Nurses who have worked in the outback NSW town of Bourke say they have been abused, threatened and physically attacked.
The nurses told the ABC's The World Today program that they fear for the safety of their colleagues and patients due to a lack of security and staff.
All of the nurses who spoke to the ABC shared their stories on the condition of anonymity.
Steve, not his real name, said he feared a nurse could lose their life if security was not improved.
"I can get stabbed any time of the day, that can happen at any time," he said.
In one of the most recent incidents, several student nurses were allegedly threatened and robbed by young offenders armed with a knife.
The escalating threat of violent crime has had an effect on staff at Bourke's hospital and their ability to care for patients, according to the nurses, and they fear some patients could even die due to a chronic lack of hospital staff.
Helen, another nurse, said staffing and security had to be improved before it was too late.
Mark Spittal, the chief executive of the Western NSW Local Health District, which has responsibility for the hospital in Bourke, said the safety of staff was of the highest priority.
"We have zero tolerance for threatening or criminal behaviour that affects our workforce," said Mr Spittal.
It said it was working with the local council, state government agencies and local leaders to address the issue.
But the town, 800 kilometres west of Sydney, is still struggling to end the threat of crime.
On Sunday night, a visiting magistrate experienced crime first-hand.
Police say several young offenders allegedly broke into a Bourke motel room where the 66-year-old woman was sleeping and tried to steal her handbag, after wrestling her to the ground.
Three juveniles, including a 10-year-old, were arrested.
Abuse 'every single day', says nurse
The nurses who spoke to the ABC shared details of several times they had felt unsafe during their time in the community.
Nancy worked as a nurse at Bourke hospital for more than two years, before leaving in 2020.
"They just abuse us, every single day," she said.
She said there were not enough staff at the hospital to deal with patients with mental health and drug and alcohol issues, which she said were common.
"A mental health patient, he was brought in by the police, they said they already frisk searched him for any dangerous items," she said.
But quickly a violent and dangerous scene broke out in front of her.
"Right in front of me, right in front of the hospital, he just took out a blade and started slashing himself," she said.
"He went out of the hospital and grabbed a rubbish bin and he smashed it, he smashed it on the front door and the glass front door, it was broken."
Incidents such as this have led the University of Sydney to suspend its student nurse placements in Bourke.
The situation is exacerbated by the lack of adequate security staffing, according to Steve.
"It's pretty scary because we don't have like a proper security guard on duty at night," he said.
He said he had been told by violent patients that they would stab him if they saw him outside the hospital.
While he worked in the town, he feared going to authorities and having to testify in court, because of potential reprisals.
"Bourke is just a small town and if I appear in court or something like that, I don't know what will happen, I'm just also scared of my life if I do that," he said.
Another nurse, Helen, said general staff at the hospital had tried to help with the security situation, but with only one security guard who was not always on shift, protecting nurses was impossible.
"The gardeners, the cleaners, the kitchen staff [tried to help but], they don’t hold a licence as security," she said.
She left Bourke in 2020, after three years at the hospital.
Mr Spittal from the Western NSW Local Health District told the ABC that after a recent security audit of the hospital, changes have been made since the incidents described by the nurses.
"A number of measures have been established or expanded, including a 24/7 presence of security personnel and improvements to infrastructure, including lighting," he said.
"Further improvements and measures will be put in place in the coming days."
Bourke thought youth crime solutions were working, until recent years
In 2013, Bourke became the first town in Australia to trial an Indigenous-led justice reinvestment program known as Maranguka.
The justice reinvestment approach is about spending money on programs to help youths avoid jail — rather than locking them up.
By 2017, there was a significant drop in crime including a 38 per cent reduction in significant juvenile charges.
But now in 2022, crime is a major problem once again.
Alistair Ferguson, the founder and executive director of Maranguka, a local organisation that works with young people in the area, said there had been great successes with scarce resources.
"At one stage, we were dubbed as one of the most dangerous communities in the world, but you know, we took that and certainly didn't accept that," he said.
"It wasn't overly ambitious to think that we could become one of the safest communities in the world and that's certainly the focus and we're working towards that."
He said COVID was partially responsible for the recent uptick of violent crime and that frustration and disenfranchisement among young people had increased.
"We're well equipped for fire, floods and droughts, et cetera but we weren't prepared for COVID," he said.
Mr Ferguson also said scarce resources made the situation more challenging, with wait times for drug and alcohol treatment reaching four months in Bourke.
He said there was no doubt about the seriousness of some of the offences that had been committed, but he believes the underlying causes must be addressed.
"This is stuff that keeps me up at night but it just makes us more determined to get the message through," he said.
"Young people are carrying quite a big burden through generational intergenerational trauma — it doesn't come from nowhere."
Student nurses vulnerable as crime escalates
While some of the incidents described by nurses to the ABC were not reported to police or could not be commented on, Detective Inspector Paul Quigg confirmed an incident where several student nurses were allegedly threatened by juvenile offenders who broke into their home.
"It's very terrifying for the nurses, they are all young people, who have come out here to assist our community in Bourke," he said.
"The whole community has suffered just because of the hands of a few young offenders, who are targeting people."
In his decades of experience, he said, seeing nurses targeted was a personal low point.
Bourke Shire Mayor Barry Hollman said the community is shocked by the level of violence in their town.
"I'm devastated by it," he said.
"It's something you would never wish to happen, and when it does, it's quite devastating to the town."
He fears that if violence doesn't stop, nurses will simply refuse to come to Bourke and it will put care at the hospital in jeopardy.
"[The hospital] plays an important role to our town and we want it here and we’ll fight to keep it here," Mr Hollman said.
Katrina Lee, lead organiser for regional, rural and remote nurses with the NSW Nurses and Midwives Association, said the recent violence against nurses was emblematic of the problems facing the health workers in the bush.
"I often lay awake at night, worrying are they actually getting through their shift today?" she said.
"I feel terrible for them, it’s just becoming more and more dangerous to work there."
Western NSW Local Health District said work was being done to make sure the hospital in Bourke would be adequately staffed.
"The district has had difficulty filling some vacant positions at Bourke permanently and we are working with Sydney Local Health District to ensure we have senior nursing staff during our recruitment," said Mr Spittal.
"These redeployed staff are expected to begin at Bourke next week."
Greatest fear is for patients, say nurses
Helen said, for many of the nurses, the biggest fear was not for themselves, but for their vulnerable patients.
She said staffing issues mean that sometimes the front office staff at the hospital had to be called in to check on patients in the aged care wing because there were not enough nurses to monitor them.
"I need to be honest, they [aged care patients] are not really getting the care they need," said Helen.
"The front [office] ladies are really good, but of course, they're not trained to change [incontinence] pads and everything."
She said that often on night shifts, just two registered nurses were responsible for: the emergency department, an acute ward, the 14 aged care patients at the other end of the hospital, and at the height of the pandemic a COVID ward as well.
She said she feared that either a nurse would lose their life as a result of violent crime or a patient could lose their life because of staffing shortages.
One of the other nurses, Nancy, said she had a continuing love for the town of Bourke, despite everything she was exposed to.
"The community is lovely, I loved my time in there, I loved serving the community," she said.
"It’s just that it’s not safe [and] the nurses, they need help."
Helen said government support for more staff and more security was needed.
"I feel the government doesn’t really care for the nurses," she said.
"They need to be in our shoes, they need to be on the floor, to know what is really happening."
