Flexible thinking for the future

To attract and keep more nurses the healthcare sector will have to concentrate on training, recognition of skills and workplace conditions. By Peter Fairchild and Sarah Mott.
Ever wondered why your feet and legs ache at the end of another shift or day at work in the clinic? Why is it that so many qualified nurses work part-time? What’s causing the demand in increasing specialisation of the nurse workforce?

It is these types of questions that are driving researchers to examine in detail the issues of the recruitment and retention of nurses.
Recruitment and retention is a global issue, with recurring commonalities across a range of countries, including the United Kingdom, New Zealand, Canada and Australia. One way of developing strategies to overcome these issues in the coming decades will be to use evidenced-based methodologies to identify the framework within which we will need to work.

Take some of the current trends and practices as an example. At the clinic level, since the introduction of the practice nurse Medicare item numbers, more than 20 million procedures have been carried out in the areas of: immunisation and wound management from 2004; PAP smears (2005); PAP smears and preventative and antenatal care (2006); chronic disease management items numbers (2007); and midwifery (2010).

Against this increase in specialisation a number of other trends have also emerged. While there are more than 380,000 people with nursing qualifications in Australia, increasing demands in aged care and lifestyle care have seen increasing shortages of trained nurses able to provide the care expected. In aged care in particular, nurse workforce turnovers annually approaching 100 per cent are becoming all too common.

We also know that just over 42 per cent of the potential workforce were unemployed (or employed in other areas) in 2006, or employed in allied areas. The Australian Health Workforce Institute anticipates that about 90,000 nurses will retire across Australia before 2020. Maximum estimates indicate that 100,530 new nurses will graduate in the same period, indicating that there will still be a significant shortfall of employable nurses. While this at first glance looks like there will be a surplus of nurses, if the same trend of 40 per cent plus “unemployment” continues, there will in fact be a significant shortfall against demand. Why is there such a high attrition rate? Is it simply that many nurses leave for family reasons and do not return?

Compounding these developments will be the changing nature of those presenting for healthcare. The general makeup of the population (percentage of baby boomers and other groups) will not change significantly over the next few decades. By the year 2051, the median population age will be 46.5 years (as against 37.2 years in 2010, according to McKrindle Research, ABS) and over 40 per cent of the population will be older than the median.

This percentage of the population will remain relatively stable for the next three decades. This means that the largest section of the workforce for the next 30 years will be aged 40 years and above. At the same time, the number of people living in senior care accommodation will increase significantly.

So what does this mean for the profession, especially given that current patterns of employment indicate a decrease in the number of nurses working in aged care (22 per cent) and a decrease of 8 per cent working in the hospital sector? What we are already seeing (and reflected in the practice nurse Medicare procedures numbers) is that this ageing population has higher expectations when it comes to healthcare.

This sector of the population is better informed than ever before and will become increasingly concerned with quality of life. Reflecting this concern is that social expenditure in the area of associated health care support is expected to significantly increase. And who will provide and meet this increasing demand in healthcare support? The answer is the practice nurse.

Given these developments, what issues will we need to address if we are to meet the demands, especially in recruitment and retention of nurses across Australia?

First, the need for further training will become paramount but by necessity it cannot involve more of the same. Why? Take a look at the current makeup of the nursing workforce in South Australia (and it is similar across the nation). Of the current workforce in South Australia half have a university degree, with the other half either being hospital trained or having a diploma or certificate of nursing. Half work in hospitals, while the rest are spread across clinics, aged care, community services, business and schools. Over 90 per cent are female, over 54 per cent work part-time and approximately 24 per cent of the nursing workforce is permanent.

This profile is unlikely to change significantly over the next three decades. What becomes apparent is that full-time study and training for any significant period of time, especially unpaid, will not be a possibility for more than 50 per cent of the current workforce.
So what are the answers? Again, we know that there is a well documented increase in demand for aged and lifestyle care and that this area is highly likely to provide increasing opportunities for employment (and training) and yet has reportedly high worker turnover.

We also know training demands at graduate levels are likely to increase as the general population seeks higher levels of healthcare. This in turn will create demands within current training programs, as well as the need to find non-traditional delivery methods, such as intensive training programs (over one to two weeks) and outside of normal working hours, particularly in regional Australia.

The training tension between hospital versus tertiary trained nurses will also need to be broken. While salary parity is recognised, a reasonable education “cross-over” that recognises the considerable experience and commitment to ongoing training that all nurses undertake will need to be formalised.

Simply saying, as many university programs do, that if you want qualification parity as an enrolled nurse with a registered nurse you must return to full-time study for a two-year period and we will not take into account your experience and training obtained on the job, is no longer sustainable. Why can we not develop a system that takes into account prior learning and experience? It is certainly done in other sectors and in other program areas within the tertiary systems.
Second, we will need to look at the role of the nurse. The traditional role of the nurse is expanding, and will need to do so if nurses are to continue to see their contribution as being relevant and meaningful within the current workforce.

Diversification of patient care at the clinic level will need to be examined to encourage better utilisation of nursing skills. Midwifery, chronic wound management, PAP smear services, diabetes management, men’s and women’s health issues, asthma management, lifestyle issues (including fitness and healthy eating) are some of the alternatives. The nurse specific medical benefit scheme needs to be further expanded to include recognition of specialisation, particularly in the areas of aged and lifestyle care.

Third, traditional employment structures will need to be diversified to cater for lifestyle and family pressures. Nurse education institutions, especially in regional areas, will need to look at providing “refresher” courses for nurses planning to re-enter the workforce after a period of absence. Part-time work will remain a predominant part of employment in medical clinics so that family and work responsibilities can be facilitated.

And finally, with the average age of the workforce increasing well past 45, someone will finally take a good look at workplace and health safety. The right shoes for the job, regular breaks to take pressure off legs and feet, scheduled “breaks” to catch up on patient recording and user-friendly training hours supported both through medical clinics and training facilities will need to be examined.

Dr Sarah Mott is head of the Mount Gambier Regional Centre at the University of South Australia and Dr Peter Fairchild is a business lecturer at the centre. Statistics for this article have been sourced, in the main, from McKrindle Research, ABS, Access Economics, and APNA position papers. A full list of references and a copy of the article on which this discussion paper has been based can be obtained by contacting Dr Fairchild on (08) 8721 8913.

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