In the AFR Laura Tingle rightly points out that nurses do not tend to fit the mould as one of those groups of fortunate students who may reap significant income returns for the cost of their university education. She goes on to point out that “modelling released by Universities Australia this week suggest nurses’ uni debts will rise from $19,398 to as much as $37,390 under the budget proposals. This is for a job paying a starting income of $48,729”. She calculates that a nursing graduate who works 6 years full time on graduation, followed by six years part-time before returning to full time work, would have a debt of $66, 195 that would take 22 years to repay.
So this brave new world of market forces is pretty bad news for nursing recruitment. That is even if you consider that caring ought to be commodified in the first place or whether there are some things that are so important the market should protect them rather than hang them out to dry. Remarkably people often feel quite differently about these matters when they are in need of intensive or palliative care.
But wait, there are more spanners to throw into the works. It’s also ipso facto bad news for nursing retention. This comes not long after Health Workforce Australia’s report Health Workforce 2025 (HWA, March, 2012) modelled future requirements for registered nurses and identified that, with no changes to the status quo, there would be a shortfall in registered nurses of 109,000 or 27%. As it turns out the government also decided to get rid of HWA in the last budget, so these data won’t bother them for much longer.
Note this is a report on registered nurses. This distinction matters for safety and quality in health care. We have an abundance of information about the impact of baccalaureate prepared RN staffing on reduction of adverse events. If the cumulative evidence from these studies were a pill, they would have stopped the trials and given the pill to everybody. Duffield et al’s work (2007) in NSW looked at the relationship between skill mix and adverse events, and governments and their advisory bureaucracies should ignore it at their peril. It is the biggest study ever undertaken examining the relationship between these two issues at unit level and she has received international acclaim as a result of it. For every 10% increase in RNs there is a 27% decrease in failure-to-rescue –we have wards way below that level today.
But HWA’s report points out that we wouldn’t need that many nurses if we only retained 1 in 5 (ONE IN FIVE!!) of the ones we currently lose. A 20% improvement in retention would ameliorate the predicted RN shortage –so we really only need to understand why they are leaving and do something about it. Elementary.
A synthesis of serial investigations and reports demonstrates that the two primary reasons why nurses leave the profession are a sense that they are not valued and a belief that they are not able to deliver high-quality care. Job satisfaction is therefore connected with both skill mix and shortages. The work environment plays an important role in job satisfaction and patient safety as well, as Aiken and colleagues’ multi-country studies indicate (2010). In a number of their studies, hospitals providing “supportive” environments, in terms of staffing levels and organisational factors, were more likely to have better patient outcomes compared to less “supportive” hospitals. These findings are consistent with other surveys indicating the central role of the work environment in job satisfaction and patient safety. So a simple question, will increasing the HECs debts and anxiety improve the work satisfaction of our RN workforce Mr Abbott?
Mary Chiarella is Professor of Nursing, University of Sydney.