Call for more scholarships

The shortage of palliative care nurses is being felt across the nation, with Queensland and remote areas having the least staff. By Yvonne Luxford

Nurses are the main carers for people who are dying and their “critical role” in caring for people at the end of life has been recognised by the Federal Senate in its report Palliative care in Australia.

The report was the culmination of nearly a year of consultation with the palliative care sector and the wider community about how we can create what all Australians want – a system which helps us to live well at the end of life, and to die well.

Importantly, the report acknowledged nurses have a leading role to play in palliative care teams and there needs to be specific incentives for attracting them to the specialty and adequate education and training opportunities provided to ensure quality of care at the end of life.

The shortage of nurses working in palliative care is well documented. The Australian Institute of Health and Welfare’s (AIHW) report Palliative care services in Australia 2012 showed that out of 277,000 nurses employed in Australia in 2009, there were 5173, or about 1 in 50, working principally in the area of palliative care nursing.

Worryingly, the number of nurses working in palliative care had actually decreased since 2007, even though the overall number of nurses had increased.

The shortage is felt unevenly across states and territories. Whilst nationally, there is an average of 20.5 full-time equivalent (FTE) nurses per 100,000 population, Tasmania and Victoria have higher staffing levels, 31 FTE and 30.3 FTE respectively, whilst Queensland only has 7.9 FTE. Rural and remote areas are also shown to have fewer nurses than metropolitan areas.

We should also acknowledge that the workforce itself is ageing. Nurses working in palliative care are slightly older on average when compared with nurses in the general workforce; 47.4 years compared with 44.3 years.

So how do we ensure that we have an adequate nursing workforce to care for dying Australians?
In an already crowded undergraduate curriculum it can be difficult to introduce more components, but exposure to palliative care at the undergraduate level is vital to cultivate interest among young health professionals. With the numbers of nurses working in palliative care decreasing, we need to inspire young nurses to consider palliative care as an attractive career option.

There is just not enough time dedicated to end-of-life care in our undergraduate curricula, with some universities offering just a few hours over the whole course.

Some improvements have been made; the Palliative Care Curriculum for Undergraduates (PCC4U) is a project which encourages the integration of palliative care training within all health undergraduate and entry to practice curricula. About two-thirds of nursing courses have implemented, or are considering implementing PCC4U, however, as it is a voluntary program its reach is limited.

In addition, we need to ensure that we have enough specialist palliative care nurses working in the sector by making postgraduate study an attractive option. There are a number of postgraduate palliative care nursing qualifications available, but their costs are prohibitive for many nurses.

The competition for scholarships, such as postgraduate Nursing and Allied Health Scholarship and Support Scheme (NAHSS), is so high that many miss out on funding, which can result in frustration to continue with higher education.

Whilst education and training opportunities are vital, there is also a need to look at new and innovative models of care to ensure the future sustainability of our palliative care workforce.

The role of nurse practitioners is one example. Their emerging role in providing a model of care that reflects the changing needs of the health system is evident.

A small number of palliative care nurse practitioners are now accredited in Australia and their roles have been implemented successfully, but not consistently. To date, analysis of the potential for such roles, and the training and support requirements for them to reach their potential, is limited.

The Senate report recommended “medical workforce training include being educated about existing pathways to specialist palliative care” and “the Australian government create an ongoing and dedicated national scholarship fund for postgraduate studies in palliative care nursing”.

These recommendations are testament to the important role that nurses play in palliative care, and we await the government’s response to the report to see if the recommendations will be adopted.

Dr Yvonne Luxford is chief executive of Palliative Care Australia.

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