Overview
Nursing is a great profession, established over 150 years
ago and now providing the largest group of employees in the health care sector.
Yet nursing in Australia is still significantly overlooked
in health policy development and in workforce calculations. The shortages of
nursing staff, especially in hospitals and aged care that has been threatening
for years, have now reached crisis point.
The Committee received evidence of critical shortages of
nurses in all areas of health care services. In some areas, particularly aged
care and mental health nursing, the problems due to nurse shortages are acute.
Issues associated with nursing including nurse recruitment
and retention, workforce planning, education and specialised fields of nursing
practice have been the subject of many inquiries, reviews, research projects
and commissioned studies in recent years. While the Commonwealth, States and
Territories have been implementing recommendations and strategies from these
various reviews, concerns were expressed to the Committee that structural
changes and reforms to overcome the major issues were slow in occurring.
Nursing has traditionally been a patient profession. Nurses
are extremely dedicated and passionate about the health care they provide and
the work they perform. However, nurses’ frustration at perceived inaction has
led to a growing militancy among their ranks. The Committee considers that
there have been enough reviews. It is now time for leadership and action.
Nursing as a profession involves many stakeholders and
contains many complexities and inter-relationships.
The Committee has made many recommendations, acknowledging
that a range of jurisdictions have roles and responsibilities in relation to
nursing including the Commonwealth, States and Territories, the Australian
Nursing Council and State registration boards, professional nursing bodies
including the Nursing Colleges, the Unions, the Universities and TAFEs, and the
providers of health and aged care services that employ nurses in the public and
private sectors.
The Committee considers that the need for a national nursing
workforce planning strategy is fundamental and urgent. There is a requirement
for a strong national leadership and coordination role, which should be
undertaken by the Commonwealth due to the crucial role that it plays in the
funding and delivery of health, education and aged care services.
To assist with national nursing policy, workforce planning
and coordination, and to advise the Commonwealth government on nursing issues, the
Committee has recommended the establishment of a Commonwealth Chief Nurse
position in the Department of Health and Ageing. The position would be
equivalent to the Principal Nursing Adviser/Chief Nurse positions in the States
and Territories.
The Committee supports the continuation of the current
university-based system for the undergraduate education of registered nurses.
Evidence to the Committee
highlighted that increasing the numbers of nursing graduates is a critical part
of addressing the shortage problem. The Committee has addressed a range of
issues in relation to undergraduate and postgraduate education and made many
recommendations the area of nurse education including:
- the need for additional funded undergraduate places in nursing
courses,
- enhanced clinical training and assistance with clinical
placements as part of undergraduate courses, and
- additional scholarships to assist in attracting students into
nursing as well as undertaking postgraduate study.
The Committee believes that like other university
disciplines nursing research needs to be encouraged to continue and further
develop and has made recommendations for increased research funding.
The Committee has also made a number of recommendations to
improve the interface between the education sector and health system including
partnership initiatives and arrangements, joint curriculum development and
joint appointments, and sharing of facilities.
One area of significant loss of nurses is in the first year
after graduation. The Committee has recommended that greater coordination and
financial support be provided in programs for the transition of new graduates
into the healthcare system. The Committee considers that there needs to be a
formalisation of the graduate nurse programs and of the training and payment of
nurses chosen to be preceptors.
Inadequate pay and unsympathetic and inflexible working
conditions are major contributing factors to nurses leaving the profession.
Improving the recruitment and retention of nurses is largely about addressing
these issues.
The Committee has made
recommendations which are applicable to all categories of nurses to address
issues of recruitment and retention including:
- promotion of a positive image for nursing and the highly skilled
work of nurses;
- extending professional development and continued education
opportunities;
- development of improved career pathways and opportunity with
professional recognition and remuneration of knowledge, skills and education;
- increasing remuneration;
- improving working conditions, especially workload, double shifts
and flexibility in rostering and working hours;
- expanding refresher and return to nursing programs;
- the introduction of more family friendly practices to meet nurse
expectations;
- providing more effective nursing leadership and management,
including greater nurse involvement in decision making; and
- provision of a safe working environment that ensures nurses are
free of fear, intimidation and violence.
Aged care nursing was singled-out as the sector of nursing
in greatest crisis. Qualified nurses are leaving in large numbers and not being
replaced. Salary rates for aged care nurses are significantly lower than for
equivalent nurses in all other areas of nursing.
The Committee considers that there needs to be a concerted
effort to ensure that all those in the aged care sector receive the quality of
care that the Australian community expects. The Committee believes that aged
care nurses should have access to working conditions, and receive remuneration
and recognition, commensurate with their training and professionalism and
comparable to similarly qualified nurses in other health areas.
The Committee has made a number of recommendations in aged
care including reducing the burden of paperwork required under RCS funding, the
need for pay parity, the increasing use of unqualified workers in aged care,
introducing measures to reduce occupational injuries to nurses working in aged
care, and to improve educational opportunity in aged care at both undergraduate
and postgraduate levels.
Mental health nursing shortages made it another area
requiring urgent action, to ensure that those already working in mental health
are supported and provided with opportunities for further education, and
improved career pathways; to ensure that there is an adequate take-up of
postgraduate places in mental health nursing courses; and that postgraduate
education for mental health nurses is rationalised and reformed.
Attracting and retaining nurses in rural and
remote areas is increasingly difficult. Experienced nurses find moving to
non-metropolitan areas unattractive due to the expense of moving, inadequate
accommodation, lack of remuneration commensurate to qualifications and the
degree of isolation or remoteness. Nursing staff already employed in rural and
remote areas are leaving because of workload, lack of recognition of their
skills, poor educational opportunities and pressures of providing care that may
be outside their scope of practice.
The Committee strongly believes that it is important to
encourage more Indigenous nurses into the general nursing workforce. Increasing
the number of Indigenous people in the nursing workforce will improve the
accessibility, quality and cultural appropriateness of health care for
Indigenous communities. Increased participation in nursing will also extend an
improved cultural awareness among non-indigenous members of the health
workforce.
Specialised areas of nursing practice are also confronted
with a range of recruitment and retention problems. The health care system needs
experienced specialist nurses. With health care becoming more complex, nurses
are seeking to undertake additional education to increase their knowledge and
skills.
Nurses endeavouring to further their education in
specialised areas face difficulties due to the cost of post graduate education,
lack of suitable courses, lack of support from employers and lack of
recognition and remuneration of their enhanced skills. This is contributing to
nurse shortages in many areas including midwifery, paediatrics, community care,
critical care and emergency nursing, as well as aged care and mental health.
The Committee recognises that these areas of health care
could not now function without specialist nursing support. With the ageing
nurse workforce and insufficient numbers of new graduates moving into
specialist areas, there is little prospect of the situation improving without
immediate action being taken.
The nursing profession has undergone a massive
transformation in the previous 10-15 years. Nurses have won the struggle to
move nursing education into the higher education sector, they have had to
adjust to new medical health technologies, developments in information
technology, and dramatic shifts in the approach to patient care in hospitals
and the community.
Nurses have had to cope with the effects on patient care of
increasing demands being placed on health services through constantly
contracting budgets. Yet nurses have little opportunity to participate in the
formulation of policies to deal with or address these changes.
It is time for the nursing profession to be recognised as an
equal player in Australia’s health care system.
It is time for the voice of nurses to be heard.
The patient profession is running out of patience!
It is time for action.
Navigation: Previous Page | Contents | Next Page