How to alleviate the shortage of critical care nurses

The spread of the Omicron variant and the COVID-19 pandemic overall have contributed dramatically to the shortage of nurses in the nation's hospitals. State and federal government must step up their efforts to ensure there are enough nurses in hospitals to supply quality health care and avoid poor patient outcomes, including funding postgraduate study to better equip nurses for crisis health care.

There are several reasons for the shortage of nurses, including critical care staff. In recent times, as the Omicron variant has infected greater and greater numbers of Australians, more people are being hospitalised and going into intensive care units. Shortages of critical care and other nurses have emerged in hospitals around the nation, pushing down nurse-to-patient ratios to worrying levels. Nurses are being seconded from the private health system into the public system to help alleviate the shortages, which have been exacerbated by COVID-19 and the quick spread of Omicron.

In recent years, the supply of nurses has not kept up with the increased demand, and now there is a shortage of nurses predicted for most specialities including critical care areas. Currently, in Australia we have 432,855 practising registered nurses and enrolled nurses. Of those, 48,207 are registered nurses practising in the health system and 3347 are non-practising. As of September 2021, there are 2277 endorsed nurse practitioners, who are legally entitled to autonomously assess, diagnose and manage a range of patient conditions in line with their scope of practice. Yet these numbers need to increase across the board to meet demand. The federal government has predicted there will be a shortfall of approximately 85,000 nurses by 2025, and 123,000 nurses by 2030.

Longer term factors contributing to the shortage of nurses include rising hospital admissions due to the growing burden of chronic disease and improved survival rates. This is linked to the ageing population and increased survival rates for those with chronic disease or co-morbidities. In addition, nurse workforce planning by governments has been sporadic, poorly integrated and inadequate to meet longer term demand. Nurses are providing more health care with fewer resources and the healthcare system is losing nurses due to burnout and dissatisfaction. This is also resulting in difficulties in recruiting and retaining skilled experienced nurses in the public and private sectors.

The labour shortage may result in compromised longer term outcomes, including poorer health outcomes and near misses in hospitals as the quality of care is compromised. This will inevitably lead to greater patient dissatisfaction. Nursing staff shortages will also diminish the organisational culture of hospitals and push up staff dissatisfaction across all areas as resources run thin on the ground.

No single policy will remedy the projected shortfall of nurses able to meet service demands. To begin, a prolonged and persistent effort is needed to address the nursing shortfall and educate people about nursing careers and thus to stimulate greater output of trained and skilled nurses. Governments need to devise strategies to minimise nursing curriculum creep to ensure integration and a coherent relevant education program.

There needs to be better defined career pathways for nurses and a greater time for transition-to-practice programs that support an environment of learning, overseen by experienced senior nursing clinicians. We need to encourage postgraduate study too, degrees such as the Master of Advanced Nursing and Graduate Certificate in Critical Care, and postgraduate training more generally should be funded by government. As it is, nursing individuals must face the cost of their education alone, even though the healthcare system overall and patients benefit.

Importantly, postgraduate education equips nurses with the necessary skills for healthcare management and it can help nurses integrate into specialty clinical areas such as critical care in ICU units. The gaining of knowledge and skills can transform healthcare practice and support a culture of evidence-based practice, which can deliver better healthcare outcomes. Furthermore, the online delivery of courses can provide nurses with greater access to educational opportunities, including those nurses located in geographically diverse regions.

Work security and employment conditions are also important. Employees of nurses, largely state hospitals systems, should look at employing more nurses on permanent contracts where possible, and move away from an overly casualised workforce. Governments, healthcare providers and educators too need to explore strategies to increase diversity and the number of men in nursing. Early career retention should be fostered through incentivisation and better ongoing education and training, which should be included in nurses’ rosters, rather than in their own time.

Separately, greater opportunity and funding for roles such as nurse practitioners would improve access to health care. Nurse practitioners need to be empowered to operate more independently of other professionals to manage a range of patient conditions. As an example, nurses should be able to sign work certificates, along with doctors. Legislation needs to be revised and Medicare Benefits Schedule (MBS) items expanded to broaden nurse practitioners’ scope in public and private practice and in rural and regional Australia. This would improve healthcare access and timeliness across Australia, including in rural and regional Australia. Governments too should consider incentivising rural and regional placements for nurses, as it does for other medical staff. The use of unregulated workers in aged-care settings should be overseen by governments to improve healthcare outcomes for the aged.

Only by introducing such a combination of measures at every level can the nursing shortage be alleviated over the longer term. In the short term, governments should provide nurses with whatever support they need to help overcome shortages and burnout, which is being exacerbated by COVID-19.

*Professor Margaret Fry is a researcher, clinician, supervisor and teacher at UTS, which offers the Master of Advanced Nursing and Graduate Certificate in Critical Care. The focus of her applied research is on improving the quality and safety of nursing care and patient outcomes. Professor Fry has over 180 peer reviewed publications and $5.5 million in grant or scholarship funding. Professor Fry has worked extensively in critical care areas (intensive and emergency) for over 20 years and possesses a highly credible reputation in the industry.

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