18 May 2022
Article from April 2022 edition of INPractice
The bad news for the nursing profession is the ability to actually get enough sleep.
Improving sleep can often reduce the severity of mental health problems, according to the Sleep Health Foundation.
In fact, frequent sleep disturbances can be associated with a higher risk of mental health problems down the track. Rigorous and large-scale studies have shown that chronic sleep disturbance is a significant risk factor for the development of mental health problems such as depression, paranoia, anxiety, post-traumatic stress disorder, hallucinations and even suicidal behaviours.
The risk increases with habitual sleep loss, insomnia, obstructive sleep apnoea and other sleep disorders.
And, of course, the association between sleep and emotional wellbeing – not to mention fatigue - has long been known.
The good news is that improving sleep will often reduce the severity of mental health problems. Getting better sleep is also a great strategy for helping to prevent mental health problems developing, or reducing the chances of a relapse.
The bad news for the nursing profession is the ability to actually get enough sleep.
“That’s an inherent problem with nurses because we’re mostly the ones who work shift work,’’ says ANMF (SA Branch) President Jocelyn Douglass.
“Nurses and midwives’ shifts can vary between late, early and night shift with varying recovery times between shifts, there’s just an expectation that that’s part of the job.
“Not taking into account the research that has been done which shows how important sleep is for recovery and for your cognitive processes and reaction times. The fact that we have people’s lives in our hands doesn’t seem to have been factored into the fact that nurses and midwives are expected to work 7, 8 or more shifts in a row as well as the current critical issue of short staffing, double shifts and overtime which has been particularly impacting nurses and midwives during the pandemic.
“And late and earlies with limited time between, recovery time. By the time people get home and manage to sleep and then have to get up again for an early the next day, it is a risk that has just been assumed by the service and the community and just an expectation of nurses, because we always have, that’s been unchanged.’’
An acute community mental health nurse, Ms Douglass says the mental impact of the pandemic will linger long after the date that life as we once knew it begins to return.
“This has now been two years that we’ve had living in this pandemic and there’s long-term consequences that people have suffered because of that,’’ she says.
“A lot of it is economic. A lot of it is psychological. Certainly, young people who have lived through very critical stages in their development are going to have potential long-term effects about being kept out of school, being behind in certain things, maybe socially as well as academically.’’
Certainly, for a lot of young people, social life is a huge issue – and COVID has essentially robbed them of two years of arguably the best years of their lives.
“It would be very shortsighted to think the mental health issues are going to disappear when the physical public health issues are more manageable. I think that that is something that will have to have increased focus and resourcing to manage that,’’ Ms Douglass says.
Working in an office right next door to a Centrelink building, Ms Douglass was able to witness first-hand the devastating economic impact of COVID-19 when it first rolled in.
“During those early weeks there were lines outside going around the building, of people lining up to get benefits,’’ she says.
“People who had never filed for benefits before. People who had lost their income or had lost a significant portion of their income.
“The pandemic has had a huge impact on how people feel about their lives, about what’s happening, just the anxiety has been enormous. We’ve certainly seen an increase in anxiety, in lots of different of mental health issues that that’s a component of.
“We’ve seen an increase in people feeling very anxious about their lives, their future, their income, their lack of connection with their families, and just the uncertainty of knowing what’s happening.’’
And then of course there is the deluge of mental health patients left languishing in emergency departments, sometimes for days, for lack of anywhere else to go.
“I can’t say that the situation has improved,’’ Ms Douglass said. “We’ve got evidence to show that it hasn’t.
“One of the big problems with a flow through the hospitals, particularly through the emergency departments, remains a logjam of trying to get people through into beds, and then managing that flow so that there’s not a backlog.’’
“One of the key issues identified immediately after the (Marshall) Government took office (in 2018) was the need to address the surging mental health presentations in emergency departments, their inordinate length of stay - often days at a time - and the urgent need for alternative places of treatment, beds and community teams,’’ ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars AM said.
“The results for patient care and for nursing staff in the emergency departments have been horrendous.’’
Former CALHN mental health executive Adj Professor John Mendoza quit his job in April last year, calling SA Health “by far the most ossified and inept central portfolio agency in my 28-year state and Commonwealth public sector career and 15 years of consultancy work”. He said the Department for Health and Wellbeing “couldn’t organise a chook raffle”.
Both Professor Mendoza and leading health unions, experts and advocates offered a 10-point plan to address the mental health crisis.
Based on the ANMF’s information, the SA health system requires an immediate injection of an additional 30-40 mental health nurses in community and approximately 100 to fill vacant shifts including those in CALHN.
This is only to cover existing workforce shortfall let alone to meet any additional bed capacity which is also desperately required in order to provide relief to consumers and the workforce serving them.
“I think that’s a really good place to start,’’ Ms Douglass said of the 10-point plan.
“I was involved with meeting up with Professor Mendoza and I certainly was aware of his 10-point plan (calling for more mental health workers, emergency accommodation and zero forensic patients in general hospitals). It seemed to be very sensible and as usual you wonder what happens to these things. These things come out and they somehow seem to get shelved or put on the backburner. I don’t know where that’s gone, I’d like to see some focus on that.
“Certainly, the Government should be listening to our union. We have a policy statement that we put out and they would be very wise to look very carefully at the issues and ideas that our union has highlighted.
“We are the biggest workforce that they have, health workforce, and I think it’s a shame, particularly this (Marshall) Government hasn’t utilised the resources and expertise that they really have at their fingertips. That they can just engage with our union, who represents our members about what we say is important.
“What I would like is perhaps there to be more consultation by Government with clinicians on the ground, about what would be useful and in funding because quite often we are not involved.
“I’ve been aware of funding which has been put in some areas which I knew from the beginning was not an area which perhaps was the best place to put that money and then that service or that funding didn’t continue.
“I’d like to see more robust data on which to base policy decisions- also suggestions to improve flow through the emergency departments such as non-acute beds for elderly patients waiting for placement and for people waiting for NDIS supports - also pathways for forensic mental health clients so that critical PICU beds are freed up.’’
Ms Douglass would also like to see more nurses and midwives getting their fair share of sleep.
An ANMF (SA Branch) Nurses and Midwives Fatigue Survey last year found fatigue and burnout levels within the professions were higher than they have ever been, with more than half of respondents intending to leave within the next five years.
“I would have thought that with research showing how important it is, that maybe there should be some review into how much sleep is necessary for someone to be able to function in a frontline critical job like nurses do,’’ she says.
“Every month I have to do a run of seven shifts in a row. That’s just an accepted part of being a nurse but I do think that perhaps they need to be starting to look at how things could be improved in that area so nurses are able to get more rest and recovery, which would reduce the risk of mistakes.
“Obviously as far as mental health, that would be a big, big improvement if we were able to get more sleep in between our shifts.’’
View the ANMF (SA Branch) Nurses and Midwives Fatigue Survey here
Click here to read the April 2022 edition of INPractice.