Sydney, Australia – Nurses in New South Wales, home to a third of Australia’s nearly 26 million people, are coming under increasing pressure as an Omicron-fuelled wave of COVID-19 sweeps across the state.
Senior Intensive Care Unit (ICU) nurse Michelle Rosentreter, who is also a member of the NSW Nurses and Midwives Association (NSWMWA), says the variant has doubled the number of patients in ICU and quadrupled the number on the wards.
Every day is a struggle to deliver the best care to an ever-increasing number of people.
“If you’ve got six [bedside call bells] going off at the same time and you’re looking after eight patients, how are you going to do that?” she asked.
After largely escaping the waves of COVID-19 that swept the world in 2020 and 2021, Australia is battling its worst outbreak of the virus. Cases have jumped from a few thousand a day in December to more than 55,000 a day, heaping pressure on the country’s public health system.
On Tuesday, Australia recorded its highest number of coronavirus fatalities, as did New South Wales. The country has been warned to expect more.
Even before the pandemic hit, New South Wales, which employs more than 90,000 registered nurses across some 220 public hospitals and other health facilities, faced serious staff shortages. The virus has made a bad situation worse, nurses told Al Jazeera.
Registered nurse, Michelle Cashman, a delegate of the Long Jetty Continuing Care Branch of the NSWNMA and a Councillor of the NSWNMA, says that some of the nurses she knows on general wards are now looking after 12 patients at a time.
“Even before COVID we used to get this one line that every nurse hated,” she recalled. “You were short-staffed, you’d say, ‘Look, we’re down two staff today’… and your… senior… would say, ‘Well, you have to work smarter’… and you just wanted to scream.”
Cashman has more than 40 years of experience in nursing.
She says the minimum staffing for a general ward on a morning shift should be one nurse for every four patients. In an emergency ward, it should be at least one to three, and in intensive care, one to one.
Before the coronavirus struck, Australia had relied on hiring from overseas to fill any staffing gaps, says Shaye Candish, acting general secretary of the association, but that approach was also affected by the pandemic because the government moved quickly to close the country’s borders, limiting even the number of citizens who were allowed to return home.
Omicron, which is so much more infectious than previous coronavirus variants, is adding to the problems, sending nurses off sick or into isolation, while fuelling an influx of patients.
“We’re in a situation where our members don’t want to pick up additional hours, they don’t want to pick up more overtime,” said Candish, who led a rally on Wednesday outside a Sydney hospital.
Prime Minister Scott Morrison insisted last week that Australia’s health system was “well equipped” to cope with Omicron.
But rules are being revised, and demands on medical staff increased, to keep the system functioning effectively.
Some theatre and anaesthetic nurses are being redeployed to the wards, and nurses are also being called in on their days off to cover shortages and sickness.
Under the latest rules, healthcare workers who are asymptomatic will “in exceptional circumstances be permitted to leave self-isolation so these key services are not disrupted”, but if they develop symptoms, they must take a PCR test and go home.
“Normally you’d be in isolation for that week,” Cashman said, “[But] they’re so desperate, you get called back and do RAT (rapid antigen) tests every day.”
Physical and emotional burnout
The effect on nurses has been immense.
Dressed in full personal protective clothing – with N95 masks, goggles, gown and gloves – Rosentreter says nurses often have to work all day with no breaks.
“It’s exhausting. It’s dehydrating,” she said, adding that she had drunk a litre (3.5 cups) of water as soon as she got in her car after the end of her shift the day before.
Rosentreter was diagnosed with Fibromyalgia, a chronic pain disorder, in September last year after years of “everything just stack[ing] up.”
“I couldn’t move, my body had locked up,” she said. “… It’s managed well if you get a routine with good sleep, diet, exercise, all of that. So these are things that are pretty well difficult to achieve if you’re working in the hospital system at the moment.”
Cashman says the toll goes well beyond the physical. It is emotional too.
Some of the things that her colleagues live and work with every day has “scarred them for life”, she said.
“When you go home, and you… just think ‘I haven’t been able to help my patients, I haven’t been able to do all that they deserve,’ because it’s just not possible.”
A NSW Health spokesperson told Al Jazeera in a statement that “there are more nurses and midwives in NSW public hospitals than at any other time in history.”
Between 2012 and 2021, according to the statement, the state’s nursing and midwifery workforces increased by 23 percent, with plans for a further 5,000 nurses and midwives over the coming four years.
But on the ground, nurses say the situation at NSW’s hospitals is having a knock-on effect on other areas of the health system.
Cashman says that recently, unable to get immediate assistance from the ward nurse, some patients called a government-run hotline known as REACH, which is meant for family and carers who are concerned that hospital patients are not receiving the care they need.
“It was so bad in one of the wards just last week, that two of the patients rang the REACH line and said ‘We’re not getting any care’,” she said.
Community patients, pregnant women and those in nursing homes are also not getting the support they need because “there’s just not enough staff”, she said.
The ambulance service too is under unprecedented pressure, with paramedics forced to queue sometimes for hours outside emergency with COVID-19 patients, leaving others in urgent need unable to get assistance, the nurses said.
‘This isn’t good enough’
NSW announced a further 29,830 cases of COVID-19 on Tuesday. But with antigen and PCR tests in short supply, many worry the real numbers could be far higher.
The NSW government is relying on a ramped-up vaccination programme to address the surge, stepping up boosters, and last week rolling out jabs for children aged from five to 11.
It has also implemented support measures for “hospitals and the community”, which include suspending non-urgent elective surgery, and prohibiting activities, such as singing and dancing, in hospitality venues and entertainment centres.
“These adjustments will allow us to continue to live with Covid and manage the pandemic in a measured and considered way,” NSW Premier Dominic Perrottet stated in a press release.
The tough conditions have already led to many nurses in their mid to late 50s deciding to take early retirement or move into less stressful roles, such as education or management, according to Candish.
But the “general overwork of the system” means fewer young people are taking up careers in nursing.
“This is becoming a far less attractive profession,” she said. “We’re seeing a lot of young graduates come and work for only a short amount of time and leave, or they don’t even finish their qualification.”
To keep hospitals and health facilities running, nurses say more has to be done to support front-line workers and mitigate the unprecedented pressure they now face.
“We need for the government to acknowledge that the system is absolutely under stress,” Candish said.
“Because if [nurses and midwives are] not here, there is no health system. That’s the reality.”