Advocate on a higher level

The role of the nurse has probably never been more important in society than today.

An ageing population combined with record hospital admissions and cuts to health budgets around the country, topped with pressure to discharge patients as soon as possible, means nurses – as the primary source of information and care for a patient – continue to reinforce their importance.

Yet nurses can, perhaps, be greater advocates for their profession and for their importance in improving outcomes.

Whilst nursing associations play a strong hand pushing for improved conditions and a greater scope of practice, perhaps a step before that is where nurses can push their cause to raise their own profile and ensure that they are involved in all major healthcare decisions around the country.

“When you are in the profession, no matter what your role, you are never out of it,” Dr Frances Hughes, Queensland chief nursing and midwifery officer, says. “That means what you do in and out of work affects the profession and the public has a great deal of trust in nurses. I believe promoting the nursing profession is multifaceted. It is a combination of individuals, associations, unions, standards, qualifications, universities and everyone involved.

“The key, I believe, to advancing the profile of the profession is to be involved in all strategic healthcare decisions at federal and state government level. That is essential. There are so many healthcare issues facing Australia today and in the future that nurses need to communicate and demonstrate the difference nursing makes to quality healthcare.”

The Australian Institute of Health and Welfare states that in 2013 there were 296,029 nurses and midwives employed in Australia, with 40 per cent aged 50 or older. Nine out of 10 employed nurses and midwives worked in a clinical role and 23,458 midwives were employed in Australia.

In Queensland alone, nursing represents 61 per cent of the Queensland Health clinical workforce and 36 per cent ($2.63 billion) of total employee expenses.

In a presentation to Queensland Health authorities, Hughes outlined that “a higher proportion of registered nurses in the mix of licensed care providers has been associated with a shorter length of stays and lower rates of shock and cardiac arrest, urinary tract infections, pneumonia and respiratory failure among medical and surgical patients”.

Another study, released in 2007, revealed that “in-patient deaths could be avoided by increasing the hours of care provided by registered nurses”.

By increasing the number of entry points to care, co-ordinating care and assisting patients in navigating the healthcare system, RNs reduce waiting times and provide timely access to care.

“Nurses are not just an add-on,” Hughes says. “We need to challenge the system and identify problems and address them. We also need to get the community on side to continually promote the role of nurses. First, we start by educating them about healthcare and by doing this we could prevent so many more people from entering the hospital system.

“We are best placed to support diseases such as diabetes, mental health, heart problems and much more.”

The Australian Institute of Health and Welfare report, Hospitals at a glance 2011–12, revealed that $49.7 billion was spent on hospitals in 2010–11, about 3.7 per cent of Australia’s gross domestic product, or roughly $2227 a person. And that hospital spending had increased faster than inflation, at 5.4 per cent each year between 2006–07 and 2010–11.

The Productivity Commission report An Ageing Australia: Preparing for the Future, released in November 2013, states that Australia’s population will reach 38 million by 2060, and the population aged 75 and above is set to rise by more than 4 million by 2060 – they will make up 14.4 per cent of the population.

The report clearly states “productivity gains can allow future health needs to be met at a lower cost”. It also states workforce demarcation and regulation under the current arrangements could inhibit efficient skill mixes and create unnecessary regulatory burdens. Another relevant point is how preventative measures could improve the health of the population.

Some broad areas where productivity improvements may be feasible that would alleviate budget pressures are: the use of the health workforce and existing technology; hospital management; procurement practices; and the way elements of the health system interact in order to achieve cost-effective treatments and a cost-effective sector overall. Financial incentives and regulations, and the institutional arrangements associated with them, often underpin potential improvements in the sector.

In an article published in The Lancet in September 2013 titled, “Caseload midwifery care versus standard maternity care for women of any risk”, it is revealed that not only is caseload midwifery safe and effective, but it could save the Australian medical system more than $500 per birth. In Queensland alone, that could have saved $76.8 million in productivity and efficiency in 2012–13.

“We need to create a space to promote the profession,” Hughes says. “We now have careers set up through university qualifications and hospital promotions but we need to outline strategies and solutions to the numerous healthcare problems affecting the country.

“We need nurses to understand and study political science, leadership, and business so they know how to hold down senior positions and use their influence.

“Nurses are often seen as looking after themselves and we need to be careful about that because we are here to serve the community and that’s what we do for the majority of time,” Hughes continues. “It is very important to promote the depth and range of skill nursing provides to patients in and out of hospital. We provide vital healthcare and we need to get the support of the community more to help push our case.”

David Stanley, associate professor in nursing and midwifery at Charles Sturt University in Bathurst, believes more nurses joining professional organisations will go a long way towards raising the profile.

Sometimes, he says, it can even be more basic than that.

“The two male nurses on the TV show The Amazing Race are doing a good job,” Stanley says. “So getting more nurses in the media – in a positive light – would be great.

“The nurse on The X Factor is also doing a good job of increasing the profile of the profession. Having more nurses join professional organisations would be helpful, too, as long as they became active and spoke out or actively engaged in political issues such as supporting nurses staying in higher education and limiting calls to move nursing education back into the hospital or to further advance nursing into TAFE.

“Nurses need to further support the professional bodies that govern nursing, as well as recognise other health professions, but keep hold of our own unique professional perspective. It is important, significant and unique and nurses should be proud to be part of the history we are making.”

There is no doubt cultural barriers still exist when you talk about the role of nursing. Doctors have always been revered in the profession. There has also been a reluctance in healthcare to allow nurses to increase their duties and take on some of the tasks that would not only free up more of doctors’ time, but also allow patients to feel more content.

“Nurses need to listen more, learn to be bold and question or challenge outdated or archaic practices,” Stanley says. “They need to put their values on show, act on them and practise in accord with the values long held significant in the nursing profession – care, compassion, clear communication, empathy.

“They also need to be there, be present and speak up for vulnerable and injured people and promote the right people have to [make] choices about their health and bodies. When I was a hospital manager and had to deal with complaints, they were mostly about nurses not communicating clearly, not feeling that the nurse listened or because they thought the nurse simply did not care.”

Another way nurses can improve their profile is to nominate one another for awards.

“Nurses need to speak positively about nursing, find the value in what they do,” Stanley says. “Remember that each nurse can influence the history and life of every person, patient, family member and relative that they come in contact with.

“Nurses are there when things are at their worst, when emotions run high, when there is loss, grief, pain, disappointment, fear and when people grow from their challenges. Nurses are often the privileged few who help bring meaning into people's lives or help them find the strength and courage to go on. Nurses can make a difference by just being there, holding a hand or offering a friendly ear. Nurses should remember the legacy and history of the profession and live up to the values that it holds dear.”

Professor Jill White, dean Sydney Nursing School at the University of Sydney, says a broad approach to increasing the recognition of the work nurses do is imperative for the profession.

“It has to be an industry push to broaden and highlight the great work nurses do within the healthcare system for it to be truly recognised,” White says. “There are many issues facing nursing today, not the least that they need to be financially compensated for the work and to be actively lobbying state and federal governments to ensure that their voice is heard.

“One key is to ensure community-based work is not only recognised but received favourably by state and federal governments as essential to an ongoing healthy society. The more nurses align with consumer health groups, the better it will be for the profile of the profession.”

The voice of nurses needs to be acknowledged, and so does the work they do. It’s imperative for maintaining the wellbeing of Australian society.

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