemptions.David Said, PhD Candidate/Researcher, Political Science, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1663252021-09-17T12:19:57Z2021-09-17T12:19:57ZNurses are leaving the profession, and replacing them won’t be easy<figure><img src="https://images.theconversation.com/files/420102/original/file-20210908-21-1czjthe.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many nurses are physically and emotionally exhausted from the toll of COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/male-nurse-struggles-with-mental-health-royalty-free-image/1309350765">lightspeedshutter/iStock via Getty Images Plus</a></span></figcaption></figure><p>The fourth wave of COVID-19 is exacerbating the <a href="https://www.usnews.com/news/health-news/articles/2021-08-19/fourth-covid-wave-swamps-stressed-nurse-corps">ongoing crisis for the nursing workforce</a> and has <a href="https://www.turnto23.com/news/national/coronavirus/you-dont-necessarily-feel-heroic-anymore-health-care-workers-facing-burnout-amid-4th-covid-wave">led to burnout</a> for many nurses. As a result, <a href="https://www.opb.org/article/2021/07/21/working-conditions-understaffing-is-driving-nurses-to-quit/">many are quitting</a> their jobs in substantial numbers <a href="https://www.npr.org/2021/08/10/1026577164/hospitals-face-a-shortage-of-nurses-as-covid-cases-soar">all across the country</a>, with 62% of hospitals reporting <a href="https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf">a nurse vacancy rate higher than 7.5%</a>, according to a 2021 NSI Nursing Solutions report.</p>
<p>But the global pandemic has only worsened problems that have long existed within the nursing profession – in particular, widespread <a href="https://www.everydayhealth.com/news/why-americas-nurses-are-burning-out/">stress</a> and <a href="https://nurse.org/articles/risks-for-nurse-burnout-symptoms/">burnout</a>, <a href="https://www.nursingworld.org/practice-policy/work-environment/health-safety/health-safety-survey/">health and safety issues</a>, <a href="https://www.fiercehealthcare.com/healthcare/depression-a-silent-epidemic-for-nurses">depression</a> and <a href="https://doi.org/10.1111/jocn.15288">work-related post-traumatic stress disorder</a>, and even <a href="https://www.nursingworld.org/practice-policy/nurse-suicide-prevention/">increased risk of suicide</a>. </p>
<p>In addition, nurses need to contend with <a href="https://www.amihm.org/nurse-workload-staffing-and-measurement/">growing workloads</a> and <a href="https://www.nursingworld.org/practice-policy/nurse-staffing/">inadequate staffing</a>, or not having the right number of nurses on the right units to ensure that patients receive safe quality care. <a href="https://onlinedegrees.bradley.edu/blog/mandatory-overtime-what-you-need-to-know/">Mandatory overtime</a> is another challenge and occurs when nurses must work extra hours beyond their shift because of staffing shortages. All of these issues can lead to low job satisfaction among nurses and are likely to contribute to nurses’ <a href="https://doi.org/10.1016/j.apnr.2019.06.001">leaving the profession</a>, a trend that began well before the current pandemic struck. </p>
<p>Despite more awareness of the challenges nurses currently face, <a href="https://doi.org/10.1056/NEJMsa1001025">nurse staffing and its impact on patient safety</a> have been studied for more than 20 years. My role as a <a href="https://health.usf.edu/nursing/faculty-staff/directory/raynaletourneau">nurse researcher and assistant professor</a> at the University of South Florida is to evaluate the needs of the nursing workforce and <a href="https://health.usf.edu/nursing/frontline-nursing">design and implement programs</a> to address them. </p>
<p>Here’s why the pandemic has made the nursing shortage even worse, and why I think health care leaders need to make bold changes to address the well-being of nurses – for the sake of nurses and patient care in our country. </p>
<h2>Disruptions in health care delivery</h2>
<p>Nurses, like many health care workers, are <a href="https://doi.org/10.1001/jamanetworkopen.2020.36469">physically and emotionally exhausted</a> after working in what has been <a href="https://www.nytimes.com/2021/08/21/health/covid-nursing-shortage-delta.html">described as a “war zone”</a> for the better part of the past year and a half. One nurse on the front lines reported <a href="https://twitter.com/shesinscrubs/status/1432796040684523523">irreversible damage</a> from the trauma of caring for extremely sick patients. Others are experiencing shortages of <a href="https://www.advisory.com/daily-briefing/2021/09/01/oxygen-shortage">oxygen,</a> equipment and <a href="https://hbr.org/2020/09/why-the-u-s-still-has-a-severe-shortage-of-medical-supplies">other needed supplies</a> to keep themselves safe and to keep their patients alive. </p>
<p>As more nurses leave the workforce, patient care will no doubt suffer. Research has shown a relationship between <a href="https://doi.org/10.1001/jama.288.16.1987">nurse staffing ratios and patient safety</a>. <a href="https://www.ncbi.nlm.nih.gov/books/NBK2657/">Increased workload</a> and stress can put nurses in situations that are more likely to lead to <a href="https://www.ncbi.nlm.nih.gov/books/NBK430763/">medical errors</a>. Lower nurse staffing and higher patient loads per nurse are associated with an <a href="https://doi.org/10.1136/bmjqs-2018-008043">increased risk for patients of dying</a> in the hospital. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1432796040684523523"}"></div></p>
<p>Because <a href="https://www.nytimes.com/2021/08/21/health/covid-nursing-shortage-delta.amp.html">hospitals cannot open beds</a> if there are no nurses to staff them, some hospitals are being forced to <a href="https://www.wfaa.com/article/news/health/coronavirus/some-north-texas-hospitals-close-ers-shift-staff-to-address-covid-19-patient-surge/287-3692c51d-00b1-4825-8fb3-343e239ef56e">shut down emergency rooms</a> and <a href="https://abc7news.com/coronavirus-surge-4th-wave-nurse-shortage/10922472/">turn away patients in need of medical care</a>. That is a problem for not only hospitals in large cities; <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/09/01/rural-hospitals-cant-find-the-nurses-they-need-to-fight-covid">rural hospitals</a> are also struggling. Alarmingly, some hospitals are considering the <a href="https://www.npr.org/sections/health-shots/2021/09/05/1034210487/covid-surge-overwhelming-hospitals-raising-fears-rationed-care">need to potentially ration medical care</a>. </p>
<h2>How some hospitals are addressing the shortage</h2>
<p>Hospitals are desperate to fill nursing vacancies. One hospital system in South Dakota is offering incentives as large as <a href="https://www.beckershospitalreview.com/compensation-issues/south-dakota-health-system-offers-40k-signing-bonus-to-nurses.html">US$40,000 sign-on bonuses</a> to recruit nurses to work in the clinical areas that are in most need. This may be a great attempt to draw nurses to an institution, but sign-on bonuses and <a href="https://www.vox.com/22600439/nurse-america-mental-health-suicide">incentives might not be enough</a> to persuade some nurses to work at the bedside and continue contending with the current workload of the pandemic. </p>
<p>Another strategy to fill vacancies is the use of travel nurses. Travel nurses work for agencies that assign them to hospitals that cannot fill vacancies with their own staff. Although this can be a successful short-term solution, the use of travel nurses is not sustainable over time and it does not help retain experienced staff nurses in an organization. Travel nurses make <a href="https://www.travelnursing.org/why-travel-nurses-make-more-money/">significantly more money</a> than staff nurses, which may lure nurses away from permanent positions and in turn increase the staffing deficit for hospitals. The <a href="https://www.indeed.com/career/travel-nurse/salaries">average salary</a> for a travel nurse in the U.S. is $2,003 per week, with $13,750 in overtime per year. Some nurses even accept <a href="https://cronkitenews.azpbs.org/2021/04/28/travel-nurses-staffing-industry-pushed-to-the-limits-by-covid/">“crisis assignments,”</a> which can pay as much as $10,000 per week. That is significantly higher than the average of $1,450 per week (<a href="https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-1">$36.22 per hour</a>) for a staff nurse.</p>
<figure class="align-center ">
<img alt="masked female health care worker looking straight at camera with arms crossed" src="https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420103/original/file-20210908-15-482jxf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hospitals cannot open beds if there are no nurses to staff them.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-doctor-nurse-with-arms-crossed-royalty-free-image/1272765461">Morsa Images/DigitalVision via Getty Images</a></span>
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</figure>
<h2>Focus on nurses’ well-being</h2>
<p>For the past 18 years, nursing has been identified as the <a href="https://news.gallup.com/poll/274673/nurses-continue-rate-highest-honesty-ethics.aspx">most trusted profession</a>. Nurses are caregivers, role models, educators, mentors and advocates and have a direct impact on the health and well-being of patients. The health of the nation’s nursing workforce is fundamental to our health care industry. As identified by a 2021 <a href="https://nam.edu/publications/the-future-of-nursing-2020-2030/">National Academy of Medicine report</a>, nurse well-being and resilience are needed to ensure the delivery of high-quality care and to improve the health of the nation.</p>
<p><a href="https://ppc.sas.upenn.edu/learn-more/perma-theory-well-being-and-perma-workshops">Research demonstrates</a> that people with higher levels of well-being have lower levels of burnout and perform better at work. Therefore, some hospitals and unions are offering <a href="https://www.nationalnursesunited.org/national-covid-19-mental-health-resources">resources and programs</a> to nurses during the COVID-19 pandemic that seek to <a href="https://www.nursingworld.org/practice-policy/work-environment/health-safety/combating-stress/">reduce stress</a>, <a href="https://degree.astate.edu/articles/nursing/resilience-is-important-for-nurses.aspx">promote resiliency</a> and <a href="https://www.mywellbeingindex.org/blog/7-ways-to-improve-well-being-among-nurses">increase well-being</a>. We have yet to see the long-term effectiveness of these programs on the health and wellness of nurses. </p>
<p>While nurses are responsible for prioritizing self-care, health care organizations are <a href="https://nam.edu/publications/the-future-of-nursing-2020-2030/">responsible for creating a workplace environment</a> in which nurses can flourish. <a href="https://www.aacn.org/newsroom/well-being-work-environment-affect-medical-errors">Nurses report fewer medical errors</a> when their well-being is supported by their organizations and they are in better physical and mental health.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1437836802631643145"}"></div></p>
<p>The long-term solution to the nursing shortage calls for <a href="https://www.aacnnursing.org/News-Information/Position-Statements-White-Papers/Reverse-Shortage">systematic changes</a> that value nurses and offer them a safe place to work. Examples include implementing appropriate salaries and flexible schedules, ensuring adequate nurse staffing, and creating jobs that allow aging nurses to continue working in direct patient care roles so they can remain in the workforce longer instead of retiring. The pandemic has made more people aware of the distressing conditions many nurses work in. But without systematic changes, the drain of nurses out of the profession – and its negative impact on patient care – will only continue.</p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p><img src="https://counter.theconversation.com/content/166325/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rayna M. Letourneau does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Long-term solutions to the nursing shortage call for changes that value nurses and offer them a safe place to work.Rayna M. Letourneau, Assistant Professor of Nursing, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1664762021-08-29T10:55:28Z2021-08-29T10:55:28ZHigh rates of COVID-19 burnout could lead to shortage of health-care workers<figure><img src="https://images.theconversation.com/files/417664/original/file-20210824-16663-1mz17j6.png?ixlib=rb-1.1.0&rect=0%2C9%2C1235%2C903&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Intensive care nurse Kathryn Ivey's Tweet illustrates the impact of the pandemic on health-care workers. Used with permission.</span> <span class="attribution"><a class="source" href="https://twitter.com/kathryniveyy/status/1330607852524867587">@kathryniveyy/Twitter</a>, <span class="license">Author provided</span></span></figcaption></figure><p>During the pandemic’s third wave, researchers interviewed nurses to see how their <a href="https://windsor.ctvnews.ca/tired-burned-out-and-angry-uwindsor-study-sheds-light-on-state-of-working-nurses-1.5536147">perceptions had changed over the preceding year</a>. Early in the pandemic, nurses had reported optimism about supporting one another through the pandemic, but by the third wave, this had been replaced by anger and exhaustion. </p>
<p>One source of resentment was how employers were managing a depleted workforce. Clinical psychologist Dana Ménard found that incentives for new hires caused anger among those who had been on the front lines for a year with no retention rewards. Vicki McKenna, president of the Ontario Nurses Association, expressed concerns about staffing, <a href="https://windsorstar.com/news/local-news/tired-depressed-angry-nurses-leaving-jobs-during-pandemic-windsor-study-finds">telling a reporter</a>, “I fear that it is going to be devastating to the workforce. I’m very worried about the future of the nursing workforce.”</p>
<p>Meanwhile, other sources warned of a potential shortage of nurses. “Canadian nurses are leaving in droves,” <a href="https://www.theglobeandmail.com/canada/article-canadian-nurses-are-leaving-in-droves-worn-down-by-16-merciless-months/">ran a <em>Globe and Mail</em> headline</a>.</p>
<h2>Understanding burnout</h2>
<p>Appreciating what is happening to these nurses and how to respond hinges on understanding burnout, which may be the primary occupational hazard of health-care work. This is especially true in a pandemic. <a href="https://doi.org/10.1186/s12960-020-00469-9">Burnout, as it is typically measured, has three components</a>: emotional exhaustion, depersonalization (indifference or emotional distance) and a diminished sense of professional achievement. </p>
<p>Burnout occurs in many occupations, but health care exposes its professionals to unusual types of stress, <a href="https://doi.org/10.1177/0969733020909523">including moral distress</a>. This arises when professionals feel constrained from providing the best care. Examples include situations when care may be too aggressive at the end of life, or when one health-care worker is concerned about care provided by another. Moral distress has increased during the pandemic <a href="https://doi.org/10.1097/ccm.0000000000004865">due to scarce resources</a> and the <a href="https://doi.org/10.1186/s12913-021-06555-5">inability to comfort families</a>.</p>
<h2>Consequences of burnout</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurses close the curtains of a patients room in the COVID-19 Intensive Care Unit at Surrey Memorial Hospital in Surrey, B.C." src="https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417915/original/file-20210825-21-y456gx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Burnout occurs in many occupations, but health care exposes its professionals to unusual types of stress.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
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<p>Burnout is bad for everyone. It is associated with <a href="https://doi.org/10.1186/s12960-020-00469-9">diminished safety and quality of care for patients</a>, and <a href="https://doi.org/10.1111/joim.12752">mental health problems and poor quality of life for professionals</a>. </p>
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Read more:
<a href="https://theconversation.com/heroes-or-just-doing-our-job-the-impact-of-covid-19-on-registered-nurses-in-a-border-city-143787">Heroes, or just doing our job? The impact of COVID-19 on registered nurses in a border city</a>
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<p>For the health-care system, burnout is associated with <a href="https://doi.org/10.1186/s12960-020-00469-9">absenteeism, reduced productivity and thoughts of leaving one’s job</a>. During a time <a href="https://www.cbc.ca/radio/thecurrent/the-current-for-feb-22-2021-1.5922712/canada-is-facing-a-nursing-shortage-here-s-why-it-s-hard-to-fill-the-gap-1.5923251">when nurses</a> and <a href="https://www.fraserinstitute.org/sites/default/files/supply-of-physicians-in-canada.pdf">doctors are in short supply</a>, we cannot afford to lose more because of burnout.</p>
<h2>Burnout is rising</h2>
<p>Burnout was common before COVID-19 and is now rampant. For example, rates of severe emotional exhaustion were <a href="https://doi.org/10.1001/jama.2018.12777">often in the range of 20 to 40 per cent</a> prior to the pandemic, with higher rates in intensive care units and emergency medicine. Compare that to Canadian surveys later in the pandemic reporting <a href="https://doi.org/10.1016/j.genhosppsych.2021.04.012">rates of 62 per cent</a>, <a href="https://doi.org/10.1136/bmjopen-2021-050380">63 per cent</a> and <a href="https://www.oma.org/newsroom/news/2021/aug/ontarios-doctors-report-increased-burnout-propose-five-solutions/">72 per cent</a>.</p>
<p>It should be no surprise that working in health care during a pandemic that is unprecedented in our lifetimes has increased burnout. </p>
<p>In addition to risking their own health, many health-care professionals have been, for example, working longer hours and are often understaffed if colleagues are in quarantine or ill. Many maintained their full-time job while their children were unable to attend school. They must also manage uncertainty as policies change and a virus mutates, while providing care to critically ill individuals who chose not to be vaccinated.</p>
<h2>Burnout may deplete the health-care workforce</h2>
<p>Surveys of health-care workers reveal an extraordinary challenge. <a href="https://rnao.ca/sites/rnao-ca/files/Nurses_Wellbeing_Survey_Results_-_March_31.pdf">A survey of members of the Registered Nurses Association of Ontario</a> found 43 per cent were considering leaving, more among those who felt burnt out. Another Canadian study reported <a href="https://doi.org/10.1097/ceh.0000000000000365">50 per cent of nurses surveyed</a> intended to leave.</p>
<p><a href="https://ottawacitizen.com/news/local-news/signing-bonuses-are-a-sign-of-the-times-as-desperate-hospitals-seek-nurses">Signing bonuses for new nurses</a>, which angered the nurses Dr. Ménard’s team interviewed, suggest that the intention to leave is translating into action. Indeed, <a href="https://www.cbc.ca/news/canada/british-columbia/nurses-quitting-kamloops-interior-health-1.6148410">reports of shortages related to pandemic burnout</a> continue to appear in the news.</p>
<p>Since understaffing is both a cause and consequence of burnout, the health-care system may be entering the downward spiral of a particularly vicious circle. </p>
<h2>Solutions</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman walks by a street mural of a health-care worker in protective equipment, flexing her bicep" src="https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=789&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=789&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=789&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=992&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=992&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417918/original/file-20210825-18784-natref.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=992&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Instead of optimism about supporting one another, nurses are now reporting anger and exhaustion.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>The solution should match the problem. Evidence indicates that <a href="https://doi.org/10.1111/joim.12752">burnout is more a consequence of work conditions than of the workers’ vulnerabilities</a>: of long hours, high workload, moral distress and <a href="https://doi.org/10.3390/healthcare8020098">violence and abuse in the workplace</a>, among other systemic problems. </p>
<p>And yet, most research studying interventions to prevent and reduce burnout focuses instead on individuals by teaching things like coping skills and stress reduction techniques. Although providing individual interventions <a href="https://doi.org/10.1016/S0140-6736(16)31279-X">may be moderately helpful</a>, as the sole response to an occupational hazard, it is perverse — like teaching the residents of a flood zone how to swim instead of elevating their homes or helping them to move. </p>
<p>The health-care system urgently needs <a href="https://doi.org/10.1111/joim.12752">system-level measures</a> that protect its professionals from harm, and compensate them for hazards. These may include manageable hours, adequate time off, appropriate staff-to-patient ratios and <a href="https://www.patientsafetyinstitute.ca/en/toolsResources/Creating-a-Safe-Space-Psychological-Safety-of-Healthcare-Workers/Pages/creating-a-safe-space-addressing-the-psychological-safety-of-healthcare-workers-2020-01-06.aspx">workplace safety measures</a>. Some organizations will try to recruit new health professionals to manage shortages, but recruitment into a harmful environment is not sustainable. </p>
<p>Which brings us to leadership. <a href="https://doi.org/10.1016/j.mayocp.2019.10.041">Evidence supports the value of leadership in reducing burnout in health care</a>, especially leaders <a href="https://doi.org/10.1186/s12960-020-00469-9">who are transparent, ethical, respectful, reflective and informed</a>. We need health-care leaders who are <a href="https://doi.org/10.1016/j.mayocp.2016.10.004">committed to protecting the health of providers and organizations</a> as well as patients. System level support is needed to prevent the COVID-19 pandemic from causing an exodus of professionals from health care.</p><img src="https://counter.theconversation.com/content/166476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robert Maunder receives funding from the Canadian Institutes of Health Research and is a member of the Mental Health Working Group of the Ontario COVID-19 Science Advisory Table.</span></em></p><p class="fine-print"><em><span>Gillian Strudwick receives funding from the Canadian Institutes of Health Research and is a member of the Mental Health Working Group of the Ontario COVID-19 Science Advisory Table. She also works at the Centre for Addiction and Mental Health.</span></em></p>Rates of burnout have increased alarmingly among health-care workers during the pandemic. Unless the system provides more support to its already depleted workforce, staff shortages may get worse.Robert Maunder, Professor of Psychiatry, University of TorontoGillian Strudwick, Scientist and Assistant Professor, Institute of Health Policy, Management and Evaluation, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1656642021-08-09T23:54:31Z2021-08-09T23:54:31ZBed rest in hospital can be bad for you. Here’s what nurses say would help get patients moving<figure><img src="https://images.theconversation.com/files/415001/original/file-20210806-17-uzr68e.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6500%2C4320&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>If you or a loved one is unlucky enough to be in hospital, you might think the best thing to do is rest in bed as much as possible. But while rest is important, lying or sitting in bed too much can actually make many conditions worse.</p>
<p>Researchers have developed mobility <a href="https://researchnow.flinders.edu.au/en/publications/recommendations-for-older-adults-physical-activity-and-sedentary-">recommendations</a> for some hospital settings but in practice, most patients still aren’t active enough.</p>
<p>To find out more, we asked 138 nurses from five Australian states about the challenges they face trying to to get patients moving more, and what changes would help. We also did some in-depth interviews with a sample of nurses involved in the study.</p>
<p>Our <a href="https://doi.org/10.1111/jocn.15994">results</a>, published in the Journal of Clinical Nursing, showed there is much we can do. Managers and team leaders have an important role in empowering nurses because our study found nurses do not always feel able to reduce sedentary behaviour in their patients.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/for-older-people-and-those-with-chronic-health-conditions-staying-active-at-home-is-extra-important-heres-how-135322">For older people and those with chronic health conditions, staying active at home is extra important – here's how</a>
</strong>
</em>
</p>
<hr>
<h2>The dangers of sedentary behaviour in hospital</h2>
<p>Lying or sitting too much while in hospital <a href="https://doi.org/10.1111/jocn.15994">can lead to</a> deconditioning (such as loss of strength, joint function and mobility), pressure injuries, blood clots, infections, prolonged hospital stays and unplanned hospital re-admissions.</p>
<p>In rehabilitation settings, where a person is recovering from conditions such as stroke, amputation or arthritis, older adults spend as <a href="https://journals.humankinetics.com/view/journals/japa/18/2/article-p171.xml">little as 5% of the day</a>
upright.</p>
<p>In acute settings — where a patient in hospital may require surgery or treatments to repair a fracture, remove a tumour or relieve nerve pain — it can be much worse. Older adults spend a median of just <a href="https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2009.02393.x">3% of their day</a> standing or walking. </p>
<p>These are staggering figures but the good news is even small increases in activity and movement can help prevent the <a href="https://diabetes.diabetesjournals.org/content/65/10/2862">rapid loss of muscle mass</a> and strength that comes from lying down or sitting too long in hospital. </p>
<p>Our study found nurses have a key role in supporting patients’ mobility and in reducing their sedentary behaviour. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&rect=16%2C16%2C5335%2C3546&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&rect=16%2C16%2C5335%2C3546&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414981/original/file-20210806-23-rswbdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses in this study told us that workload and lack of time were significant barriers to encouraging reduced sedentary behaviour.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What are the barriers?</h2>
<p>Perhaps unsurprisingly, nurses in this study told us workload and lack of time to encourage reduced sedentary behaviour were significant barriers.</p>
<p>However, they also told us there was a perception among family and sometimes patients themselves that they needed to rest and that older people had earned the right to sit back and relax. </p>
<p>This was especially the case when people were unwell or had complex needs. As one nurse said:</p>
<blockquote>
<p>For example, ‘Dad’s in his 80s, does he need to do this?’ It is a common mindset of the family of an older person.</p>
</blockquote>
<p>So <a href="https://link.springer.com/content/pdf/10.1186/s12966-020-00970-3.pdf">how much exercise</a> should you get while in hospital? There’s no “one size fits all” answer. For some patients, it might just mean getting out of bed and walking to the bathroom, getting dressed or moving around a room. For others, it might mean walking around hospital hallways or doing more specialised movement programs such as <a href="https://pubmed.ncbi.nlm.nih.gov/31602693/">My Therapy</a>. </p>
<h2>What would help?</h2>
<p>Nurses told us that help from family in getting patients up and moving would be a huge bonus.</p>
<blockquote>
<p>Families can also help by providing really comfortable shoes and clothing. We know patients are less likely to participate if they are not comfortable. </p>
</blockquote>
<p>Another said:</p>
<blockquote>
<p>We involved family members at mealtimes [by walking to] the lounge and it has improved nutritional intake by bringing in [special] food and contributing to the social aspects. One brought Italian food and they loved it.</p>
</blockquote>
<p>Some patients, however, have only family members or visitors who are, themselves, older and unable to assist the patient with walking. Or, a patient may have no visitors at all.</p>
<p>Working closely with other members of the care team yields results, with one saying:</p>
<blockquote>
<p>Going to a team meeting is good […] they say to the patient, this is what we are aiming for, do you agree that you will sit up for lunch every day […] it’s a team effort.</p>
</blockquote>
<p>Another told us: </p>
<blockquote>
<p>I like to read the physio notes every day and then just have an idea what their actual functional goals and actual functional levels are like. Encouraging people to achieve those tiny little goals like ‘oh, we walked to the toilet’, ‘oh, we brushed our teeth at the sink’. </p>
</blockquote>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A nurse helps an older woman walk down a hospital hallway." src="https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415140/original/file-20210809-14-xo9g25.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses told us that help from family in getting patients up and moving would be a huge bonus.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>One nurse spoke of the value of interventions aimed at getting patients more active, such as the UK’s <a href="https://endpjparalysis.org/">End PJ Paralysis</a> program.</p>
<blockquote>
<p>[…] although not very well promoted, [it] was a great help. Many resources went
into it. With our model of care, there was a social aspect that was a great success, they started friendship groups, lots of activities, we had the Melbourne Cup down in the lounge, and they watched the tennis together. It’s been so positive. We used to really encourage them to go just once, now they want to go all the time. But some nurses still need to learn it’s not about wheeling people down there.</p>
</blockquote>
<p>In other words, it’s about walking, not wheeling.</p>
<p>A nurse leader said:</p>
<blockquote>
<p>It’s staggering how much time they [patients] spend alone. There’s a potential connection here. Isolation and boredom is one thing. If we tackle the boredom, we tackle the sedentary behaviour, there is a link, and we will solve the social isolation. Enabling nurses to be the coach for getting people up, and there’s definitely an educational aspect. </p>
</blockquote>
<h2>Creative and sustainable solutions</h2>
<p>Our study shows that reducing sedentary behaviour in hospitals is often complex and there are important roles for nurse leaders and organisations in working together on creative and sustainable solutions. </p>
<p>As influential British doctor, Richard Asher, put it in his oft-quoted <a href="https://britishgeriatricssociety.wordpress.com/2017/04/26/sit-up-get-dressed-keep-moving-deconditioning-syndrome-awareness-and-prevention-campaign-why-is-everyone-talking-about-it/">poem</a> about the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2056244/?page=1">danger</a> of sedentary behaviour in hospitals:</p>
<blockquote>
<p>Teach us to live that we may dread;</p>
<p>unnecessary time in bed.</p>
<p>Get people up and we may save;</p>
<p>patients from an early grave.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sitting-for-too-long-could-increase-your-risk-of-dying-even-if-you-exercise-105014">Sitting for too long could increase your risk of dying – even if you exercise</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/165664/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Breanne Kunstler is a practising physiotherapist and co-lead of the Physiotherapists for Physical Activity group, which advises the Australian Physiotherapy Association on physical activity matters. </span></em></p><p class="fine-print"><em><span>Christina Ekegren is co-lead of the Physiotherapists for Physical Activity group, which advises the Australian Physiotherapy Association on physical activity matters. She has received funding from the National Health and Medical Research Council (NHMRC).</span></em></p><p class="fine-print"><em><span>Nicole Freene is a physiotherapy academic-clinician and founding member and cardiorespiratory lead of the Physiotherapists for Physical Activity group. She has received funding from the Medical Research Future Fund.
</span></em></p><p class="fine-print"><em><span>Virginia Plummer was a past staff member at Peninsula Health where some of the data was collected.</span></em></p><p class="fine-print"><em><span>Danny Hills and Tracy Robinson do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most nurses spoke of having to contend with family members who assumed patients should rest as much as possible.Danny Hills, Associate Professor, Deputy Dean, Federation University AustraliaBreanne Kunstler, Research Fellow, BehaviourWorks Australia, Monash Sustainable Development Institute, Monash UniversityChristina Ekegren, Senior Research Fellow, Monash UniversityNicole Freene, Associate Professor, Physiotherapy, University of CanberraTracy Robinson, Senior Lecturer in Nursing, Charles Sturt UniversityVirginia Plummer, Professor, Federation University AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1604212021-05-17T12:26:15Z2021-05-17T12:26:15ZLack of sleep is harming health care workers – and their patients<figure><img src="https://images.theconversation.com/files/399828/original/file-20210510-15-1xda38n.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C5111%2C3415&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The high prevalence of insomnia symptoms among health care workers has concerning implications for our health care system.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tired-black-surgeon-laying-on-hospital-gurney-royalty-free-image/103919430?adppopup=true">ER Productions Limited/Getty Images</a></span></figcaption></figure><p>Many people often assume that health care providers are healthier than the general population. The COVID-19 pandemic, however, has shined a concerning light on the the physical and mental health of health care workers – and their lack of sleep.</p>
<p>Poor sleep can harm well-being – it’s been shown to be a strong risk factor for <a href="https://doi.org/10.1161/HYPERTENSIONAHA.112.193268">cognitive decline and early mortality</a>. I am an <a href="https://www.cbcs.usf.edu/agingstudies/slee">expert in sleep and stress among middle-aged adults in the workplace</a>, and my research has found that work-related stress influences sleep quantity and quality. And not only that – poor sleep may increase the risk of adverse health outcomes for both health care workers and their patients.</p>
<h2>Sleep problems are common among health care workers</h2>
<p>Health care workers face many stressors, and many studies have shown that sleep plays a major role. For example, a <a href="https://doi.org/10.2298/mpns1606183s">2016 review</a> of multiple studies on sleep deprivation among nurses found that 55% work over 40 hours a week and 30%-70% report getting fewer than six hours of sleep a night. My research, which focuses on nurses and direct-care workers, such as nursing assistants, personal care aides, and home health aides, has had similar findings. We found that <a href="https://doi.org/10.1177/0733464820978612">57% of direct-care workers</a> in a long-term care facility and <a href="https://doi.org/10.2486/indhealth.2020-0291">68% of nurses</a> in a cancer hospital reported experiencing insomnia symptoms like difficulty falling asleep and frequent nighttime awakenings.</p>
<p>Sleep issues are more prevalent in health care workers compared to workers in other industries. A <a href="http://dx.doi.org/10.15585/mmwr.mm6608a2">CDC report</a> on 2013-2014 data on 22 major occupation groups found health care support workers and practitioners had the second and third highest levels of short sleep duration – defined as less than seven hours – with 40% of these workers reporting short sleep. A <a href="https://doi.org/10.1007/s10900-019-00731-9">2018 study</a> found similar results, with health care support occupations continuing to rank second highest at 45%.</p>
<p>Sleep loss in health care workers also manifests in different forms. My collaborative research team compared the sleep quality of 1,220 direct-care workers with 637 IT office employees using both self-report and <a href="https://doi.org/10.5665/sleep.3142">sleep actigraphy assessments</a>, which is a method that objectively quantifies sleep and wake patterns based on movement. We found that <a href="https://doi.org/10.1016/B978-0-12-815373-4.00034-4">over 60%</a> of both groups experienced at least one sleep issue over the past month, such as sleep insufficiency, short sleep duration or more nighttime waking. However, direct-care workers had <a href="https://doi.org/10.5664/jcsm.6980">poorer sleep characteristics</a> across multiple <a href="https://doi.org/10.5665/sleep.3298">sleep dimensions</a> that are critical for optimal functioning and health. These include regularity, satisfaction, alertness, timing, efficiency and duration.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="health care worker yawning next to stack of medical records" src="https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399836/original/file-20210510-16-8u3kfq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Health care workers experience sleep issues that differ from workers in other industries.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-male-medical-professional-yawning-royalty-free-image/91497167?adppopup=true">ER Productions Limited/Getty Images</a></span>
</figcaption>
</figure>
<h2>Health care worker sleep problems can be costly</h2>
<p>Insomnia symptoms pose a significant public health and economic burden. In 2010, it was estimated that insomnia has cost U.S. workers an annual total of <a href="https://doi.org/10.5665/SLEEP.1230">252.7 days of lost productivity and US$63.2 billion</a>.</p>
<p>For health care workers in particular, insufficient sleep duration, poor sleep quality and untreated insomnia may increase medical errors at the front lines. A 2020 study found that very high sleep-related impairment is associated with <a href="https://doi.org/10.1001/jamanetworkopen.2020.28111">97% greater odds</a> of self-reported clinically significant medical errors among physicians. Sleep loss has also been associated with <a href="https://doi.org/10.1016/j.sleh.2019.11.001">lower patient safety and care quality ratings</a> among nurses. </p>
<p>Just one night of insufficient sleep can reduce cognitive performance by <a href="https://doi.org/10.1097/01.jpn.0000270624.64584.9d">as much as 25%</a>. The effect of prolonged sleep loss on performance has even been <a href="https://doi.org/10.1038/40775">likened to alcohol impairment</a> – 19 hours of sustained wakefulness has been found to be equivalent to a blood alcohol concentration of 0.05%, and 24 hours to 0.10%. </p>
<h2>Sleep loss poses health risks for providers</h2>
<p>Sleep loss doesn’t just hurt patients – it harms health care workers, too. Many studies have found chronic sleep loss to <a href="https://doi.org/10.1097/01.NAJ.0000463025.42388.10">increase the risk of a number of conditions</a>, including musculoskeletal injury, obesity, diabetes and cardiovascular disease. Nurses working rotating night shifts for over 15 years have been found to be <a href="https://doi.org/10.1097/01.ede.0000190539.03500.c1">1.79 times</a> and <a href="https://doi.org/10.1093/jnci/95.11.825">1.35 times</a> at risk to develop breast and colorectal cancer, respectively.</p>
<p>It’s clear that the unique work conditions of health care workers, like <a href="https://doi.org/10.1038/s41598-019-40914-x">nonstandard hours</a>, <a href="https://theconversation.com/the-psychological-trauma-of-nurses-started-long-before-coronavirus-140131">proximity to life-threatening disease and reduced autonomy</a>, may make them more vulnerable to sleep problems. Other factors like frequent interruptions during on-call sleep periods or shift work disruptions to normal sleep patterns can further exacerbate problems by <a href="https://doi.org/10.1097/01.JPN.0000270624.64584.9d">fragmenting sleep</a>.</p>
<p>These stressful conditions may also be compounded by caregiving burdens in their own personal lives. Many nurses find themselves doing <a href="https://doi.org/10.1093/geronb/gbu139">double- and triple-care duty</a>: Not only do they provide care to their patients at work, but they also continue to serve as caregivers for their own children and aging parents. </p>
<p>These stressful conditions can have a negative impact on their <a href="https://doi.org/10.1136/bmj.m1211">mental health</a> – and even more so when adding on the challenges of dealing with a global pandemic.</p>
<h2>How can we improve sleep quality for health care workers?</h2>
<p>Health care workers clearly understand they need help to improve their sleep. In a survey of health care workers at a hospital and assisted living facility, my team found that <a href="https://doi.org/10.2486/indhealth.2020-0291">92% of nurses</a> and <a href="https://doi.org/10.1177/0733464820978612">66% of direct-care workers</a> would participate in a sleep intervention if given the opportunity.</p>
<p>The challenge, however, is that sleep interventions are not one-size-fits-all.
One of my studies examined whether reducing work-related stressors, like work-family conflicts, by increasing employee schedule control and supervisor support would help improve sleep quality. Though this intervention <a href="https://doi.org/10.1016/j.sleh.2016.08.004">increased sleep duration among IT workers</a> by about one hour per week, there was <a href="https://doi.org/10.1016/j.sleh.2016.09.002">no improvement for direct-care workers</a>. These findings suggest that different work environments can impose different sleep burdens on workers. Sleep interventions need to be specific to their targets.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="nurse sitting in a chair in a hospital corridor" src="https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399838/original/file-20210510-23-10335ha.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For sleep interventions to be effective for health care workers, they need to be designed around their specific needs.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-female-medical-professional-sitting-in-chair-royalty-free-image/91497435?adppopup=true">ER Productions Limited/Getty Images</a></span>
</figcaption>
</figure>
<p>Our next step was to figure out what kinds of sleep interventions would work best for health care workers. When we asked inpatient nurses what sleep interventions they preferred, <a href="https://doi.org/10.2486/indhealth.2020-0191">the majority</a> preferred mindfulness-based strategies over cognitive-behavioral therapy for insomnia and sleep hygiene education. <a href="https://doi.org/10.1097/00006842-200201000-00010">Mindfulness-based strategies</a> focus less on changing behavior and more on centering the individual in the present moment. By neutrally observing and accepting their thoughts and feelings, meditation practices may <a href="https://doi.org/10.1016/j.brat.2012.08.001">improve insomnia symptoms</a> by decreasing physiological arousal and minimizing psychological factors like rumination. </p>
<p>This preference for mindfulness-based strategies may be attributed to a desire to reduce stress – nurses with insomnia symptoms reported <a href="https://doi.org/10.2486/indhealth.2020-0291">higher perceived stress</a>. Greater problems with sleep have been seen to be closely related to <a href="https://doi.org/10.1016/j.socscimed.2021.113800">higher perceived stress</a> in a general adult sample. </p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>The relationship between mindfulness and sleep is bidirectional. This means that they mutually affect each other – increasing mindfulness may improve sleep, and improved sleep may increase mindfulness. My team found that better nightly sleep for health care workers is associated with <a href="https://doi.org/10.1016/j.sleh.2020.07.005">higher mindfulness</a> the following day. As a practice that cultivates attention to and awareness of what is taking place in the present moment – a state of mind critical to providing care – these findings suggest that improving sleep may provide important benefits to patent care delivery by increasing “mindful care.”</p>
<h2>Health care workers can’t lose any more sleep</h2>
<p>Sleep is not just a personal issue. Many <a href="https://doi.org/10.1016/j.socscimed.2012.05.002">social and cultural factors</a> directly impact sleep quality – and for health care workers, it’s clear that their work environment is not conducive to healthy sleep.</p>
<p>Health care workers need sufficient sleep to efficiently and effectively deliver high-quality patient care. The high prevalence of insomnia symptoms among providers not only has worrying implications for the well-being of our health care workers, but the well-being of our health care system as a whole.</p>
<p>To support our health care workers, we need to let them sleep. </p>
<p><em>This story was collaboratively developed by <a href="https://www.usf.edu/cbcs/aging-studies/stealthlab/">Dr. Lee’s research team</a>, which includes Christina Mu, Julia Woolley, Mónika Domenech-Acevedo, Cassandra Richardson, and Arooj Khan. The co-investigators of the research project this story was based on include Drs. Brent Small and Brian D. Gonzalez. Other project collaborators include Drs. Orfeu Buxton and David Almeida.</em></p><img src="https://counter.theconversation.com/content/160421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Soomi Lee received funding from the University of South Florida College of Behavioral & Community Sciences Internal Grant Program. </span></em></p>To keep our health care providers healthy, we need to help them sleep.Soomi Lee, Assistant Professor of Aging Studies, University of South FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1586242021-04-22T20:13:38Z2021-04-22T20:13:38Z‘I want to scream and scream’: Australian nurses on the Western Front were also victims of war<figure><img src="https://images.theconversation.com/files/395636/original/file-20210419-19-yrd8h5.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An unusually sturdy and comfortable CCS during the first world war.</span> <span class="attribution"><span class="source">Australian War Memorial</span></span></figcaption></figure><p>The revival of interest in Anzac since the 1980s has depended in part on the repositioning of soldiers as victims. We rarely celebrate their martial virtues, and instead note their resilience, fortitude and suffering.</p>
<p>This shift in emphasis opens up more promising space for the inclusion of women. Nurses were not warriors - they were caregivers. But they too suffered trauma as a result of their service.</p>
<p>In what must be regarded as something of a miracle, no Australian nurses were killed. But like the men they devoted themselves to, they were worn down and in some cases shattered by the horrors they witnessed. </p>
<p>From 1916, Australian nurses served in <a href="https://www.thehistorypress.co.uk/articles/evacuation-of-the-wounded-in-world-war-i/#:%7E:text=Casualty%20Clearing%20Station%20(CCS)&text=Facilities%20included%20medical%20and%20surgical,and%20soldiers%20of%20the%20unit.">Casualty Clearing Stations</a> (CCS), almost on the front line, often under fire and always under immense pressure. This was the most dangerous and intense working environment in which they could serve. It was far removed from the hospital ship environment at Gallipoli, or the hospitals further from the lines, where there was at least the prospect of regular respite.</p>
<p>The CCS was a 1915 innovation designed to provide treatment to men as soon as possible after they were injured. They operated close to the front lines, and so took nurses into the danger zone. CCS nurses were assailed by the realities of trench warfare and the demands of treating damaged men. Soldiers came to the CCS within hours of wounding, bloody and dying, needing urgent surgery for their shattered limbs and mangled bodies, or blistered and blinded from gas attacks. </p>
<p>The sight of the battle front was terrifying and compelling — Sister Elsie Tranter, for one, was captivated. She wrote in <a href="http://throughtheselines.com.au/research/elsie-tranter">her diary</a> that on her first night at a CCS near Grevillers, in March 1918 she:</p>
<blockquote>
<p>[…] had the flaps on the tent fastened back and spent most of the night watching the flashes in the sky from the guns […] everything seemed so surreal. </p>
</blockquote>
<p>For Sister May Tilton, it was the industrial sounds of battle that impressed. She <a href="https://catalogue.nla.gov.au/Record/80526">wrote</a> that the <a href="https://www.awm.gov.au/articles/blog/battle-of-passchendaele-third-ypres">Third Battle of Ypres</a> (also known as the Battle of Passchendaele) started with:</p>
<blockquote>
<p>[…] a continuous rumble and roar, as of an immense factory of vibrating machinery filled the night. The pulsing sounds and vibration worked into our bodies and brains; the screech of the big shells, and the awful crash when they burst at no great distance, kept our nerves on edge. </p>
</blockquote>
<p>Shrapnel falling to the ground, the thrilling sight of aerial dog fights, damp and dirty dugouts, sandbagged tents, constant artillery fire, the smell of gas, the tremble of the earth — this was the landscape of the CCS.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=442&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=442&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=442&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=555&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=555&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395642/original/file-20210419-19-ovnest.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=555&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nurses and soldiers at the 3rd Casualty Clearing Station.</span>
<span class="attribution"><span class="source">Australian War Memorial</span></span>
</figcaption>
</figure>
<p>Sister Connie Keys <a href="http://onesearch.slq.qld.gov.au/primo-explore/fulldisplay?docid=slq_alma21199982810002061&context=L&vid=SLQ&lang=en_US&search_scope=SLQ_PCI_EBSCO&adaptor=Local%20Search%20Engine&tab=all&query=any,contains,constance%20keys">did not expect</a> they would come through safely, and later confided to her mother that now “I’m only afraid of being afraid”. She had experienced terror beyond measure.</p>
<p>CCSs struggled to cope at the height of battle, and staff worked extremely long hours to deal with the flood of casualties. One of them, 2nd Australian CCS, had a nursing staff of 20 and put through 2,800 patients in the first 18 hours of the “<a href="https://www.army.gov.au/our-heritage/history/history-focus/battle-messines">Messines push</a>”.</p>
<p>May Tilton recalled in her memoir that she often “went on duty at 8pm, worked continuously during a ‘stunt’[a minor military operation], until the following midday, with ten minutes for supper at midnight, and half an hour for breakfast at 8am”. </p>
<p>The experience of nurses attests to the aphorism of war as long periods of boredom interspersed with brief periods of terror.</p>
<p>Static attrition warfare, conducted through artillery bombardment, gassing and close fighting, produced fighting conditions and wounds that appalled both the victims and those who cared for them.</p>
<p>The resuscitation wards were the greatest test for nurses. Tilton recalled that:</p>
<blockquote>
<p>[…] only the worst cases could we possibly hope to attend to. The work in the resuscitation ward was indescribable. The butchery of these precious lives […] To watch them dying was ghastly. </p>
</blockquote>
<p>The night sister confessed</p>
<blockquote>
<p>I cannot speak of it […] I want to scream and scream. </p>
</blockquote>
<p>Nurses were brought to despair – not because they were unable to save lives, for nurses were accustomed to death, but because they were unable to care for patients as they would have done “at home”. They had been trained to fashion order out of chaos, to bring a patient through the days and nights of a health crisis with patience, gentleness and watchful vigilance, and in some cases to ease their path to a painless and tranquil death.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=454&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=454&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=454&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=570&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=570&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395644/original/file-20210419-17-3ahsg6.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=570&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nurses and patient at the Auxiliary Hospital Unit in Belgium.</span>
<span class="attribution"><span class="source">Australian War Memorial</span></span>
</figcaption>
</figure>
<p>But in war, they wrestled with the irresolvable conflict between duty and fear, and between their compassion and the realities of conflict. Death on the Western Front was ugly, chaotic and painful, so much so that some “ministering angels” came to doubt their Christian faith. “I can’t believe there is a God,” <a href="https://www.awm.gov.au/collection/C2073761">wrote Sister Alice Ross King</a> after the Ypres Offensive, “it is too awful for words”.</p>
<p>Nurses, like soldiers, knew when they were at breaking point, and feared being unable to fulfil their duties. Tilton confessed:</p>
<blockquote>
<p>[…] the privacy of our tents was a welcome relief for the weakness we dared not show before our brave, suffering boys.</p>
</blockquote>
<p>Even the Armistice, when it eventually came on November 11 1918, brought little comfort. <a href="https://archival.sl.nsw.gov.au/Details/archive/110336114">Anne Donnell</a> became terribly depressed and, like many, found joy impossible when she contemplated the sadness of empty homes and hearts.</p>
<p>Nurses carried the burden of putting back together the victims of conflict, yet struggled to maintain their own physical and mental health. For many, their return to Australia was marred by ill-health, and what we would now call post-traumatic stress disorder.</p>
<p>But they also displayed courage and resilience. The experiences of Australian Army nurses on the Western Front can be a starting point, reaching through all Australia’s wars, for discussion of the response to extreme physical and psychological stress borne by those who treat the casualties of war. They too were war’s victims.</p><img src="https://counter.theconversation.com/content/158624/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While no Australian nurses died in service on the Western Front, the horror of what they saw and treated on the front lines caused tremendous suffering and pain.Fiona McLeod, PhD Candidate, The University of QueenslandMartin Crotty, Associate Professor in Australian History, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1589122021-04-21T10:33:02Z2021-04-21T10:33:02ZWhy nursing in Denmark pays less than professions dominated by men<figure><img src="https://images.theconversation.com/files/396005/original/file-20210420-21-7layrv.jpg?ixlib=rb-1.1.0&rect=264%2C0%2C733%2C615&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rehab-elderly-people-536383975">GagliardiPhotography/Shutterstock</a></span></figcaption></figure><p>The gender pay gap and what to do about it in Denmark recently came to a head in the nursing profession. During the pandemic, focus on the work of nurses has come to the fore in a number of countries, including in the UK where a recent proposal for <a href="https://www.bbc.co.uk/news/56294009">a 1% pay increase</a> was heavily criticised. </p>
<p>In national public sector negotiations in Denmark, nurses voted against a recent pay offer of up to 5% which was set to preserve <a href="https://www.economicsonline.co.uk/Definitions/Real_wages.html">real wages</a> for public workers over the next three years. But <a href="https://pure.au.dk/portal/da/persons/astrid-elkjaer-soerensen(b9a2868f-221f-4990-9fa0-d306724ab7f1)/publications/det-offentlige-loenhierarki(1a976843-623a-40ee-abbd-ef19c4ccc4e5).html">research shows</a> that it’s not just a question of a pay rise: the wage level itself is set unfairly low for those in the profession. And the root of the problem dates back to a law that came into force some 50 years ago. </p>
<p>Denmark has a reputation globally for equality, but <a href="https://politiken.dk/udland/art8172855/Britisk-ambassad%C3%B8r-forventede-total-ligestilling-i-Danmark.-Hun-tog-fejl?shareToken=ajEgmeAAdDoA">it still has problems</a> with unequal pay. Danish nurses still receive <a href="https://dsr.dk/politik-og-nyheder/nyhed/dsr-uligeloen-er-strukturel-sexisme-skabt-af-politikerne-derfor-er-det-dem">10%-20% less</a> in pay than male-dominated professions requiring a similar level of education. There are <a href="https://nordics.info/show/artikel/gender-segregation-of-nordic-labour/">many contributing factors</a> to unequal pay, but a <a href="https://menneskeret.dk/sites/menneskeret.dk/files/media/document/Rapport_Tjenestemand_06.pdf">recent report</a> from the Danish Institute for Human Rights (DIHR) found that legislation enacted in 1969 led to nurses and other female-dominated professions placed at a lower pay level. </p>
<p>Not only was the recent pay offer rejected, <a href="https://www.borgerforslag.dk/se-og-stoet-forslag/?Id=FT-07299">a citizens’ petition</a> to reform the law in respect of many traditionally female professions received the requisite 50,000 signatures, within a record-breaking eight days, to make it to parliament.</p>
<h2>Structural sexism</h2>
<p>Central to the current fight for equal pay in Denmark is the call for the Danish parliament to revisit the <a href="https://dsr.dk/politik-og-nyheder/det-mener-dsr/tjenestemandsreformen-af-1969">Public Servant Reform Act of 1969</a>. The act was intended to modernise the employment system for state employees and allow the state greater control over wage increases. The act is regarded as one of the main reasons that female-dominated professions in the public sector still have lower salaries than male counterparts in positions with a corresponding level of education and responsibility. </p>
<p>In 1965, a commission was tasked with collecting data on and assessing all job functions as officials wanted to construct a wage scale and terms and conditions based on solely objective criteria. However, collecting such a large and diverse amount of data turned out to be more challenging than anticipated. </p>
<p>The commission also could not decide which criteria it should use when classifying the different professional groups and exactly how these should be weighted in relation to each other. In a letter forwarded to all government ministries, the commission mentioned workload, education and responsibility as criteria for work assessments, but it never actually succeeded in developing a proper system. </p>
<p>The commission was also tasked with not significantly increasing spending on public salaries. It therefore had to maintain the existing status quo, limiting the number of professional groups that could be moved to a higher wage bracket. The status quo at that time dated back to the first Civil Servant Act of 1919, and the commission had little room to manoeuvre: increasing wages for one professional group would lead to demands from others. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Protesters gather in a square with red banners" src="https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396008/original/file-20210420-23-1tog4d0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Protesters for equal pay gather in a square with red banners.</span>
<span class="attribution"><span class="source">Foran Christiansborg</span></span>
</figcaption>
</figure>
<p>Though its aim was to modernise, in the end, the commission’s <a href="https://nordics.info/show/artikel/unequal-pay-in-denmark-an-outdated-laws-far-reaching-consequences/">final proposal</a> – which became law – perpetuated a system that dated much further back in time. Against this backdrop, the female-dominated professions were generally placed at a lower level in relation to their education and level of responsibility at the time. </p>
<p>The act set out that the rest of the public sector should synchronise its wages with the new system, and this wage gap eventually spread to every other type of public worker. This also effectively ensured the state a relatively high degree of control over wages in the public sector.</p>
<h2>Public pay scales today</h2>
<p>In December 2020, the <a href="https://menneskeret.dk/sites/menneskeret.dk/files/media/document/Rapport_Tjenestemand_06.pdf">report from the DIHR</a> examined the relationship between wage scales for public workers in 1969 and 2019 and found an overall correlation, demonstrating similar wage differentials today as there were then. </p>
<p>This in itself would not be a problem if the wage differences between the professions initially seemed well-founded and remain so. To investigate whether the wage scales in 1969 and 2019 were unfavourable for female-dominated professions, levels of education were analysed. The report found that female-dominated professions in 1969 were, in general, placed lower that what could be expected based on the corresponding length of education, while male-dominated professions were placed higher.</p>
<p>The same trend could be observed in 2019 but, perhaps surprisingly, there was even less correlation between educational level and position on the wage scale.</p>
<h2>Political action</h2>
<p>While wage disparity from the 1969 act and equal pay generally has been on the agenda for many years in Denmark, the report has triggered renewed public and political interest in recent weeks. What should be done to solve a wage gap stemming from a law passed over 50 years ago? </p>
<p>COVID has in Denmark, like elsewhere, highlighted care work as an essential part of society’s infrastructure, creating <a href="https://www.borgerforslag.dk/se-og-stoet-forslag/?Id=FT-07299">support and momentum</a> for equal pay activists. The citizens’ petition calls for the 1969 act to be repealed and for equality of pay between all public professional groups to be introduced.</p>
<p>Longstanding concerns over piggy-backing claims (if the wages of one profession are increased, another group will demand the same) must be overcome – and there is only one pot from which all public sector pay comes, fixed by the government. </p>
<p>Politicians have to date tried to avoid responsibility by suggesting that the common method of resolving industrial disputes in Denmark should be used, that is, collective bargaining between the trade unions and the employer federations (so-called “social partners”). However, the message of nurses and the other caring professions is loud and clear: it is up to the politicians to do something about an outdated law that has unwittingly echoed down the ages.</p>
<p><em>This article is co-published with <a href="https://nordics.info/">Nordics.info</a></em></p><img src="https://counter.theconversation.com/content/158912/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Astrid Elkjær Sørensen receives funding from Ligelønsalliancen (A umbrella organization for Danish Trade Unions)</span></em></p>A law from 1969 is still having an impact on nursing pay in Denmark today.Astrid Elkjær Sørensen, Postdoctoral Researcher in History, Aarhus UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1554532021-02-18T03:15:39Z2021-02-18T03:15:39ZHow the Pfizer COVID vaccine gets from the freezer into your arm<figure><img src="https://images.theconversation.com/files/384901/original/file-20210218-17-1rif73i.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/buenos-aires-argentina-november-27-pfizer-1865003029">from www.shutterstock.com</a></span></figcaption></figure><p><a href="https://www.theguardian.com/australia-news/2021/feb/15/australias-covid-vaccine-rollout-to-begin-next-monday-as-first-pfizer-shipment-arrives">From Monday</a>, people at high risk of COVID-19 will be lining up to receive the Pfizer vaccine, marking the start of Australia’s long-awaited COVID vaccination program.</p>
<p>We’ve heard about the need to store the vaccine <a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">frozen at about -70°C</a> — a temperature well below freezing and unusually cold, <a href="https://www.antarctica.gov.au/about-antarctica/weather-and-climate/weather/">even for Antarctica</a>. The vaccine also comes in a multi-dose vial, meaning the vaccine will have to be diluted then individual doses taken from the vial. </p>
<p>These two aspects make the Pfizer vaccine rollout one of the most complex vaccine programs ever delivered. So all nurses and doctors set to give the Pfizer vaccine in Australia need to have gone through <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/covid-19-vaccination-training-program">special</a> <a href="https://www.covid19vaccinationtraining.org.au">training</a> in how to store, handle and administer the vaccine.</p>
<p>If you’re one of the high-risk groups set to receive the Pfizer vaccine from next week — because of your occupation or you are in aged- or disability care — here’s what goes on behind the scenes to get the vaccine from the freezer into your arm.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=956&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=956&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=956&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1201&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1201&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384652/original/file-20210217-13-1ftv7cw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1201&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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</figure>
<h2>Once the vaccine leaves the freezer, the clock starts ticking</h2>
<p>Once the vaccine is removed from the “deep freezer” there is no turning back; we <a href="https://www.abc.net.au/news/2021-02-08/australia-tries-to-avoid-covid19-pfizer-vaccine-losses/13130808">don’t want to waste</a> any of these precious vaccine doses.</p>
<p>As you would expect, the vaccine needs to be thawed before it can be injected. Once this happens, it cannot be re-frozen; it must be used.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">How mRNA vaccines from Pfizer and Moderna work, why they're a breakthrough and why they need to be kept so cold</a>
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<p>The thawing process <a href="https://www.tga.gov.au/sites/default/files/auspar-bnt162b2-mrna-210125-pi.pdf">has rules</a>. Frozen vials are transferred from the freezer to a fridge set at 2-8°C to thaw. A pack of 195 vials, containing about 975 doses, may take three hours. But it can sit in the fridge for up to five days, if needed. To speed things up, it is possible to thaw the frozen vials for 30 minutes at temperatures up to 30°C. But then, the vaccine needs to be used within two hours.</p>
<p>Either way, people must be lined up ready to be vaccinated to avoid wastage.</p>
<p>Once thawed, the vaccine needs to be mixed gently. So the vaccinator needs to turn each vial up and down (invert it) ten times. They cannot <a href="https://www.youtube.com/watch?v=czlIrRDFAPs">shake the vial</a> as the vaccine is fragile.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1337587741941501952"}"></div></p>
<h2>Then each vial is split into individual doses</h2>
<p>One of the challenges with the Pfizer vaccine is that it comes in multi-dose vials, containing enough vaccine for five or six doses.</p>
<p>Nearly all current vaccines in our national immunisation program are single-use. Many come already prepackaged in the needle and syringe. So for many vaccinators,
“drawing up” and giving a vaccine from a multi-dose vial will be new. This too has rules.</p>
<p>The vaccinator first needs to clean the top of the vial with an antiseptic swab. This is important to ensure the vials remain free from contamination.</p>
<p>Then the vaccinator injects a set amount of sterile saline into the vial, through the top, to dilute the vaccine. Care must be taken not to introduce contaminants during this part of the process.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse giving vaccine to elderly person" src="https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384903/original/file-20210218-23-1w87za9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaccinators have several steps to go through before giving the Pfizer vaccine.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-nurse-doing-vaccine-injection-senior-1852449988">www.shutterstock.com</a></span>
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<p>The vial then needs to be turned up and down ten times to make sure the saline mixes with the vaccine. Again, the clock is ticking. Once the vaccinator injects the saline into the vial and mixes it, the vaccine must be used within six hours. After that, any unused vaccine must be discarded.</p>
<p>The vaccinator must then take a new needle and syringe, clean the top of the vial again and “draw” up 0.3 millilitres of vaccine from the vial. This is a new volume for our vaccinators to get used to as most vaccines given as part of our current immunisation program are 0.5 millilitres.</p>
<p>Once the 0.3 millilitres is in the syringe, it is ready to be injected into the upper arm.</p>
<p>The vaccinator must use a new needle and syringe to “draw” up the next dose. This is repeated until five or six doses have been removed from the vial. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-covid-vaccine-while-im-pregnant-or-breastfeeding-is-it-safe-for-me-and-my-baby-153309">Should I get a COVID vaccine while I'm pregnant or breastfeeding? Is it safe for me and my baby?</a>
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<h2>Ready, set, go</h2>
<p>Next, the injection itself. In most cases, the person will be sitting down and have their upper arm exposed so the vaccinator can see the deltoid muscle. This is the large fleshy part of muscle on the outer edge of your upper arm. </p>
<p>There is usually no need to clean the upper arm unless it is visibly dirty. The needle is then inserted at 90⁰ to the arm and the vaccine injected slowly over a few seconds. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/not-sure-about-the-pfizer-vaccine-now-its-been-approved-in-australia-you-can-scratch-these-4-concerns-straight-off-your-list-153719">Not sure about the Pfizer vaccine, now it's been approved in Australia? You can scratch these 4 concerns straight off your list</a>
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</p>
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<h2>That’s not all</h2>
<p>Once you have been given the vaccine you will be <a href="https://www.health.gov.au/sites/default/files/documents/2021/02/covid-19-vaccination-preparing-for-covid-19-vaccination_2.pdf">asked to stay</a> in the clinic for at least 15 minutes to make sure you don’t have any reactions. In some cases, especially if there’s a history of severe allergic reactions, people will be asked to wait for 30 minutes. </p>
<p>Your vaccine details will be added to the <a href="https://www.servicesaustralia.gov.au/individuals/services/medicare/australian-immunisation-register">Australian Immunisation Register</a>. This is <a href="https://theconversation.com/the-covid-vaccine-is-here-when-and-to-whom-will-we-need-to-prove-weve-had-it-155122">now mandatory</a>. That’s because it is very important we know exactly which vaccine you were given and will be checked when you return for the second dose, 21 days later. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-covid-vaccine-is-here-when-and-to-whom-will-we-need-to-prove-weve-had-it-155122">The COVID vaccine is here. When and to whom will we need to prove we've had it?</a>
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<img src="https://counter.theconversation.com/content/155453/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a Career Development Fellowship </span></em></p>The clock starts ticking once the vaccine leaves the freezer. Here’s what to expect.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.