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.