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Apple Isle feels the squeeze

Amie Larter talks to Neroli Ellis about the state of nursing in Tasmania.

What were the main challenges for nurses in Tasmania throughout 2011- 2012?

The significant budget cuts in health in this financial year resulted in the closure of over 100 acute hospital beds, 280 nursing positions slashed, theatres closed, mental health and family child health service and access reduced resulting in major issues with bed block and subsequent ambulance ramping and 25 per cent elective surgery cancellations.

The pressures were on all major Tasmanian hospitals which were operating at about 100 per cent occupancy, which is unsustainable for safe patient care over the long term. This resulted in ambulance ramping, re-admissions, and increasing complexity of medical illnesses due to delays in elective surgery and delayed diagnosis of cancer, which are some of the symptoms demonstrating the poor state of our health system in Tasmania.

Front-line nurses wore the brunt of most of the effects of the budget cuts and yet continued to do their best to deliver quality services. All sectors of primary health were also reduced with cancellations of mental health and family child health appointments, and community nursing access reduced. Nurses and midwives received enormous public support. The federal Minister for Health, Tanya Plibesek, announced a $325 million four-year package, which if allocated to the crisis areas would have made a difference.

Concurrently, nursing graduate employment was cut by 40 per cent of pre-budget numbers (FTE) despite the Health Workforce Australia projections of shortages within three years if all graduates were employed. Tasmanian nurses and midwives, on average, are the eldest in the country and the impending retirements will create added pressure in the near future.

There was extensive coverage of the staff shortages, funding cuts and extensive work hours for nurses. What plans need to be put in place to ensure it's not the same throughout 2013?

The outcome of this short-term strategy is evident now with nursing roster shortages, reliance of casual staff and ongoing fixed-term contracts and job insecurity and many of the 280 nurses who lost their jobs last financial year have already moved their families interstate.

The ongoing delay in the implementation of the new nursing career structure due to budget cuts is also affecting recruitment with a lack of recognition of the value of nursing and midwifery.

The Australian Nursing Federation (ANF) will pursue the classification reviews and implementation of new classifications through ongoing conciliation in the Tasmanian Industrial Commission and pursuit of the finalisation of the working party for a new career structure for community nurses.

The human resources processes must be improved and the ANF has recommended implementing KPI's to improve the recruitment timeframe, which is unacceptable at the current four months for a permanent appointment.

The graduate nurse campaign will continue to ensure our graduates can stay in Tasmania for a career pathway.

The ANF will be monitoring and intervening in workload issues through the local workload committees and ensuring that permanent employment is offered to assist in retention.

How did the state government respond to the issues, and was the response satisfactory?

The government made a policy decision to cut the health budgets and reviewed the forward estimates to maintain current cuts without proposed additional cuts this financial year.

However, the cuts remain unsustainable and despite the additional federal funding, which only offers less than $8 million for the state elective surgery per annum, access to both acute and primary care will continue to be compromised for Tasmanians. The government's response has not been satisfactory and the preliminary findings of the Legislative Council inquiry have determined that the community is being adversely affected.

Coming into an election year, what will be the main issues on the agenda for nurses and the ANF in the state?

1. Development of a statewide health strategic plan. Many expensive consultant reviews have been undertaken over the last 10 years but yet the health system continues to lack direction and strong leadership. Regional parochialism has to be removed and services offered based on a statewide plan.

2. Appropriate resources to implement this plan must be allocated in the relevant budgets.

3. Implementation and funding for the new nursing career structure, which must include models of care recognising the scope of practice of all levels of nurses including funding for nurse practitioners, nurse-led discharge, walk-in clinics and nurse educators.

4. Development and commitment to a Tasmanian nursing and midwifery workforce plan and graduate nurse program expansion.

5. Funding to reopen critical services in health and ensure Tasmanians have equitable access to the universal health system.

What is your vision for nursing in Tasmania?

Strong nursing leadership to advocate and lead and promote our profession forward.

Support for research and ongoing education to enable nurses and midwives to work at full scope of practice, and value and recognition of the great innovation that continues despite the hardship of the system due to the budget cuts.

Clinical information systems to support our practice and enable accurate data to enable practice improvements.

The ability to deliver quality care that is supported by the appropriate skill mix and support staff re-employed to enable nurses and midwives to be relieved of the non-nursing duties, which continue to be absorbed by nurses particularly as positions are removed through budget cuts.

A dynamic system to enable positive change led by nurses and recognising those nurses in clinical leadership positions. Support and recognition for nurses and midwives without the constant fight through the obstructions of the bureaucracy.

A sustainable nursing workforce plan to be developed and supported to avert the predicted workforce crisis.

Aged care funding to ensure nurses and care staffing levels and skill mix to provide quality care to our ageing demographic.

Neroli Ellis is the Tasmanian branch secretary of the Australian Nursing Federation.

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