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What happens if nurses stop showing up to work?

What happens if this pandemic gets worse? What if it got so bad that healthcare workers, doctors and nurses all walked off the job?

While the Australian healthcare system has been stretched by the COVID-19 crisis, it has yet to feel its full force when compared to its US or European counterparts.

Over the last week we have seen the numbers of coronavirus sufferers explode in the US, and a number of doctors and nurses have criticised the lack of essential PPE available to protect themselves, resulting in a number of workers falling ill and dying.

In early March when the first Australian aged care home experienced an outbreak of COVID-19, aged care workers refused to come to work the following day.

After news of the outbreak was confirmed by BaptistCare, The Australian reported that aged care staff collectively called in sick, forcing the NSW Health Department to step in.

“Just this afternoon, NSW Health has had to agree to fund NSW Health staff into a nursing home that has had some coronavirus issues and its staff have become, for whatever reason, unavailable,” said NSW Health minister Brad Hazzard at the time.

Staff who did go to work at the facility said they were not given any information about what was happening.

If PPE becomes scarce and the rates of infection go up, would nurses be forced to choose between the safety of patients and the safety of their family and themselves?

Erin Smith, Associate Professor in Disaster and Emergency Response at Edith Cowan University, says that previous research indicated that a pandemic was one of the situations that would likely result in decreased willingness to work among paramedics.

"We have known for some time that essential frontline workers would have difficulty weighing up professional obligation with personal risk when it came to a situation like a pandemic," she says.

"However, despite this obvious ethical dilemma, clarification of acceptable an level of personal risk for many healthcare workers and essential frontline personnel – like police officers – is still lacking."

The Guardian has reported that doctors and nurses in the UK are being “bullied and shamed” into treating patients with COVID-19 despite not having the masks, gowns and eyewear they need to protect themselves from the virus. They are also being advised to hold their breath when treating patients due to PPE shortages.

A perfect storm of a lack of communication from management, a lack of PPE, panic and low pay could come together and cause an issue among the nursing workforce, Smith says.

“I think we're coming off the back of an unprecedented bushfire season, so psychologically we've already been stretched to our limits. In terms of PPE, we've used up a huge amount of our existing stockpile, particularly in terms of the face masks that we need.

“Here comes this pandemic of a brand-new virus and we're being asked to get back up off the ground and start again. It's difficult because we know first-hand from a lot of the people that I'm speaking to that their hospitals are essentially gagging their staff and saying, ‘You cannot speak to the media. You cannot tell people what's happening,’” Smith says.

Smith says that you only have to walk down the corridors of Australian hospitals now and you can see all the hand sanitiser stations are empty and nurses and doctors are being told to use their PPE masks for well beyond what the standard protocol would usually be.

“That's not out of a malicious kind of direction from the hospital, it's simply because they are trying to ration what they have. It's a bit of a perfect storm because we've run out of the stockpile, the government are working as hard as they possibly can to replenish those stockpiles, but it takes time.

“We need to remember that a lot of those are coming in from overseas, ships are being quarantined. There's not as many flights coming in. When they do arrive, a lot of these have been waiting for at least 14 days in isolation before they can be a distributed. Then it's that interesting process of how we actually divvy these up.

“The government announced last night on TV that 30 million masks arrived in the country. But it would be very interesting to see how long it takes before they are actually being on the faces of our frontline healthcare workers because there will be that complex decision-making process now of who actually gets them,” says Smith.

And Smith says that if health workers attempt to speak out about PPE shortages they are threatened with losing their job.

“What's the priority matrix here and who makes those decisions? Because I'm talking to nurses and I'm talking to GPs, they're down to if not weeks, days’ worth of supply left.

“They will be making very real decisions very soon about, ‘My life and my health is not worth my job. My job is not worth it.’”

Adding to this bubbling issue is the accumulative psychological scarring the nation has incurred after a long, hard bushfire season, which captured the nation’s attention for months.

“The psychological impact of that is going to be huge as well,” says Smith.

“Only a month ago I was talking in the media about how we haven't seen the effects of a bushfire season like this before and now all of a sudden we're layering a pandemic on top of this.

“We simply just don't know what this is going to do. We know everyone is already exhausted. We're now layering a fear response on top of that, so people are actually really scared that they are going to take this virus home and give it to their loved ones.

“The scary reality of working in healthcare at the moment is that we just don't know what's going to confront our healthcare workers as they walk through the doors each day, what the long-term psychological toll of that will be; I don't think anyone will even want to hazard a guess at the moment,” Smith says.

Smith points to a phenomenon known as ‘collective trauma’, which is when an event – such as war or a pandemic – is so life-changing that it disrupts our norms, values and rituals, which are the foundations of social order. It can change the way we think about the world, undermine our perceptions of safety, and rupture social bonds, and, ultimately, has the ability to change entire countries for years to come.

“We witness things as far back as the Holocaust, for example, that actually left a permanent imprint like an actual collective trauma on an entire group,” Smith says.

“We will certainly see that on certain groups that have been really badly impacted by this. I'm thinking certainly the Italian healthcare workers, the Italian communities, for example, who really bore the brunt of this pandemic early on and had to make horrific decisions around rationing care.

“Those doctors who had to decide, ‘Okay, anyone over the age of 60 years of age does not get intensive care. Anyone with a serious illness who is very unlikely to survive, they simply don't get any care.’ Imagine the impact on that collective group of healthcare workers, the collective community.”

As an expert in disaster and emergency response, Smith admits that it is an occupational habit to think and plan for the worst. However, she does believe that Australia and its government is doing the best it can, currently, to fight the spread of the virus.

“I have to say I think Australia and our government at all levels have done incredibly well with a very complex situation, a very rapidly evolving situation. They brought together some fantastic expertise to help guide us through this. I think we only have to compare ourselves to some other countries to show that we have had some solid leadership.

“We've locked down borders early. It would have been nice to have maybe a little bit more in the medical stockpile, but again we've had unprecedented situations occurring. Who could have known we would've lived through an unprecedented bushfire season right before a pandemic? Sometimes they are just things we can't plan for. Given everything that's happened, I think we've done remarkably well.”

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  1. I am worried about ever being on the frontline due to my age (over 60) and being immunocompromised position at the moment. I have however stopped my medication and I am just waiting for them to be out of my system. Also want to wait to see if symtoms return. Still working in private practice but not on the frontline.
    I think we have done exceeding well except for the cruise ship fiascos.

  2. Hopefully Australia won’t get to that point. But if it does will we be expected to just soldier on and catch the disease, and some of us die? Many places are following the “No emergencies in a pandemic” and even in an emergency you stop and don PPE before going into a coding patient. Will the same rule apply to routines care for a not very sick patient?

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