Future Nursing Workforce: A need for innovation

Future Nursing Workforce: a Need for Innovation

Health workforce reform now and into the future is a global priority to ensure sustainability of health care and continue to provide access, quality and safety. Latest nursing and midwifery workforce statistics (Australian Institute of Health and Welfare 2011) report that;

Size of nursing and midwifery workforce

• The total number of nurses and midwives registered in Australia in 2011 was 326,669, a 6.8% increase since 2007 (305,834).
• Between 2007 and 2011, the number of nurses and midwives employed in nursing or midwifery increased by 7.7% from 263,331 (86.1% of registrations) to 283,577 (86.8% of registrations).
• Of these people employed in nursing and midwifery, 36,074 were midwives (including 1,517 people registered as midwives but not nurses), though only 15,523 reported working in midwifery as the principal area of their main job.
• Overall, nursing and midwifery supply decreased by 1.3% between 2007 and 2011, from 1,095.1 to 1,081.1 full-time equivalent nurses and midwives per 100,000 population, based on a 38-hour week. This was mainly a result of a 7.4% decrease in the number of employed enrolled nurses and a 1.6% decrease in the average hours worked by all nurses and midwives over this period.
• Nursing and midwifery supply across regions ranged from 1,101.6 full-time equivalent nurses and midwives per 100,000 population in Major cities to 994.7 in Outer regional areas to 1,335.5 in Very remote areas, based on a 38-hour week.

Demography

• Nursing and midwifery continued to be a female-dominated profession, with women comprising 90.1% of employed nurses and midwives in 2011 (down from 90.4% in 2007).
• The average age of the nursing and midwifery workforce increased between 2007 and 2011 (from 43.7 to 44.5 years). The proportion of nurses and midwives aged 50 or older increased from 33.0% to 38.6% over this period.

Working arrangements

• The average weekly hours worked by employed nurses and midwives decreased from 33.3 hours in 2007 to 32.8 hours in 2011.
• Of all employed clinical nurses and midwives, almost two-thirds (65.2%) worked in hospitals.
• Almost two-thirds of all nurses and midwives reported working in the public sector (59.3%), and these nurses and midwives worked an average of 2.4 hours more per week than their private sector counterparts.  
• The clinical area of nursing and midwifery with the largest number of workers in 2011 was aged care (40,443), which also had the highest proportion of enrolled nurses (41.5%).

With nearly 40% (an increase of over 5 years since 2007) of the Australian nursing workforce over the age of 50, the last of the baby boomer generation are moving towards retirement age within the next 10-15 years.

There is however more than a need for merely recruitment and retention strategies.  Innovation in practice and models of delivery, government, sectoral and organisational policy shifts, changes to restrictive legislation and regulation of health care professionals and capacity building, all require consideration and significant change.

Within this context, the transformation of nursing practice and the critical examination of practices that enable nurses to work within the full extent of their scope of practice is imperative. A great deal of rhetoric has been paid to enabling scope of practice for a number of years.  We have professional practice scope of practice decision-making frameworks, the burgeoning nurse practitioner role and a shift towards advanced enrolled nurse roles.

Yet there remain significant and often artificial barriers that continue to constrain this transformation. These include regulatory and legislative barriers, professional resistance both from other professions but also and most unfortunately from within the nursing profession, the fragmented nature of the health care system, outdated insurance and Medicare systems which restrict nurses from directly accessing provider numbers and claim items, difficulties encountered in the transition from education to practice, and demographic challenges most significantly in rural and remote areas.

Further, reforming the health care system so that it focuses principally on the client, their needs and priorities, rather than on the convenient and often entrenched practices of the health professional will in turn require a fundamental shift in the roles and scope of practice of all health professionals. With new roles comes new opportunities and innovative nursing and midwifery models of care will create new opportunities for nurses in a more sustainable health care system.

Nurses and midwives have always been innovators and this innovation is already seeding itself. In the latest edition of the Nursing Review (Nov 2012), the front cover leads with an article “Nurses To Discharge Hospital Patients.” It reads;

“Nurses at Flinders Medical Centre in South Australia will be discharging patients from early [2013] as part of an efficiency experiment. The trial will see nurses given the responsibility of discharging patients whose condition has improved to predetermined levels.

Currently patients are sitting in beds waiting for discharge when people [the patient, their family and nurses] are aware that their condition has improved to a level such that they really should be going home.”

On page 4 of the same journal, another article leads with “Private midwife, public hospital” and explains that;

“In a first for Australian health, private-practice midwives are being given access to birthing and postnatal services in hospital [Gold Coast Hospital and Health Service lead the way]. Nurses and midwives now have the opportunity to work in self-employed mode within the heath service.

Continuity of care is the principle behind the move, with research suggesting it’s what Australian women want. In 2010, legislation was passed by the Commonwealth [government] enabling eligible midwives to apply for a Medicare provider number.”

As these examples demonstrate, nurses capacity and adaptability to practice effectively in a broad range of environments and settings means they are well positioned to provide and lead client centred care that re seamless across tertiary and primary and community models of care.   Adaptability, flexibility, diversity and versatility are key strengths of the nursing profession. By our weight of numbers and our adaptive capacity, nursing has reinvented itself frequently over time. In their practice nurses have embraced the use of high level technology, expansion of primary health care, remote area care, higher level health acuity in community based care, nurse specialist and nurse practitioner roles, nurse led clinics in primary health care, broader health promotion and health education roles and health informatics to name but a few.

Nurses are like ivy, they fill the cracks and expand into them. As Health Workforce Australia (www.hwa.gov.au) strives in the coming years to create innovation in health reform, nurses should be positioning themselves directly in the centre of this collaboration and ensure that their experience, knowledge and record for adaptation and effective change are well utilised in this process.