Remember us? We’re called nurses
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Last time I was in hospital, I was cared for round the clock by highly skilled health professionals – nurses. But in all the debate about health reform, one could be forgiven for thinking that doctors are the only people who provide front-line health care. When the premiers and the Prime Minister figure out how they want to fund the local hospital networks, will they stop to think about how they are going to staff these hospitals? On its own, $632 million for doctor training won’t give Kevin Rudd the workforce he needs to meet his emergency department waiting time guarantee. Why? Because the front-line staff in an emergency department are nurses. Kevin Rudd’s funding might buy him a few more aged-care facilities, but how is he going to make sure your granny has someone to check that she takes the right pills? Nurses working in aged care do this but the government isn’t handing out funding for training aged-care nurses. As Greg Barns pointed out in ‘Health reform debate ignores non-vote winning mental health issues’, mental health isn’t a s-xy vote-winner. Mental health nurses running community mental health services are still waiting to find out how the federal Government’s “takeover” of community health will affect their services. Needless to say, they aren’t expecting much in all this to support their profession. We nurses don’t mind admitting that we are getting old. But we do get a tad anxious about who will look after us in the future. In 2007 the average age of employed nurses was 43.7 years and a third of all nurses are over 50 (AIHW, 2007). Universities turn potential nurses away every year due to lack of places and funding. But the Government hasn’t announced millions of dollars for a nursing workforce strategy as part of health reform. It’s about time the Government stopped throwing bribes at the medical profession and started to seriously invest in capacity-building for the nursing profession. Because nurses are the people who will be critical to achieving health reform on the ground. |
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8 Comments
Nurses: The front line of health delivery and the most abundant number of health service providers in Australia….. Nurses ARE the front line, mid fielders and back row of the health service! When will we (the Australian public) get that health service is about HEALTH policy and improving health and well-being….it is not about sickness, illness, operations (waiting lists), medical procedures and labels. It is also not about number crunching and bureaucrats. It is about the HEALTH of people….. When politicians start to talk about health, the debate will become meaningful….until then, it is just more of the same…… reorganizing the pantry shelves with the same contents. Meanwhile our pollies continue to deliberate about who is paying for the pantry shopping list in the current debate, and not get down to the more important discussion about the health of the people in this Nation. And certainly….mental health has to be a big part of that discussion, given that 1/4 of us are likely to have a brush with a mental health problems in our life time….. hmmmm!
I am one of those “ageing” nurses delivering aged health care. I am 54 and the youngest of the 32 x Registered Staff in my Aged Care facility.
Our combined Nursing experience keeps at least 75%of the 150 residents in our aged care facility instead of a public hospital.
Because there are very few mental health facilities in NSW after the Richmond Report 90% of those 150 residents have a psychiatric illness as one of their 3 primary diagnoses. ( there’s a point, has anyone been able to get a bed in a public hospital or a Nursing Home since they closed all the psychiatric hospitals)?
If the 33 of us stopped work tomorrow, ( or after they lower our pay $6 dollars and hour on 1st July as part of the “Fair Pay” farce), the public health system in our Health Area would be blocked for weeks.
If all experienced aged care nurses in this state did the same thing, the public health system in this state would collapse.
We need help. We demand reasonable pay. Our residents are being ripped off. Prisoners get more than they do. No one is talking to us and we are just about sick of it.
When we go, so does the whole system; and no amount of money will solve that problem.
I am sure we will have a crisis and massive unforseen skills shortage in nursing forcing us to import a bunch of overseas professional some time soon. There is nothing not particularly predictable about how the working populations are aging and where the skills are.
The big problem is that the Government seems to think that the _market_ will sort things out. That somehow the increasing population will not require more nurses and medical facilities, that magically, the existing facilities can be made more efficient to cope. That people leaving high school somehow know, like migrating Salmon maybe, where the gaps in the job market will be when they graduate university. That the training providers will be able to predict the numbers required for professions in the next 6-10 years and make spaces for them to be trained now.
The Government should be driving these processes and this development. That should be their primary responsibility, to provide for the wellbeing of all Australians, current and future. The problem is they seem to have turned on the Cruse Control and gone to sleep.
Although I agree with the thrust of the points made by Kim Ryan about the central importance of the nursing profession to real health care, I must draw attention to an even more egregious omission from the debate - the Paramedics of Australia - who must rank as truly the most forgotten of health professionals.
While recognised in survey after survey as Australia’s most trusted professionals, paramedics are not even recognised as health professionals or allied health professionals by state or federal governments, they receive virtually no incentives or scholarships to assist them in approaching rural and remote practice, they aren’t provided with special arrangements to assist their continuing professional development and they aren’t even registered as health professionals on a national basis to facilitate practitioner mobility and workforce sustainability.
One must remember that paramedics are often the first practitioners to attend to patients in need, and according to the Productivity Commission, Emergency Medical Service providers attended just under 3 million incidents nationally in 2007-08. That’s a lot of incidents - and we are not just talking about shoving a patient in the back of an ambulance, putting the siren on and driving quickly to the nearest hospital. Those days are long gone.
Emergency health care actually starts with the patient, wherever they are – not necessarily at the doors of a hospital, and the clinical interventions performed by paramedics are often crucial in keeping a patient alive until they can receive more definitive care. Paramedics routinely administer powerful medications, apply CPR, defibrillation, perform intubations, triage and treat unconscious, intoxicated and rebellious patients.
Interestingly, many of these procedures would fall under Medicare if they were performed in a hospital or by someone with a provider number. But Medicare doesn’t cover emergency medical services or paramedic attendances.
Nurses are vitally important and have at least been partially recognised in the present health reform debate, but the omission of emergency health care and paramedics is a disgrace when one considers their role in the chain of survival. The attention being given to interprofessional care that extends well beyond the context of the medical profession is minimal to date.
Imagine for a moment what your reaction would be if there was no paramedic to call on in your hour of need. I think the average urban community member would be outraged - yet that situation is something that many of our rural and remote areas have to grapple with every day. The sooner our paramedics are registered on an independent national basis to provide a more flexible workforce the better.
Ray Bange
The lead article and the subsequent comments are clearly self-serving, in that the authors, all of them, are nurses or paramedics. This explains the lack of objectivity.
However, they are all correct. It is past time that the health care delivery system became a mainstream topic, not sidelined for mspecial pleading on behalf of professional sub-groups. For a start, as a rural resident, I have to travel for 50km to get to my GP - 100km round trip. There is a system in place which rations the number and location of pharmacies. Similarly, taxis are geographically distributed. Why not the same for medical practices?
It seems to me that the problem of enticing doctors to the bush would be very much reduced if practicing certificates were similarly made available on a geographic basis. Want to own a practice? Buy one. Is a city practice too expensive for you? Consider elsewhere, or remain an employee under a license holder.
Despite/ In spite of my lack of objectivity, I trained in a Public Hospital.
The Hospital was a major source of employment in the district, especially in small towns like the one where I trained.
It wasn’t just that the local youth got the chance to gain a career in Nursing, Pathology, Radiology or ancillary health specialities such as Physiotherapy, or become an electrician, a plumber or god forbid, a hospital administrator; the Hospital and its staff were also answerable to the town and the people they served.
Most large country towns had a hospital and the townspeople were very proud of their Hospital.
The State Government is still trying to close them, or dumb them down so that are pathetic and useless holding stations for ambulances and helicopters to take their patients to “real” hospitals, where they can wait for days for treatment and line up and wait for a bed.
The Howard years aided this plan by withholding funds,and the state health ministers responded by getting rid of their biggest bill item - patients. A bean counter, with a breathtakingly similar plan to a Yes Minister episode, decided that by closing beds, they would need less staff. Simple!
The villains in this piece are many- fold;
The feminazi pseudo nursing intellectuals who demanded that nursing be removed from its logical home and sent to university comfortably fell in line with the government of the days plan and the beginning of the shortfall we now have was begun.
Together, they are the reason we have the problems we have now.
Ask Andrew Pesce, the current AMA President, which country hospital he was seconded to during his training at Westmead. Trainee Doctors, both senior and junior, did time at Lithgow, Bathurst and Dubbo Hospitals.
When the specialists pulled the pin, and demanded these doctors return to their city hospitals, they were replaced with “contracted” doctors who earned $5,000 a weekend with free board, meals and paid transport to and from the Hospital. Dubbo Hospital used to fly them out and back and give them $7,000 for the weekend. This was in the late 1980`s and early 1990`s. Any wonder Hospitals became expensive.
Doctors don’t come past Penrith now. As far as they know, the earth ends at the Nepean River.
This is of course a self serving solution to a very difficult problem, but putting health training back in all hospitals might not be a bad idea.
I must correct the observation (by John) that I am a nurse or paramedic … I am a retired civil engineer (by first qualification), a Fellow of the Institution of Engineers and a Fellow of the Australian Institute of Management. My principal livelihood comes from investments and active currency trading, and I provide consultancy services to selected clients across a range of business, corporate governance, procurement, public policy and regulatory issues including health care.
My views have been formed by a substantial study of out-of-hospital Emergency Health Services over the past several years following my initial astonishment at the lack of national regulation, the disparities in funding and the inequities in the distribution of emergency out of hospital care. My views also reflect the concerns of a relatively well-informed analyst and potential consumer of health services.
If John would advise me of just where my comments do not show objectivity I would appreciate his counsel.
I agree that the business of health is strange indeed, and would commend that everyone read the insightful article by Ian McAuley : “Health care - a weird industry” first presented to the Health Care World Conference, April 2010 and available at http://bit.ly/cqQ7zX
Ray Bange
Thanks, Ray. Your initial contribution reead as though you were a paramedic. I, too, am a retired civil engineer, still using my head to make a living when it suits. Apologies for my error.
DRMICK, I agree that medical practitioners need to be brought back to the real world. Clustering at the teaching hospitals and waiting for the helicopters leads to very poor outcomes. One simple example from my own life - in order to visit my wife after her accident a few years back, I had to drive past the local Singleton hospital on a daily basis and travel to Maitland, a further 40+km’s each way. This is the lot of many, many country folk as they try to stay in touch with loved ones who have been whisked away by “the system”.
I am not too old to remember the days when the Sydney Morning Herald kept a list of the qualifications of the various medical practitioners in NSW. The subeditors consulted this list and used the term “medical practitioner” when the particular person’s qualifications did not entitle them to use of the homorific “doctor”. I now note that vets, dentists and medical practitioners of every stripe have awarded themselves this title as if by right. There is a reason behind this change, and it has to do with a feeling of personal entitlement and lack of humility.