The role of the disability nurse is under threat due to low wages and a poor perception amongst the community coupled with proposed cuts to salary benefits by the NSW government.
Disability nurses play a vital role in the community but sadly numbers are decreasing. The numbers in NSW have decreased from 3005 in 1996 to 2510 in 2001 to just 1811 in 2012.
"While it is difficult to identify them specifically across the country as all nurses are grouped under disability and rehabilitation nursing, which are two distinctly different areas of nursing, they both play a key role in our society," says Linda Goddard, president of the Professional Association of Nurses in Development Disability Australia (PANDDA).
"The disability nurse is an expert in the healthcare needs of a vulnerable group of people in the community who may experience a wide range of healthcare needs.
"These nurses have always been perceived to be the 'poor relation' of nursing despite their ability to provide holistic nursing care to people with the most complex and chronic physical and mental healthcare needs.
"The lack of recognition of the nurses skills and expertise, reduces the confidence of the nurses as they move out of nursing all together, which anecdotally we know has occurred in a number of states across Australia (Victoria, South Australia and Tasmania). Therefore they are not recognised and therefore not respected and this has been a huge loss to a population with enormous healthcare needs."
Award conditions targeted
This situation is set to be compounded in NSW with the state government applying to the NSW Industrial Commission to change 98 awards for public sector workers, including more than 1000 nurses who assist people with disabilities and those in aged care facilities.
A series of long-held conditions, including an annual leave loading of 17.5 per cent, will be cut along with penalties for all shift workers for staff stationed in remote areas.
The two nursing awards under attack are the Nurses' (Department of Family and Community Services - Ageing, Disability and Home Care) (State) Award 2011 and the Crown Employees Nurses' (State) Award 2011.
"Nurses and midwives understand this is the first step towards ripping away the important wage and condition improvements, won by the NSW Nurses and Midwives Association in recent years, which are helping to maintain nursing and midwifery as attractive career options," says Brett Holmes, NSWNMA general secretary.
"The NSWNMA is fully across what the government is trying to do with this application against public servants and it will vigorously oppose this unjustified attack on the income and rights of NSW wage and salary earners, including nurses and midwives in disability services."
Ageing, Disability and Home Care (ADHC) nurses working under the Department of Family and Community Services are the first nurses to face sweeping cuts to their awards by the NSW government.
Disability nursing services, which now struggle to find and hold sufficient staff, face an "approaching tsunami" from the growing number of disabled people with complex health needs, warns registered nurse Gary Dunne.
Dunne has worked for 20 years at ADHC's Complex Health Unit, formerly the Grosvenor Centre, providing long-term accommodation and short-term respite care in the Sydney suburb of Summer Hill.
Disabled living longer
Medical knowledge and technology have prolonged the life expectancy of many disabled people whose health problems multiply and worsen as they age.
"The need for nurses in disability services is growing, not declining as was once predicted," says Dunne, secretary of the ADHC metro south branch of the NSWNMA.
"The number of medically frail clients with support needs keeps increasing. From gastrostomy, tracheostomy or complex epilepsy management, through to palliative care, these people need qualified nurses to keep them alive and to enable a decent quality of life."
Research has shown that the disability nurse requires greater skills than the general nurse in the area of assessment due to the likely inability of the person to communicate their feelings in a way that could be readily understood.
The decrease in numbers of a key group of professionals with background knowledge and clinical experience has significant implications for the ongoing healthcare of people with a disability.
"Worldwide research has shown that the changes in the education of undergraduate nursing students, and the lack of education for all health disciplines has resulted in an inability to provide appropriate healthcare to people with disabilities and their families living in the community," Goddard says.
She says it is becoming harder to recruit staff for positions because of changes in university curriculums.
"It is probably harder because of the erosion of disability specific content in the supposed 'comprehensive curriculum in NSW nursing programs and the removal of clinical placement in a number of universities.
"Although work is currently in progress to try and increase placement in the disability field in NSW, in other states there may not be any content related to the person with intellectual/physical disabilities. Nurses in many places feel that they do not have a role to play regarding the health of people with disabilities, they believe wrongly that this area is covered by specialist nurses, this places the person with a disability at risk.
"Nurses make up the largest group of health professionals and yet the majority of them have no idea how to provide healthcare to someone who might have a disability (specifically intellectual disability)."
Goddard believes that the curriculum content in Australia needs to contain information specific to people with intellectual disabilities and tap into the knowledge that currently exists within the workforce.
"We need to harness the expertise of the current disability nurses before it completely disappears, then people with disabilities will receive the care they are entitled to," she says.
"We need to develop content to integrate into all curricula across Australia, however, it will take a number of years to actually see the outcomes of nurses graduating with the skills and knowledge. Therefore we need to respect, value and utilise the skills, knowledge and expertise while we still have it."
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