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Australian nurses: facts and figures

Annie May looks at how the nursing profession fared in the latest national report card on health.

Nursing and midwifery professionals have the lowest growth rate within the nation’s health services industries, which as a whole is growing at a rate almost double to other occupations.

This was one of the findings revealed in the latest national report card on health, released by the Australian Institute of Health and Welfare (AIHW), which brings together the latest available national statistics on health.

Despite the well recognised and publicised nursing shortage and recent government initiatives to address the issue, the number of nurses and midwives only increased by eight per cent between 2003 and 2008, recording the lowest growth among occupations in the health service industries. Dental associate professionals and assistant didn’t even make the grade, declining in numbers by three per cent.

Growth over the periods was highest for psychologists at 66 per cent and complementary therapists at 61 per cent. Nursing and personal care assistants increased by 15 per cent.
However, nurses remain the largest occupational group in the health workforce.

Nursing also didn’t score well in completing higher education courses. Increases were recorded for all health fields, with the largest growth seen in the fields of nutrition and dietetics, up 94 per cent and podiatry, up 64 per cent.

The smallest increases were for occupational therapy, up only eight per cent and rehabilitation therapies, up 11 per cent. Nursing was next lowest at 17.7 per cent, a similar figure to medical studies.

As well as growth in the take-up and completion of further study, the report looked at sustainability.
To do this, the sustainability ratio, an indicator developed by the National Health Performance Committee, was used. The ratio is the number of graduates in nursing, medicine and pharmacy as a percentage of each group’s total workforce.

Between 2002 and 2007 the sustainability ratio for employed registered nurses was around three per cent, compared to above five per cent between 1994 and 1996. According AIHW this was “due to many registered nurses taking the opportunity to upgrade their hospital-based training to academic qualifications”. The decline can be accounted for by fewer nurses upgrading their qualifications, the report said.

A retiring workforce
The main reason for permanent loss from the health workforce is the retirement of older workers. Much like the Australian population, the health workforce is ageing, and is doing so faster than non-health workers.

“While many health workers are replaced by new entrants there is concern that the rate of workforce replacement is not keeping up with the increased demand for healthcare services as a result of the ageing population,” the report said.

According to the AIHW health labour force surveys, the percentage of registered nurses aged 55 years and over increased from 15 per cent in 2003 to 18 per cent in 2007 and the number of enrolled nurses in that age group increased by four per cent.

Not just a matter of head counts
Measuring supply can’t just be done by counting the number of workers, argues AIHW. Equally important, it said, was the number of hours spent working.

“For example, in some professions, particularly those with a high proportion of females such as nursing, a substantial number work part time. In others, such as the medical profession, it is usual to work more than the standard 35 hours per week.”

The health professions with the longest average working weeks were specialist medical practitioners. Working the shortest was nurses, personal care and nursing assistants and complimentary therapists.

Falling short
In developing targeted initiatives, knowing where the shortages are is essential. For each state and territory, the Department of Education, Employment and Workforce Relations produces a list of occupations where skill shortage or recruitment difficulties exist.

Not surprisingly, shortages were identified in a broad range of health occupations across the country. Every state and territory at 2007 and 2008 had a state-wide shortage in registered nurses and registered midwives, as well as medical diagnostic radiographers and sonographers.

All but Tasmania experienced a state-wide shortage in registered mental health nurses, but it did struggle in regional areas.

Australia is also lacking in nurse managers, with Victoria, Queensland, Western Australia, ACT and the Northern Territory all experiencing state-wide shortages. NSW and Tasmania were found to have difficulty in recruiting nurse managers, while South Australia had no shortage assessed.

Medical practitioners are not evenly distributed across Australia and are highest in major cities, “contributing to different levels of healthcare access for people living in different geographical areas”.

Where does Australia rank
In comparison to other OECD countries – New Zealand, Canada, USA, United Kingdom - in 2007 Australia had a higher rate of nurses than all but the USA. This was an increase from 2003, unlike the United Kingdom which reported a decreased rate.

In 2007, Australia had higher numbers of general practitioners relative to the population than the four other countries. Australia also ranked higher than New Zealand and Canada for medical specialists, but lower than the USA and United Kingdom.

Australia’s Health 2010: key points
• In 2007-08, just over two per cent of total health expenditure was for preventative services or health promotion.
• Between 1998-99 and 2008-09, there was an increase in general practitioners’ management of some chronic diseases, including hypertension, diabetes and depression.
• The number of hospital admissions rose by 37 per cent in the decade to 2007-08.
• In 2008-09, about one in nine of all prescriptions under the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme were for a mental health-related medication.
• Health expenditure during 2007-08 was $103.6 billion, exceeding $100 billion for the first time.
• Governments funded almost 70 per cent of health expenditure in 2007-08.
• For indigenous Australians in 2006-07, spending per person on health and high-level residential aged care was 25 per cent higher than for other Australians.
• Employment in health occupations is still growing – 23 per cent growth between 2003 and 2008, almost double that across all occupations (13 per cent).
• Between 2002 and 2007, there was a 26 per cent increase in people completing health occupation and university courses.
• The profile of the health workforce continues to age – in 2008, 18 per cent of the workforce was aged 55 years and over compared with 13 per cent in 2003.
• The health workforce in 2008 was 75 per cent female, compared with 45 per cent for all occupations.
• More children are being vaccinated against major preventable childhood diseases, with 91 per cent fully vaccinated at two years of age, but only 82 per cent of five-year-olds covered.
• In the five years from 2003-04 to 2007-08, the median waiting time for elective surgery in public hospitals rose from 28 days to 34 days.
• People living in rural and remote areas tend to have higher levels of disease risk factors and illness than those in major cities.
• Cancer is the leading cause of disease burden (19 per cent) followed by cardiovascular disease (16 per cent) and mental disorders (13 per cent).

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