Slow learners on nurse education

Politicians love to talk up the number of university places when it comes to nurse education but underfunding by the federal government is critical to the quality of nurse education. The Lamp investigates.

It is now conventional wisdom that Australia has a severe skills shortage. In November last year, the Reserve Bank warned that ‘shortages are widespread across most industries and skill levels’. The Australia Industry Group predicts that Australia will need 270,000 more skilled workers over the next 10 years.

Nursing is one of the crisis areas. It is estimated there will be a national shortfall of 40,000 nurses by 2010 – 12,000 in NSW – if nothing is done and current trends continue.

These figures have put the spotlight on the state of our university and vocational education. Since 2001, almost 150,000 eligible applicants have been turned away from Australia’s universities. Since 1998, 300,000 have been turned away from TAFE colleges.

In 2005, 2,716 applicants were turned away from nursing courses, 235 in NSW.

More education places is important

The Howard and Iemma governments have both implemented measures to increase training places for nurses.

NSW Health increased the number of enrolled nurses being educated from 900 to 1,200 in 2006, with a 21% increase in the number of enrolled and trainee nurses employed since 2001-2002.

The Howard government has increased the number of Commonwealth-supported positions (CSPs) in undergraduate nursing courses over the past two years with a further 1,036 CSPs allocated for 2007 Australia-wide.

NSWNA General Secretary Brett Holmes says while these initiatives are welcome it is a common misconception to think that an increase in raw numbers of nurse places will lead to an increase in the number of nurses in the workforce.

‘This does not allow for the complexities that are involved in the delivery of registered nurse education. The federal government has allocated 326 new pre-registration nursing places (CSPs) to NSW in 2007. It is unclear how many of these places universities will offer as they will only fill them if they can ensure a quality education for all students,’ he said.

Brett says the increase in nursing places has not been accompanied by a sufficient increase in appropriately qualified academic and clinical staff to accommodate the increase in student numbers. Nor has it been accompanied by increased access to clinical places for students.

‘Clinical placements are increasingly difficult to access and to fund even though they are an important part of nurse education. Although the federal government has increased the funding for the clinical education component of nursing it remains insufficient.’

The Iemma government announced initiatives in its election nursing policy which the NSWNA says will help address the nurse shortage and education costs. The government promised an extra 80 nurse educators, assistance with the cost of nursing textbooks, the extension of the Nursing in Schools program and 1,600 extra scholarships for enrolled and registered nurses.

Brett Holmes says the extra 80 Clinical Nurse Educators will help, but the number is short of the real requirement.

‘Given the ever-increasing complexity of health care, the NSWNA wants to see a Clinical Nurse Educator in every ward of 30 beds or more and in every equivalent community health facility,’ he said.

Elizabeth Schlossberger, the undergraduate nurse coordinator at Prince of Wales Hospital, agrees that improving clinical education is the key and stresses the importance of allowing educators to focus on their core role.

‘More CNEs would definitely help. At the moment their time is now taken up by new graduates and new staff. They don’t have time for students,’ she said.

‘The CNE has a hard role educating ENs, EENs, undergraduates, undergraduate AiNs and new staff all vying for their time. One problem they frequently voice is that they spend a lot of their time orienting people rather than educating because of the high turnover of staff.’

Universities struggle as funding shrivels

Despite a long, sustained period of economic growth, the net contribution by the Federal government to fund university places has fallen significantly in the past decade while the contribution students make to their education has doubled.

The proportion of commonwealth funding in the form of grants has decreased from 57% (of university revenue) in 1996 to 41% in 2004, while HECS contributions have increased from 12% to 15%.

Since 1995, Australia’s public investment in tertiary education has dropped by 7%, compared with an average increase by other OECD countries of 48%. Australia is the only country that has cut its public investment in tertiary education.

Universities are clearly struggling to manage with the reductions in Commonwealth funding, as they are forced to expand class sizes and reduce the number of lectures and tutorials in an effort to make ends meet. Consequently, the Australian Vice-Chancellors’ Committee has called for a 15% increase in the Government’s contribution per student over three years.

The Howard government has also linked funding to the universities with the adoption of its industrial relations laws.

To access a 7.5% increase in funding, unis need to offer staff AWAs, remove limits on how many casual staff they employ and prevent unions from negotiating contracts unless employees specifically ask for it.

Nursing is a national priority in word but not deed

The Australian Government’s higher education reforms recognised the urgent need for qualified nurses by identifying nursing as a National Priority area and declared that additional funding must be directed to the costs associated with clinical practice in nursing.

But in practice, the federal government has failed to deliver. The Deans and Heads of Schools of Nursing across NSW say that despite recent increases in funding for the clinical component of undergraduate nursing education, there is still a shortfall of approximately $3,000 per student per year for clinical education alone.

Sydney University’s closure of its undergraduate nursing program is evidence that universities will not continue cross-subsidies to disciplines, that are chronically and consistently under-funded, if they believe the financial consequences of this process to be too great.