Introduction by Croakey: The message was clear from senior Coalition and Labor federal politicians at the Australian College of Nursing’s (ACN) National Nursing Forum last week: nurses are critical and are playing a crucial role in the pandemic.
Despite no new policy and practice announcements from the Federal Government or Opposition, Croakey’s Jennifer Doggett found multiple examples of nurse-led initiatives presented to the NNF which are addressing some of the most pressing challenges facing our health system.
“If political leaders are stuck for policy ideas in the lead-up to the next election, NFF 2021 could be a great place to start,” she writes in the post below, the latest in a series of stories for the Croakey Conference News Service. You can bookmark the #NNF2021 coverage here.
Jennifer Doggett writes:
Politicians rarely agree on many issues – but the importance of nurses appears to be one of them.
Last week’s National Nursing Forum – the annual conference for the Australian College of Nursing – included keynote addresses from three portfolio holders in federal parliament: Minister for Health and Ageing Greg Hunt, Shadow Minister for Health Mark Butler, and Minister for Aged Care and Senior Australians Senator Richard Colbeck.
All three Ministers praised nurses for their service to the Australian community and in particular noted their crucial role in supporting Australia’s response to the COVID pandemic.
At the opening session of the conference, Hunt called Australian nurses “the best in the world,” stating, “you’ve kept Australia safe. Our nurses and other health professionals are our heroes”.
On Day 2 Mark Butler acknowledged the risks faced by nurses during the pandemic, saying:
Nurses are right up the front of the frontline. Nurses, through every phase of this pandemic, have turned out to work every single day, often putting their own health on the line. It is a bit of an overused terminology to say that nurses have been heroes but I don’t think we can say it enough.”
Day 3 saw Senator Colbeck reiterating the vote of thanks from Hunt and Butler, with a particular emphasis on nurses’ important role in protecting older Australians in residential aged care.
While these sentiments were no doubt welcomed by the 750 attendees at #NFF2021, they could also be forgiven for feeling that they deserved more than words from their political leaders.
Disappointingly, despite their effusive praise for nurses’ contribution during the pandemic, none of the portfolio holders made any announcements of new nursing policies or offered any additional funding to support nursing initiatives.
This was not clearly not due to any lack of appreciation of the need for action in this area.
In fact, all three political leaders identified some major challenges facing nursing in their keynote speeches.
Minister Hunt nominated the uncertain future for nurses as an issue, saying that he wanted to give them “long term certainty and financial support.” But beyond referencing the National Nursing Strategy and 10 year Nurse Practitioner Plan (already under development) there was nothing new from him to address the need for nurses’ increased career security.
Shadow Minister Butler identified workforce issues as a major problem, citing the “parlous state” of Australia’s health workforce strategy.
He emphasised the importance of making sure that our health workforce is equipped to deal with future challenges, with all health professionals working to full scope of practice. However, he did not provide any details about how a future Labor government would achieve this goal.
Minister Colbeck said he welcomed input from nurses into the Royal Commission into the Quality and Safety of Aged Care.
But he also did not provide any new information about how the Government is working with nurses to implement these recommendations, or respond to criticism from nursing groups about the slow pace of the reforms.
Given the lack of tangible commitments from the politicians at the NFF, nurses could be forgiven for feeling cynical about the commitment of both political parties to nursing issues.
Of course, it could be that the major parties are waiting for the upcoming election campaign to make any major policy announcements.
If that is the case, the NFF could provide political leaders with some useful ideas to include in their parties’ election platforms.
The three days of the conference showcased the many areas in which nurses are already finding solutions to the challenges facing our health system. Some examples which should be of particular interest to policy makers are outlined below.
Chronic disease management
One major health issue facing any future government in Australia is the rising rate of chronic disease.
This is due to a range of factors, including our ageing population, and poses a number of challenges to the Australian health system.
The structure of our health system was developed a generation ago when our greatest health burden came from short-term, acute conditions, such as infectious diseases and injuries, and it is not well equipped to provide the sort of multi-disciplinary, long-term and coordinated care that we need today.
Finding new models of care should be a priority for policy makers, and a number of sessions at the NFF demonstrated the central role of nurses in improving the prevention, management and care coordination of chronic disease.
For example, Liz Tomlinson, Clinical Nurse Educator at St Vincent’s Public Hospital in Sydney, presented the results from a nurse-led foot care project within the Renal Ambulatory Care unit.
The project was developed in response to a trend of increasing hospitalisations and rates of amputations within the unit’s patient population.
It involved three key areas: development of a foot screening tool, referral pathway for the high-risk foot clinic and staff and patient education.
The program effectively demonstrates some of the key features required for effective chronic disease management:
- interdisciplinary collaboration (in this case between podiatrists, specialist renal nurses and consumers)
- consumer education and empowerment (education on self-care practices)
- integration of services (health promotion, screening and referral now taking place at one point of care in the patient’s journey during their scheduled dialysis treatment).
Its impressive results include a reduction in outpatients requiring admission to the inpatient setting for management of lower limb wounds and amputations from 338 days in 2016 to 59 days in 2019.
In another presentation, Jeroen Hendriks, Professor of Cardiovascular Nursing at Flinders University and the Central Adelaide Local Health Network, focussed on the development of a model of nurse-driven, specialised and comprehensive care for patients with atrial fibrillation.
This program is currently being evaluated by a randomised controlled trial comparing the nurse-led team-based approach to the usual care provided by one single health care professional, such as a cardiologist.
The outcomes of this and other research on nurse-led models of care can be used to inform new models of nurse-led chronic disease management to provide more cost-effective care to consumers as well as addressing workforce shortages in medical specialties.
Aged care
Aged care is likely to be a focus for both the Government and Opposition in their election platforms.
The Royal Commission into Aged Care Quality and Safety identified high levels of need in almost all areas of aged care and while the government committed a major package of funding in the 2021/22 Federal Budget, more is needed to implement all the Commission’s recommendations.
A number of sessions at NNF could provide political leaders with ideas for innovative, nurse-led aged care programs in both community and residential settings.
For example, Matiu Bush, a nurse practitioner in community health, outlined ACN award-winning work on addressing loneliness and isolation of older people in the community.
Bush developed the One Good Street initiative which seeks to reduce hospitalisation of older people by harnessing the power of local volunteers and, during the COVID lockdown, sought to reach out to isolated and lonely members in a safe way.
One strategy was to hire an out-of-work photographer to take pictures of people in front of their houses.
Another innovative strategy developed by Bush to support the well-being of older people is the CaTPin (from ‘conversation as therapy’), which is a wearable and objective indicator of loneliness and isolation.
Other sessions which provided innovative and practical solutions to improving the lives of older Australians included presentations by Leslie Coo and Julie Westaway on improving continence care and Elizabeth Roberts who described how a nurse-led falls prevention program resulted in a significant reduction in falls with harm at her busy inner city hospital.
The importance of taking a broad social, emotional and environmental approach to identifying the care needs of older people was discussed by Jennifer Boak from Bendigo Health.
She discussed how care of older people in a community setting can be improved through new models of detection of complexity. While her specific focus was on the development of this model, her presentation contained some important messages about the need to “look beyond the model and see the person” relevant to all areas of aged care.
Indigenous health
Addressing the health and life expectancy gap between Aboriginal and Torres Strait Islanders and non-Indigenous Australians should be a high priority for all political parties at the next election.
This requires action at many levels, both inside and outside the health system, as outlined in the 2021 Close the Gap report from the Lowitja Institute.
One element of ensuring the health system provides culturally safe and equitable care to Aboriginal and Torres Strait Islander people was outlined in a presentation at the NFF by the current and former presidents of the Nursing and Midwifery Council NSW (NMC) Dr Bethne Hart and Professor Greg Rickard.
Hart and Rickard discussed NMC’s journey towards cultural safety, including their research on the intersectionality of cultural safety and regulation to identify the challenges and questions for nursing regulators when responding to complaints from Aboriginal and Torres Strait Islander people, families and/or communities.
This involved analysing several complaints to the Civil and Administrative Tribunal about poor nursing care provided to Aboriginal people where the outcomes of this care resulted in serious harms and deaths.
Hart and Rickard identified a number of common factors to all these health system failures, including a lack of identification of Aboriginality and a failure on the part of health care providers to respond to cultural differences and to include families in their care.
While the presentation focussed on the learnings from this research for regulatory processes, health professionals, service providers and policy makers could find some valuable lessons in this research for how to increase cultural safety and improve quality of care for Aboriginal and Torres Strait Islander people.
Politicians and their advisers interested in understanding how to support better nursing and midwifery care for Aboriginal and Torres Strait Islanders could also benefit from reading this book by ACN Fellow Professor Odette Best and Professor Bronwyn Fredericks, which addresses the relationship between Aboriginal and Torres Strait Islander cultures and mainstream health services.
Read the Twitter thread of the presentation here, or via a PDF.
International issues
International aid and development does not usually rate highly as a priority for Australian voters in election campaigns.
But next election provides an important opportunity to change this record, given the disproportionate impact of COVID-19 on developing countries which are now struggling with the health, social and economic burdens of the pandemic.
There is certainly room for improvement in this area, given that Australia’s already low contribution to foreign aid was cut by an additional $144 million or 4.9 percent in the last Federal Budget.
If politicians want an example of what nurses can achieve in low resource setting they could look at the presentation about the HOT (hands on training) resuscitation program in Tanzania by Captain Jan Becker, the founder of Midwife Vision International.
Becker, a clinical midwife educator from Queensland was volunteering at a Tanzanian hospital with her daughter, who also trained as a midwife and is now a medical student. After seeing six babies die one day in the maternity ward they realised that the midwives there were not using evidence-based resuscitation skills, resulting many preventable neo-natal deaths.
They developed an immersive training program in simple resuscitation skills, called the HOT program, which centred on guided resuscitation with an experienced midwife.
This program has significantly reduced neonatal deaths and demonstrates how major gains in low-resource environments are possible through investing in nursing education and training and supporting local nurses to become educators and leaders.
Read this Twitter thread of the session, or via this PDF.
Health equity
Improving the health of the most at risk in our community is also not an issue that receives as much political attention as it should, given the significantly poorer health status experienced by many groups in our community.
If political parties want to address these inequities, there were many examples provided at NNF of how nurses can make a difference to the health of marginalised populations often forgotten by the mainstream health system.
As earlier reported at Croakey, these include 2021 award winner Sonia Martin who started the medical outreach service Sunny Street with Dr Nova Evans.
Martin used her extensive experience in nursing to identify a need for outreach services targeting people who are experiencing homelessness and living on the streets.
The role of nurses in improving health outcomes for men and boys was also a focus of a number of presentations with some important learnings for politicians and policy makers.
Research from the Australian Institute of Health and Welfare (AIHW) shows that men experience a greater share of the total disease burden (53 percent) than females (47 percent), including experiencing almost three-quarters (69 percent) of the total burden from injuries and a greater proportion from cardiovascular diseases (59 percent).
Progress in this area is being made by the Healthy Male Nursing Reference Group (HMNRG), established to support the National Men’s Health Strategy 2020-2030.
Vanessa Jones, Health Promotion Manager at Healthy Male, discussed the work, demonstrating how nurses are well placed to advocate for change and support for men, particularly those from priority populations including Indigenous males, males in rural and remote areas, males from CALD backgrounds, those identifying as LGBTI+, veterans, and males in the criminal justice system.
It also highlighted the ways in which nurses can influence the health system for improved outcomes for Australian boys and men from a systems-level through to the grassroots.
Health workforce
The need to address health workforce shortages was mentioned in the keynote speeches by all three political leaders, who noted that the COVID-19 pandemic had increased pressure in many areas of our health system.
Workforce issues were also addressed in a number of presentations of strategies to attract and retain nurses within the profession.
This included a nurse leadership program developed at Alfred Health to build capability across three domains, leadership, management and governance. Another, the ‘Transition to Professional Practice’ program, supports nursing students moving to become registered nurses through the development of key clinical skills and mentoring by senior nurses.
Strategies to attract men into nursing were discussed by Luke Yokota, Chair of the Men in Nursing Working Party, who presented progress that this group is making in increasing awareness of men in nursing while also addressing the barriers and perceptions that men face entering the profession.
He discussed the local and national media coverage the group has received as well as the resources they have produced to promote the message that ‘it’s ok to care’ to Australian men.
Other sessions focussed on supporting nurses to work at their full scope of practice, including a presentation from the first Australian nurse to perform prostate biopsies, David Heath.
Heath has now done over 200 biopsies and argued that Australia is lagging behind other countries, such as the UK in harnessing the potential contribution that could be made by nurse practitioners.
Conclusion
Given that predictions of a late 2021 election have given way to consensus around a likely March 2022 poll, political parties still have some time to develop their policy platforms.
This provides an opportunity for political leaders to turn their complimentary words about nurses into actual policy and funding commitments which support nursing priorities and concerns.
NFF 2021 provided multiple examples of nurse-led initiatives which are addressing some of the most pressing challenges facing our health system. If political leaders are stuck for policy ideas in the lead-up to the next election, NFF 2021 could be a great place to start.
Disclaimer: Jennifer Doggett provides consultancy services to the Australian College of Nursing.
See Croakey’s archive of stories about nurses and nursing.
See also our coverage of the 2019 NNF.
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