Occupational Health Services for Nursing Sustainability: Lessons From Hong Kong

Dear Editor,

The provision, adequacy and management of occupational health services (OHSs) for nurses in Hong Kong (HK) hospitals are long overdue for reappraisal. Wong’s historical review covering 1997 to 2022, following up on her 2017 mixed-methods study ¹ and the experience of the 2003 SARS and COVID-19 pandemics highlighted a clear disparity between protections under the 1997 Occupational Safety and Health Ordinance ² and fulfilling the actual occupational safety and health (OS&H) needs of frontline nursing staff.

In Wong’s 2017 study, ¹ OHS providers and their nursing staff consumers in HK hospitals reported their satisfaction that organizations and services were effectuating the legislation. But notably, nursing staff reported significant internal and external stress in their working environments, frustrated about day-to-day issues which could have been prevented or ameliorated by better understanding of their needs. Critically, ownership of workplace OS&H was ill-defined. Some nurses take ownership for their own health and safety; others fail to report problems due to a sense of futility about the outcome, or a fear of blame, or a lack of faith in governance. Their roles, rights and responsibilities are not always clear; decisions that affect their day-to-day work can be made without their consultation. The rights and responsibilities of frontline staff should be taught during professional training, and these need to be supported by the legislation.

The 2019 COVID-19 pandemic amplified staff burnout, infection and even death. Lessons from the 2003 SARS epidemic should have mitigated these outcomes. Despite numerous improvements and post-SARS initiatives from both legislation and the Hospital Authority, ³ long-term staff shortages have contributed to work stress amongst frontline health care staff, and they are exacerbated by heavy workloads, poor overtime pay, lack of help with administrative work and overcrowded hospitals. In 2019, the Association of Hong Kong Nursing Staff publicly protested their working conditions. A few months later, the Hospital Authority Employees Alliance reported that nursing staff had still not been provided with a safe and healthy working environment. ⁴ It has been evident that frontline nurses lack opportunities to influence policy, which has contributed to a misallocation of frontline resources to address health crises, even those which are predictable, such as winter flu. OHS providers have not prioritized the safety of the nurses as required in their management and reporting structures.

Over the near-30 years the 1997 Ordinance has been operative, the workforce might expect their whole OS&H needs – physical, mental, social and spiritual well-being – to be recognized and well-served.^2,5 However, the recommendations from Wong’s 2017 study ¹ are still relevant today. Stakeholders must jointly develop a practicable workplace culture where nurses’ OS&H competence is prioritized equally with clinical competence to advance the goals of the 1997 Ordinance. ² A fundamental review of nurses’ OS&H is needed. It is time to review why Wong’s 2017 recommendations (as opposed to the mandatory legislative requirements) have not been more widely implemented. ¹ Against a background of unpredictable health crises and a declining local nurse workforce, decision-makers should raise the priority on fulfilling the practicable needs of the frontline staff and enabling their ownership of occupational health.