Messages were reaching Gavin Wayne every day: calls from hospital management or locum agencies scrambling for healthy staff as the Omicron wave hit Victoria’s healthcare system.
Presentations of coronavirus have increased as the army of workers trained to care for them has been depleted. Thousands of people have been forced into isolation, exposed or sick with the virus.
When Wayne received requests for volunteers to help with extra shifts, the young doctor felt compelled to help. Even though his days were already full. Even though it was already hard to get enough sleep. Even if it can be to the detriment of one’s own well-being.
“If we don’t have people stepping up to care for the sick, it’s not like we can just say ‘the hospital is closed today, don’t get sick,'” he says. .
Talk to a healthcare worker in a Victorian hospital today and they will search for similar words and phrases. Burnout. Exhaustion. Tired. I’m just taking a break.
All workplaces have been forced to adapt during the pandemic. But in hospitals — where waves of COVID-19 cases overwhelm them, only to recede before falling again with the next variation — the staffing crisis has been unsettling. In an industry tightly rationed to reduce labor costs, labor shortages became all too evident.
“We still have a very large number of really sick patients, many of whom need to be admitted to hospital, for which we do not have the capacity,” says Sarah Whitelaw, an emergency physician and Federal Medical Association board member. Australian. “There is no relief for us.”
From Monday, semi-urgent or “category 2” surgery resumes in public and private hospitals, further straining the system. And surgeons are pushing for even elective surgeries to resume.
Stephen Parnis, an emergency physician from Melbourne, remembers speaking out on the issue of a severe nursing shortage when he was vice-president of the federal AMA six years ago. “Tens of thousands of nurses [were] needed and at the time I felt like things were happening meeting after meeting without the sense of urgency that we needed.
The public hospital crisis is so severe, not just in Victoria but across the country, that the AMA has for the first time launched a campaign targeted in the upcoming federal election on the crucial issue of chronic problems in public hospitals: shortage of beds, multiplying ambulances, overcrowded emergency departments and long waits for elective surgery.
The organization doesn’t have the budget for an advertising campaign, but it may have something more powerful: a network of trusted doctors and captive patients from the posters posted in doctors’ waiting rooms.
The association is doing everything possible to put the issue at the center of the next federal election.
Need for surgery: surgeons
The Omicron wave saw Victorian coronavirus hospitalizations peak on January 17 with just over 1,200 people filling hospital beds that night. The number of cases has stabilized.
As of Sunday, there were 358 people hospitalized with COVID-19. The “code brown” in place for three weeks to direct resources to coronavirus services by limiting certain types of less urgent surgery was removed last week.
Surgery in Victoria falls into three categories: urgent, semi-urgent and elective. From Monday this week, semi-urgent or “category 2” surgeries can resume.
Surgeons have been pushing for more surgeries to begin quickly, even those deemed non-emergency. Urologist Mark Frydenberg is an advisor to the Royal Australasian College of Surgeons and chairs its Health Policy and Advocacy Committee.
He says it’s not just the recent Code Brown that has caused the backlog in surgery. “We’ve had intermittent surgical restrictions for probably the best part of 18 months.”
The most needy patients were still operated on, says the professor. Those with issues deemed not life threatening, however, were constantly pushed back a month, then another and another. “Perhaps these are people who are in a lot of pain but are not about to succumb to their disease.”
Frydenberg regularly sees cancer patients who, depending on the categories used in Victoria, might not be considered the most urgent and therefore have had their surgery delayed.
Patients with an underlying malignancy, says Frydenberg, “even if you try to rationalize with [them] and saying that, you know, “We’re not envisioning that you’d necessarily be hurt in a month,” psychologically, most people with cancer who need an operation just want it gone. This causes enormous psychological distress.”
Under code brown, surgery was restricted in private hospitals so that the most urgent surgical cases could be transferred from public hospitals if they were overwhelmed with COVID-19 cases.
“But in fact, very few people were transferred,” says Frydenberg. “So what we were seeing as surgeons was quite a few empty operating rooms, canceled sessions and available nursing staff in some hospitals – not all hospitals, but some.”
Burnout like never before
Even with the decline of COVID-19 and with it the immediate strain on the healthcare system, hospital staff are still exhausted like never before. After last year’s shutdowns, there was a noticeable uptick in treatment in hospitals as people caught up on care delayed during the waves of the pandemic. It is expected again. This time, however, it will combine with new challenges, including the likely return of influenza – nearly eradicated during the pandemic due to travel restrictions, social distancing and mask-wearing – and a possible winter double wave of COVID-19.
“The public hospital system is in crisis. It was before the pandemic. Now is the time to recognize that,” says Sarah Whitelaw of the AMA.
A state parliamentary inquiry into the pandemic last week heard from the heads of Victoria’s biggest hospitals. Everything has been said about the difficulties of adaptation during the summer. The chief executive of the Royal Women’s Hospital, Sue Matthews, said her staff were exhausted and any potential increase in ongoing surgery had to consider the impacts on them as well as patients.
Outside of the hospital, people were living almost before the pandemic, she said. “There’s this feeling that COVID is almost over in the community, but it’s not in the hospitals,” she said. “It’s almost an alternate universe.”
On Tuesday the AMA will release a poll, carried out by Essential Research, showing that of 1,069 voters polled, 34% said they were less likely to vote for the government because of its handling of public hospital funding. Public hospitals were more important as a vote picker than economic management or Australia’s relationship with China, the poll found.
Nurses beyond fatigue, union says
In New South Wales, nurses are taking industrial action over their conditions, but also over exhaustion due to COVID-19. In Victoria, where there are 115,000 nurses and 8,000 midwives, that burnout is also present, says Australian Nursing and Midwifery Federation Victorian Secretary Lisa Fitzpatrick.
Nurses and midwives are “exhausted and need to recover from the summer slump they just went through,” she says. “We must not delay elective surgery a moment longer than necessary, but we cannot tackle waiting lists without the safe supply of nurses to care for patients during and after their operations.”
Dr Parnis says that while January’s COVID-19 wave was not as severe as expected, the number of absent employees meant that even the slight increase in the coronavirus workload “was a very heavy burden to carry”.
Sometimes more than half of the nurses in some hospitals were unable to work, which enormously increased the pressure on those who were still there. And few hospital staff have had the chance to rest and recharge the batteries. “We’re running on empty,” he said.
But he says it’s important to tackle as much surgery as possible with available staff. “I’ve seen a lot of people in the ER – and will see even more in the weeks to come – who wouldn’t have needed [emergency] care if they had been able to receive an elective procedure in a timely manner.
Tom Symondson is chief executive of the Victorian Healthcare Association, which represents Victoria’s public hospitals. Symondson says it’s good that the state government is considering phasing in elective surgery, but any prospect of an “elective surgery blitz” must now come to terms with the reality: Healthcare workers are exhausted. Victoria needs, says Symondson, “to catch up on delayed care, but not at the expense of pushing our exhausted healthcare workers overboard.”
The association wants a return to elective surgery carried out gradually to take into account the continued furlough of staff and to retain capacity for emergencies due to COVID-19. “We need to proceed with caution to keep our healthcare system available for the sickest people who need the most urgent care.”
No finish line
For Dr. Gavin Wayne, the pandemic has been a unique emergency: relentless and yet without a defined finish line. Many of the junior doctors Wayne speaks with (he chairs the AMA Victoria’s Doctors-in-Training group), when asked about their future plans, say they needed the time off.
“If you win the America’s Cup, everyone gets Monday off… but there won’t really be a day when you wake up and that’s mission accomplished. Yes, the restrictions will ease and things will get easier, but a lot of these issues are still going to exist,” he says.
“That end point for this is going to be this slow decline as we adjust to this new kind of normal. But then what happens after that is we just go back to what our normal life used to be, which for many of us is busy, stressed, long hours and little sleep.
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