Nurses conflicted between home and work in duty of care

Lee McKinney: "A better patient ratio wouldn't wear people down so much."
Lee McKinney: “A better patient ratio wouldn’t wear people down so much.”

Sandwiched between the needs of the generations, in an ageing society, nurses are caught between multiplying pressures that can cost them their jobs.For some workers, having both children and ageing parents is a mixed blessing that comes at the cost of permanent employment.

The burden of care tends to fall more heavily on women, especially professionals such as nurses, whose working lives are already stressful due to their obligations to patients, and who have rules to meet.

One finding of the ACTU’s Working Australia Census, a survey of 41,600 people, provided confirmation of the existence of a group the ACTU terms ‘the sandwich generation’, usually women working full-time or permanent part-time. They can also be called the ‘three-jobs generation’ in the sense they have unpaid care responsibilities for their parents or parents-in-law, their children and a paid job.

Until nearly a year ago, Lee McKinney (pictured) worked full-time as a nurse in the intensive care unit at St George Hospital, Sydney. Now she works as a relief casual, averaging about two afternoon shifts a week, in clinical emergency response.

Lee is a mother of three children, aged 11, 10 and 5, and a part-time carer for her father, who is in his early 70s. Until recently, Lee’s parents were healthy with no chronic problems. However, her father, who lives in his own home with his wife, now travels regularly to hospital for cancer treatment. While Lee’s father is relatively young, the conflict Lee faces is of a kind likely to grow in our ageing society.

For Lee, her sense of professionalism ruled out taking high levels of absences to care for her children and her father. She felt she would let down colleagues in her nursing unit if she tried to maintain full-time employment without keeping up the usual shifts. She decided, reluctantly, to step aside from permanent employment at the hospital. It was her call, and a tough one.

‘It’s too difficult on a permanent roster, with three children of your own,’ says Lee. ‘My husband and I had to make a decision. Until the kids had settled down, that [casual] would have to be the basis of work.’

She found support from the hospital and her unit. ‘I had a fantastic boss in the intensive care unit where I worked. If ever there was an issue, I could go to her or give her a call and explain what was going on.

‘It wasn’t like I was pushed out. The hospital tried to accommodate my situation. It was my philosophy, [about] how dedicated I should be.’

With teamwork central to the intensive care unit’s operation, Lee thought it was unfair to leave the unit with an agency replacement, if one could be found, when she was unable to work. Where teamwork is involved, because of the inter-reliance of staff, it is problematic for the members of a nursing unit to work with someone not experienced in the unit’s work, or familiar with hospital policies and procedures.

Lee believes more staffing and flexibility would ease pressures on employers and nurses.

‘Patients are much sicker than before. The acuity is rising,’ she says. ‘More staff would help. A better patient ratio wouldn’t wear people down so much. If a hospital is well staffed, it has a very safe and supportive environment.’

Lee is one of a generation of nurses that has been coping with both older and younger care.

‘Our parents are going into their 70s and having health problems,’ she says. ‘My father has been sick for about 10 months. He developed cancer and it rapidly spread. I and my two sisters have done everything we can to make him comfortable at home.’ That care includes taking him to and from hospital. ‘I run the in-laws around to a point, too,’ Lee says.