Date of Award

2024

Degree Name

Doctor of Philosophy (Nursing)

Schools and Centres

Nursing and Midwifery

First Supervisor

Professor Sadie Geraghty

Second Supervisor

Dr Aisling Smyth

Third Supervisor

Dr Rosemarie Hogan

Fourth Supervisor

Professor Karen Clark-Burg

Abstract

Background: The COVID-19 pandemic has seen an outpouring of attention focusing on the global nursing and midwifery shortage and its damaging impact on healthcare systems worldwide. However, there is limited research, both globally and in Australia, on its impact on nurses’ and midwives’ job satisfaction and their associated intentions to stay or leave their job and/or profession, as a result. The lack of extensive research in this area highlights the importance of this Doctoral thesis. My research aimed to fill this gap by conducting a detailed study of the personal experiences of nurses and midwives who worked during the pandemic in Australia and examined how COVID-19 affected their job satisfaction.

Aim: The aim of my research study was to investigate Australian Registered Nurses and Registered Midwives’ lived experiences of working through the COVID-19 pandemic, whilst examining how the pandemic has affected their intention to stay, or leave, their job or profession.

Methods: In this convergent parallel mix method research study, 306 Registered Nurses, 42 Dual Practicing Registered Nurses and Midwives, and 16 Registered Midwives from across Australia completed an online validated quantitative questionnaire named the Nursing Workplace Satisfaction Questionnaire (developed by Fairbrother and Jones and used with permission). This tool measures three key domains of job satisfaction: intrinsic job satisfaction, extrinsic job satisfaction and relational job satisfaction. Concurrently, further in-depth qualitative data was obtained via 11 semi-structured, online interviews with six Registered Nurses and five Registered Midwives who worked in various facilities across four states and territories, using an Interpretive Phenomenological approach. Furthermore, my study was underpinned by the Postpositivist Theoretical Framework.

Results: Participants experienced significant isolation from the community, family, and friends, feeling like ‘lepers in the eyes of the public’. Participants also reported being bullied and labelled ‘troublemakers’ for questioning unsafe policy changes. Nurses and midwives felt undervalued and expendable, due to the rationing of personal protective equipment that favoured physicians. It was revealed that nurses and midwives working in both public and private sectors reported lower levels of extrinsic and relational job satisfaction compared to those employed in just one sector. This variation was confirmed as statistically significant. Midwives showed higher relational job satisfaction, yet lower extrinsic job satisfaction compared their nursing

counterparts. While participants dual practicing as nurses and midwives reported higher job satisfaction in all categories. Specifically, their relational job satisfaction was statistically significant. The study’s midwifery participants likened pandemic healthcare protocol changes, such as limited pain relief and birthing partner restrictions, to a loss of women’s rights. Participants relied on personal resilience to cope with organisational failures and shortcomings. Poor organisational resilience led to participants having feelings of helplessness and anxiety. Nurses and midwives in Western Australia had job satisfaction levels remarkably similar to those in other states and territories, with only a 0.01% difference. Profound emotional distress was evident among participants regarding redeployment. In some cases, redeployment anxiety surpassed the fear of the pandemic itself. The participants reported severe mental health deterioration during the pandemic, including burnout, anxiety, depression, post-traumatic stress disorders, suicidal ideation, and disrupted sleep patterns with nightmares akin to wartime experiences.

Conclusion and Implications: In my study it was found that challenges like isolation, workplace bullying, and societal perceptions negatively impacted nurses and midwives intrinsic job satisfaction, with individual resilience being crucial in mitigating these effects. Extrinsic job satisfaction was severely affected by hierarchical bullying, often forcing nurses and midwives to choose between unsafe practices and professional repercussions. Relational job satisfaction varied, with midwives generally having higher relational job satisfaction, but were more adversely affected by strict pandemic guidelines that affected the relational aspect of their profession. Despite being calculated independently, each individual job satisfaction (intrinsic, extrinsic, and relational) score was found to be statistically correlated.

Regardless of the case numbers or mortality rates, nurses and midwives are inherently prone to psychological distress due to the inherent nature and demands of their professional role, identity, and sense of duty. Involvement in pre-pandemic preparedness and informed awareness about potential redeployment may reduce the shock of sudden redeployment during a pandemic. My study highlights the need for organisational adaptability and proactive risk management, shifting the focus from individual resilience to organisational responsibility.

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