Nursing staff numbers on the critical list

Australia faces a critical shortage of nurses over the next decade unless governments address dwindling job opportunities, an over-reliance on skilled migration, and a lack of training in aged care. 

With projections that Australia is to be short more than 100,000 nurses in just over a decade, the industry might be in a better position if supply and demand is constantly balanced, say experts. For one sweeping look at the workforce reveals a seeming disconnect between high demand for care and marked shortages in the workforce.

Shouldering the shortfall

Health Workforce Australia (HWA) has projected one of the most quoted statistics in nursing supply: a shortfall of more than 109,000 nurses, or 27 per cent, by 2025.

And it looks like it’s going to be a chain of shortages. As the industry lacks nurses and available jobs, all health services are at risk of being compromised in some way.

HWA also found that mental health and aged care areas are particularly at risk of shortages, fresh nursing graduates have insufficient job opportunities, and the health workforce depends highly on immigration for doctors and nurses.

“Without nationally coordinated reform, Australia is likely to experience limitations in the delivery of high-quality health services as a consequence of maldistribution of the medical workforce, resulting in less accessible services for Australians living in rural, remote and outer metropolitan regions,” said the HWA report.

Lack of reform will also mean inefficiency in the training system and “continued reliance on poorly coordinated skilled migration to meet essential workforce requirements – with Australia having a high level of dependence on internationally recruited health professionals relative to most other OECD countries,” HWA said.

Importing help

Professor Christine Duffield from University of Technology, Sydney (UTS) agrees that Australia’s health workforce has traditionally depended on immigration for doctors and nurses. “We have always relied on overseas workers and will continue do so,” she said.

“We can’t actually stop people from travelling. People will always try and work in other countries,” added Duffield, the director of the UTS Health Services and Practice research department.

She said trends in immigration of health professionals will be constantly evolving. For instance, the Philippines once topped the list of suppliers of export labour to Australia, but more recently it has been the UK and Ireland due to falling employment levels in those countries.

Duffield said many nursing graduates want to work in acute care setting, while others prefer paediatrics and intensive care. Although, this is not always the case, she said, as preference depends on a range of factors.

“Some people like high-activity work, some people like children, while others prefer more time with patients such as in aged or palliative care,” she said.

The problem with trends in nursing programs, however, is that many of the least popular areas are those most in need.

An ageing (nursing) population

The Australian Nursing and Midwifery Federation (ANMF) says it has its own problems of supply and demand.

“Transition to practice or graduate-year programs are mainly provided in public and private acute hospitals, with very limited numbers in areas such as aged care,” said an ANMF spokesman.

“In the aged care sector alone, there is a current shortage of 20,000 nurses to meet the challenges of Australia’s ageing population,” he said.

“It’s imperative that nursing graduates, who after all will be the senior nurses of the future, are afforded the opportunity to obtain graduate programs so we can build a sustainable nursing workforce to replace the current staff retiring over the next 15 to 20 years.”

Not only are bridge programs lacking in the industry, but also placements.

Echoing the HWA report, the ANMF spokesman said Australia’s graduate nurses continue to face limited employment opportunities: “The ANMF thinks it’s disgraceful that graduate nurses can’t find employment in a graduate year, and are forced to work in supermarkets after three years of education and a clear desire to work in nursing.”

The ANMF is concerned about the impact on the safety and quality of patient care that nurses can deliver.

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

The rural route

Similarly, there is a shortfall of nurses in rural areas. Jamie Smith, marketing manager at the Nursing and Allied Health Rural Locum Scheme (NAHRLS), listed nursing demand in different states.

“Since [NAHRLS] began, registered nurses with remote area experience have been in high demand, particularly in the Northern Territory, where nurses find it difficult to take leave as there are no other staff to take their place,” said Smith.

“NAHRLS often receives locum support requests from NSW for theatre nurses, theatre nurses specialising in anaesthesia and nurses with midwifery experience.

“In South Australia, midwives are often in high demand.”

Established by the federal government to support rural and remote health services, NAHRLS provides locum support at a subsidised cost for the purposes of tackling staff shortages due to short-term leave requests.

Smith said NAHRLS is always seeking more registered nurses for emergency, mental health and paediatrics, nurse practitioners and registered midwives. And due to a high volume of applicants, NAHRLS is no longer accepting EN (medication and non-medication approved) and RN (general practice, intensive care, primary health care, remote, and ward) applications until further notice.

Tracey Mesken, marketing manager at the workforce solutions company HealthX, also emphasised the great demand in rural regions. HealthX recruits, relocates, settles and seconds RNs in rural and regional locations. Mesken said that rural and regional aged care providers face chronic challenges in recruiting and retaining skilled staff, particularly registered nurses.

In her summary of the latest Aged Care Workforce report, Mesken noted that problems with short staffing include insufficient number of RNs with specialist aged care knowledge, slow recruitment, and challenging rural and regional relocation.

She said earlier reports suggest that residential aged care RNs are in short supply because most training organisations focus on training graduates for acute care. In fact, aged care is offered as an elective.

“There has also been a long-standing differential in award rates between aged care and acute care sectors, and aged care is seen by many nurses as less challenging than acute care,” she said.

A package of possible solutions

When questioned on possible solutions to the country’s workforce and placement shortage, Professor Duffield said Australia needs to focus on “how to retain our staff and do it better”.

“I don’t think that universities can educate any more undergraduate nurses because there are limitations on availability of clinical placements,” Duffield said.

“The only way we are going to be able to increase our supply is to increase retention. We just can’t keep producing more and more and have them leaving after two and three years, so retention is really critical.”

The recruitment burden may be reduced by maximising retention of existing staff, because as Mesken observed, “The use of agency personnel is expensive and a short-term fix only … The cost of staff turnover is high.

“Upskilling of the existing workforce and succession planning takes time but can make a significant contribution. Running graduate recruitment programs also takes time, but these programs are an important component of the strategic mix.”

She said developing a set of strategies is necessary in facing challenges from skills shortages, and the best answer appears to be “a portfolio of strategies including graduate recruitment programs, skilled immigration, use of web-based consulting to improve productivity, retention of older workers, relocation support programs, training and development programs, and engaging and motivating employees”.

Indeed, with a complex mesh of supply and demand issues, a package of possible solutions serve as a better approach than a single answer.

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