Nurses and midwives made vital contributions to the healthcare industry, providing health services to people of all ages, experiencing various forms of diseases and illness (WHO, 2020). It is the profession that requires lots of compassion and dedication since “being a nurse is not without its challenges”. The shortage of staff, violence and assault in the workplace and environmental hazards are some the significant issues that nurses and midwifery are facing nowadays in Australia and globally. These problems have many negative impacts on healthcare workers physically and psychology. In order to promote recruitment, retention and sustainability of qualifies nurses are urgently needed, the government, organisation and stakeholders always come up with new plans and strategies to ensure that the patients satisfied with the healthcare services and nurses also deserve better support and respect.
There are many problems that nurses and midwives confronted today. The nursing profession continues to face ‘catastrophic’ shortages of staff and a shortfall unable to meet the population demands, which will continue for another decade. Especially in the Indigenous community, the shortage of nursing is worse. According to SBS, NSW will need approximately 82,000 more nurses and midwives by 2030, but only 74,000 will be available. Similarly, the other developed countries like the United States is also facing the massive nursing shortage. 92% of emergency rooms always in the state of patient overcrowding as stated by the Bradley University. It means the patients have to wait for a longer time and also put more significant pressure on nurses to treat patients efficiently. These facts emphasize the seriousness of the problem and notify the organisation and the stakeholder to modify and come up with practical solutions to tackle this issue and limit the further impact on the healthcare facility.
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How to address the shortage of nursing in Australia and worldwide? Australian government implemented several programs which help to maintain a significant proportion of experienced and expert nurses in the workforce. The program “Initial Registration of Overseas Nurses (IRON)” is known as an overseas program that provides an opportunity for nursing who wish to upgrade their oversea qualification to Australian qualification to adhere to Australian standards (IHNA, 2019). It encourages more register nurses to pursue their career in Australia with many better benefits. Moreover, effective leadership play a vital role in contributing on employee satisfaction, trust in management, and mobilising people towards achieving outstanding health outcomes and creates a positive practice environment that attracts and retains nursing staff. The Florence Nightingale Trust in Tasmania, which offers an annual $10,000 nursing leadership grant to attract Registered Nurses to undertake a leadership project which contributes to their leadership skills. The government implemented several evidence-based programs across Australia to build nurse leadership, including Take the Lead in NSW, Leading Great Care in Western Australia and the Clinical Leadership Programme in South Australia. In like manner, the policymakers and health ministers also develop the most effective policies to address this issue by the support of the Health Workforce as they always provide them with the most up-to-date nursing numbers and projections with detailed analysis.
Furthermore, Occupational Health and Safety (2020) reports that nurses are suffering more violence and assault in the workplace by the patients, the visitors or even from other healthcare workers. A number of surveys demonstrate that the prevalence of violence among health care workers is on the rise and at an alarming level. 21% of the health workers in the nursing profession experienced physically assaulted, and 50% verbally abused in a 12-month period (OHS, 2020). Notably, the Emergency Department Nurses have the highest chance of experiencing violence and assaults, which is up to 90% (Hughes, 2017). Physical, verbal assaulted, or bullying is unacceptable; this is not only impacting on the physical well-being but can have a long and lasting negative effect on the workers’ psychological and mental health. Consequently, this reasonably decreases the quality of care and puts heal-care provision at risk. However, the frequency of violence and bullying is difficult to determine because it is often under-reported; approximately 44% of nurses do not report physical abuse. It is due to many reasons for instances, lacking reporting policy, reporting does not make any difference or reporting can cause further violence (Hughes, 2017). These incivility behaviours have to report to control patient-to-worker and worker-to-worker violence in the clinical environment and prevent further serious consequences.
For organisations to maintain the current nursing workforce and prepare for the future, it is necessary to address the workplace violence issues and build a more respectful and healthy practice environment. The American Nurses Credentialing Centre implements a program “Pathway to Excellence” which comes up with a framework for a positive environment that ensures the organisation protects the healthcare workers through safety policies and practices. Some of the strategies of the Pathway to Excellence program include annual online learning about disruptive behaviours, domestic threats, self-awareness, predisposing factors and active shooter training which available for all healthcare workers worldwide. Limited access into the hospital after 10 p.m. that is also a part of the framework which use to mitigate the potential of staff isolation in work areas. As a result, these strategies create an opportunity for nurses to work in a better environment and helping them become more productive and engaging. The hospital encourages to put up the poster indicating zero tolerance for all forms of violence placed throughout the facility at public entrances and elevators that helps to raise the awareness of people about the essence of safety workplace. In addition to these strategies, the National Institute for Occupational Safety and Health (NIOSH) offers a free course “Workplace Violence Prevention for Nurses”. This course builds up to help healthcare workers recognize and mitigate all types of violence and strengthen teamwork skills to prevent and manage the disrespectful behaviours. Raising awareness about workplace violence and harassments boost safety and increase the likelihood of reporting. Importantly, the nurses have to acknowledge that workplace violence is not “part of the job”, reporting is a key to protect themselves and prevent future occurrences.
Additionally, the environmental hazard is one of the significant issues that nurses have to face nowadays. In the workplace, nurses confront endless occupational hazards regularly. The statistic indicates that nurses suffer one of the highest levels of work-related back injuries compared to any other occupations globally, accounting over 70% of all injuries in the nursing profession. Approximately 55 per 1000 nurses experienced a work-related injury or illness in 2018, as stated by the Australian Bureau of Statistics. Lifting, transporting and repositioning patients and working in extremely awkward postures which play a part in causing musculoskeletal disorder injuries. Especially, nurses more often get injured due to the sharp objects, for instance, needles and blades which usually contaminated with blood or other body fluid where mainly contains a variety of bacteria and germ predisposes. It directly links to the threat of infectious disease such as tuberculosis, hepatitis and HIV. Several studies found that nurses who are working in the radiology department are at higher risk of toxic exposures. Coming in contact with chemicals like sterilizing agents or chemotherapy drugs will have a severe impact on nursing’s health. The reasons for incidence include improper handling and accidental spill on the skin, inhaling fumes from chemotherapy drugs and small spay when the chemical container punctured by needle. Nausea and rashes are some of the side effects. Still, it can be more dangerous if the individual exposes to the chemicals repeatedly over a period of time and that more severe consequences can be mentioned such as nervous system damage or organ failure (Jacoby, 2016). The injuries can cause short-time and long-term health effects and have direct consequences on patient care, and they are likely to retire early, which contribute to the looming nursing shortage.
From these numerous issues and challenges mentioned above, staff shortage can consider as the most severe problem, and it is now a recognised global challenge. The reasons for the lack of nursing in Australia are broadly similar to other countries in the world. This well-documented deficiency is due to the aging population, the aging workforce and a more massive burden of chronic diseases which increase health care needs. The most predominant reason is the aging population of both patients and nurses. The epidemiology shows that many developed countries have a relatively large proportion of its population is aged 65 and over. That indicates an increase in health issues and hospitalisation for patients who require intensive care. Along with the aging population, Australia’s rising population is also putting more pressure on healthcare. Another contributing factor that decreases in numbers of registered nurses is the nature of the industry. Working in the nursing profession is physically and mentally challenging and stressful, and sometimes inflexible, leading to high rates of burnout. They also have to work in a harsh environment; thus, there is a mass exodus of nurses leaving the industry. As mentioned above, there is such a drastic shortage of rural nurses in the Indigenous community because nursing in remote areas faces more challenges than those working in the urban environment. The problem can include isolation and lack of support from the healthcare organisation and government. Therefore, the healthcare workforce has insufficient staff capacity to meet the population needs.
Undoubtedly, the shortage of nursing beneficial for new graduate nurses as it is easier for them to look for a job and better pay is also an advantage. However, the shortage of nurse can have a largely negative impact on nursing themselves. If the hospital can not hire enough nurses, the nurses will end up working overtime. Long working hours and doing overtime can cause fatigue, post-traumatic stress disorder, reduce productivity and increase the risks that the nurses will make mistakes. Nursing burnout and job dissatisfaction endanger both the patients and themselves. The workplace violence, as referenced in the above paragraph, is also due to the inadequate staffing levels and supervision, contributing to stress. The presence of workforce violence is associated with intention to leave and turnover rates. In the context of global nurse shortages, what is the future action or initiatives to address this issue? The results of this study give compelling arguments for changes to healthcare policy and management. Healthcare management and policymakers must ensure maximum exposure to nursing work and provide sufficient support to undertake the task properly. Furthermore, the government in charge of providing financial support in order to create health and positive work environment that support safe staffing practices such as implementing strategies to reduce job strain and overload, improving leadership support and reducing the physical demands of the job. Most importantly, the hospital needs to capitalize on nurses’ inherent attachment to work and irrespective of generation to increase the retention of nurses in the hospital and to reduce nurse shortages worldwide.
According to WHO (2019), nurses and midwives account for almost half of the global health workforce; they play a critical role in healthcare service by improving the patient’s quality of life and providing care in primary, community and hospital settings, including emergency and critical care area. Nursing and midwifery have been central to delivery to modern healthcare for many decades. It is undeniable that healthcare workers have to face a lot of issues and challenges throughout their career. These problems can include the shortage of nursing, violence and assault in the workplace and environmental hazards. These challenges place onerous demands on healthcare workers and healthcare systems around the world; therefore, potential initiatives and strategies need to develop in order to address these challenges.
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