Introduction
Virus outbreaks and pandemics have occurred regularly over the last 300
years (Balicer et al. , 2006). In
the last two decades, new viruses associated with Severe Acute
Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and
the H1N1 epidemic have exposed health system challenges in responding to
overwhelming levels of morbidity and mortality
(Koh et al. , 2005). When the
World Health Organization (2020) declared
the novel coronavirus COVID-19 a global pandemic on 11 March 2020, there
was deep concern at the severity, levels of spread, and societal and
economic disruption occurring internationally. Countries were called on
to take immediate action to contain the virus
(World Health Organization, 2020).
Global emphasis has been given to public health responses to the
pandemic (Patel et al. , 2008,
World Health Organization, 2020) and on
the capacity of acute care services to meet the demands of those
infected with COVID-19 (Commonwealth of
Australia, 2020a). This includes the impact on health professionals
caring for the critically ill (Chunget al. , 2005, Madhav et
al. , 2017, Imai et al. , 2005,
Fernandez et al. , 2020). Less
attention has focused on health professionals working outside acute
care. However, primary health care (PHC) professionals are pivotal in
the identification of new cases, monitoring those at risk, and reducing
indirect mortality associated with health and social service disruption
(Shaw et al. , 2006,
Australian College of Nursing, 2020). PHC
professionals also have an important role in community education,
managing the public’s response and psychological sequelae to COVID-19
(Shaw et al., 2006).
In Australia, PHC is provided in a combination of government funded
settings, such as community health centres, and non-government
organisations, including schools, non-for-profit services, and general
practices operating as small businesses
(Australian Institute of Health and
Welfare, 2016). Highly skilled nurses constitute the largest group of
health professionals in PHC, usually employed on a full or part time
basis to provide clinical care and delivery of a range of programs
designed to meet community needs (Halcombet al. , 2014).
In response to the spread of COVID-19, the Australian Government
introduced social distancing, placed limitations on social gathering and
imposed a stepped lockdown on movements of people and organisations
(Australian Government Department of
Health, 2020b). These actions created a unique set of challenges to
ensure both a response to the pandemic whilst maintaining continuity of
PHC services to support the ongoing health needs of populations
(Commonwealth of Australia, 2020b). As
face-to-face consultations were reduced, the government introduced
funding for telehealth services to be provided by PHC professionals
(Australian Government Department of
Health, 2020a). Initially, this funding did not extend to nursing
service delivery (Australian College of
Nursing, 2020). In some circumstances this led to reduced face-to-face
consultations and cancellation of specific health initiatives which in
turn raised concerns about the financial viability of some PHC nursing
services (Nelson, 2020).
Limited research has been published about the experiences of nurses
during respiratory pandemics or epidemics,
(Koh et al. , 2012,
Lam & Hung, 2013,
Corley et al. , 2010). A recent
systematic review found most research is focused on acute care nurses
(Fernandez et al., 2020). However,
understanding PHC nurses’ experiences is important to ensure that
appropriate support is provided to facilitate workforce retention and
high quality clinical practice at a time where community health needs
are high. In order to ensure safe, consistent PHC nursing services
during the current pandemic and guide future planning, accurate data
relating to current experiences of the PHC nursing workforce is vital.
Therefore, a survey of PHC nurses was undertaken to explore their
experiences of the COVID-19 pandemic. The findings provide policy makers
with robust data for urgent decision making now and into the future
regarding workforce protection, support and sustainability.