Amid vigorous public and professional debate about a pressing need for health reform in the wake of calamitous stress on health systems and workers, the Australian College of Nursing’s National Nursing Forum could not be more timely.
Dr Amy Coopes previews the discussions below for the Croakey Conference News Service. On Twitter, follow #NNF2022, @WePublicHealth and this Twitter list of National Nursing Forum participants.
Amy Coopes writes:
Workforce and wellbeing issues for an “exhausted” profession at the frontlines of the COVID-19 pandemic and rolling climate disasters will be in focus on Larrakia Country this week in Darwin at a national summit of Australia’s nurses which aims to celebrate and recognise the profession’s unsung leadership in times of crisis.
The Australian College of Nursing’s National Nursing Forum is among the peak events of the nursing calendar, and will bring together some 700 delegates from across the country to reflect on an unprecedented three years in healthcare. It will be the first time the College have convened in person since COVID swept the globe, in a hybrid face-to-face/virtual offering.
Themed Nursing Leadership Unmasked, this year’s event will have an emphasis on wellbeing and workforce sustainability, as well as the climate emergency, as Australia’s nurses toil through a third winter of the SARS-CoV-2 pandemic close on the heels of a torrential summer of flooding.
In no way a reference to the use of masks during the pandemic, ACN says the “unmasked” theme highlights “the extraordinary skill it takes to be a leader of the nursing profession and all health and aged care services, particularly during disaster-like conditions that are not easing up”.
For a system already under significant strain, ACN CEO Adjunct Professor Kylie Ward said the past few years had pushed things to breaking point, and seen a crisis of moral injury among nursing staff where “people have had to step out, step away”, perhaps never to return.
“We have a profession and an industry that is exhausted,” Ward told Croakey ahead of the summit. “People have done so many double shifts, worked down the furloughing. They’ve been working in such unreasonable and unrelenting conditions for so long, and their own personal boundaries have been stretched.”
Amid talk of the so-called ‘Great Resignation’, Ward said World Health Organization estimates of the global nursing workforce shortage had blown out from 6-7 million pre-COVID to 13-15 million, making investment in attracting and retaining a pipeline of locally-grown and imported staff an urgent priority.
Reforming the Medicare Benefits Scheme to allow nurses and nurse practitioners to be fairly recompensed for working to the full scope of their practice was a major piece of the puzzle, she said.
Failure to act on this was tantamount to “a government and a health system that supports inequity in pay, disparity for women, and for nurses,” she added.
The Federal Government’s new Strengthening Medicare Taskforce includes two nursing representatives – Karen Booth, President of the Australian Primary Health Care Nurses Association, and Annie Butler, Federal Secretary of the Australian Nursing and Midwifery Federation – and lists as one of its five focus areas of work “increased access to multidisciplinary care, harnessing the full skills of nurses, pharmacists and allied health professionals”.
The ACN would like to see stronger representation of Nurse Practitioner and Advanced Practice Nurses on the Taskforce. These expert professionals are crucial to addressing gaps in health care delivery, particular for those in rural and remote areas, said Ward.
“I have said for many years now that the nursing profession has been underrepresented, disproportionately represented and at times not represented at all. I am pleased to see two nursing organisations on this Taskforce but it is simply not enough to represent the largest health workforce in the nation,” she told Croakey.
Disaster conditions
For many, Ward said attending this year’s Forum would be the first time they had been able to take leave since the outset of the pandemic, which was punctuated for those living along Australia’s east coast by an unprecedented season of deluges driven by an intense La Nina system.
“Nurses are actually nursing, and have been for many years now – and this is why I worry about our profession – in disaster conditions,” Ward said.
“I met with nurses who were still turning up to provide care in the recent floods in northern New South Wales and Queensland while they were part of the mud army trying to clear out their own homes.”
As the largest and most geographically dispersed clinical workforce in the country, Ward said nurses were embedded in and suffered alongside their communities, providing care “through droughts, through fires, through floods” and should be leading and speaking out on climate action.
Greens leader Adam Bandt will be among high-profile speakers delivering keynotes at the conference.
Health Minister Mark Butler will address the Forum via video, and Ward said it was important the new Government was represented given the importance of nurses during the pandemic.
“For some of the delegates attending here in Darwin from the aged care sector, the acute sector and primary health, this will be the first break they have had in the past year or two,” she said.
“Nurses have also been essential in ensuring all Australians were vaccinated and they have been stretched further than any one of us would wish. I believe it is important that Government and political leaders show the nursing profession the respect they deserve, and acknowledge how many Australian lives were saved over the past few years because of the service and sacrifice nurses made.”
While workforce was a key policy priority for discussions with the new Government, issues in aged and primary care and preventative health were also on the agenda, and in a Parliament with more Independent MPs than at any other time in history, Ward said ACN was lobbying widely.
Ward said the forum would celebrate the pivotal role of women in pandemic leadership, which she said extended well beyond nursing into professions like teaching and childcare which had demonstrated, in a time of crisis, just how essential they were.
“I think this is a time to really acknowledge the effort that all communities have made, but particularly women,” she said. “While they have also had the responsibilities of their families, home schooling, really being the glue that has kept our society together.”
Presenters in focus
Professor Patricia Davidson, previously Dean of the Johns Hopkins School of Nursing and, since 2021, the University of Wollongong’s first female vice-chancellor, is one of the event’s opening keynotes, and co-author of an article published in The Conversation this week calling for a greater focus on recruiting and retaining more men in nursing.
“This would help address workforce shortages and could, over time, reduce the industry gender pay gap as the existence of men in nursing becomes more normalised,” writes Davidson and co-authors.
“And as jobs dry up in traditionally male-focused industries – such as mining and manufacturing – work in healthcare should be an attractive option for men, providing job security, career opportunities and salary.”
The article says a recent Australian report shows the dominance of women in the nursing workforce may hinder some men from considering nursing as a career, particularly those for whom masculinity is central to their identity. “So we must work to undo the perception nursing is a feminine job – it is not,” say Davidson and co-authors.
Also speaking in the first session is Sonia Martin, who was 2021 winner of the Health Ministers Trailblazer Award for her work with homeless Australians.
Professor Sandy Middleton, a renowned clinical researcher in stroke and director of the Maridulu Budaryi Gumal academic health science partnership, will deliver the 2022 NNF Oration, titled ‘Leadership, Change and the Age of Aquarius’.
The forum will have four main streams across its three days of programming, grouped around the themes of cultural change, innovation, quality and safety, and workforce.
Ward said it would be a “safe and productive environment” to discuss diversity and inclusion for marginalised populations, both within nursing and among their patient cohort.
Making history
The College will be commemorating 20 years of the Puggy Hunter Memorial Scholarship with an address by the late Dr Hunter’s wife Matilda Pascoe, and his daughter Emily Hunter, who is a Registered Nurse. Puggy Hunter was the inaugural chair of NACCHO and a celebrated figure in Indigenous health, receiving the Australian Human Rights Medal in 2001.
It is a significant week in Aboriginal and Torres Strait Islander nursing, with the Congress of Aboriginal and Torres Strait Islander Nurses and Midwives (CATSINaM) also holding its annual conference on Friday, to be followed by a gala dinner marking 25 years of activism and advocacy. You can read more about the #CATSINaM25Years campaign here.
The CATSINaM conference will feature a national apology from the Council of Deans of Nursing and Midwifery for the profession’s contribution to the harm and ongoing suffering of Australia’s First Nations peoples, which Ward said the ACN endorsed in full as a member since inception of the Closing the Gap committee.
“We recognise the widespread and consequential impact of intergenerational trauma faced by Aboriginal and Torres Strait Islander peoples due to decisions made both past and present by people in positions of power,” she said.
“ACN advocates for nurses within our community to have respectful engagement with and understanding of the culture and history of their local Indigenous community and their needs.”
Commenting on the apology, Ali Drummond, a nurse, researcher and National Director of Education and Practice at CATSINaM, said Australia’s nursing and midwifery professions must commit to understanding “the unsettling reality of our disciplines’ past and ongoing contribution to poor health and wellbeing and premature death of First Nations People”.
“This is a result of the professions’ compliance with racially discriminatory government policies that normalised culturally unsafe health services and nursing midwifery care,” said Drummond, a Meriam and Wuthathi man who grew up in Zenadh Kes (Torres Straits).
“Individually we have the opportunity to make differences in the decision making we contribute to, whether this be at the boardroom table or at the patient bedside. We can be more aware of the power we hold over people receiving care, and ensure we don’t use this power to further disempower and devalue them.
“Collectively we can change problematic cultures of our wards, departments, hospitals and offices, challenge and change policies, procedures and models of care that are not meeting the needs of First Nations peoples. We must advocate for better resourcing of First Nations-led models. For future conferences, it would be good to have more focus on Aboriginal and Torres Strait Islander health and Aboriginal and Torres Strait Islander led nursing and midwifery models, around clinical care, and health management.”
Drummond also urged National Nursing Forum participants to consider their roles, at individual, professional and organisational levels, in engaging with the forthcoming referendum process around developing a Voice to Parliament for First Nations Peoples, as well as Agreement-making and Truth-telling as outlined in the Uluru Statement from the Heart.
“Our disciplines play such a pivotal role in the development and implementation of Indigenous health policy,” he told Croakey.
“We have a duty of care to take a leadership role in figuring out what truth telling, agreement-making and Voice means for our disciplines, and to support those principles in our nursing and midwifery practice as a way of demonstrating our commitment.
“To me, voice means listening to the voices of First Nations peoples, including nurses, midwives, people receiving care, as well as First nations health services and community organisations. Agreement-making speaks to the notion of sharing power, particularly of being accountable to First Nations peoples and organisations for delivering culturally safe care. Truth telling refers to the importance of understanding the legacies we have inherited as nurses and midwives, and committing to not reproducing racist policies and practices.
“As disciplines, we need to figure out how best our roles can contribute to this higher agenda. We have a pivotal role along the patient journey. We are always there, there is always a nurse or midwife. There is something very different we can bring to the national conversation.”
Drummond also encouraged NNF participants to engage with a new national exhibition charting the activist history of Aboriginal and Torres Strait Islander nurses and midwives, ‘In Our Own Right: Black Australian Nurses and Midwives Stories, which opens in Sydney this week and will later go on tour across the country. 
Bearing witness
There will also be commemorative events in the lead-up to the conference to mark 80 years since the World War II bombing by Japan of Darwin, where the NNF will convene, as well as wartime events specifically affecting Australian nurses including the sinking, during the Japanese invasion of Singapore, of the SS Vyner Brooke, and the ensuing Bangka Island Massacre.
The College has been fundraising and campaigning for a number of years to have the massacre’s sole surviving nurse, Lieutenant Colonel Vivian Bullwinkel, immortalised at the Australian War Memorial.
Bullwinkel escaped execution on Bangka Island by lying in the shallows and pretending to be dead, after she and 21 other nurses were marched into the ocean and shot in the backs by Japanese invaders. She eventually surrendered to Japanese forces and spent several years as a prisoner of war before making it back to Australia to give evidence about the wartime atrocities she had witnessed.
The only way we know about this massacre was because Bulwinkle came back and testified in the tribunals, said Ward.
The National Nursing Forum will be held at the Darwin Convention Centre from August 17-19, and online. Dr Amy Coopes will be reporting for the Croakey Conference News Service on the 17 August discussions. Bookmark this link for all our stories, and join the conversation using the hashtag #NNF2022. Read our archive of NNF coverage from 2021 and 2019.
