The Shortage of Nurses in Australia - Coursework Example

CONTEMPORARY NURSING CONTEMPORARY NURSING Insert name: Course code: Instructor’s name: August 25, 2010 Table of Contents Table of Contents 2 1.0 INTRODUCTION 4 2.0 GENERAL FACTORS IMPACTING ON WORKFORCE DEMAND AND SUPPLY 5 2.1 Demographics 5 2.2 Structural change and central government initiatives 6 2.2.1 Effectiveness and efficiency 6 2.2.2 Changes in the medical workforce 7 2.3 Changes in technology and the philosophy of care 7 Technological improvements continue to greatly influence health-care practice. The main reason for the increasing demand for nursing specialists is to be able to respond to these advances as well as use of novel techniques, treatments along with procedures to improve patient care. Clearly this is an area where the availability of professional development is vital and much shortage may be arising from this area. However, as well as creating opportunities for developing more specialist roles there is the possibility that technology may replace certain tasks or make them more appropriate to other staff groups. Technological advances are also evident in the way health care and health services are being organized and reorganized in the 1990s, with approaches like ‘patient-centered care’ and ‘hospital process re-engineering’ becoming more widespread. Behind these approaches are new philosophies of care that seek to organize health services around the needs of patients rather than managerial or physical boundaries. It is good to note that where these projects are taking place, there is substantial impact on the design of jobs and roles to meet the requirements of new ways of working that will potentially alter the demand for staff, nurses included (Azbell, 1969). 7 Australia suffers a big turnover in hospital nurses. Most of their registered nurses go to England, and many just leave to see the world (Azbell, 1969). In Australia, outpost nurses are required who can carry out every kind of job. The supply of nurses in Australia is a reflection of what is happening in the general economy as well as of the mobility of men in their jobs. The most urgent shortage is in those educated to be teachers of nursing. Unless quick measures are taken to increase the enrollment in schools, the number of nurses required in Australia cannot be obtained. Although the shortage in nursing workforce has been attributed by growth in population, this is not the main reason (Azbell, 1969). Nursing, like any other health discipline is involved in two simultaneous revolutions: the scientific, which has forced specialization as well as the cultural, which has raised the aspirations for medical care. While the number of nurses has increased relative to the growth of population, it has not increased in proportion to the demand for nursing care. 8 3.0 STATISTICS ON THE SHORTAGE OF NURSES 9 4.0 SKILLS REQUIRED 11 5.0 POLITICAL FACTORS 12 6.0 POSSIBLE SOLUTIONS 13 7.0 CONCLUSION 13 References: 15 1.0 INTRODUCTION There are a number of factors that have contributed to the shortage of nurses in Australia. It is critical to note that a range of factor may be relevant to each individual provider of health care and may differ from other such organizations when considering the supply and demand for nursing staff in Australia. There are also several general trends that have impacted on health services over the last few years which partly provides a number of reasons as to why there is an imbalance between the demand for and supply of nurses. There is a severe scarcity of nurses, and if this problem is not thoroughly dealt with, it may deteriorate in future. In reality, the tending scarcity has turn out to be a kind of mini-industry. This shortage is not mainly due to the aging of the workforce. As a matter of fact, the aging factor is a symptom of the fact that there is a global shortage of people willing to put up with the conditions under which they are asked to deliver hand-on care to the sickest, most vulnerable people in the societies. They are drained by small payments, of deprived work environment, of medical practitioners who view nurses like hand-maids, and of sanatoriums along with other organizations that view them as contemptible and of no use. Several nurses claim they also feel attacked or unsupported by some nurses who are academics and managers who claim to be professional leaders but who work in jobs in which they are constantly asked to ‘de-professionalize’ – or sometimes even disparage – bedside nurses and fight against them, not for and with them. Many nurses are using ‘voice’ to protest these developments. They participate in strike, form gatherings, write article in addition to petitioning representatives for wide-ranging legislation overriding specialized principles and performance. However, as birthrates keep on declining in developed societies, with smaller number of youth obtainable to look after the sick aged citizens, as well as with ladies having numerous more professional choices, nursing may turn out to be a higher-status, top salaried profession. Australia has been facing a dire challenge of shortage of nurses. This paper analyzes this shortage from the socio-political perspective, and the factors that have contributed to this shortage like demographics, Structural change and central government initiatives (Effectiveness and efficiency along with Changes in the medical workforce), Changes in technology and the philosophy of care as well as revolution in nursing. 2.0 GENERAL FACTORS IMPACTING ON WORKFORCE DEMAND AND SUPPLY 2.1 Demographics The reduction in the number of school leavers in the 1990s left the Australian health systems extremely vulnerable as new recruits reduced. This was also partly affected by the economic recession of the late 1980s and 1990s (Quinn, 1998). This recession seriously affected other areas by reducing other employment sectors that were expected to recruit from the traditional NHS recruitment pool of school leavers. The effect of the downturn on community funds constrained public expenditure on the National Health Services. Consequently, many employers did not recruit in traditional numbers and also sought to replace perceived ‘high-cost’ professional staff with lower-cost ‘support workers’, which was a disliking move to the NHS workforce. However, there are other elements of the demographic dimension impact on the supply of and demand for nursing staff in the recent past. According to Quinn 1998, the aging population has greatly influenced the demand for health services as the dependency of the population have increased. Second, the number of females in the workforce has always been high (90% of the nursing workforce is female) and expected that by late 1990s, the working condition would have been better but this never happened (Quinn 1998). This led some to resign and look for other better jobs that would sustain their life or went to other countries where the pay for nurses was better. The third reason is that as the recession intensified, other employment sectors which compete with Australian health service in the labour market became more active and thus increased pressure on Australian health service in terms of its ability to attract new recruits. 2.2 Structural change and central government initiatives The organizational and managerial changes in the Australian health services have had a significant impact on the nursing workforce (Chitty, 2005). Some of the impact on the demand for and supply of nurses are: 2.2.1 Effectiveness and efficiency The value for money has been at the heart of many health services reforms in Australia and this has impacted on staff demand in various ways. The need for yet more efficiency savings has led many health-care providers to seek to replace professional staff with support workers (Quinn, 1998). At the same time this quest for efficiency has led to many management roles being created at local and ward level, with the result that significant numbers of nurses are now classified as senior managers, altering the statistics of nursing numbers even further. As a result, this nursing workforce sought employment in other sectors while others left the country to be better job in other countries. The need for continuing efficiency and effectiveness is likely to have had a more subtle impact on the supply of nurses. Most of those that have left the health services have claimed to be dissatisfied with the job. Apart from other sources of dissatisfaction, reorganization and efficiency savings of Australian health services have some impact on this (Chitty, 2005). 2.2.2 Changes in the medical workforce The Australian medical workforce is undergoing some substantial changes due to central initiatives, many of which will have a direct impact on nursing demand and the types of role required. These initiatives have, and will continue to have, a profound impact on doctors in training but will also impact other health-care professionals, especially nurses (Quinn, 1998). The increasing numbers of specialist nursing roles and nurse practitioners can in part be attributed to the implementation needs of the central initiatives. Chances are that as a result of the emergence of these roles, the boundaries between doctors and nurses, and nurses and other professional and support staff will continue to be challenged and will influence nursing demand (Chitty, 2005). 2.3 Changes in technology and the philosophy of care Technological improvements continue to greatly influence health-care practice. The main reason for the increasing demand for nursing specialists is to be able to respond to these advances as well as use of novel techniques, treatments along with procedures to improve patient care. Clearly this is an area where the availability of professional development is vital and much shortage may be arising from this area. However, as well as creating opportunities for developing more specialist roles there is the possibility that technology may replace certain tasks or make them more appropriate to other staff groups. Technological advances are also evident in the way health care and health services are being organized and reorganized in the 1990s, with approaches like ‘patient-centered care’ and ‘hospital process re-engineering’ becoming more widespread. Behind these approaches are new philosophies of care that seek to organize health services around the needs of patients rather than managerial or physical boundaries. It is good to note that where these projects are taking place, there is substantial impact on the design of jobs and roles to meet the requirements of new ways of working that will potentially alter the demand for staff, nurses included (Azbell, 1969). 2.4 Revolution in nursing Australia suffers a big turnover in hospital nurses. Most of their registered nurses go to England, and many just leave to see the world (Azbell, 1969). In Australia, outpost nurses are required who can carry out every kind of job. The supply of nurses in Australia is a reflection of what is happening in the general economy as well as of the mobility of men in their jobs. The most urgent shortage is in those educated to be teachers of nursing. Unless quick measures are taken to increase the enrollment in schools, the number of nurses required in Australia cannot be obtained. Although the shortage in nursing workforce has been attributed by growth in population, this is not the main reason (Azbell, 1969). Nursing, like any other health discipline is involved in two simultaneous revolutions: the scientific, which has forced specialization as well as the cultural, which has raised the aspirations for medical care. While the number of nurses has increased relative to the growth of population, it has not increased in proportion to the demand for nursing care. Three or four decades ago, there was little that could be done by nurses at the bedside of the patient. There were no antibiotics or the current scientific knowledge. Currently, medical practitioners are on the offensive against disease, and have all the modern types of drugs and surgery. This has resulted in a proliferation of services that ought to be provided to hospitalized patients. Rather than providing the most excellent health care to a few people severally, medical practitioners including nurses are currently expected to do it for all of the people at all times. This means that there is a need of nurses within hospitals at all times (Azbell, 1969). Furthermore, a growing population of the elderly people is demanding nursing care, backed up by increased private and federal health insurance (Azbell, 1969). With advanced technology, there is reduced mortality and increased birth rate thus resulting for more babies to care for. The nursing profession is currently facing challenges and competition from other sources in their recruitment of young women to fill all these needs. 3.0 STATISTICS ON THE SHORTAGE OF NURSES There is a shortage of nurses in Australia and around the world. This implies that there are not enough nurses to fill the jobs they are needed for. According to the report by The Australian Workforce: An overview of workforce planning 2001 – 2004, it was found that between 10,000 and 12,000 new registered nurses are required to graduate in Australia each year to meet the demand but only 6,000 are graduating each year. Furthermore, the mean age of nurses is now well over forty, indicating that within fifteen years large numbers of the profession will retire, and the shortage is likely to get worse. The effect of this shortage is that some health facilities are chronically understaffed, leaving the existing staff overworked. Furthermore, supply has failed to keep pace because of various factors like fewer people entering the workforce, a greater range of professional opportunities, a perception that nursing is undervalued as well as negative perceptions of nurse working conditions (OECD, 2004). According to research done, the main reasons for nurse shortages are likely to be: There are no enough nursing places at colleges as well as institutions of higher education to keep up with demand. There is a universal turn down in attention about health professions. Due to shortages, the remaining nurses have huge workloads which compel them to leave the profession. As the health sector grows, there are more patients who are older and in need for attention due to their complicated problems and there is not enough nurses to meet the demands. There is likelihood that the health system is overly bureaucratic. There are great community misconceptions that nurses are doing menial work and earning poor pay. Much shortage is coming from the fact that there are few males in the nursing profession as nursing are seen as a feminine profession. Films and TV shows in Australia have clichéd and inaccurate portrayals of nurses. The other reason for scarcity of nurses in Australia is that 90 % of the occupation is composed of female, and numerous nurses depart from the occupation because of family responsibilities. In spite of these challenges, the nursing shortage clearly shows that nurses will have excellent job stability in a world where most other workers are facing more uncertainty than ever (Buckis, 2006). 4.0 SKILLS REQUIRED In Australia, there are two main nursing qualifications – the registered nurse (RN) qualification, which requires a university degree, or the enrolled nurse (EN) qualification, which requires a TAFE certificate (Elliott D., Aitken, Chaboyer, 2007). In Victoria, enrolled nurses are referred to as ‘registered nurses division two’. Registered nurses (RNs) are qualified at university, and can work in a huge range of specialties and positions. Enrolled nurses (ENs) are TAFE qualified and normally work in clinical roles, caring for aged people and patients in hospitals. We find that the number of graduates released every year is very few and most of them fry abroad in countries like Britain and USA to seek better paying jobs. Furthermore, according to the recent analysis, there are many patients that are seriously sick and require highly trained and experienced nurses to handle their cases. The nurse: patient ratio that is required is 1:1 and this is currently not possible in Australia (Elliott D., Aitken, Chaboyer, 2007). This clearly shows the great shortage of nurses in Australia. Even the skill mix that is being done is not fully meeting the demand for nurses in Australia. 5.0 POLITICAL FACTORS Political factors include health care entitlement programs as well as prospective payment systems. The learning needs and competencies required of nurse executives included having the ability to lad across cultural, functional as well as departmental boundaries. Nursing leadership ought to facilitate change, be comfortable with constant change, have expertise in financial management, facilitate teamwork through team building, accept ambiguity in addition to managing personal growth. According to Astarita T., Materna, and Blevins, 1998, there are needs for the strategic management skills and knowledge in health care organizations. Here is absence of skills required for strategic implementation and the need for solid business and financial training. 6.0 POSSIBLE SOLUTIONS The nurses that are currently in the Medicare Field can be maintained by changing the strategic plan. The change agent can assist people as well as systems to shift gears that are necessary to implement a strategic plan. This will also help minimize or eliminate some of the crisis that the nurses face while carrying out their tasks (Sare and Ogilvie, 2009). There are also several ways in which the community groups can assist nursing meet the demands it is facing today in Australia. Families are supposed to ‘give up their wives’ if they are nurses; ‘give their money’ if there are nursing schools in their community that require financial assistance for students; as well as becoming interested in nursing. The government should also offer enough funds and scholarship funds to students who want obtain nursing education. Most schools do not have enough money to meet request for financial aid. The government as well as other funding organizations should raise funds to expand nursing service or nursing school facilities, instructional programs to develop management skills among nursing administrators or even publicizing the health services available to the community. 7.0 CONCLUSION Currently in Australia, nursing is actively seeking the assistance of the community so as to increase and expand its services. Nursing is also aiming at having the community well informed about the career as well as the education opportunities in the field, the services nursing can offer to the people of the community, along with the nursing problems the community can assist to solve (Votroubek and Tabacco, 2009). The medical leaders and personnel should influence the nurses by use of effective communication, networks and strategies to provide information and motivate others to change their thinking and behavior especially of quitting the profession (Shaw, 2007). The leadership of the health care institutions along with the administration ought to take keen measures when staffing. The decisions concerning the suitable staffing levels for any patient care unit need to reflect the analysis of both individual and aggregate patient needs, not forgetting the unit functions necessary to support quality patient care delivery (Hall, 2005) The right staffing will ensure safe, cost-effective and will deal with workload fluctuations in addition to maximizing and maintaining resources in a responsible way. Staffing and scheduling in a hospital should uphold the nursing’s philosophy, objectives as well as the job description. If this is done, is simplifies the efforts to evaluate or measure progress based on patient safety, quality of care as well as the RN professional judgment (Huber, 2006). References: Astarita T. Materna G. and Blevins C. (1998). Competency in home care. Sudbury, Jones & Bartlett Learning Retrieved August 25, 2010 from http://books.google.com/books?id=dDCy3JimGGAC&pg=PA114&dq=factors+which+have+impacted+on+nurses%27+work&hl=en&ei=zd90TLfYNYyKOObLnKQG&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDIQ6AEwAjgK#v=onepage&q=factors%20which%20have%20impacted%20on%20nurses%27%20work&f=false Azbell A. R., 1969. Where are the nurses? The Rotarian Dec 1969 Vol. 115, No. 6. Rotary International Retrieved August 25, 2010 from http://books.google.com/books?id=TTUEAAAAMBAJ&dq=causes+of+the+nursing+shortage+in+Australia&source=gbs_navlinks_s Bosher S. D. and Pharris M. D. (2008). Transforming nursing education: the culturally inclusive environment. New Jersey, Springer Publishing Company. Retrieved August 25, 2010 from http://books.google.com/books?id=1PxJWcJeQjMC&pg=PA375&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=wId2TJP7FNOOONuuuc4G&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCoQ6AEwADgK#v=onepage&q&f=false Buckis, C. (2006). Nursing NSW, Career FAQs. Retrieved August 25, 2010 from http://books.google.com/books?id=544Tto0ZxrcC&pg=PA11&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=3uB0TLQFtmVOLuZucoG&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC0Q6AEwAA#v=onepage&q&f=false Chitty, K.K. (2005). Professional nursing: concepts & challenges. Edition4, Ultimo, Elsevier Health Sciences Retrieved August 25, 2010 from http://books.google.com/books?id=dHadLhrTL9QC&pg=PA97&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=3uB0TL-QFtmVOLuZucoG&sa=X&oi=book_result&ct=result&resnum=9&ved=0CGIQ6AEwCA#v=onepage&q&f=false Diers D. (2004). Speaking of nursing--: narratives of practice, research, policy, and the profession. Sudbury, Jones & Bartlett Learning. Retrieved August 25, 2010 from http://books.google.com/books?id=y0noEkUNhIoC&pg=PA332&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=wId2TJP7FNOOONuuuc4G&sa=X&oi=book_result&ct=result&resnum=3&ved=0CDcQ6AEwAjgK#v=onepage&q&f=false Elliott, D., Aitken L. and Chaboyer W. (2007). ACCCN's Critical Care Nursing. Ultimo, Elsevier Australia. Retrieved August 25, 2010 from http://books.google.com/books?id=T6CzxAIoFNkC&pg=PA21&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=3uB0TL-QFtmVOLuZucoG&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDMQ6AEwAQ#v=onepage&q&f=true Hall L. M. (2005). “Quality work environments for nurse and patient safety”. Sudbury, Jones & Bartlett Learning. Retrieved August 25, 2010 from http://books.google.com/books?id=nJu2fNDgFhYC&pg=PA187&dq=factors+which+have+impacted+on+nurses%27+work&hl=en&ei=eN50TJbiCoGCOKPIweAG&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEAQ6AEwAw#v=onepage&q&f=false Huber D. (2006). Leadership and nursing care management. Edition3, Ultimo, Elsevier Health Sciences. Retrieved August 25, 2010 from http://books.google.com/books?id=fZi5liZ0PaYC&pg=PA719&dq=Nursing+work+and+the+use+of+nursing+time&hl=en&ei=R9l0TIKKHIqtOPWTyKUG&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDEQ6AEwAQ#v=onepage&q=Nursing%20work%20and%20the%20use%20of%20nursing%20time&f=false Gordon, S. (2006). Nursing Against the Odds: How Health Care Cost Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care. New York, Cornell University Press. Retrieved August 25, 2010 from http://books.google.com/books?id=1pdpOx4QZ8MC&pg=PA8&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=3uB0TLQFtmVOLuZucoG&sa=X&oi=book_result&ct=result&resnum=7&ved=0CFUQ6AEwBg#v=onepage&q=causes%20of%20the%20nursing%20shortage%20in%20Australia&f=true Organization for Economic Co-operation and Development (OECD) (2004). The OECD Health Project towards High-Performing Health Systems Paris, OECD Publishing. Retrieved August 25, 2010 from http://books.google.com/books?id=IJ0_yGBYDN4C&pg=PA59&dq=causes+of+the+nursing+shortage+in+Australia&hl=en&ei=3uB0TLQFtmVOLuZucoG&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEAQ6AEwAw#v=onepage&q&f=false Quinn, F. M. (1998). “Continuing Professional Development in Nursing: A Guide for Practitioners and Educators”. Edition2, Cheltenham, Nelson Thornes. Retrieved August 25, 2010 from http://books.google.com/books?id=Wgk1ncslpDsC&pg=PA86&dq=factors+which+have+impacted+on+nurses%27+work&hl=en&ei=eN50TJbiCoGCOKPIweAG&sa=X&oi=book_result&ct=result&resnum=5&ved=0CEYQ6AEwBA#v=onepage&q=factors%20which%20have%20impacted%20on%20nurses%27%20work&f=false Sare M. V. and Ogilvie L. (2009). Strategic Planning for Nurses: Change Management in Health Care. Sudbury, Jones & Bartlett Learning. Retrieved August 25, 2010 from http://books.google.com/books?id=s8RiDUj5rMsC&pg=PA172&dq=factors+which+have+impacted+on+nurses%27+work&hl=en&ei=eN50TJbiCoGCOKPIweAG&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDEQ6AEwAQ#v=onepage&q=factors%20which%20have%20impacted%20on%20nurses%27%20work&f=false Shaw S. (2007). International Council of Nurses: nursing leadership. Oxford, Wiley-Blackwell. Retrieved August 25, 2010 from http://books.google.com/books?id=I6QVTE7VzEC&pg=PA40&dq=factors+which+have+impacted+on+nurses%27+work&hl=en&ei=eN50TJbiCoGCOKPIweAG&sa=X&oi=book_result&ct=result&resnum=9&ved=0CGAQ6AEwCA#v=onepage&q&f=true Votroubek W. and Tabacco A. (2009). Pediatric Home Care for Nurses: A Family-Centered Approach. Edition3, Sudbury, Jones & Bartlett Learning. 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