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Perception versus the reality during COVID – from a casual nurse perspective

June 1, 2020

While many think nurses are in short supply as a result of COVID-19, the reality is that some nurses have joined the ranks of the unemployed.

Read the full story in our article, first published in The Lamp, the magazine of the NSW Nurses and Midwives’ Association.

A couple of weeks ago, I posted on Linked In about the perception that nurses were in short supply as COVID-19 started to spread, versus the reality that there are seemingly tens of thousands of nurses available right now in Australia, many of whom are desperate for work, but unable to secure it. It touched a raw nerve with many.

I don’t think anyone imagined what was about to unfold following the confirmation of Australia’s first confirmed case of SARS-CoV-2 on 25 January this year, followed by Australia’s first tragic death on 1 March.

At a time when almost everyone thought that the demand for nurses would follow that of Italy, the UK and the US where demand has far outstripped supply, the opposite has been the case in Australia, where many nurses have been left without work at worst; on leave without pay and having to use holiday leave, or have been deployed into very different roles with their employers.

The incredible response of Federal and State Governments has presented something of a paradox that has cut deep for some.

“I’m a permanent staff member, no shifts available, so now I’m on leave without pay. My hospital hasn’t been able to negotiate for benefits, and we are not entitled to JobKeeper.” (QLD-based RN)

COVID has been especially difficult for nurses working as casuals (and it’s estimated that there are around 30,000 who work this way, either in a permanent capacity as a career casual, or to supplement their full-time incomes ). While most recognise the generosity of the Government stimulus packages, some nurses have been left with no choice but to apply for jobs outside of their areas of expertise, in areas that currently have increasing demands for staff, such as essential workers in supermarkets.

Why? The reasons are many and complex.

First and foremost, hospitals acted quickly (and rightly so) to ensure they could meet the unpredictable need for ICU beds. With additional service requirements such as contact tracing departments and COVID testing clinics, some nurses were deployed to other areas within the hospital when theatres closed or when recovery departments were converted to COVID wards, so the balance of staff requirements remained the same, without the need for external casual nursing support.

Meanwhile, some casual nurses working for public hospitals have lost their entire income, with no support. Public hospitals are ineligible for JobKeeper – the $1500 a fortnight wage subsidy – due to the fact that certain employers – ie: public health employers such as NSW Health, as well as State or Territory Governments – are not allowed to participate in the scheme.

However, a nurse employed by an agency operating in that same hospital may be eligible for JobKeeper, because they are an employee of the agency, not the hospital.

The definition of casual that has been used for the JobKeeper subsidy is from the Fair Work Act, which requires a systemic connection to an employer for 12 months.

Also excluded from the scheme are casual nurses who have been employed by nursing agencies for under 1 year, forcing them to pursue JobSeeker – the equivalent of unemployment benefits – at a time when most expected to have skills in demand.

“A casual can still work and earn up to $104 per week without losing a single cent of the JobSeekerpayment,” according to Attorney general, Christian Porter, but this is little consolation to the majority of nurses who have been unable to secure any shifts at all.

The cessation of elective surgery had an immediate impact on the availability of casual shifts – for hospital casuals and agency casuals. In some areas, casual nurses have had no shifts since the beginning of February, whereas others have found themselves working in areas they never considered previously, such as telehealth, COVID testing centres and clinical research.  As the founder of uPaged, I have a vested interest in making sure that there is work for nurses who are registered on the platform, and as a nimble, tech-based business, we’ve been lucky to have been approached by some really diverse healthcare providers to assist them. We’ve been able to quickly adapt to offer nurses to services outside of our core service area of hospitals during the pandemic.

5th year RN and uPaged nurse Sarah explains: “I’ve worked well outside of my usual comfort zone in the past couple of months, working in aged care and doing telehealth, but I’ve also learnt some great skills, and gained a whole new level of respect for my peers who work outside of clinical settings.”

The launch of the pandemic response sub-register – a ‘call to arms’ of sorts – also raised concerns for some nurses. Introduced to assist with fast-tracking the return to the workforce of experienced and qualified nurses should they be needed, as of 20 April, 25,710 nurses and midwives have registered – an admirable response and very generous of all non-registered practitioners to step up in the crisis.

Nonetheless, the launch of the sub-register caused friction amongst nursing new graduates, not least because many of them have not secured, or have had delayed graduate placements, and have also been left without work – and all are desperate to begin work in any nursing capacity rather than join the ranks of the unemployed.

Debates about (tax-deductible) AHPRA annual registration fees also raged in some circles once Government stimulus packages were announced. A number of nurses felt strongly enough about the fact that fees were not waived this year to petition for fee relief, with comments such as ‘tradies had their licences waived – why aren’t ours?’ To which others responded in full support of their registration, and highlighted all many free and heavily discounted offers including training, currently available to nurses as a result of the pandemic (you can see our list of offers here), and suggested the time could be used to upskill.

While COVID has been a great opportunity for many to brush up on CDP, many casuals hoping to take advantage of free training have been left without the benefit their permanent peers have enjoyed. For example, many non-public sector nurses suddenly found that their training was cancelled part-way through the much-publicised Surge Critical Care course to upskill nurses for ICU, because it was determined that they weren’t eligible due to their employment status.

While some may argue that career casuals take risks such as this for the benefit of higher rates of pay in choosing to work as a casual, this too is often a case of perception versus reality as casual rates of pay rarely compensate for benefits enjoyed by permanent staff.

I’ve been shocked at times at how much derision is held towards nurses who choose to work agency and casual shifts. I get it – agency nursing and casual nursing isn’t for everyone, but as nurses, I’ve always held a belief that we’re all in this together, and one nurse’s career choices is their choice entirely.

Nurses choose casual shifts for a variety of reasons – because they want to supplement their full-time nursing salary; they want to ‘try before they buy’ and check out other hospitals before they commit to permanent work, or for the opposite reason – they use casual nursing as the entry pathway to securing a full-time role at their hospital of choice.

Others choose casual nursing because they’ve been burnt out after a full-time nursing career and no longer want a permanent role, or because they love to travel, or they consider themselves ‘grey nomads’ and casual nursing affords them the flexibility and choice they seek – enabling them to choose when and where they work. Some nurses choose to juggle several jobs at once – RN and photographer; RN and small business owner, RN and university student to name a few – and others use casual to try shifts in areas outside of their specialisation – lucky for them, many hospitals support and encourage this.

The fact of the matter is that hospitals need a contingent workforce, and casual nurses will likely always be a part of that.

Working as a casual is often a necessity for some, and it could well be that as we emerge from COVID, Australia, and indeed, around the world, nurses will reassess their working conditions and environments. Many may decide that, in fact, working as casual, and the freedom, choice and flexibility it offers is by far and above a better option in a post-pandemic world.

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