It is often said that truth is stranger than fiction and indeed, that is the way I am feeling about the news that the Australian Medical Association (WA Branch), which has a registered training organisation (RTO) that offers a number of short courses and certificate and diploma programs, has recently advertised a Diploma in Nursing.
This is an 18-month full time program to provide education to enable people to become enrolled nurses. The course was approved by the Nursing and Midwifery Board of Australia on 25th October, 2022 and is set to commence shortly.
My reaction of disbelief to this news is based on three factors. First, the concept that it is actually appropriate for the medical profession to be running courses leading to a nursing qualification. Secondly, that an organisation that has been so trenchantly and publicly opposed to the professional development of nurse practitioners would even imagine it has any role in the education of nurses. Thirdly, the notion that the medical profession would imagine it was appropriate to profit from funding that was directed to nursing education for graduates to enter the nursing profession.
Let me take each of these in turn. Although AMA Training Services is a registered training organisation (RTO) and thus completely entitled to offer certificate and diploma programs, the topics to date have been more along the lines of practice managers, medical receptionists, first aid, infection control and health administration – non-profession specific programs for people who would in all probability be the employees of medical practices. Notwithstanding this, with regard to generic clinical topics such as first aid and infection control, all professions need to learn about these topics and multidisciplinary education for short courses is to be applauded. However, the AMA were unsupportive of undertaking Government-funded vaccination programs provided by the Australian College of Nursing during the early days of COVID, and preferred to do away with a “one-size-fits-all” approach to those programs.
But nursing is a recognised and regulated profession distinct from medicine. One can only imagine the outrage should a nursing organisation’s RTO decide to offer a degree in medicine. That response would probably be somewhat similar to my significant concerns now, although potentially less respectful, given the language that has been used in the past by the AMA and the RACGP in the nurse practitioner debate. To refresh your memories: here is some of the language used when nurse practitioners were first mooted in NSW. The medical press published comments from doctors who considered that nurses, in seeking this legitimation, were ‘out of line’, perhaps impertinent, and should stay doing that which they had always done. There is a sense of this in the following quotes:
To claim to be able to work as independent nurse practitioners is certainly a gallant wish from the militant nursing educators to justify their existence and their claim for glory. (Kwong AYM. Four years not enough. Aus Doc 1992; August 14: 9).
“Strong threats to our profession are being mounted by a handful of nurses with a grossly inflated opinion of their abilities”. (Buhagiar A., General practice must repel invaders Aus Doc 1992; August 28th: 6.)
“Nurses do excellent work, but they are not doctors – they aren’t trained in diagnosis and treatment, and a bridging course won’t be enough to cross that gap. There are better ways for the government to spend public money – we need more skilled nurses rather than semi-qualified people acting as de-facto GPs. (Napier R. Nurse practitioners – costly politics?” (Health Management Bulletin 1998b; 4: 8-10)
““Patients wouldn’t want to see a winger in the forward pack” (Phelps in Australian Medical Association, Rural Doctors Association, Australian College of Remote & Rural Medicine, Royal Australian College of General Practitioners.” (NSW Government prescribes peril for patients and health care. Joint media release May 22nd 2000).
The language used was and still is telling: ‘militant nurses’, ‘claim for glory’, ‘threats’, ‘grossly inflated opinion of their abilities’, ‘semi-qualified people’, ‘wingers in the forward pack’- such language reeks of both domination and disdain. Two medical groups, the AMA and the Royal Australian College of General Practitioners (RACGP), were consulted and included in the early work on nurse practitioner implementation at that time. Their concerns were addressed as a result of a significant number of compromises and, although the AMA never really shifted in its opposition to nurse practitioners during the three-year consultative process, for a while the RACGP supported the outcomes of the research and the Stage Three recommendations. However, although nurse practitioners are now well established across Australia, both the RACGP and the AMA continue to be publicly unsupportive of nurse practitioners working in primary health care.
The language of the current press releases is far less florid, but still makes it clear that nurses must be under the control and supervision of doctors.
The language and history above supports my second point. The education of nascent professionals such as enrolled nurses, who then have the opportunity to convert their diploma to a degree through Edith Cowan University, should surely be overseen by an organisation that is ambitious for its students and graduates to reach the highest pinnacles of their clinical careers, which in nursing would be the nurse practitioner positions? This feels to me like putting the fox in charge of the henhouse.
The third point is that, for domestic students wishing to commence enrolled nurse training, the course is fully subsidised by the Western Australian government, so the funding for each student’s scholarship would go directly to the educational institution, apparently after successful completion of semester one of the Diploma Ten TAFE programs already offer Diploma courses in WA, along with a few other RTOs, so presumably there is strong competition for these scholarships.
Presumably, much of that scholarship funding would go towards the infrastructure to run such a program, the educational equipment and teaching staff, all of which would be specified under the ANMAC accreditation standards. For international students, there is an application Fee of $250, a tuition Fee of $30,000 and a Resource Fee of $1,485 and the same entry requirements to the programs as for domestic students.
Given the ongoing lack of support for the professionalisation and growth of the nursing profession by the AMA , a preparedness to become the recipients of nursing scholarships and overseas nursing funding seems to be an unusual direction for their educational program development. But a development it is, approved by our own regulatory authority and regardless of my concerns, so I can only hope that it is being undertaken with the best interests of the nursing profession in mind.
Author’s note:
The author wishes to clarify that Edith Cowan University (ECU) is one of many universities in Australia offering EN to RN degrees and that there is no progression agreement between ECU and the AMA College. It was simply used as a local example.
July 18, 2023
Mary’s career spans 40 years both in the United Kingdom and Australia. Mary is Professor Emerita, Susan Wakil School of Nursing at the University of Sydney. In 2003/04 she was the Chief Nursing Officer, NSW Health Department and prior to that was the Foundation Professor of Nursing in Corrections Health, with the University of Technology, Sydney.
Mary is a Board member of Northern Sydney LHD and chairs their Health Care Quality Committee. She also serves on the Health Ethics Advisory Panel to the NSW Minister for Health and the Clinical Governance Advisory Committee to Healthdirect Australia.
Mary was awarded an AM for significant contributions to nursing and midwifery education and healthcare standards in June 2019.
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