Stepping up to the challenge
Published: 5 October 2009
In the last few months there have been very disturbing developments for nursing and midwifery south of the border. Various NSW Health Area Health Services are making hundreds of registered and enrolled nurse positions in hospital and community health settings redundant, replacing them with unlicensed personnel in an attempt to rein in the health budget. In the Sydney West Area Health Service alone there are planned cuts to over 100 RN, RM and EN positions affecting areas such as Neonatal Intensive Care, Radiation Oncology, Women’s Health, Emergency Department and various other specialty units.
The NSW Nurses’ Association (NSWNA) responded swiftly by launching its campaign at its annual conference in July. This campaign highlights the critical need to ensure there are the right nurses, in the right numbers, in the right place at the right time. Delegates to the NSWNA conference rallied outside the NSW Health Minister’s office calling for patient safety to be protected from budget cuts that undermine the proper nursing skill mix in healthcare settings.
The situation in NSW places in sharp relief the critical issue of ensuring not only the right number but also the right mix of nursing and midwifery staff. The importance of skill mix was highlighted in the research by Professor Christine Duffield, Glueing it together: Nurses, their work environment and patient safety which found:
Skill mix is more critical to patient outcomes than hours of nursing.
A skill mix with a higher proportion of RNs produced statistically significant decreases in rates of negative patient outcomes such as decubitus ulcers, gastrointestinal bleeding, sepsis, shock, physiologic/metabolic derangement, pulmonary failure and “failure to rescue”.
The QNU has highlighted for many years the urgent need to address the current and predicted worsening of the nursing and midwifery workforce shortages, most recently through our Nurses. For you. For life campaign. The repeated failure of governments, the education sector and health and aged care providers to address this urgent health policy priority is a disgrace. The Council of Australian Governments (CoAG) announced at the end of 2008 that health workforce was a priority and that a national Health Workforce Agency would be established by May this year to guide planning. This agency is still to be set up and yet it is critical to achieving a coordinated and appropriately planned and funded approach to health workforce shortages.
Couple the significant planned expansion of health service provision in Queensland with the fact that over the next 20 years 60% of the currently employed registered and enrolled nurses in Queensland will be reaching retirement age, and we have a very scary vision of the future.
The longer there is policy neglect in this vital area the worse skill mix concerns will get. This crisis will effectively have been engineered, leaving open the way for nursing and midwifery positions to be replaced with generic health workers, many of whom are unqualified. As we know, this agenda is already well under way, being driven by some policy makers and educational institutions promoting courses and career frameworks for new health care roles and lobbying government to embrace such concepts.
The QNU will continue to be vigilant in this space and actively promote models of nursing and midwifery that ensure safe, sustainable and patient centered health services for the community of Queensland.
Members play the pivotal role in sustaining our core values of advocacy, holism, caring and professionalism. Wherever nursing and midwifery are needed by our community then nurses and midwives must determine who does what. The facts are that nurses and midwives keep the system safe.
The models that we advance include all levels—assistants in nursing, enrolled nurses and registered nurses, nurse practitioners and registered midwives. All have an important contribution to make to our health and aged care systems.
It is also essential that we use the evidence to determine the critical issue of skill mix from the perspective of what facilitates the provision of high quality patient centered care. The expert clinical judgment of regulated nurses and midwives must inform this and we need to be prepared to step up and fight to defend our judgments.
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