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Almost half of the Australian primary healthcare nurses who took part in a national survey at the height of the COVID-19 pandemic had their hours cut, were threatened with, or actually ended up, losing their jobs, a new study has revealed.

The majority of participating PHC nurses also reported never or only sometimes having access to sufficient personal protective equipment (PPE) in their workplace, while a third (34%) felt the care provided in their workplace was significantly or slightly worse than before the pandemic.

Fears over personal physical and psychological safety, as well as lack of job security or reduced hours, also drove more than one in five (22%) participating PHC nurses to consider resigning in the grip of the pandemic.

Undertaken by the Primary Health Care Nursing Research Group (PHCNRG), based at the University of Wollongong (UOW), the study, The Experiences of Primary Healthcare Nurses During the COVID-19 Pandemic in Australia, set out to explore and understand the impact of the coronavirus pandemic on the employment status and role of PHC nurses, as well as their access to PPE.

“We were hearing stories of nurses having hours reduced or being let go and it was scaring us that we were in the middle of pandemic and yet nurses were losing their jobs,” lead author Professor Elizabeth Halcomb, Professor of Primary Health Care Nursing at UOW’s School of Nursing, told the ANMJ.

“It seemed ludicrous, at a time when we needed all the healthcare workers we could get, to have nurses telling us that they were losing their jobs and having hours cut.”

The study surveyed 637 primary healthcare nurses from across the country during April at the height of the pandemic.
Findings highlight the significant impact COVID-19 has had on the employment of PHC nurses, their role, and the quality of care delivered.
They also revealed a significant lack of PPE within primary healthcare settings.

Many respondents reported a reduced nursing role due to fewer face-to-face consultations being conducted and the scaling up of telehealth consultations by GPs, which led to decreased income and a “lesser need for the nurse at the practice”.

“Often these nurses still tried to deliver care the best way they could in their practice but at the same time they were facing the fact that they might not get paid or might lose their jobs,” Professor Halcomb says.

“The opening up of the telehealth item numbers to include nurses has been a really important step in securing nursing work.”
In contrast, other respondents reported an initial increase in hours to prepare workplaces for an influx of patients by “writing policy, developing triage tool, educating staff, sourcing increased stock”.

Examining access to Personal Protective Equipment (PPE), the study found less than half (47%) of respondents said that their workplaces had COVID-19 specific PPE guidelines. Just 23% of respondents reported having sufficient access to P2/N95 masks at all times. Respondents reported a high level of concern regarding PPE shortages and inadequate access to PPE in their workplaces. Some spoke of management rationing PPE and others suggested hospitals were being prioritised with supply.

Among PHC nurses with some stock of PPE, respondents described “having to reuse masks for a few shifts to make stock last” and “sharing goggles” while others revealed they resorted to making their own gowns at home.

Discussion points raised by the study’s findings include the need to ensure PHC nurses are adequately supported during and after COVID-19 to optimise workforce retention, sustainability and care quality.

“COVID-19 has had a big impact on our health system and our communities but people still have chronic conditions,” Professor Halcomb says.

“Those chronic conditions don’t go away just because COVID-19 is around and people need the same sort of chronic disease management and ongoing care that they would have at any time.”

“What the study showed is that PHC nurses are stuck in an awkward position because they’re beholden to general practices and community service providers for funding. So although the health needs of the community haven’t diminished, and in many ways have increased, the fact that general practices were unable to provide face-to-face care that provides a Medicare rebate meant that it was difficult to sustain nursing employment. The challenge is that the current health system funding model doesn’t really facilitate nurses giving the kind of care that the community needs or that nurses can deliver.”

Professor Halcomb says the study provides nurse leaders, employers and policymakers with timely PHC evidence to be able to effectively plan and enhance nursing resources to meet the demands of current and future pandemics.

A second report from the survey investigated the key support needs of Australian primary healthcare nurses during the COVID-19 pandemic.

This report identified six themes around what PHC nurses believed would help support them in their role – PPE, communication, funding, industrial issues, self-care, workplace factors and valuing nurses.

The study, The support needs of Australian primary health care nurses during the COVID-19 pandemic, found issues relating to personal health and safety, care quality and job security must be addressed to support primary healthcare nurses during COVID-19.

Over three-quarters of respondents (77%) identified the need for an adequate supply of Personal Protective Equipment (PPE) to enable the delivery of quality routine care during the pandemic as the most important issue.

Tellingly, more than half of respondents identified the need for better high level communication supports, including standardised protocols to govern clinical care, up-to-date delivery of information regarding COVID-19, and increased access to COVID-19 education for both health professionals and the community, to continue to provide quality nursing care.

“Some of that has perhaps been addressed a little bit as the pandemic has unfolded but moving forward it demands looking at ways that we can better communicate between health professionals and the community to make sure they’re receiving consistent and quality messaging.”

Researchers are currently building on the studies by interviewing primary healthcare nurses who took part in the initial survey back in April.

Professor Halcomb says emerging issues for PHC nurses include areas like mental health and its impacts.

She says many PHC nurses are reflecting on their own mental health amid the pandemic and considering how their career choice impacts that and if it best suits their needs moving forward.

“Nurses have raised a couple of issues that are more important to them now and some of those revolve around their mental health and the impacts. Not only their concerns around the COVID-19 illness, but also the way they’re being treated by some members of the public. A few have spoken about being abused and spoken to inappropriately by patients and other staff.”

The initial chief concern around nurses losing hours and their jobs remains ongoing, Professor Halcomb says.

“It’s been relieved a little bit with telehealth item numbers being extended to nurses, whereas in the early stages it was just open to doctors and allied health. But there’s still ongoing concern around employment for nurses in PHC.”

“The other thing that nurses are concerned about is ongoing chronic disease management of patients out in the community and what that is going to look like as the pandemic progresses because people are perhaps not getting the care they need or attending their usual appointments to keep their health in check.”
Professor Halcomb stresses that PHC nurses must be properly supported through the pandemic to ensure they are not lost to the profession.

“If we don’t support and manage their mental health and the issues facing them, then we run the risk of ending up with a significant workforce shortage,” she argues.

“Everyone is putting an emphasis on the quality of primary care and the need to develop the system, but if we don’t have sufficient staff that leaves us open to not being able to meet the demand we’ve created.”

Citations to the papers from this study are as follows:
Halcomb , E., McInnes, S., Williams, A., Ashley, C., James, S., Fernandez, R., Calma, K. R. B. (2020). The experiences of primary health care nurses during the COVID-19 pandemic in Australia. Journal of Nursing Scholarship, in press. doi:10.1111/jnu.12589.

Halcomb , E., Williams, A., Ashley, C., McInnes, S., Stephen, C., Calma, K., & James, S. The support needs of Australian primary health care nurses during the COVID-19 pandemic. Journal of Nursing Management, DOI 10.1111/jonm.13108.