20 December 2022
Article from January 2022 edition of INPractice
A much-loved nurse tragically taken by fatigue at just 23 years of age and yet more than eight years later fatigue among nurses and midwives has never been higher.
Pictured above: Enrolled nurse Courtney Dijksman
In October 2013, Enrolled Nurse Courtney Dijksman was driving home after a night shift at the Gawler Health Service.
Just three minutes, 5km, from home, along the Williamstown to Springton Rd, Courtney’s car careered into a tree, killing her instantly. It’s believed the 23-year-old had succumbed to a micro sleep and, upon waking suddenly, panicked, over-corrected and crashed into the tree.
Her tragic death rocked the close-knit Barossa Valley community. The bubbly young nurse was hugely popular among her colleagues and the Springton townsfolk.
Courtney’s parents Janet and Mario and her twin sister Brodie at the time made a heartfelt plea for other drivers not to ignore the dangers of driving while fatigued.
“She wasn’t speeding ... she was just a good girl coming home from helping people,” Mrs Dijksman told The Advertiser. “If we can just save a couple of people, it’s better than having other families go through what we have to.”
Years later, Courtney’s close childhood friend, Registered Nurse Mary (not her real name), still worries about working night shifts.
“We were very close growing up,’’ she says. “At the time (of the accident) I was actually studying nursing. So I obviously felt particularly affected by this.
“‘Is this a role I actually want to progress into if this is the risk associated with it?’. I still remember my first ever night shift, I was absolutely terrified.
“So, it was quite difficult trying to adjust to the night shift and thinking ‘Am I actually going to make it home?’. “And I know still to this day my mum stresses every time I do night shifts about getting home safely.’’
Mary says she has “definitely” felt fatigued while driving. “And you hear lots of nurses talking about it as well.
“I’d wind the windows down and blast the music or I’d eat an apple just to make sure I’m not going to fall asleep at the wheel. A lot of the time people laugh it off but really it’s something quite serious.
“Obviously the staffing shortages are making people more fatigued. So it seems nothing has been put in place to help us deal with this and it’s been eight years since Courtney died.
“When people do a double shift you are actually entitled to a taxi voucher to and from. A taxi voucher to your home after your shift is finished and then you should get another taxi voucher to your car after you’ve slept. It is happening but I think staff don’t know that they are entitled to that.
“I think lots of people think maybe it’s just a short drive and I’ll be OK. Courtney’s drive was only 15 minutes.’’
An ANMF (SA Branch) survey last year of more than 3,000 nurses and midwives revealed that fatigue in this state was at record levels, with more than half of respondents (56.1%) intending to leave their profession within the next five years due to burnout.
A staggering 70% of nurses and midwives reported working unpaid overtime, with 25% working double shifts. The Women’s and Children’s Health Network had the greatest proportion of nurses/midwives working double shifts (34.3%), an obvious danger to the young patients in their care given the potential for fatigue.
“Overall, this pattern of data suggests we are facing a generational loss of younger nurses and midwives because of the pressure placed on them by the system to work in such demanding and fatiguing environments,’’ ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM said.
“We have grave concerns for workforce capacity in the future which is intrinsically linked to burnout and fatigue as evidenced in the survey results.
“Much of the fatigue being experienced now has arisen from shortages in the workforce.’’
Chronic understaffing is so bad at the WCH that childhood cancer patients are having treatment postponed and safety is being put at risk “every day”, senior nurses told a parliamentary committee in August.
Nurses said there was a “very high risk” of deaths occurring, prevented only by “hypervigilant”
staff forced to do double shifts “to ensure that’s not happening”.
“We are the safety barrier and it’s about to break,” one nurse said.
Their disturbing evidence, InDaily reported, included:
- Overbooked clinic lists for cancer patients, resulting in delays and postponement of treatment.
- Positions being cut and a “chronic” staffing crisis forcing nurses and doctors to work double shifts of 18 hours without a meal break.
- Children collapsing in the front waiting room because of a lack of staff to notice how sick they are.
- Patients being moved out of the dedicated cancer ward because it is full and treated in other wards with “ill-equipped” staff.
- Theatre lists running late causing delays in procedures and extended fasting times for young children.
- Delays in chemotherapy preparation.
- Claims of safety incident reports made by staff being “removed”.
“They are literally hurting themselves because they care so much for their young patients, because they are doing those double shifts and filling in,’’ Ms Dabars said of the exhausted WCH nurses.
The results of the ANMF fatigue survey were sent to the CEOs of SA Health and all local health networks, urging them to take action.
Later that same September the ANMF (SA Branch) called on the State Government to recruit all graduating nurses and midwives who completed their course in November. For many years only about half of graduates had been offered Transition to Professional Practice Program (TPPP) places - otherwise known as graduate places.
“This is urgently needed to address the existing shortages which are forcing nurses and midwives to work double shifts and excessive overtime to plug gaps,” Ms Dabars said.
In October, the State Government heeded that call, announcing a decision to employ the total crop of 1,200 nurses graduating in November. The ANMF called it a “fantastic win for members, graduates and the community at large”.
Ms Dabars said the extra 600 graduate nurses were desperately needed but warned that “if they do end up literally as boots on the ground we have to recognise they are novices, they need support and mentorship. They cannot be used as cannon fodder in a system which is already overburdened and overwhelmed”.
Mary says the extra graduates “will definitely help”. “Obviously we have to be able to train these nurses as well, especially working in the emergency department, it is such a critical and unique environment,’’ she says.
“I did a double shift last week, 18.5 hours. It was a late shift and I was meant to be on for the early but they were so short staffed with senior nurses that they asked if anyone wanted to do a double.
“Unfortunately this is becoming a really common occurrence and that’s actually why I shared Courtney’s story just because lately we are short-staffed and there is so much pressure for nurses to do double shifts or pick up extra shifts when they’re not on.
“I think the importance of fatigue and looking after yourself needs to be re-emphasised.’’
Sadly, Mary and Courtney never got to work with each other. “I was studying and she was an EN in the country,’’ Mary says. “She was planning to do her RN so potentially one day we would have worked together, which would have been lovely.’’
Despite the tragic loss of her much-loved friend, and the stress and fatigue of frontline health care, nursing remains Mary’s passion.
“I think for me every day is different,’’ she says. “And that’s what really entices me to do emergency and that other than the paramedics who are on the scene, we are the frontline people that these people see and we can make such an impact on their journey and that’s kind of what I love the most about nursing.’’
Click here to read the January 2022 edition of INPractice