A quarter of the primary care nurse workforce could soon quit, survey shows

It is no secret that the pandemic has continued to place a significant strain on general practices, and now new data has revealed there may be longer term consequences for the delivery of care.
 
A survey conducted by the Australian Primary Health Care Nurses Association (APNA) has found that more than a quarter (28.73%) of nurses working in the sector plan to leave their job within the next 2–5 years, with 78.8% of respondents saying that have felt burnt out.
 
Sydney GP, Wiradjuri woman Dr Josie Guyer, worked as a nurse for almost two decades and told newsGP she is surprised by the findings, but concedes it has been ‘a difficult time for everyone’.
 
‘The current COVID times that we’re having to live with, especially in primary care, [have increased] demands not only on us as GPs, but certainly on nurses,’ she said.
 
‘Trying to screen patients and find ways to manage patients that are acutely unwell with respiratory infections, but also protecting ourselves and our staff and being able to keep our clinics open.
 
‘That’s put a lot of pressure on our practice nurses and our reception staff as well, and just finding ways to mitigate the risk and to stay safe, but also to be supportive for our patients, has been very complicated and difficult.’
 
The added pressure referred to by Dr Guyer appears to have been reflected in the survey results.
 
Among the 1061 nurses who took part in APNA’s annual workforce survey from November–December 2021, more than four in five said they have felt stressed (86.7%) while at work. Nearly three quarters said they worked too much (72.9%), 76.4% said they worked overtime and 80.4% said they felt exhausted.
 
APNA President and practice nurse Karen Booth said despite the ‘almost superhuman efforts’ within primary care to keep the community safe during the pandemic, there has been a lack of support.
 
‘While health authorities recruited extra staff and provided extra resources to help with hospital admissions, they forgot the primary healthcare sector,’ she said.
 
‘The latest moves to bring forward booster shots and end COVID restrictions were the final straw. This has severely impacted the primary healthcare nurse workforce, with thousands of sick nurses furloughing, leaving an intolerable workload on those nurses who remain.’
 
The prospect of there being a mass exodus of nurses from the sector has raised significant concerns about the future delivery of care in the coming years through general practice, aged care and Aboriginal and Torres Strait Islander health, among other community settings.
 
Dr Guyer said the impact would be ‘devastating’.
 
‘Certainly from my experience as a practice nurse, I used to perform many, many tasks; coordinating patients with complex care and chronic illness with management plans and triaging unwell patients, wound care, vaccination, health screening,’ she said.
 
‘And aside from all of that, just the time spent and relationships that you build with patients as a practice nurse, I think, is invaluable.
 
‘Sometimes as busy GPs we don’t have a lot of time to do those extra things. So I think it’d be devastating for primary care to lose practice nurses.’
 
To help ease the pressure on practice nurses in the immediate future, one solution APNA has proposed is to place nursing students into primary care settings to carry out supervised activities.
 
The association is running a nursing student placement program, with 118 Victorian and 19 interstate organisations currently registered to take part.
 
As well as providing nurses with the help they need, Ms Booth said it would also ensure the thousands of students who have found themselves unable to undergo clinical placement due to the staff shortages get to graduate, without having to rely on hospitals, as well as ensuring there are adequately trained staff for primary care in future. 
 
‘Our primary healthcare nurses desperately need help, and nursing students … are a ready-made solution,’ she said.
 
‘Nursing students can be utilised in primary healthcare to triage patients, help with health checks, and help registered nurses with vaccine clinics and other clinical activities.
 
‘More importantly, supervised student nurses, using approved scripted checklists, could do welfare calls to people at home who are sick with COVID, and escalate treatment to registered nurses or general practitioners as needed.’
 
Irene Thorson, a second-year nursing and midwifery student at Monash University who participated in the program, said her placement helped her to learn practical aspects of the job while freeing up nurses to respond to other responsibilities.
 
‘I was given quite a bit of responsibility and trust – I helped with patient screening, health histories, blood pressure monitors, ECGs – the things that take time,’ she said.
 
‘You go in expecting to be thrown in the deep end, but when I actually got in there, I understood just how important primary healthcare nurses are.’
 
But while Dr Guyer said she agrees that bringing more students into the sector is a ‘good strategy’, she notes the need for supervision from senior nurses could prove to be a challenge in the current environment.
 
‘They still need experienced nurses to guide them through the plethora of things that they have to do in terms of their skill set and their knowledge,’ she said.
 
‘I think experienced nurses are really still quite invaluable and still very necessary.’
 
Moving forward, to help retain and attract staff, Dr Guyer says there is a need for greater Federal Government investment.
 
‘I think nurses have been very undervalued and underpaid, certainly in the private sector as well, and it’s something that really needs to be looked at,’ she said.
 
‘And I’m sure that their skillset will continue to expand as the demands on general practice increase over the next few decades. So it’s very important for us to find ways to keep nurses in the primary care industry.’
 
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