By Professor Margaret Fry

A shortage of nurses is predicted for most specialities across Australia, including critical care, and the Covid-19 pandemic has significantly exacerbated the shortage.

The forecast shortfall of about 85,000 nurses by 2025, and 123,000 nurses by 2030, will result in significant service gaps, sub-optimal care for patients and the potential for a rising number of adverse events in hospitals.

The reasons for the shortfall are complex, but it is in part the result of ever-increasing demand for hospital care. In 2020-21, over 8.8 million people presented to emergency departments.

There has also been an increase in hospital admissions and a 6.9% annual increase in emergency department presentations since 2019-20. 

Other longer-term factors are the increasing burden of disease due to an ageing population and improved survival rates from chronic diseases, including cancer.

Since the Covid-19 pandemic began, many Sydney hospitals have had difficulties recruiting nurses and there has been a deficit in the number of permanently employed nurses.

The Omicron variant that began spreading in late 2021 has placed additional demands on hospitals and nursing resources. In recent weeks, stories have emerged of ambulances with Covid patients being turned away from hospitals because there are not enough ICU-trained nurses, particularly in New South Wales1. 

Nurses are becoming overworked and burnt out due to staff shortages. They are also being redeployed to the Covid-19 response, including assisting with testing, vaccinations and patient care.

The impact of the critical care nursing shortage is potentially widespread. For patients, a nursing shortage may prevent access to critical care beds and hospitals may need to increase triage, necessitating tough decisions about who and who does not receive care due to an inability to roster nurses to clinical areas.

We have already seen this in 2022 as result of the Omicron variant and rising hospital admissions.

In addition, the workforce shortages may lead to increases in the length of hospital stays in clinical areas such as emergency departments, a trend which may compromise the timeliness, efficiency and appropriateness of patient care.

Long term nursing staff shortages may increase the rate of adverse events and near misses as quality of care and patient safety are compromised, leading to greater patient dissatisfaction.

The risk of staff shortages may also negatively influence the organisational culture of care and push up nurse dissatisfaction leading to burnout and poor retention.

Nursing shortages may lead to the fragmentation of nursing roles, substitution of care, and changes in qualifications and models of care.

No single policy will remedy the projected shortfall of nurses. The use of unregulated workers, for example, in aged care settings has led to significant adverse events, poor outcomes and sub-optimal care.

These workers need to be regulated by state and federal governments to optimise care and patient safety.

Greater opportunity and funding for roles such as nurse practitioners would improve access to healthcare. Legislation should be revised to expand the scope of practice of nurse practitioners, who need to be able to operate more independently to manage a range of patient conditions.

For example, nurses are unable to sign work certificates as the legislation states only doctors can sign these forms. This needs to change.

The federal government also needs to increase Medicare rebates for care by nurse practitioners to enable a greater scope of practice for rural and regional nurses. This would improve access, timeliness and equity of care across Australia.

A prolonged and persistent effort is needed to address the shortfall and educate people about nursing careers to increase the numbers of trained nurses.

Governments need to devise strategies to minimise nursing curriculum creep and ensure integration and a coherent and relevant education program.

We need to encourage postgraduate study, such as the Master of Advanced Nursing and Graduate Certificate in Critical Care and postgraduate training should be funded by governments.

Defined nursing ratios for all critical care areas, such as emergency departments, should be mandated by governments, which would support a reasonable patient load and factors in acuity and not simply patient numbers formalised.

The government needs to consider incentivising rural and regional nursing placements as it does for other medical staff.

Career pathways for nurses should be better defined, and the time for transition to practice programs that support a learning environment overseen by experienced senior nursing clinicians should be increased.

Researchers need to explore strategies to increase diversity and the number of men in nursing. Only by introducing such strategies now will the nursing shortage be alleviated over the longer term.

About Professor Margaret Fry

Professor Fry is a nationally and internationally recognised 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 dollars 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.

1 https://greens.org.au/nsw/news/hazzard-must-immediately-act-icu-nurse-shortage