From workload to equipment problems, Australian nurses sound off in our survey on the largest obstacles to their success on the job.
Overworked, physically and verbally abused, and bullied. These words can be used to describe the nursing workforce throughout Australia and, not surprisingly, nurses are pretty concerned about that.
“If they are injured in the workplace then that has a significant effect on their ability to work, and their lives more generally,” Australian Nursing and Midwifery Federation federal secretary Lee Thomas says. “It’s absolutely imperative that people adhere to the internal policies around work health and safety but also look after not only themselves but their colleagues.”
With this in mind, Nursing Review sent out a poll asking readers what the biggest current health and safety concerns were in the workplace. In this issue, we profile the areas readers identified as top priorities.
The biggest safety concern, identified by more than a quarter of respondents, was staff/patient ratios and the resulting workload.
Survey participants noted that decreases in the number of workers are resulting in a longer list of duties and increased pressure on the remaining workforce. Respondents also said this means there are fewer senior staff members supervising inexperienced nurses, resulting in more potential safety problems.
The ANMF has received similar responses when gauging the views of its members.
“When we survey our members, one of the top three issues they [consider] problematic in the workplace is the number of staff available compared with the number of patients,” Thomas says. “This is particularly the case in aged care, where there are no staff-to-patient ratios mandated.”
Thomas says low ratios mean often nurses are working in very high pressure environments with too few co-workers, as well as with staff who don’t have the right skills to manage the patient load.
“In areas where there aren’t workload management tools implemented through industrial agreements, obviously employers need to ensure that there are the right number of staff with the right skills on duty at all times to manage the patient or resident load,” she argues.
Thomas says where these tools aren’t established and there aren’t enough staff members to care for patients or residents, then nurses have to prioritise work to ensure that the more important care is done, resulting in individuals missing out on the attention they need.
The problem may be getting worse. As emeritus professor Robin Watts from Curtin University’s school of nursing and midwifery points out, if graduates are unable to find jobs in nursing and look to other professions for employment, this could make staffing issues even more severe long term. Meanwhile, she says, the complexity of the patients that nurses are looking after, in terms of illnesses and needs, is also increasing, placing even more demand on staff.
Watts also explains that whilst it’s good to bring workload issues to the attention of managers, often they’re being instructed to save money by those above them, whilst their staff is working increasingly harder.
Violence and security
Violence in the workplace and the related lack of security were huge concerns amongst respondents. These fears revolved around physical and verbal abuse from patients as well as their families.
Watts says violence is widespread now and a serious issue for nurses, and adds it’s something that wasn’t seen to the same extent in her era.
Thomas says, “It is absolutely unacceptable that nurses and midwives in the course of their work in caring for patients and residents are exposed to verbal and physical violence.”
She says this can often be spitting, hitting, punching and yelling abuse and that such actions are quite often seen in emergency departments and places where people are under significant stress.
“We would say that hospitals and employers need to put in place a range of mechanisms that ensure that nurses and midwives are safe in the course of their employment,” she adds.
In dealing with aggressive patients, Watts says, remaining calm and focused helps, as does refraining from reacting to what is said if possible. But she acknowledges this is difficult when workers are busy and some patients are not receiving the care they need due to the disruption. She says heavy security is needed, particularly in emergency rooms.
Respondents also highlighted external security as an issue. Some nurses reported feeling unsafe when called in for emergencies after dark and required to park in non-secure areas.
More than 10 per cent of nurses who responded to the survey identified bullying as a major issue in their workplace. Many feared that experiencing this would impair their clinical judgement, result in absenteeism serious psychological effects.
Respondents also addressed a misunderstanding surrounding what constitutes bullying. Forms of it that were identified included exclusion, aggression and being put-down by fellow nurses, superiors and patients.
The union has heard of this problem many times from its members. “Unfortunately, we do see and hear from our members that bullying is happening in workplaces and of course the union advises members and represents members on the best way to manage these unfortunate situations,” Thomas says.
Mental health and stress
Increased workloads, a lack of time for breaks and the general demands on nurses result in stress and burnout in the workplace, which are carried on to the home.
The ANMF has received multiple reports on this issue. Thomas says, “Stress often results from a range of things but quite often it is a result of poor workload management.
“Employers really need to be clear about having in place staff-to-resident ratios that ensure the right number of nurses are on duty to care for the type of patient and resident.”
Watts says that in dealing with the workload, it’s important to have a life outside of nursing. “You have to make the most of your time off,” she says, but adds it’s often difficult as nurses have pressing demands at home as well.
“You have to monitor yourself. It’s so easy to burn out. You do have to care for yourself, that’s absolutely vital. If you can afford to do a little less work for your own health, just do it.”
Respondents identified maintaining good communication pathways as crucial to keeping a workplace safe. This includes ensuring knowledge of patients and how to deal with them is passed on between professionals.
“Communication is important for every aspect in a [nursing] environment,” Thomas says. “The communication between the staff is vital in order for everybody to be aware about what’s going on in the clinical environment.”
Watts says this is particularly important when dealing with patients who are disruptive.
Whilst she says this sort of interaction doesn’t need to be face-to-face, it does need to be manageable, clear and concise. It’s also important for communication pathways to be set up between management and staff, as it allows nurses to have a say on potential problems and on developing innovative solutions to address them.
“It’s vital that you allow nurses in the workplace the opportunity to suggest different ways of managing things and what the major problems are in terms of safety,” Watts says.
Back and neck problems
An increase in bending, lifting and other strenuous movements that health professionals are required to make throughout the care of patients is causing pain and distress to many.
Queensland Health stresses the importance of identifying and reducing harm that back injuries cause. Risk-management strategies and targeted training programs have since been established in some areas to deal with the problem.
For some nurses, it isn’t the need to engage in physical activity that causes pain, rather the lack thereof. Sitting at a desk for long hours and the resulting neck pain were identified as issues for those who have more computer-based roles. Inadequate workspaces, long drives, vast amounts of notes and auditing and insufficient breaks were believed to be exacerbating the problem.
A lack of appropriate equipment within hospitals was a big concern.
Watts says there are particular areas where this is an issue, such as outer-lying regional hospitals and others in remote and rural areas, but it can also come up in any ward in Australia due to the increasing obesity problem. Nurses often have to do the best with what they have and may be required to turn to local organisations or clubs to get the funding needed to purchase necessary equipment.
Thomas says having the right item for a task is vital. “If a nurse or midwife need a particular piece of equipment in order to fulfill a requirement for the patient’s care plan, then the employer really has the responsibility of providing that.”
She says often it’s not a shortage of equipment, rather a problem with its condition that poses problems.
Adequate servicing and appropriate, up-to-date technology that allows the care staff in any environment to perform to the best of their abilities is necessary, Thomas says.Do you have an idea for a story?
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