There’s no substitute for a qualified nurse – July 2009

NSW Health is exploring ways of introducing more third level health workers into our public hospital system. We need to be on our guard.

The most recent annual Roy Morgan professions survey showed nurses are regarded as the most ‘ethical and honest’ of all professions. This is the fifteenth year in a row that nurses have headed the survey.

It confirms that the Australian public continues to appreciate the benefits that nurses bring to Australia’s health.

Our own research shows that while the public has the deepest respect and admiration for the care nurses bring to their job, they don’t always have an understanding of the high level of education, skill and professionalism of the nursing role. The goal of our current advertising campaign is to make people more aware of this.

This is important because the status of our profession is facing serious and immediate challenges and we need the community at our side.

It is often overlooked that NSW has a world-class health system. There is  relentless media scrutiny of the public health system, more often than not conducted in a negative light. Breakdowns in the system and crises are always in the spotlight. But an overwhelming majority of the public, as our research also tells us, has positive experiences when they come into contact with our public hospitals.

The Garling inquiry highlighted the challenges before the health system: a sudden and dramatic increase in the number of people using it, an ageing demographic among nurses, and poor workforce planning.

Numerous university studies clearly indicate that quality health outcomes and better patient safety come from high numbers of RNs.

The dilemma before us is how to find the right skill mix in our public hospitals, with sufficient numbers of RNs to meet the challenges and maintain that world-class system.

The NSWNA is conscious there has to be innovative thinking to achieve this but we are also adamant that patient safety and quality health outcomes are paramount.

The Health Department has flagged an intention to introduce an unlicensed generic health worker into the public health system (see story p12). This is a development for which we need to be on guard. Our experience in aged care has shown us that the introduction of an unlicensed worker without mechanisms of accountability can lead to these workers being misused in roles outside nursing care. They can end up doing gardening or cooking as well as care work. Effectively they are jacks-of-all-trades and masters of none. This is not a model we want in public hospitals or any health setting, for that matter.

There is an important place for third level health workers but there needs to be accountability in the role and appropriate numbers employed.

At least with an AiN the role is carried out within a nursing team with training and supervision by an experienced nurse. By assisting and supporting the nursing team, an AiN’s contribution is important and valuable. But it is a role that needs to be clearly defined and tightly supervised by an RN in a clinical leadership role.

To be effective within the nursing team, AiNs need access to training delivered by quality providers. This gives them a taste of working in the nursing profession and provides them with a career pathway into enrolled nursing or registered nursing.

There is a place for well trained AiNs with a clearly defined role. How they are deployed within wards, and in what numbers, needs to be left to the professional judgement of the NUM.
It would be all too easy, when confronting the challenges articulated by Garling, to see the introduction of more third level workers – whether AiNs or generic care workers – as a simple, cheap fix to the workforce problems in public health.

We believe that would be a mistake with adverse impacts on patient safety. Experienced nurses are the key to high quality patient care and when looked at in a rational way, the most cost effective way of delivering that care.