Extra cash won’t be enough

Wednesday saw Rudd’s first major health initiative announced, to encourage non-practising nurses to return to nursing to address the current staffing shortage.SMH:

Under the policy, which would cost $81 million over five years, nurses who had not been working as nurses for at least 12 months would be offered bonuses to return. A $3000 bonus would be paid once a nurse had been back in the hospital system for six months. This would be followed by a second $3000 bonus if the nurse continued to work in hospitals for another 12 months. The bonuses would be available to 7750 nurses. A Labor government would also pay hospitals $1000 for each nurse re-entering the workforce under the scheme to help meet retraining costs.

Labor would increase university funding to create 500 new places for nursing students next year and an extra 1000 places from 2009. Mr Rudd said this would deliver an additional 1500 nurses within five years.

Mr Rudd has made health care and hospital reform a central element of his election campaign.

ABC Online:

KEVIN RUDD: We can’t solve all problems overnight. This is a huge step forward across the designated period through to 2012 to meet the projected shortage. Now this goes a huge step in that direction.

We will have further things to say about workforce planning when it comes to nurses later in the campaign.

Well, he needs to. As a sweetener the return to nursing bonus is a great attention-getter, but the response from nursing unions and nurses who rang into talkback radio was cautious, because although pay is an important issue the over-riding concerns of nurses centre on the conditions under which they work.

Australian Nursing Federation:

“This initiative is a good first step” says Ged Kearney, Assistant Federal Secretary “however we still require a coordinated approach through a national workforce strategy linking education to workforce needs. With nurses continuing to leave the profession it is important to address issues like poor pay and conditions and unmanageable workloads. We have to address retention as well as recruitment.”

Anyone who went into nursing in the first place is aware that it is extremely hard work that it not especially well financially compensated, but what galls is that their crucial work is undervalued by administration in terms of ensuring reasonable working conditions and respecting that their work is important enough that they should have adequate support staff to do essential non-nursing duties at all times.

Just a few examples:

  • Currently, nurses working night shift have no support from clerical or cleaning staff in most units, yet clinical guidelines and occupational health and safety requirements mean that paperwork and data entry still have to be done during the shift, that wards must be kept clean as the predictable messes surrounding unwell people occur, and that acute treatment rooms must be thoroughly cleaned to the proper antiseptic standard between patients. Nurses on night duty are expected to do all this as well as their normal nursing duties without any change in the nurse to patient ratio or any extra remuneration for performing these duties, and their shift last for 10 hours rather than 8.
  • Nurse:patient ratios are often calculated on a farcical basis. I’ve been told that in obstetrics at one major Sydney hospital, all nurse-patient ratios are predicated on the idea that only the mother is the patient, and takes no account of how much care each mother actually needs. This means that a pregnant woman assessed as “at risk” of premature delivery who has been placed on monitored bedrest is assigned the same value in calculating the necessary staff roster as a post-caesarian surgery mother of twins who is on IV pain-relief, requires post-surgical monitoring and is having difficulties establishing breastfeeding of two underweight infants. Obviously this often leads to understaffing when high-dependency infants are on the ward along with their mothers.
  • The way in which rosters are organised is increasingly outdated and actively hostile to an equitable work/family balance. Shiftwork of course is essential for providing 24/7 care, but it is the way in which the staff are rostered to fill these shifts that is the problem, with frequent double-shifts and shift changes which disrupt sleep patterns and childcare routines. The profession, to its credit, has tried very hard to improve rostering from at least an OH&S view, mandating sufficient rest time between double shifts and changing shifts etc so that nurses are not overtired and therefore endangering themselves and their patients. But attempting to make truly innovative structural changes to rostering patterns has come up against incredible institutional inertia, which can’t see why the system should change so much as all that. After all, the nurses of old could do it, what’s wrong with these soft young nurses today? The problem is that the original systems of rostering nurses relied upon nurses being nuns, spinsters or widows, either childless or with extended family to care for their children, and also relied on the social standards of the time that respectable women did not socialise much outside their home, so that variable rosters made little difference to their social lives. To expect modern nurses to forgo any hope of reliably spending time with partners, children and friends during normal social hours just to make the hospital administration’s rostering problems easier is futile.

There’s more, much more. The pay issue certainly rankles, and needs to be addressed, but there is a whole culture of just expecting nurses to suck it up, then suck it up some more, just like the nuns used to do back when women had few options of ensuring their personal financial security, that is really at the heart of the nursing shortage crisis. The perceived glass escalator [pdf] for male nurses into managerial positions is also a continuing issue in the retention of senior female nurses seeking professional recognition for their years of experience, as is the enormously strong institutional hostility to whistleblowers (although hospitals are hardly unique there).

Yesterday Rudd’s announcement was sidelined by the exacerbating tensions in the Victorian nurse’s strike, and it’s worth noting that a core issue for the nurses on strike is that their claim addresses work conditions, especially patient ratios, not just a pay rise.

The Australian Nursing Federation has refused two requests to lift work bans while talks continue in the Commission.

The federation’s Lisa Fitzpatrick says nurses do not want the Commission to rule on their pay claim.

“Because the powerless Industrial Relations Commission, now under this new legislation, cannot grant nurses nurse patient ratios and also cannot provide anything more than what the employer can afford to pay,” she said.

“Of course public hospitals’ employers are the actual hospitals and they can only afford to pay what the Government provides them.”

Today, Howard has announced yet another attempt to move health from the public and into the private industry sphere: Australia’s first ever clinical school for medical students in a private hospital.

How well will Rudd’s response play? At least it’s not more me-too-ism.

Mr Rudd insisted he would not try to keep pace with the Coalition in an election spending spree. He said he had read carefully the latest International Monetary Fund Economic Outlook on Australia, which this week sparked fears of an overheating economy.

“I remember very carefully Mr Howard’s spendathon back in the last election campaign “” $6 billion in one speech, you could almost see the numbers spinning over,” he said. “I will not be matching Mr Howard dollar for dollar for every promise he makes this election because we’ve got to be responsible, prudent, conservative, cautious fiscal managers “” I intend to be that.”

Healthcare is becoming a bigger and bigger issue every day of this election period. Throwing money at it won’t be enough, the system requires overhauling to attract and retain sufficient nurses. There is still insufficient emphasis on enhancing retention rates.



Categories: health, Politics

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