Nursing is in crisis – how can it be resolved?
An INMO survey in 2021 found more than 90% of nurses have experienced mental exhaustion while off duty and 60% have considered leaving healthcare as a result.
The nursing workforce is struggling with numerous complex intersecting issues including chronic shortages, inadequate staffing, excessive workloads, toxic workplaces and violence. The pandemic has compounded these challenges and introduced new concerns with occupational exposures, overcapacity issues, and mounting issues of burnout.
An Irish Nurses and Midwives Organisation (INMO) survey in 2021 found more than 90% of nurses have experienced mental exhaustion while off duty and 60% have considered leaving healthcare as a result.
Issues that include feeling disrespected, frustrated, overwhelmed, and lacking control over the way they practice their profession with little or no work-life balance has led to many nurses leaving the profession and many more contemplating leaving full-time positions.
One of the key issues is the cost of housing, particularly in major cities, being out of step with nurses' pay.
The prospect of additional payments to teachers and other public sector employees working in Dublin was raised earlier this month at the Irish National Teacher’s Organisation conference when delegates voted to instruct the union’s executive to negotiate for the payment of such an allowance. However, Tánaiste Micheál Martin suggested that the provision of additional payments to teachers and nurses working in Dublin in order to address problems with recruitment and retention would be "very, very challenging" for the Government to agree to.
"We do acknowledge the challenge of residing near the school that you are working in the Dublin region given the impact of house prices and the anecdotal evidence that people are moving to schools further away from the capital as opportunities arise, but it is very, very challenging to come up with a pay framework that would respond to that," he said.
He added that the Government would seek to provide general supports that would help with affordability as addressed in the last budget with the cost-of-living package and tax credits for renters.
Another option that has the potential to be game-changing is the provision of accommodation for staff being recruited for work. The INMO has called for this to be provided at the new children’s hospital in central Dublin and has warned that the rollout of services at the facility will inevitably be delayed if the issue is not addressed as it will be impossible to hire the nurses required.
In January, one of the country’s busiest hospitals was reported to be considering buying property to accommodate "critical hospital staff" because of growing challenges posed by the housing crisis.
The Mater Hospital in Dublin is looking to purchase and develop property that could be used as accommodation and be provided to key healthcare workers at "a reasonable rental rate". The report noted that the "potential advantages to staff and the recruitment of staff were significant".
This would be most likely for up to 12 months – allowing critical hospital staff time to source more permanent accommodation – exactly what new nursing recruits need. However, longer-term affordable accommodation could still be a challenge at current rents in Dublin and other major cities.
In a statement, the hospital said recruiting and retaining staff was an important issue for the Mater Hospital, as it was for acute hospitals across Dublin, the country, and internationally.
"One of the areas that the Mater Hospital is examining is the provision of accommodation on a short-term basis for critical hospital staff to rent at a reasonable rate within a short distance of the hospital," the statement said.
Similar plans have been developed in the UK for NHS staff. Key worker accommodation is close to busy hospitals in London and Southern England. Homes are reserved for staff working in the NHS and other critical public services. The scheme includes no agency fees when you start your tenancy; the inclusion of utilities – water and electricity in the rent; and accommodation close to the hospital where you work to save on travel time and costs; flexible tenancy agreements that allow you to rent from one night to one year and the ability to pay your rent straight from your salary if you work for the NHS.
Eligibility for the scheme includes all those in a permanent clinical role in the NHS (except doctors and dentists) as well as people working in another public sector role that qualifies for key worker housing where total household income is less than £60,000 sterling a year.
Available housing includes furnished single or double en-suites with shared kitchen facilities; a furnished studio; or one-, two- or three-bedroomed apartments depending on whether you are single, a couple, or a family.
This type of key worker scheme would have huge advantages in terms of affordable housing being consistently available for single people starting off on their career as well as couples and families looking for affordable housing near to their place of work in major cities across Ireland.
A recent paper from Canada ‘Sustaining Nursing in Canada’ (2022) published by the Canadian Federation of Nursing Unions suggested that ongoing nursing recruitment issues in Canada needed to be addressed under three headings: retaining and supporting existing personnel; fostering the return and integration of recent leavers and internationally educated nurses; and the recruitment and mentoring of new trainees into a system that has been stabilised.
Retaining and supporting existing nurses includes reducing excessive workloads, fostering supportive workplaces, supporting mental health, and targeted retention initiatives that take into account nurses’ experience in terms of time and specialist expertise.
Fostering the return and integration of recent leavers includes steps such as incentives to move from the private to the public sector and facilitating ease of return from abroad. The incentives offered to key workers to work in the Middle East, including health insurance and return flights home on a yearly basis, are examples of how successful these initiatives can be in attracting workers from abroad.
Recruitment and mentoring of new trainees is facilitated by expanding domestic training programmes as well as supporting and incentivising nurses to work in remote, rural or disadvantaged communities.
The report commented that a fourth ‘R’ is respect for nurses, including them at key decision-making tables.
Critical to all of these factors is the availability of affordable accommodation close to their place of work for key workers within major cities. More workers being able to access accommodation has the potential to hugely improve the success of recruitment campaigns, ease work pressures and patient/ staff or pupil/ staff ratios in the health and education sectors across Ireland.
Now is the time to identify game-changing solutions to the accommodation crises for key workers in the public sector before the problem is aggravated by the start of new school terms in the autumn and further looming crises in the healthcare sector as winter approaches.
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