‘There are vacancies everywhere’: State battles dire nursing shortage

Nurses have been the backbone of the pandemic, but now Victoria’s healthcare system is battling a serious shortage of them, as staff are re-deployed to almost every corner of the COVID-19 frontline.

With nurses working as contact tracers, vaccinators and testing centre staff, hospital managers are struggling to fill shifts, while health unions warn of an “unprecedented” amount of double shifts being worked and dangerous levels of burnout.

Nurses outside Royal Melbourne Hospital's COVID-19 testing clinic.Credit: Getty Images

The aged care and mental health systems are among the hardest hit. The shortage of workers left a psychiatric triage service in Melbourne’s south-east on the brink of closing for several hours last week, due to a staff shortfall.

Mental health calls are also going to voicemail with calls to some hospital crisis triage teams, designed to support people who may be suicidal or experiencing a mental health emergency, have also gone to voicemail.

Kath Riddell, the chief nursing officer at St Vincent’s Hospital who also chairs a group of nursing executives across metropolitan Melbourne, said there was staffing stress across Victoria’s hospitals.

“It’s a universal challenge that there are most days where we can’t fill rosters,” she said.

The state’s mental health sector is expecting a long-awaited injection of funding and staff off the back of the recent Royal Commission, but as they wait for it to arrive, leading mental health advocate Patrick McGorry said the system had gone from “broken” to “disintegrating”.

“People are exhausted,” Professor McGorry said. “There are vacancies everywhere.”

Health services have been relying on nursing and other health students who have come out of retirement to help ease the load. But there is also concern the problem could deteriorate before it gets better, when mass doses of coronavirus vaccines arrive in coming months.

The state government is running a recruitment campaign calling for more healthcare workers to sign up to COVID-related roles including hotel quarantine, vaccination and testing.

Associate Professor Riddell said the situation was already “relatively fragile” before coronavirus, particularly in mental health and emergency and intensive care, which have higher training requirements but can demand a lot of staff.

“So all of it draws nursing out of the business-as-usual services and when you are thin on the ground anyway, you can’t afford that attrition,” she said. “On top of that, our nurses have been working absolutely flat out for 18 months. They are tired.”

Associate Professor Riddell said work was underway with the Victorian health department to try to ensure that nurses weren’t doing jobs that could be done by other workers.

Health and Community Services Union secretary Paul Healey said before the coronavirus hit, Victoria was roughly 450 mental health nurses short.

He said many nurses working in major hospitals during the second wave last year were burnt out, opting to leave “stressful and difficult” hospital jobs in mental health for temporary work at hotel quarantine, vaccine centres, COVID-19 respiratory and testing clinics.

“It’s a workforce in crisis everywhere. It’s a crisis in mental health, disability, aged care and drug and alcohol services,” he said. “There is a shortage of staff in every sector.”

A former mental health nurse, he said staffing shortages meant it would be impossible to open new mental health beds because there weren’t enough staff to care for an influx of patients.

He said some mental health nurses were working more than 70 hours a week. Last week, one mental health nurse working at a busy Melbourne hospital worked several 15-hour shifts in a row.

“She hadn’t seen her four-year-old child awake in five days as she would leave so early in the morning and get home so late,” he said.

A health source with close knowledge of a psychiatric triage service run by Monash Health, which assesses people and determines whether they need to be hospitalised, said it was four full-time staff short, meaning that crisis calls were often going through to voicemail.

“Often there will be two people on the team working when there should be six, and they are dealing with up to 50 calls a day from people,” the source said. “Staff are so exhausted. There just isn’t enough staff to cope with the demand.”

Last decade, it was estimated there would be a shortfall of nurses of more than 80,000 in 2025, and more than 120,000 in 2030. But Australian College of Nursing chief executive Kylie Ward said not enough had been done to address this expected shortage.

“We know through the [aged care] royal commission, there’s been some disastrous stories and that’s because one [registered nurse] has been left to look over 100 or 200 residents,” Adjunct Professor Ward said. “They’re brilliant nurses, but if you’ve got [another] option, you take it.”

Professor McGorry said there was a large number of unfilled positions before the pandemic hit, but there was now higher demand for mental health services.

Patrick McGorry said demand for mental health services had increased markedly since the pandemic began. Credit: Luis Enrique Ascui

Specialist youth mental health services Orygen was only able to accept one in four “seriously unwell” people who needed help, he said.

“Obviously we will over the next six to 12 months have the ability to reduce that, but we need to do something now.”

He said people may need to be re-assigned from other areas of the health system “because the unmet mental health dwarfs any other area”.

Australian Nursing and Midwifery Federation Victorian branch secretary Lisa Fitzpatrick said nurses and midwives were working an “unprecedented amount” of double shifts.

“We’re concerned that’s dangerous. It’s far from ideal.”

A spokesman for Monash Health said the healthcare service was experiencing staffing shortages, including in mental health.

“We are continuing to recruit in all areas of our health service as we ensure that our patients, clients, and the community receive appropriate, high-quality care,” he said.

“We strongly encourage people to continue seeking care and support when needed throughout the pandemic.”

A Victorian Department of Health spokesman said $3.7 billion had been allocated over the next four years to support the health workforce.

Minister for Mental Health James Merlino said the government understood how tough repeated lockdowns are on all Victorians and staff were working tirelessly to reach everyone who needed support.

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