Setting the agenda

As a federal election looms, it's time to bring major nursing issues to attention. By Louis White

On the eve of the recent Western Australian state election, premier Colin Barnett caved in to nurses' demands for a 14 per cent pay rise over the next three years.

Barnett had been steadfast in his denial, but backed down after a sustained campaign of newspaper advertisements and protests by nurses throughout the state. The Australian Nursing Federation ran a well-orchestrated campaign.

The 14 per cent increase will cost the WA taxpayers an estimated $71 million, with the re-elected premier none too happy about having to give in.

"When you are faced, as premier, with clear professional advice that lives could be lost - and they probably would be - I think I had a responsibility to act on that," Barnett said at the time.

The truth of the matter is that Barnett inherited a problem that has been passed from state government to state government around Australia. Nurses have been underpaid for a long time, and the ramifications around the country are being felt.

The issue with the state of nursing in Australia is important and one that won't go away no matter whether there is a federal election looming or not. It just so happens that there is a federal election in September.

ANF federal secretary Lee Thomas aims to ensure the issue is on the election agenda.

"As Australia's largest health union, the ANF continues to call on all sides of politics to ensure that health and particularly safe patient care is a priority at the upcoming federal election," she said.

"That's why we will be seeking urgent representations with all major parties, as well as key independents over the coming months, to put our health platform to them and asking that they commit to the ongoing delivery of safe patient health care for the Australian community."

Thomas said the ANF has a health platform of significant issues that must be addressed as part of the federal campaign, including the predicted shortage of 109,000 nurses and midwives by 2025.

The ANF claims that in aged care there is a shortage of 20,000 nurses and that there is the continued underemployment of nursing graduates.

The ANF is also campaigning for the reimbursement of HECS fees as an incentive for nursing graduates who relocate to areas of need such as rural and remote communities; on behalf of experienced nurses and midwives losing their jobs due to 'slash and burn' budget cuts across the states and territories; and for the right staffing levels for nurses and midwives to ensure the delivery of safe care.

"These are serious issues which impact the ANF's growing 225,000 membership, as well as the whole of the Australian community," Thomas said.

"As a major stakeholder in the health, aged care and the industrial and professional arenas, the ANF will be working hard throughout this election campaign to ensure all parties listen to our concerns and commit to safe patient care this election."

The nursing shortage in Australia is only growing. It is an area which needs to be addressed on a federal and state level, and one that the ANF is campaigning to highlight, especially in the area of nursing graduates not being employed.

"Even though we have a well-documented prediction of a shortage of nurses, as high as 109,000 nurses by 2025, the non-employment of graduate nurses by state governments across the country is staggering," Thomas said.

"Almost every state is affected, with Queensland employing only 10 per cent of graduates, while in Victoria more than 800 graduate nurses will be without employment.

"At the same time, we have seen highly trained nurses and midwives sacked and the recruitment of graduates stopped, as part of so-called savings to state health budgets.

"Billions of dollars have been slashed from public health systems across Australia and it is nurses and midwives and the people they care for, each and every day, who are suffering as a result of it.

"The ANF believes these cost-cutting exercises are nothing but a direct attack on nursing, midwifery and care staff and their daily working conditions across the public health system, and we're concerned these cuts will dramatically impact the amount of safe, quality patient care nurses and midwives can deliver.

"The federal government, along with state and territory governments, must finally accept that the growing shortage of nurses and midwives is everyone's responsibility if we are to ensure a sustainable heath workforce in the future," Thomas said.

Dr Mary Casey, from the Casey Centre in New South Wales, which combines nursing, education, training and counselling services, believes that an overhaul of the system is essential in order for everyone to work in harmony and more systematically.
"Simplifying the whole system is critical," she said. "At this point in time it is not just confusing but impossible to understand. There are too many departments, conflicting guidelines and rules. Those involved need to go back to the drawing board and include people at all levels -beginning at the grassroots - and from every area of nursing.

"There is currently a lack of insight into the funding and where it is actually wasted. Wages need to be examined and streamlined for registered nurses, enrolled nurses, assistants in nursing carers, attendant care workers; again, consultation needs to be with all those involved," Casey said.

She believes assistant nurses can play a bigger role if it is accepted that "a proportion of the work that registered nurses have done in the past can in fact be done by assistant nurses".

"Train more assistant nurses to carry out those duties and utilise registered nurses to suit their expertise. Wage changes need to be in conjunction with funding as they are not in line with each other and in many cases the funding does not match the industrial relation requirements."

Professor Julie Considine, director, Eastern Health, at Deakin University's Nursing and Midwifery Research Centre, believes that although there is a lot of talk about a nursing shortage, she is not quite sure it exists. She concedes, however, that interns can struggle to get work.

"There are nursing graduates who are unable to get employment in graduate year programs and there are health services in Victoria who have very few nursing vacancies and are winding right back on employing casual nurses on their nurse banks."

But there are nursing problems within every state of Australia that have been present for many years. It is not just pay - safety, funding, workloads and genuine commitment from governments are also issues.

Mike Smith, a clinical nurse consultant in the HIV Outreach team in the NSW Health Service, believes that pay needs to increase in accordance with responsibilities.

"Workloads and responsibilities continue to increase and yet wage [increases] in NSW are fixed at 2.5 per cent with yearly increases," says Smith.

"Funding for wages and improved conditions is vital to recruitment and retention of nursing staff.

"We need a genuine commitment from governments to improve wages and conditions. If these improve, nurses are less likely to leave the profession for other professions and overseas work.

"Also, improved wages and conditions should improve both sick leave and work-related stress.

"Further research about nursing practice will support arguments about the productivity and positive health outcomes that nurses can provide."

Smith is adamant that reduced funding helps no-one and leads to more errors within the profession due to staff shortages.

"Nursing is also given a lot of lip-service by politicians about how vital we are, what a good job that we do, but this is never represented in work and conditions," he said. "Our entitlements are often less than other public servants and other health professions.

"This is despite the fact that we can be criminally accountable for our work and we are heavily regulated by our registration body. The media always identify nurses if ever patient care is poor and it is never reported that the health area may be under high workload and stress. No-one ever publicly reports on why errors occur," Smith said.

Another important area of nursing is the role that academia can play. Nursing is a popular option for students and there are now more options for graduates in terms of post-graduate courses and career opportunities.

The role of the specialist nurse is set to grow, but academia must work in partnership with other government and private enterprise health bodies.

Professor Carol Grech, the head of the Nursing and Midwifery School at the University of South Australia, says that the higher education sector "must work in partnership with government health departments to determine workforce numbers and the skill set nurses and midwives need for future practice models in a sustainable health system".

"We know that many programs still prepare graduates for work in traditional hospital settings, but the growth area for the future health workforce is in primary practice.

"With an ageing population, nurses can play a lead role in coordinating and delivering primary health care services in the community, services that improve health outcomes in cost-effective ways.

"Nursing programs nationally meet the accreditation standards identified by the Australian Nursing and Midwifery Accreditation Council so we need to continue to work collaboratively to ensure that programs are producing work-ready graduates with the knowledge, skills and attitudes to deliver high-quality health services.

"Government needs to ensure that the jobs are there for graduates and working conditions are such that they want to remain in the profession," Grech says.

She believes that addressing the nursing shortage in rural areas should be a main priority for governments in every state and territory.

"To some extent, it depends on the region," she says. "However, rural Australia, in particular, has a significant shortage of experienced nurses.

"Nurses working in rural Australia, often in areas with no local medical officer support on site, need to be highly skilled to manage the vast array of conditions that people can present with in these settings.

"Often there will be only one registered nurse working in a rural or remote community and this places considerable demands on these nurses who may be on call 24/7, which can often lead to burn-out," Grech says.

Casey agrees: "Nursing shortages have been identified nationally and internationally for the past 30 years and therefore what is in place is not working ... it is worse in the rural areas."

As the build-up to September's federal election intensifies, other issues will be thrown into the spotlight. But the problems facing nursing won't disappear. The ANF will only grow stronger, and its campaigns longer, to improve the conditions for nurses around the country.

It is time for all parties to gather around the operating table before it is too late.

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