The $3,000 bonus payment by the Victorian government to nurses, doctors, and paramedics who work in the state’s public hospitals is not so much a “thank you for fighting COVID-19” as a “please don’t leave.”
Prime Minister Daniel Andrews described the bonus as part of a $353 million “retention package” to encourage health workers to stay through the winter.
“This is all about encouraging people to take shifts when they can to go from part-time to maybe a few more hours,” Andrews said at a news conference on Thursday.
His New South Wales counterpart Dominic Perrottet had announced a $3,000 bonus for health workers just days earlier.
The concern that healthcare workers are leaving the sector is not the result of COVID-19. It has been lurking for years.
Money is part of the solution. More important is to face the realities of hospital work and find smart solutions to problems routinely spotted by people on the front lines.
Before the pandemic
In 2019, before the pandemic, some hospitals experienced a 30 percent turnover rate of nursing staff each year.
The complaint was not about money. It was about escalating work pressure and burnout.
At the time, the Australian Department of Health predicted a nursing shortage of about 85,000 by 2025.
In February, a survey by the Australian Primary Health Care Nurses Association found that:
More than one in four (28.73 percent) nurses in primary care plan to quit their current job within the next two to five years. More than four in five (80.4 percent) said they feel exhausted at work. More than four in five (86.7 percent) reported feeling stressed at work. Over three-quarters (78.8 percent) of primary care nurses felt burned out.
Better management of night shifts
What must we do? This week the European Society of Anaesthesiology and Intensive Care gathered in Milan for the Euroanesthesia Congress.
Dr. Nancy Redfern, an anesthesiologist at Newcastle Hospitals NHS Foundation Trust (UK), presented an overview of the “potentially deadly effects of fatigue on physicians and nurses themselves, and its impact on the quality of their clinical work and judgment and thus on patient safety.””.
Dr. Redfern concluded that because of these risks, “all doctors and nurses require a 20-minute power nap during night shifts to keep patients safe (and make their own journey home after work safer), and also recommend that no doctor or nurse does more than three consecutive night shifts”.
Dr. Redfern presented evidence, including surveys, “showing that approximately half of doctors, counselors, and nurses in training had experienced an accident or near miss when driving home from a night shift”.
She said workers driving home after a 12-hour shift are twice as likely to crash as those who worked an 8-hour shift.
A ‘sleep debt’ starts to build up after two or more nights of limited sleep, and it takes at least two nights of good sleep to recover from it.
Cognitive function is impaired after 16-18 hours of wakefulness, leading to a deterioration in the medical worker’s ability to interact effectively with patients and colleagues.
“When fatigue sets in, we in the medical and nursing team are less empathetic with patients and colleagues, vigilance becomes more variable, and logical reasoning is impaired, making it difficult to calculate, for example, the correct doses of drugs a patient needs,” said Dr. Redfern.
Dr. Redfern presented evidence on how 20-minute power naps improve staff and patient safety and how they can be built into night shifts.
She concluded, “We need to change how we manage night shifts to reduce the effects of fatigue.”
The Australian experience
A senior nurse at a Sydney public hospital, who spoke on condition of anonymity because she was not authorized to speak in public, said her ward was so understaffed that a 20-minute power nap was routinely impossible.
“They may be trying to nap, but they’re usually interrupted by a patient who needs attention.”
She said there was no provision for power naps.
She said her full-time nurses routinely worked four 10-hour shifts in a row.
She said improving night shift management was good but impossible to implement without increasing the number of nurses.
“So many have left because of COVID-19,” she said.
Calls to the Australian Nursing & Midwifery Federation went straight to voicemail. We’ll update this story when the union gets in touch.