Examination of the issue of insufficient nurse staff

Prepared for

Byron Tang
Chief Administrative Officer
Hong Kong Hospital Authority

Prepared by

Emma Lee, Research Assistant

5 November 2023

1
 Hong Kong Hospital Authority
07 Kowloon Road, Kowloon, Hong Kong
Tel: 23456789 Fax: 23456780 Email: HA@hkgovern.com.hk

TO: Byron Tong, Chief Administrative

Officer
FROM: Emma Lee, Research Assistant
DATE: 20 April 2021
SUBJECT: Examination of the issue of insufficient nurse staff
This is the report on nurses in Hong Kong which you approved on 1 October 2023.

The report investigates the stress and causes of HK nurses, and recommendations
were given by the nurses due to their experiences. A questionnaire was conducted.
10000 nurses from different hospitals participated. The result disclosed the stress
level of nurses and the origin.

The causes of the stress of HK nurse are huge number of patients and overtime
working. These causes stress with moderate symptoms of depression and anxiety.
Most participants express that more nurses and attractive offers are needed.

If you have any questions, please feel free to reach out to us, we will be glad to
answer any questions that you have.

Regards,
Emma Lee

2
 CONTENTS

Executive Summary ...................................................................................................... i

Introduction ................................................................................................................... 1
Purpose of the Study ...................................................................................................2
Methods and Procedure Used .................................................................................... 2
Assessment of antibiotic compliance .............................................................................2
Participants ................................................................................................................. 2
Procedure and Methods .............................................................................................. 2
Measures .................................................................................................................... 3
Assessment of Patient’s Understanding .............................................................. 3
Assessment of Antibiotic Compliance of Patient ................................................. 3
Outcome of assessment on antibiotic compliance ........................................................ 3
Characteristic of Respondents..................................................................................... 4
Patient’s Knowledge of Antibiotic............................................................................. 4
Patient’s Antibiotic Compliance. ...............................................................................6
Patient’s Reasons for Non-compliance to Antibiotic Therapy ..................................6
Analysis ..........................................................................................................................7
Patient’s Lack of Information on Antibiotics ............................................................. 7
Drug Manuals of Antibiotics are Too Difficult to Understand ................................... 8
Lack of Advice from Doctors and Pharmacologists ...................................................9
Conclusion .................................................................................................................... 9
Recommendation......................................................................................................... 10
More Promotion in the Hospital .............................................................................. 10
A Simplified Version of Drug Manual Given to Patient at the Pharmacy Counter 10
Provide Training for Doctors and Pharmacologists ................................................. 10
Reference ................................................................................................................... 12
Appendix ..................................................................................................................... 13

FIGURES
1 Number of Cases Involving Antibiotic Resistant in Good Care Hospital ................ 1
2 Expenses Regarding Antibiotic Resistant in Good Care Hospital ............................. 1
3 Percentage of Study Population’s Understanding Level Regarding Antibiotics ...... 5
4 Percentage of Study Population’s Compliance to Antibiotics. ...................................6

3
 TABLES
1 Respondent’s Demographic and Socioeconomic Characteristics .............................4
2 Incident Rate for Questions Answered Incorrectly in the Part Regarding Patient.
Understanding ...........................................................................................................5
3 Subject’s Reasons for Antibiotic Noncompliance .................................................... 7

4
 EXECUTIVE SUMMARY

Nowadays, most nurses in HK are having too much stress, which causes moderate symptoms of depression
and anxiety. The reasons are the high nurse to patient ratio and the overtime working. The long period of
working with extreme heavy workload causes their stress. This causes mostly half of the nurses thinking of
resign and if the situation happened, HK healthcare system would be collapsed.
For the recommended solution, more education degrees and attractive offers are needed. Increasing the
number of education degrees can fix the root cause of shortness of nurses. Attractive offers like salary increases
and more welfare can decrease the act of resigning of nurses.

5
 Examination of the issue of insufficient nurse staff

Introduction
An urgent problem plaguing Hong Kong's healthcare sector is a shortage of nurses.
The lack of qualified nurses in the area is a serious problem since it affects both the
accessibility and quality of healthcare services. Notwithstanding the city's renown for
cutting-edge healthcare facilities and excellent care standards, there are substantial
obstacles because of the shortage of nurses. In light of this, it is imperative to address
the underlying causes of the scarcity and investigate viable remedies to safeguard the
population of Hong Kong.

According to Hong Kong Hospital Authority’s Annual Report, the percentage of

nurses resigning had increased from 5.8% in 2021 to 11.0% in 2022. Since the
increasing rate of resigning means the problem of originally insufficiency of nurse
staff will be more severe and seriously impacts service quality.

Purpose of the Study

The purpose of this report is to define the nurses’ level of stress and what influence
their stress load.

Methods and Procedure Used

Questionnaires were distributed to Hong Kong nurses from all kinds of hospitals and
clinics.

Assessment of antibiotic compliance

The questionnaire was designed to assess nurses’ level of stress, reasons, and changes
wanted to enhance their willingness to keep working as a nurse.

Participants
All participants were randomly chosen by random hospital, clinic, seniority, and
gender. From September 2022 to October 2022, 10000 out of 66492 nurses
including enrollment and registered nurses were selected from all hospital.
Procedure and Method
Selected participants were given the questionnaire at the pharmacy counter. In order
to minimise the effect of disruptions on the result, they were assigned a quiet room to
6
finish the questionnaire.

Measures
The questionnaire access data regarding nurse’s mental stress information and
reasons of stress.

Assessment of nurse’s stress level

Participants were required to do the DASS 21 test. This test is a self-report
questionnaire designed to measure the severity of symptoms related to depression,
anxiety, and stress. The 21 questions have seven items for each of the three scales.
The higher score indicates more severity of symptoms of depression, anxiety, and
stress. The scores will be listed in the sequence of depression, anxiety, and stress. If
the scores are below 5,4,8, the participant is normal. If the scores are between 5-6,4-
5,8-9, the participant is having mild symptoms of depression, anxiety, and stress,
then moderated symptoms for 7-10,6-7,10-12, and severe symptoms for 11-13,8-
9,13-16. If the score is more than 14,10,17, the participant is having extremely severe
symptoms of depression, anxiety, and stress.
Outcome of assessment on antibiotic compliance
Questionnaire were distributed to 10000 nurses, out of which 9856 nurses
completed the questionnaire and would be covered in the following analysis.

7
Nurses’ stress
As shown in Figure 1, there are few (9%) participants having no symptoms, most of them (79%)
having mild symptoms, few (9%) having moderate symptoms, and few of them (1%) having severe
symptoms, and few (2%) having extremely severe symptoms of depression, anxiety, and stress. It
shows mostly all nurses having mild depression and anxiety due to stress.

Nurses' scores at DASS 21

1%2% 9%
9%

79%

normal mild moderate severe extremely severe

Figure 1
Reasons of stress
In the questionnaire, many nurses’ complaint of the busy workload, and broken work
life balance, so we conducted another questionnaire asking of the nurse-to-patient
ratio and the problem of overtime working.

As shown in Figure 2, a quarter of participant (29%) must take care of 10 patients

alone during dayshift, almost half of them (42%) must take care 11 patients, and
another quarter (29%) must take care 12 patients. According to the data, the median
number of patients taken care by one nurse is 11. However, according to the
recommendation from the Legislative Council Secretariat, the nurse-to-patient ratio
should be 1:6.

8
 The Nurse to Patient Ratio during Dayshift

30% 29%

42%

1:10 1:11 1:12

Figure 2

As shown in Figure 3, few participants must take care of 22 (9%) and 23 (8%)
patients alone during night shift, and most of them (83%) must take care of 24
patients. It means most nurses must take care of 24 patients. The ratio is much more
than the recommendation ratio.

The Nurse to Patient Ratio during Nightshift

9%

8%

1:22
1:23
1:24

83%

Figure 3

For Hong Kong nurses, they normally work 44 hours per week. However, many of
9
them complain of overtime working.

As shown in Figure 4, a quarter of participants (26%) need to have extra on-call duty.
And in Figure 5, there are small numbers of participants (4%) have to work more
below 19 hours, one-fifth of participants (18%) have to work more 19 hours, half of
participants (53%) have to work more 20 hours, 53% one-fifth of participants (53%)
have to work more 21 hours, few participants (5%) have to work extra more than 21
hours.It shows the severity of nurses overworking, and huge interruption of nurses’
work-life balance.

Percentage of having extra on-call duty

26%

74%

Yes No

Figure 4

10
 Hours for Nurses overworking per week
5% 4%

18%
20%

53%

Less than 19 19 20 21 More than 21

Figure 5

11
Thought of quitting
As shown in Figure 6, there are over half (57%) of the participants want to quit their
job. For Figure 7, Half of them (48%) think that is because the salary is not worthy
enough for their hard work, another half of them (50%) think that is because the
situation of heavy workload has no changes for a long time, and few of them (2%) have
other reasons for leaving thought. Then the smaller half of the participants (43%) in
Figure 6 deny having thought of quitting. In Figure 8, most of them (97%) explained
that they have a sense of mission to give back to society, the rest of them (3%) has other
reasons. The data shows the urgency of changing the working quality, or Hong Kong
will face a huge loss of labor in the medical system.

Percentage of Participants Wanting to Quit their job

43%

57%

Yes No

Figure 6

12
 Reasons for Participants wantting to Quit
2%

48%
50%

Salary not worthy enough No changes for heavy workload Other

Figure 7

Reasons for Participants to stay

3%

97%

Sense for mission Other

Figure 8

13
 Analysis
The gathering and summarizing of data had given rise to analyzation on the data
collected.

Nurses’ huge stress due to heavy workload

The emotional and physical health of Hong Kong nurses is suffering as a result of the
extreme pressure they work under. An environment that is extremely stressful has
been created by the ongoing need to manage scarce resources while providing high-
quality treatment. It can be emotionally taxing for nurses to select patients based on
urgency and to frequently face difficult decisions. In addition, their stress levels are
further raised by their lengthy workdays and lack of breaks.

It is admirable how committed and resilient Hong Kong nurses have been in the face
of these difficulties. They keep working nonstop, prioritizing the needs of their
patients before their own health. But it's imperative to deal with the underlying
problems that fuel their stress and provide them the assistance they need.

Policymakers and healthcare authorities must act immediately to reduce the workload
for Hong Kong nurses. A critical first step in preventing nurses from being
overworked is to increase staffing levels. The patient-to-nurse ratio can be raised by
recruiting more nurses, which will result in better treatment and lower stress levels.

Enhancing the working environment is an additional crucial element that requires

focus. Giving nurses enough rest periods, places to relax, and support networks can
reduce their stress and keep them from burning out. Furthermore, providing mental
health support services like therapy or counseling might give nurses the means to
manage the emotional strain of their jobs.

In conclusion, there is an urgent need to address the extreme stress that Hong Kong
nurses experience as a result of their high patient volume and hard overtime work.
The well-being of nurses must be given top priority by healthcare authorities and
legislators, who should solve staffing shortages, enhance working conditions, and
offer mental health support. By doing this, we can make sure that nurses in Hong
Kong have the assistance they require to keep providing high-quality care while
preserving their own health.
14
 Conclusions
After conducting and analysing the questionnaire, the factors leading to nurses
wanting to quit their job are as follow:
1. Salary not worthy for the heavy workload
2. No changes have been made by the government

15
 Recommendations

To minimise patient’s risk of having antibiotic resistant in Good Care Hospital, a few
approaches could be adopted by the hospital.

1. Increase amount for Nursing Degree

The government can play a critical role in raising the nursing education degree in
order to reduce the burden and stress that nurses encounter. Through government
investment in postsecondary education and granting nurses the chance to seek
additional degrees, the nursing profession can be improved, which will ultimately
result in a more effective and efficient healthcare system.

Creating alliances between academic institutions and medical facilities to provide

specialized nursing programs is one strategy. These courses can concentrate on
advanced clinical skills, management, and leadership, giving nurses the
knowledge and abilities to manage challenging patients and assume leadership
positions within healthcare organizations. Nurses can gain a deeper understanding
of patient care by broadening the breadth of nursing education.

Expanding the scope of nursing education will help nurses become more
knowledgeable about patient care, evidence-based practice, and critical thinking,
which will help them make better decisions and deliver higher-quality care.

The government can also support nurses in pursuing advanced degrees by

offering financial aid and scholarships. More nurses will be encouraged to
continue their studies and develop their skills if the cost of postgraduate degrees
is lessened. Individual nurses will gain from this, and it will also help the nursing
workforce's overall professional development.

In order to create continuing education initiatives, the government can also work
with professional associations and nursing associations. In order to keep nurses
abreast of the most recent developments in healthcare practices and technology,
these programs can provide them with continual chances for training and growth.

16
 The government can foster a culture of professional development and continual
improvement among nurses by providing funding for lifelong learning, which will
ultimately result in a workforce of nurses who are more capable and self-assured.

In conclusion, the government can provide nurses with advanced skills and
knowledge by raising the nursing degree, which would ultimately reduce their
workload and enhance patient care. The government can assist nurses in their
pursuit of advanced education through collaborations, financial incentives, and
continuing education initiatives, resulting in a workforce of nurses that are more
capable and resilient.

17
18