Addressing the workforce gap and supporting retention

With many nurses reportedly planning to step away from the profession, there is an urgent need to acknowledge and address the reasons. 'Now, more than ever, the world needs nurses working to the full extent of their education and training.' [1]

The issue

There is currently a world-wide shortage of nurses and the demands and expectations being placed on them are changing. Gaps between supply and demand for nurses are not new. Nor are problems with retention of nurses. [2] However, more recent population growth and mobility, increasing prevalence and complexity of chronic illness, population ageing, and the recent COVID-19 pandemic are just some of the issues that have created new challenges - demand for skills in palliative care is one of them.


For Australia

In 2014 a shortfall of 85,000 nurses was projected for 2025, and 123,000 nurses by 2030. [3]

In 2022, 58% of nurses in NSW planned to leave their job, with one in five to leave the profession. [4]

In 2023-24 there is a gap of 11,800 Registered Nurses needed to meet aged care 24/7-RN-on-duty. [5]

In 2023, with more than 8,000 vacancies across the country, RNs are the most in demand occupation. [6]


Taking action

'No single policy change is capable of closing the gap between nursing workforce supply and demand.' [3]

Strategies to increase nursing numbers generally centre on education and recruitment. For Australia in 2019: [7]

  • nursing graduates increased at five times the rate of the population
  • one in three of Australia's nurses were foreign-born
  • four in five gained their initial qualification in Australia.

Policy priority: Optimise the domestic production of midwives and nurses to meet or surpass health system demand. [8]

WHO Global Strategic Directions for Nursing and Midwifery (2021–2025)

The WHO global strategic directions for nursing and midwifery 2021-2025

These strategies align with priorities outlined for Nursing and Midwifery by the World Health Organization (WHO). [8] With one third of all residents born in a country other than Australia, the representation of foreign-born but Australia-trained nurses reflects our population. However, recruitment of foreign-trained nurses is a different issue, and whilst common practice it potentially risks health-related outcomes in countries unable to match salaries and conditions.

Understanding factors behind the increased demand for and demands on nurses might also help to address retention issues by directing support to where it is needed. The WHO report on the State of the World's Nursing refers to many of these including those shown in Figure 1.


Demands and expectations placed on nurses: Changed settings of practice - move into community and care settings, Changing contexts of practice - more older people with chronic illness, Limited Health care and education funding, Population growth means more patients, New technology - within practice and used by patients, Retirement and burnout, Limited wage growth.

Figure 1: Demands and expectations placed on nurses

Figure 1: Demands and challenges faced by nurses

How CareSearch can help

With the challenges of population ageing, increasing rates of chronic illness, and the move to community based care, developing skills in care at the end of life is now essential for all nurses across all settings. 'As primary providers of palliative care, nurses enable an end-of-life experience characterised by dignity and compassion.' [1] However, it is known that many nurses lack training and/or confidence in providing palliative care.

In support of nurses taking on this role, CareSearch has recently updated the Nurses Hub to ensure it is fit for purpose. As outlined in the brief, we reviewed the evidence and collaborated with nurses to define the palliative care-related activities undertaken and the areas in greatest need of support. Here we list our resources and those of our partners developed to address these needs.

CareSearch Evidence Brief - Supporting Nurses

Communication

Good interaction and communication between the person approaching their end of life and health care professionals is essential. Communication with family and within the care team also matters and impacts on care delivery. 

Psychosocial care

By building rapport, nurses can begin to understand how patients view themselves, what is important to them, and how their relationship with others may affect their decisions and their ability to live as they approach death.

Clinical Skills

Recognising changes as illness progresses including the assessment, management and re-assessment of needs is part of a nurse’s role. 

Self-care

While rewarding and satisfying, caring for others can be stressful. Self-care includes ways of coping with stress, grief, burnout, compassion fatigue, and promoting health and well-being.

Education in palliative care

As part of national registration requirements, it is mandatory for nurses to undertake a minimum of 20 hours of professional development a year and keep a written log of these. A number of National Palliative Care Program projects provide education and/or connect you with opportunities.

Read some of our Palliative Perspectives blogs related to Nursing and care at the end of life.

  1. World Health Organization (WHO). State of the world's nursing 2020: Investing in education, jobs and leadership. Geneva: WHO; 2020. Available from: https://www.who.int/publications/i/item/9789240003279
  2. Parliament of Australia. Senate committees completed inquiries and reports 2002-04: Chapter 2 - Nurse shortages and the impact on health services. Canberra; 2002. Available from https://www.aph.gov.au/parliamentary_business/committees/senate/community_affairs/completed_inquiries/2002-04/nursing/report/c02
  3. Health Workforce Australia (HWA). Australia’s future health workforce – Nurses overview. Canberra: HWA; 2014. Available from: https://www.health.gov.au/resources/publications/nurses-australias-future-health-workforce-reports?language=en
  4. Sharplin G, Brinn M, Eckert M. Impacts of COVID-19 and workloads on NSW nurses and midwives’ mental health and wellbeing. A report prepared for the New South Wales Nurses and Midwives’ Association. 2023. Adelaide, Australia.
  5. Commonwealth of Australia. FOI 4178 Document senate committee: Community affairs budget estimates 2022-23. Canberra2022. Available from https://www.health.gov.au/sites/default/files/2023-02/foi-4178-release-of-documents-hot-issues-briefs.pdf
  6. Jobs and Skills Australia. Labour Market Update. Canberra: Australian Government; 2023. Available at https://www.jobsandskills.gov.au/reports/labour-market-update-december-2022
  7. Department of Health and Aged Care. Factsheet, Nursing and Midwifery 2019. Canberra: Commonwealth of Australia; 2020. Available from https://hwd.health.gov.au/resources/publications/factsheet-nrmw-2019.html
  8. World Health Organization (WHO). The WHO global strategic directions for nursing and midwifery 2021-2025. Geneva: WHO; 2021. Available from: https://www.who.int/publications/i/item/9789240033863

Last updated 05 May 2023