20 July 1999
Nursing Under Threat!
Health services and health workers are not immune to the wider economic rationalist agenda currently pervading the broader community. Contracting out of health services, privatisation, collocation, Casemix funding, the replacement of qualified nursing staff with unqualified personnel, the Aged Care Reform Agenda, the implementation of National Competition Policy – all of these significant changes are driven largely by economic considerations. The health sector is seen as just another market with a product to supply and one where a major priority of government is to cut costs. Yet in an essential service such as health other considerations, such as quality and appropriateness of care health outcomes, access and equity, should be of paramount importance. Economic imperatives should not take precedence over wider social welfare considerations.
As a result of economically driven health care policies, nursing is increasingly coming under attack in all sectors. This is clearly evident in the aged care sector where cost cutting, rather than a concern for quality care, has resulted in a concerted push to reduce nursing numbers and hours in nursing homes.
What’s Happening In Aged Care?
The attack on nursing in aged care is occurring in a number of ways including:
- Many employers reclassifying Assistants in Nursing (AINs) and Enrolled Nurses (ENs) to ‘personal carers’ or ‘aged care workers’, resulting in cuts in wages, lesser working conditions and their removal from the nursing team.
- Employer attempts to remove references to nurses and nursing within their facilities/services
- Widespread cuts to nursing hours
- Nurses being expected to perform ‘domestic’ chores (eg. cleaning) because of cutbacks in those areas
- Resistance and opposition from providers to the establishment of proper nursing staffing levels and skills mix
- Proposals by some providers for a new award in aged care which deletes reference to nurses and nursing almost entirely
- Less money spent on nursing care hours by providers as a result of the de-regulation of aged care by the federal government – which no longer requires providers to account for how they spend taxpayer’s money.
- Widespread promotion of the (false) notion that residents in nursing homes require little more than ‘a roof over their heads, food and clean surroundings’.
Cuts To Nursing In Aged Care Have A Wider Impact
There is mounting anecdotal evidence from QNU members in the acute care sector that there have been increasing public hospital admissions from nursing homes as a result of cuts to nursing staff in aged care. This in turn places further pressure on an already stretched public hospital system. In effect, this shifts costs from nursing homes (funded by the federal government) to public hospitals.
The QNU believes there is an urgent need for further research into the relationship between hospital admissions and the reduction of nursing hours and the loss of qualified nurses from nursing homes.
DID YOU KNOW?
- Aged care was the first officially recognised specialty for nurses in Australia
- Aged Care is currently the largest specialty area of nursing in Australia.
If such attacks can happen in the largest and oldest area of nursing specialty, it can happen in other areas of nursing as well.
QNU – Protecting Nursing – Protecting You
Every day of their working lives nurses play a critically important role advocating on behalf of those in their care. This individual advocacy role can be extended to a collective advocacy role via the QNU. Nurses have already recognised that their union should legitimately perform an advocacy role on significant health issues on behalf of the community. In fact the objectives of the QNU, as listed in our rules (which are determined by members), reflect this.
These formal objectives require the QNU:
- To establish standards for nursing practice and to take any action deemed necessary to ensure that nurses are able to practise effectively.
- To enunciate standards of nursing service and participate with all health agencies in promoting measures to meet the health needs of the public.
QNU Activities In Aged Care
- Major submission to the review of the Resident Classification Scale
- On-going campaigns to inform politicians of the impact of aged care reform on nurses and residents
- Major award application to establish staffing levels and skills mix
- Major submission to the Productivity Commission Inquiry into Nursing Home Subsidies
- Membership of Aged Care Accreditation Agency Industry Panel
- On-going campaigning for wage parity between public and private sector nurses
- On-going lobbying of the state government about State Government Nursing Homes
- Major submissions to the state government on industrial relations legislation to protect nursing conditions in awards
- Active participation on the Occupational Health and Safety in Residential Aged Care – National Steering Committee and on-going evaluation of strategies
- No Lifting campaign to reduce manual handling injuries
- Lobbying for proper education/training in aged care for nurses linked to the nursing career structure
- Empowering members through QNU training to advocate for themselves and their residents
- Organising workplaces
- Extensive representation of members in aged care both professionally and industrially
- Aged care specific information, policies and support to members.
Why Aged Care Needs To Be Regulated
In 1984, the then federal government commissioned a report into the care being provided for elderly Australian citizens in nursing homes. Known as the Giles Report, it documented widespread examples of sub-standard accommodation, poor food and inadequate nursing staffing and was a damning indictment of the standards of care being provided to some of the most frail and vulnerable members of our community.
As a result of this report, regulations were introduced over a period of years to ensure appropriate standards of care. These included, among other things, an attempt to ensure adequate levels of nursing staffing through the introduction of a system to assess the nursing care needs of residents and the requirement on providers to prove that taxpayers’ money given to them by government to employ nursing staff was actually used for that purpose.
Since 1984, and as a direct result of increased nursing presence supported by this regulatory regime, standards of care in aged care facilities in Australia have improved dramatically. Interestingly, one of the findings of the Giles Report was that the presence of nurses was the key to improving health and quality of care to older people in nursing homes.
While some of the regulations introduced were criticised as cumbersome, the QNU believes that wholesale de-regulation of the aged care industry accompanied by funding cuts is putting standards of care at risk. De-regulation by the current federal government is providing a window of opportunity for cost cutting practices to flourish (particularly as Accreditation is not mandatory until 2001).
Why Aged Care Needs Nurses
De-regulation by the federal government, employer cost cutting and economically driven models of care which fail to recognise the real health care needs of residents are placing nursing care under threat in aged care facilities.
Care provided within a nursing model is subject to established and publicly acceptable professional standards and a code of ethics. Nursing provides a holistic approach, which includes health promotion and illness prevention, ensuring residents enjoy quality of life. The following table contrasts the differences between nursing models and care models. | 
