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Australia hasn’t run out of hospital beds — we’ve run out of nurses

Former Chairman of the Federal AMA and Deputy President of the NSW Medical Board, Dr Peter Arnold, writes:

Although John Deeble and I were, literally, on opposite sides of the table when Bill Hayden was planning Medibank (Mark I), our views have, over the decades, gradually moved towards one another.

We are agreed, in private conversation, for example, that a continuing fault of Medibank I and its successors has been the absence of a ‘brake pedal’ to dampen the accelerated use (and abuse) of the almost free service.

I have done my bit, on behalf of the AMA, in trying to reduce ‘overservicing’, now known by the more accurate term which I suggested – ‘inappropriate practice’.

Now I cannot help but agree with John’s views in the Sydney Morning Herald on April 14 (“Hospitals plan is a vague prescription“).

However, while his views are based on the ‘dismal science’ of Economics, my agreement is based on something more realistic.

Australia has run out of nurses.

There is, Mr Rudd, no ‘shortage of beds’.

There are beds aplenty, but in closed wards.

The wards are closed because of the shortage of nurses.

The ‘politically correct’, allegedly ‘pro-feminist’, transfer of nurse training from the public hospitals to the universities has depleted our hospitals of young people willing to learn ‘on the job’, while lending a helping hand in caring for patients.

The ‘career paths’ of many nursing university graduates leads away from the bedside, to administrative office jobs and, via Masters and Doctors degrees, to further theorising of what is, in essence, a hands-on, caring profession.

Work which used to be done by trained ‘registered nurses’ is increasingly being done by ‘enrolled nurses’.

Work which used to be done by ‘enrolled nurses’ is increasingly being done by ‘nursing aides’.

Family members are now stepping in, as in most third-world countries, to help care for hospitalised relatives.

No volume of words about ‘bed shortages’, and no quantum of money spent on hospitals, will alleviate the shortage of nurses.

Unless we find out why young people do not want to nurse and unless we make nurse education and nursing careers attractive once more, the waiting lists will simply lengthen.

Comments 14

  1. Holden Back says:

    ” Unless we find out why young people do not want to nurse and unless we make nurse education and nursing careers attractive once more ”

    A rhetorical question, surely? I assume your last paragraphs meant to read:

    Nursing is a difficult, sometimes dangerous, low status job, frequently dealing with people and situations the rest of society finds distressing or disturbing, and it’s not particularly well-paid. If you can make the entry marks for a nursing degree, why not do Commerce or Finance, unless you are dedicated to the idea of nursing? If you do better, why not become a doctor?

    Nursing used to be a job for young women prior to marriage, and few who stayed on after marriage, or chose not to marry to manage this apprenticed and junior labour force. This was good supply of strong young backs and experienced heads to direct them. People didn’t work continuously on the hospital floor for thirty years. What was attractive to women whose expectations were of motherhood was partly the camaraderie and taste of independence of the nursing life, an instruction in the practicalities of dealing with ill children and family, and apossible professional life to return to after children.

    It’s the privilege of a blogger to be able to articulate those things which would have you howled down as a dinosaur, but that’s the reality of falling nurse numbers. If you can solve that little problem of a changed society and educational and working expectations for women, you’re well on the way.

  2. MARN says:

    Don’t worry Peter, Keven has promised 6000 new doctors. There are plenty people out there like yourself who know what nurses do/should do/shouldn’t do, so I am sure the new doctors will be able to fill the gaps to lend ‘a helping hand to care for patients’ once they are taught these things. Just make sure they are not ‘politically correct’, or allegedly ‘pro-feminist’.
    And you might want to look at the possibility that the “nursing shortage” is an excuse for enaging less trained (or not trained) generic workers who are cheaper. It was reported last year that a large number of new nursing grads couldn’t get jobs in public hospitals in NSW some of which was due to substitution. Be careful the same doesn’t happen with new doctors being bumped off by medical assistants.

  3. Margi Macdonald says:

    That’s right Dr Arnold; when the children are sick, or behaving badly, or failing to achieve, blame it on their mothers.

    Pfaffing on about bed shortages, and all of this being the fault of over-educated nurses does nothing to address the multiple, coalescing factors which have caused public hospitals to become the monolithic, dysfunctional ‘children’ they are now.

    I agree with you, that there are significant problems with nursing career structures, expected roles and task allocations within acute care hospital environments. I was one of the last of the generations of RNs who were hospital trained, and to be frank, nursing today, is a mess.

    Last year, I too had to ‘step-in, as in most third world countries’, and not only provide basic physical care to my usually fit, vital, and mentally sharp mother, I had to manage her on my own, for 24 hours, until I could convince ANYBODY with the qualification of MBBS to consider her bop to the head was a potentially life-threatening brain injury.

    Last year my mother was discharged from an ED, and allowed to walk out with an undiagnosed sub-arachnoid haemorrhage. For the next 48 hours, like some kind of macabre Alice-in-Wonderland-surreal-hospital-drama, my mother fell, and fell and fell through the holes in the swiss cheese. Pretty much everything which could go wrong, did go wrong, in not one, but two public hospitals. None of the major errors, was a nursing error.

    Our family’s experience of the congested, failing health care system in this country, and our observations of the way medical and nursing care is delivered in a tertiary teaching hospital these days, can be found here : http://wp.me/pverz-2R

  4. Sancho says:

    I’m one of the few university-trained nurses who supports a return to hospital-based training. Nursing is a trade that had to be recast as a tertiary-educated profession in order to get away from the perception that it’s a semi-skilled role for working class women, but it hasn’t really worked.

    Instead, the defining features of nursing have been ground away to make it conform to a strict medical model which is appropriate for doctors and surgeons, but not for nurses. Refocussing on actual patient interaction via hospital training may be an improvement.

    Barring that, I can think of a few things which might make nursing more appealing as a career:

    – Expand the scope of practice of nurses. Dr Arnold seems fairly informed about what’s going on with the dearth of nurses, but his own organisation, the AMA, needs to shoulder some of the blame here. Many, many nurses would like to upskill to semi-medical roles, but the AMA protects its turf more aggressively than the Crips and insists that only doctors can, say, stitch up a small wound, when a nurse practitioner could do it at a fraction of the cost the AMA’s members hold out for. And let’s not even get started on that expensive and unnecessary piece of surgical equipment – the anaesthetist.

    – Establish a proper career path. As Arnold notes, progressing in nursing means moving away from patient care into administration, which very few patient-oriented nurses want to do for a living. Again, the AMA perpetuates that by maintaining a clear, quasi-military medical hierarchy in which nurses aren’t permitted to progress in clinical areas.

    – Change the bloody name. Seriously. “Nurse” is an ancient and value-laden term that screams “nice lady who mops the doctor’s brow”. It’s humiliating for male nurses, to the extent that many will say they’re “in anaesthetics” or “a clinician” rather than deal with tiresome questions about why they’re not doctors instead (pro-tip: nursing isn’t medicine for dunces; it’s a different role) or jibes about their masculinity.

    It’s interesting that nursing is the only profession which carries a gender expectation. When was the last time you heard someone referred to as a “male teacher” or a “female engineer”? But I bet you’ve heard “male nurse” a lot.

    I would prefer the generic title of “clinician”, with an associated grade (or something similar). For example, a Division 2 nurse might be a clinician (grade 1), while an experienced surgeon might be a clinician (grade 10). I can just imagine Dr Arnold’s mates at the AMA getting behind that. ROFL.

  5. tiwi says:

    Australia does not have a shortage of nurses – it has a shortage of people with nursing qualifications who are willing to work in the current system. There are many thousands of people with such qualifications who are doing other things. It is supply and demand.

    That’s why I love it when people defend executives’ massive salaries with “Well the companies need to pay them that much because they are competing on a world market, and anyway look at the fantastic value their decision-making has added to the company.” [Yes, I admit that in the recent financial woes the second part of the argument looks a bit thin!]

    What I love is if these same people get onto the topic of nurses or teachers they will often bang on about the “appalling shortages”, blaming university-based nurse education, and despairing over the lack of male primary school teachers.

    My response is that hospitals and schools are also competing on a world market for these people’s skills. A classic example is Intensive Care nurses – most nurses who do the specialized training course work in this area for less than two years after they finish their training. Yet many who leave will later work there for locum shifts when the pay and conditions are better.

    Sancho – I agree that the roles of nurses can be expanded, and I am very much in favour of the model of “nurse practitioners” – I have worked in the Northern Territory where there have been their equivalent for many years in small communities. These nurses basically have to do everything in delivery of health services.

    But even in city hospitals I agree that there are many more responsibilities that nurses could take on. As per my example of Intensive Care – much of the minute to minute management of the sickest patients in the hospital is (rightly) entrusted to the trained nurses.

    As for gender – I still hear the term “female doctor”, though probably more from patients than anyone else.

  6. William says:

    Sancho, you point out that being a doctor and being a nurse are different roles but suggest a unified title of ‘clinician’…? puzzling.

    You clearly were not around when all this was going on, but you’ll be hard pressed to find many doctors who thought turning nursing into a tertiary-educated profession was ever going to be a good idea for the majority of nurses. This was a move driven entirely from within the nursing profession…

  7. William says:

    With respect to the original article…

    does anyone really think that the statement ‘lack of beds’ only refers to those metal things with four legs, wheels and that flippy bit at the top that you can rest the pillows on.

    Surely Dr Arnold, you should give credit even to our politicians, who I suspect understand that a bed is only a hospital bed if it has the attendant staff required to look after the patient (and therefore includes the nurse, the doctor, the cleaner, the person that brings the food etc etc etc)

  8. MARN says:

    Recent news
    $632 million to train more than 6000 new doctors – who will, probably end up in the cities as usual.
    $17.5 million for a cricket centre of excellence. (Qld Gov contribution $5m – no wonder Anna wanted Kevin to pay for hospitals.)
    $13 million for more mental health nurses in the community – where the patients are.

    Something doesn’t look right to me.

    And continually blaming the naughty nurses going for a tertiarty education as the cause of a poorly managed, big money pit (even in a shortage of nurses) hospital system is bordering on dysfunctional grieving. Time to be constructive guys and be innovative with what you have.

  9. Harry Aizenberg says:

    Dr Arnold’s comment reagrding lack of nurses is correct but if we were somehow able to provide additional nurses the fundamental problem of “the absence of a ‘brake pedal’ to dampen the accelerated use (and abuse) of the almost free service” still remains. We have a free service available to all which competes with an expensive or “out of pocket” private health system. Guess who wins hands down? Until a political party has the courage to means test free access to the health system through Medicare we will continue to see increased demand and cost blowouts. It is scandalous that a person on an income of $100,000 receives free treatment. Let’s have a safety net for the financially disadvantaged to enable them to get free treatment and force the others to either pay or take out health insurance.

  10. John Donovan says:

    Hi Guys – sorry for posting here, but was not sure where else to go. I followed Crikeys “Thing for the day” last week, and signed up as a blood donor. I’ve just made my first donation (I have excellent blood apparantly, and filled the 760ml bladder in 5m 3s!) I just received a letter however, asking if they can use my blood to supply to a third party company to produce reagent blood cells. As a donor, I’m not 100% sure if I am happy with my donation being sold to a third party that produces commercial products. Why don’t I just sell my blood to these companies myself (I’m being facecious), as they are on selling to the hospitals anyway.

    What are the ethics involved in this?

    Any information would be most helpful.

    Thanks,

    JD

  11. Ian Haywood says:

    I agree the counsel of perfection is a unified clinical profession with a clear upgrade path for various roles. But this arguments cuts both ways, if it’s takes X amount of training to perform certain tasks, then that should be the same for everyone. I object to nurse-practitioners demanding my job (for more pay) because they find it interesting, but aren’t interested in the training requirements or negative aspects (like on-call!)

  12. Jenny Haines says:

    Yes nursing is a tough game, but governments have made many foolish mistakes over the past 30 years. It was not a mistake to go to university education. It was the way it was done, that contributed to the shortage of nurses. Planners “forgot” that students and graduates from hospital based programs supplied the turnover in nurse numbers, so while student nurses were at university, their numbers were not available for employment. Uni students to this day are not employed while they are educated. Should they be – another very big debate!!
    It is too late to go back to hospital based training. All the hospital education infrastructure has gone. So we have to be creative, but keep in mind that we are trying to deliver quality of care. When the taxpaying public go to hospital they expect care from an educated, knowledgeable, caring nurse. Throwing any person, untrained, or partly educated in caring, at the patient does not guarantee quality of care. It just makes the staffing numbers look good on the bureaucrats page.
    How to get more women and men into nursing – there are all sorts of incentives around – scholarships, cash payments, shortened courses. Certainly it seems the Global Financial Crisis has helped -driven people into nursing for the job security in bad times. But I am mindful of what happened in the Howard Government years, where over 2000 applicants per year were turned away by universities because the Howard Government would not fund their places. Where was the forward planning in those decisions? Mind you this was based on that government’s cynical downskilling of the nursing workforce to reduce costs. The current Federal Government to their credit have reversed much of the lunacy of the former government, but it is going to take time to repair the damage done.

  13. Topender says:

    The cure for health service demand is not funding more health service!!!!

  14. Rick Turner says:

    Sorry this whole dichotomy between hospital and university based training is completely artificial and does nothing to move the state of our hospitals or the quality of nursing forward.

    See
    http://critcare-reflectionsofamalenurse.blogspot.com/2011/05/problem-of-university-vs-hospital.html

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