In 2020 the International Year of the Nurse and Midwife there has been a focus on nurses and nursing. Not the one planned, but nonetheless, nurses have been seen: by politicians and the public. But not by the medical doctors with their vested interests.
At least it was thought that there was a focus on nurses until the Medicare Benefits Schedule Review Taskforce Final Report was made public. Not one of the 14 recommendations relating to Nurse Practitioners was endorsed.
It is time to stop having medical doctors determine the practice of nurses. They are far from independent voices but rather highly vested interest groups.
“I want to thank the many nurses, men and women, whose care has been astonishing. When things could have gone either way…they stood by my bed… For every second of the night they were watching and they were thinking and they were caring, making the interventions I needed.” Boris Johnson, April 2020
“Nurses and Midwives have been on the frontlines of the fight against Covid-19, putting themselves in harm’s way. Many have made the ultimate sacrifice in the service of humanity… Now more than ever the world needs nurses and midwives.” Dr Tedros Ghebreyesus, DG World Health Organisation, May 2020
Across the world in 2020 nurses were recognised as having been the heads, hands and hearts that kept people safe through innovative rapid and accessible COVID testing; caring for the very ill whilst wearing insufferable PPE for 12-hour shifts and being the human face, albeit in gloves and masks; attempting to provide dignity and human contact in death for those who succumbed during this strange period. They also found creative technological ways to keep families connected in these dreadful times.
There was praise, global hand-clapping, Easter egg deliveries to hospitals in obscene quantities and artistic expressions of nurses as superheroes. It began to feel as though the often-invisible work of nurses and nursing was being “seen” for the first time perhaps since World War II.
The Global Nursing Now Campaign, of which the Duchess of Cambridge is patron, had called consistently for better recognition of the work of nurses, having determined their work to be “underutilized and undervalued.” The Campaign sought to bring to the attention of the policy makers the need for greater nursing input, not only into health and social care policy making but also into framing the issues around which policy was to be made. The Director-General of the World Health Organization echoed this call in addressing the World Health Assembly in May and in the designation of 2020 as the International Year of the Nurse and Midwife.
So there had been growing optimism in the profession in Australia that at last, we may have been “seen” as appropriate to take a greater role in health care policy framing and service delivery. Nurse Practitioners had been a growing part of the health workforce in Australia for just on 20 years. Robust research had categorically demonstrated the quality, safety and acceptability of their work and the need for greater numbers for greater patient access.
The national Medicare Benefits Schedule Review Taskforce (MBSRT) had set up a highly respected Nurse Practitioner Reference Group (NPRG) and the report of this group had been seen to be well-argued and evidence-based. It made 14 recommendations to the MBSRT in the hope that these would be endorsed and key roadblocks to service provision would be removed.
AND THEN THE BUBBLE BURST!
The MBSRT Report to Government released in December 14th endorsed not one of the 14 recommendations. (Details of these appear in Pearls and Irritations by Chiarella and Currie, 18/12/2020).
Rather than rehearse the arguments of Chiarella and Currie I feel there is a broader point here. I ask myself is this the “Me TOO” moment for Nurses and Nursing in Australia. Is this the litmus issue over which we collectively say ENOUGH? Nurses have put up with medical doctors’ organisations presuming to speak on our behalf for too long. Too long have medical doctors been the only health professionals setting policy direction and shaping funding models and controlling access.
The MBSRT had 43 working parties exploring specialty areas, almost all headed by medical doctors, and 5 reference groups, of which the Nurse Practitioners group was one. The Taskforce of 15 mostly medical doctors then deliberated on the recommendations. One might see this as a somewhat stacked deck! The Taskforce Chair does, however, indicate the “door is still open” if some taskforce conditions are met.
Individually medical doctors frequently indicate they are in favour of more autonomy and inclusion of nurse and midwives in policymaking and service provision. However, when speaking en masse it is a far different story of turf protection and paternalism. It is 200 years in 2020 since the birth of Florence Nightingale. She was no shrinking benevolent “lady with the lamp”. She was an activist, a statistician, a public health revolutionary.
She was what nurses are today – well educated, articulate, evidence-based, innovative and creative. She changed systems for the better for the health and wellbeing of people. This is what Australian nurses are educated and want to do. We must not be stopped by out-dated monopolies and anachronistic understandings of the role of nurses as somehow subservient to medical doctors. (Many nurses are doctors themselves have taken the hard road to PhD but like Dr Jill Biden, some people find this difficult to acknowledge and respect).
Minister Hunt, this is the moment for you to demonstrate you do “see” nurses and understand their value and potential for an enhanced contribution to Australian health care and improved access to services. Engage with the Australian College of Nurse Practitioners (ACNP) and the Australian Primary Health Care Nurses Association (APNA) and endorse these 14 recommendations for Nurse Practitioners. Discuss these recommendations with those who know this work best and need those changes most.
It will be a strong flag nationally and internationally that this government does want the greatest access to quality care for its people, for that is what nurses (and particularly nurse practitioners in this case) can and do deliver. There are more than 400,000 of us. We vote and we are angry and we are looking for a sign we are being seen and heard.
Professor Jill White is a Professor Emerita of the Susan Wakel School of Nursing and Midwifery at the University of Sydney and the Faculty of Health University of Technology, Sydney (UTS) Australia.
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