Hot topics, from this year to next

Three sector stakeholders discuss the year’s biggest issues – and what’s still on the agenda for 2015. 

The Australian public’s continuing confidence in nursing, advances in the nurse practitioner space and better career prospects are amongst the industry’s biggest successes to date, as judged by nurses in a recent survey.

Nurses, who were responding to Nursing Review’s 2014 readership survey, also put nursing education and care at the top of the list. On the flipside, the biggest concerns were employment for graduates, workload, patient-staff ratios and the ageing workforce.

For a more in-depth look at the hurdles and highlights of 2014, as well as what to expect moving into 2015, we asked a nursing academic, a nurse blogger and the head of one of Australia’s largest unions for their thoughts.

Looking back on 2014

Lee Thomas, ANMF federal secretary: The lack of jobs for Australia’s graduate nurses and midwives remains one of our biggest workforce issues. It’s a disgrace that we have a growing shortage of nurses, yet state and territory governments and private providers are unable to provide employment opportunities for thousands of highly educated local nursing and midwifery graduates each year.

We’re seeing more and more graduates from all over the country walking away from the professions because they can’t find jobs, throwing away years of education and only contributing to the shortage in the future.

With an ageing nursing workforce, it is crucial that governments and the private sector invest in employing new graduates. After all, graduates are our senior nurses of the future.

Christine Duffield, professor of nursing and health services management at the University of Technology, Sydney and Edith Cowan University: We have not effectively sold the importance of nurse managers – but particularly nursing unit managers – in retention of staff, job satisfaction and most importantly, ensuring positive patient outcomes. We are likely to face challenges again about why there needs to be a nurse leading each clinical ward or unit. For me the answer is in the title nursing unit manager. They are responsible for ensuring that appropriate nursing care is provided to the patients and they do so through the best use of their staff nurses. They should therefore be involved in the selection, development and allocation of these clinical staff on a daily basis.

We cannot continue to staff clinical units as we have done before. We will never be able to afford (nor is it necessary) to have an all-RN workforce. However, we do need to consider the best use of registered and enrolled nurses and, more importantly, how we best use advanced practice nurses and unregulated workers like assistants in nursing.

We may [also] need to consider regulation of assistants in nursing. Doing so will provide a degree of safety for the general public in terms of the standards of training and practice that can be expected.

Laurie Bickhoff, RN and founder and editor of the blog Defining Nursing: One of the biggest challenges we need to address is the ongoing violence many healthcare workers face in the line of duty. We need to be aware violence extends past the emergency department and is an issue nurses face every day in many wards across Australia. This is not a new problem. For years, we have approached this issue with zero-tolerance campaigns and increasing penalties for those involved. However, it’s time we acknowledged these approaches are not working.

We need to look at what is driving our patients to violence. Is it an organic or traumatic cause – for example, dementia, delirium, drugs, alcohol, brain injuries etc.? Or is it caused by the frustrations of dealing with an over-stretched healthcare system that isn’t meeting their needs? The cause of the violence should guide us in how to prevent and reduce these instances.

Big wins for nursing in 2014

LT: “We were heartened that the government finally agreed to help support a new 100-bed Ebola treatment facility in Sierra Leone. [We] had been calling on the government to get more involved in the international relief effort in West Africa so we were pleased it listened and acted, but there is still more to be done in West Africa and it’s now time Australia showed true leadership.

As the federal secretary of the ANMF, I was personally so proud that 350 nurses from across Australia told us they were ready and willing to volunteer to join in the Ebola fight.

Our members in Victoria have also welcomed state opposition leader Daniel Andrews’ pledge that he will legislate safe patient ratios if he is elected premier next year.

This [would] mean nurses and midwives would never have to fight for ratios again. Mr Andrews has promised to work with the ANMF with a view to expanding and improving patient ratios in the future. This would be a first for Australia’s public hospitals and aged-care settings.

CD: I think the general public has a greater understanding of the importance of having sufficient staff to provide care to patients and this is due in no small part to federal and state industrial campaigns that have emphasised this point. There is probably less recognition about the importance of having the right mix (regulated vs unregulated workers) of staff on clinical units to provide the care.

LB: I think one of the biggest wins for nursing has been the growth of #FOANed (free open access nursing education) and the connection of nurses from all over the world on social media. The positive stories and impact of nurses on social media now far outshine those who use it inappropriately.

Globally, nurses are creating communities, sharing research, advice and resources through social media. Nursing education is now making use of these tools and nurses are connected more than ever. Nurse bloggers are telling their stories and sharing how amazing a profession nursing is. I think this will continue to grow in 2015, and I’m looking forward to seeing it.

Areas of focus for health in 2015

LB: Our healthcare system is already stretched and with our population ageing, it will need to stretch even further. However, we need to look beyond focusing only on increasing bed numbers and putting more money into health. We need to make more efficient use of our current resources.

[In addition], we need to look at our primary healthcare system, and look at increasing health promotion and prevention and better management of chronic diseases in our communities. Resources used in these areas will not only save the healthcare system money in the long term, but also, more importantly, improve the quality of many patients’ lives.

CD: We need to de-emphasise the role hospitals play in healthcare and ensure there are alternatives. The role of primary care and the use of practice nurses and nurse practitioners in maintaining positive health outcomes must be expanded.

The nursing workforce is aging (as is the general public) and should they retire they take with them significant corporate knowledge. If the retirement age increases to 70 we will need to consider how to use these staff appropriately. Whilst rewarding, nursing is also a demanding job both physically and emotionally. As a profession and industry we need to consider how to maintain older nurses in the workplace with an appropriate workload or an appropriate position that takes into consideration their extensive experience and expertise.

LT: Without doubt, Mr Abbott’s attack on Australia’s successful system of universal healthcare must be stopped.

The government’s planned introduction of a user-pays scheme for basic, everyday health services like GP visits, will only shift the cost burden onto individual patients at a time when Australians have some of the highest out-of-pocket health costs in the world.

In fact, there is no existing evidence that any of Mr Abbott’s planned co-payments will achieve savings, or importantly from our perspective, improve health outcomes.

What’s on your agenda for 2015?

CD: Defining what we mean in Australia by advanced practice nursing; how we define their roles and activities and in what sort of roles employers can most effectively use these advanced practitioners to [add value] to the patient experience.

[Also], the health of nurses.

LB: In 2015, I plan on continuing my focus on nursing leadership and working to increase the understanding and recognition of the many roles nurses play in health.

I believe we need to rethink our definition of leadership in health, recognising that leaders are present in all levels of our system, not just in higher positions. We need to work on our succession planning within nursing and start developing the leadership skills of our early-career nurses, so when the time comes, we will have nurses with the knowledge and abilities to fill some of the very big shoes our current nursing leaders will leave behind.

I would like to see a better understanding by the general public, as well as other health disciplines, of the work nurses are involved in, the quality of the care we provide and the high level of responsibility we now carry. We need better recognition that nurses do not just tick boxes. We are continually assessing, initiating treatments and providing essential cares. We are not easily replaced.

LT: The ANMF will continue in its fight to save Medicare.

Medicare means all Australians can still visit their doctor without having to find the money to make a co-payment in order to access healthcare. We say that if you need to go to a bulk-billing GP then you shouldn’t have to make a co-payment for it.

The ANMF is concerned this would blow out waiting times and impact nurses who are already struggling with high workloads.

Nurses and their patients will suffer. That’s why we will continue to lobby senators to reject the planned changes in Mr Abbott’s devastating health budget.

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