The outcome of the upcoming federal election is uncertain, but one thing we know for sure is neither side of politics can deliver on their promises in health and aged care without nurses.
Take for example Labor's pledge to fund 50 urgent care clinics across the country, or the commitment from both parties to realise 24/7 nursing coverage in aged care following the aged care Royal Commission's recommendations. These are all good intentions the Australian College of Nursing (ACN) supports, but with a predicted shortfall of nearly 100,000 nurses by 2030, the numbers aren't adding up.
That's why ACN is calling for a bipartisan plan to address the growing workforce crisis - a plan that is nurse-led and reflective of the lived experience of nurses across the country.
It's no secret nursing workforce challenges existed prior to COVID-19, but over the past few years we've increasingly heard from exhausted and burned-out nurses frustrated with our disjointed healthcare system, inadequate pay and poor working conditions. Nurses are no longer prepared to tolerate feeling undervalued and underappreciated given the significant contribution they have made - and continue to make - towards keeping Australians safe.
For example, along with the stress and additional work that came with the pandemic, nurses around Australia have reported higher than normal levels of occupational violence over the last 20 months.
This is on top of already unacceptably high levels when compared to other professions: In 2018, ACN published peer-reviewed research into workplace aggression in Victoria and found 96.5 per cent of nurses and midwives had experienced some form of aggression. On a national basis, 60 per cent of female nurses and 34 per cent of male nurses have additionally reported episodes of sexual harassment on the job.
The high rates of abuse sustained by the nursing profession have deep, lasting impacts and many members of ACN report symptoms of trauma and post-traumatic stress, as well as the moral injury sustained from not being able to provide the care they know consumers deserve.
As a result, I am concerned nurses will leave the profession in droves. In the 2020 Aged Care Workforce Census it was reported 29 per cent of the direct care workforce had left their employment over the 12 months from November 2019 to November 2020, and there were almost 10 000 vacant roles in aged care alone.
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Addressing this mounting workforce crisis won't be easy but it must be done by both parties if they hope to reform aged, primary and tertiary care. It cannot be a bureaucratic exercise. Rather, it must be led by the professionals who have worked with the issues and know what is needed for sustainable solutions.
The Australian College of Nursing suggests five key strategies to kick off a process of renewal, noting none are silver bullets, but rather common sense investments in a sustainable workforce that are long overdue.
Firstly, as one of the major providers of the Aged Care Transition to Practice Program, ACN has witnessed first-hand how investing in such a model for graduate education in aged care and gerontological nursing can and must work. Now we need to focus on scaling up this initiative in cooperation with federal and state stakeholders.
Secondly, we need more work visas for overseas-trained nurses. Skilled nursing migration enhances opportunity, diversity and care delivery to those living in Australia. All nurses deserve to have a choice about where they work, and we should encourage our foreign colleagues to exercise their agency and work in Australia if they meet the necessary criteria.
Thirdly, we need additional support for nurses' mental health and wellbeing. As we begin to emerge from the pandemic the full scale of this trauma is becoming evident, and its effects will be long-lasting. Our approach needs to touch every facet of nursing, from education to the workplace, and down to the individual level.
Fourthly, we need additional funding for refresher courses for retired registered nurses and enrolled nurses, as well as non-clinically active registered nurses, allowing them to supplement the workforce across Australia. Additional funding is also needed for bridging and re-entry courses so that nurses who are no longer registered can re-join the workforce. This needs to be coupled with job certainty and tangible benefits - especially in rural and remote areas.
We also need to pay our nurses fairly for the work they do. We can't just rely on the emotional investment and personal responsibility that our nurses take every day while caring for our most vulnerable citizens.
And finally, we need to change outdated funding models which prevent nurses from accessing Medicare item numbers. Specialist registered nurses and nurse practitioners have enormous potential to meet workforce shortages and provide high quality care in a range of areas such as aged care and primary health care settings - including Labor's proposed critical care clinics.
ACN is recommending the incoming government hold a post-election national summit to discuss these five important strategies and develop an action plan for implementing them.
Most importantly, nurses must be at the centre of these discussions, working with policy makers every step of the way. Without such an approach, the workforce crisis will only deepen and undermine the ability to deliver the meaningful health reform Australians deserve.
- Professor Kylie Ward is the chief executive of the Australian College of Nursing.
