The H1N1 influenza 09 and its potential impact on the Australian nursing workforce
Article Outline
Emerging diseases continue to have a deleterious impact on global health. The spread of infectious diseases is now much more rapid, and while it may have taken months to spread between countries in the past, pandemics now have the potential to spread between continents within hours (Mathews, Chesson, McCraw, & Mc Vernon, 2009). In June of this year (2009) the first influenza pandemic in 41 years was announced (WHO, 2009). The H1N1 Influenza 09, or Human Swine Influenza virus, has already infected almost 36,000 people in 76 countries (WHO, 2009). It is estimated that the disease will infect up to 40% of Australians, particularly the most vulnerable. Adolescents and children appear to be over-represented in the current pandemic, and people with chronic co-morbidities are more severely affected by the H1N1 Influenza 09 virus (MMWR, 2009). Older people, especially those in institutions, are also more vulnerable as too are pregnant women (Cheng et al., 2009). In the current H1N1 09 outbreak, a healthy pregnant woman was the second death in the USA (Jamieson et al., 2009). Indigenous people are also more at risk from influenza. Previous influenza pandemics took a devastating toll on Indigenous Australians when mortality rates approached 50% in some communities compared to the national rate of 0.3% (Curson & McCraken, 2006). While Indigenous people are thus more at risk from the current H1N1 09 outbreak, Indigenous Australians living in rural areas may be at even higher risk because of their already disadvantaged situation which includes overcrowded housing, excess co-morbidity, poorer access to health services, communication problems with health professionals, and reduced access to medications (Massey et al., 2009). While plans for the management of the current influenza outbreak are being developed, marginalized communities are often neglected in these plans (Massey et al., 2009). It is also interesting to note that tropical regions, including Northern Australia, show a peculiar pattern of bimodal influenza outbreaks during the calendar year: an early peak in February/March which precedes the winter epidemic, followed by a second larger peak in August/September (National Influenza Surveillance report, 2008; National Influenza Surveillance report, 1997; National Influenza Surveillance report, 1996). There is also evidence to suggest the H1N1 09 virus may also have a second peak in tropical regions (Rambaut et al., 2008; Nelson & Holmes, 2007). This means that tropical regions such as Northern Queensland, as well as feeling the impact of the current outbreak of H1N1 09, may actually have to manage a second outbreak in the New Year. This has the potential to place an even greater demand on staff and health services in tropical regions and rural/remote communities.
These points are important when the global shortages of nurses and other health professionals, and the current available health workforce are considered. We know that the current outbreak has led to a sharp increase in admissions and presentations to accident and emergency services as well as GP clinics across the country. This has the potential to indirectly impact on the workload of nurses and other health workers. Increases in workload and patient acuity are known to have a direct impact on health worker satisfaction and job satisfaction is a significant factor in retention (Aiken et al., 2001, Wilson, 2006). In fact, in a hospital study in the US, Aiken, Clarke, Sloane, Sochalski, and Silber (2002) found that each additional patient added to the workload of a nurse was associated with a 23% increase in the likelihood of the nurse developing burnout and a 15% increase in the likelihood reporting job dissatisfaction. Increased workloads are predictable when nurses are caring for sicker patients (Duffield et al., 2007). Dissatisfaction is also a predictor of a person's intention to leave the organization (Blau & Lunz, 1998; Cowin, 2002). Due to the current widespread shortages of nurses, and other health workers, it is important to pay particular attention to dissatisfaction and burnout (WHO, 2006) as a way of preventing unnecessary attrition of staff. Little is currently known about the impact of the H1N1 09 virus on nurses and other health workers, in particular, on work role, workload, or job satisfaction. We do know however that the workload of nurses has changed as they are dealing with mass presentations at emergency clinics and managing large numbers of critically ill infectious patients. One of the fundamental aspects of a good working environment is the ability to provide the quality of care expected by a patient (Duffield, Roche, O’Brien-Pallas, Catling-Paull, & King, 2009), which is often not possible when nurses and others are faced with an influx of presentations as a result of an emergency such as the H1N1 09 outbreak. As nurses currently make up the largest part of the Australian health workforce it is imperative to explore the impact of the H1N1 09 on the work of nurses. Moreover, nurses are the ones who provide close personal care to acutely ill people, are generally the ones responsible for undertaking most of the tasks related to infectious disease containment, yet their work in emergencies such as the H1N1 outbreak, while extremely important, is often hidden or unrecognized. This is particularly the case in tropical and rural/remote areas where health capital and essential services is already scarce (Humphreys and Wakerman, 2009).
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PII: S1322-7696(09)00089-4
doi:10.1016/j.colegn.2009.10.001
© 2009 Royal College of Nursing, Australia. Published by Elsevier Inc. All rights reserved.
