A collective approach needed on the big issues – October 2006

The nursing shortage creates a terrain where a host of health policy issues such as skill mix, health management, training, and industrial issues are all in play. From our union perspective, it is both a strength and a weakness.

The nursing shortage can be seen as a strength when we are arguing for better wages and conditions – but it does make us vulnerable to attacks across multiple environments.

Employers are clearly unable to recruit enough nurses locally and are looking to either bring in nurses from overseas or, more sinisterly, create alternative categories of workers parading as nurses.

In this issue of The Lamp (pp 20-23), we look at some of the issues facing overseas nurses in Australia. We are not opposed to the use of overseas nurses to address the acute aspects of the shortage but we are opposed to their exploitation before or after their arrival. There are also important policy issues that need to be addressed such as the lax implementation of 457 Visas by the federal government and the need to give priority to more university places for nurses. This is a vital pillar in any viable strategy to fill the vacancies in our hospitals with appropriately educated nurses.

Other tactics being used by employers to fill nursing positions are of even greater concern to us. These tactics are particularly visible in aged care with the advent of the Certificate IV aged care worker who is un-licensed and used by employers in traditional nursing roles including administering medications and supervising staff.

Nurses need to think carefully about skill mix issues. We eagerly await research undertaken by University of Technology Sydney on skill mix and workload (The nursing workloads, skill mix and patient outcomes study). This rigorous study will give us a clearer appreciation of the relationship between skill mix and workloads.

But we cannot sit on our hands while we wait for this research. As a profession we need to think clearly and realistically about how we manage the whole problem of skill mix.

The commonly held belief that nurses are able to define themselves by their traditional role of administering medications is now outdated.

This is particularly clear in aged care where employers are using the nurse shortage and economic factors to push hard on who should administer medications.

Under intense pressure from aged care employers, the Nurses and Midwives Board is currently reviewing its policy on delegating the administration of medications to other categories of staff.

Nurses will need to respond strategically to this threat if we are to maintain our pivotal role in health care provision that until now we have assumed is our right and obligation.

We need to seriously assess whether the role of AiNs should be licensed as a complementary part of the nursing family with registered and enrolled nurses.

The public deserves the same sort of protection with new categories of workers who have direct contact with patients as they get from the registration of nurses.

There are many other big ticket items in play in the health sector and workplace relations that have great relevance to nurses besides the administration of medications.

The federal Health Minister Tony Abbott has often floated the idea of the federal government taking over health from the states and recently proposed that the management of public hospitals should be privatised.

There is also the massive threat posed by the federal government’s IR changes to the pay and conditions of nurses and their right to be represented by their union.

We cannot pretend these things are not happening or will go away. We need to recognise them, debate the issues in a robust way and then stick together and defend our interests.