Why the ranks of nurses are rapidly thinning

A combination of image and funding problems is taking its toll on the will of nurses to work on in the profession. Karen Kissane reports.

Han-Wei Lee, 22, is everything the nursing workforce is not: young, male and non-Anglo. An intensive-care nurse at the Royal Melbourne Hospital, he takes pride in his work. But he is a man in a woman’s world, and has grown used to strange looks when he tells people what he does for a living.

More annoying is the way some patients ask, “Is that all you’re going to be, a nurse?”

“Especially where I’m working; if you turn your head away for half an hour, someone dies,” Mr Lee says. “I think people have this perception of nurses as handmaidens, but it’s so much more involved than just making beds.”

For nurses, the image problem is tiresome. But for the rest of the community, the consequences of this and other problems facing the profession could prove disastrous. A Federal Government report released last week warns that Australia faces a shortage of 31,000 nurses by 2006 because 22,000 are expected to leave the workforce in the next five years. Three-quarters will be retiring; many of the rest will leave because they are burnt out and disenchanted.

Jill Illiffe, national secretary of the Australian Nurses Federation, warns that if the shortfall is not averted: “It means you’ll have to close beds, because you won’t have enough people to look after them. The only other option is that we’re going to be like developing countries: people will come in and get critical care, but their families will have to come in, too, to look after them.”

The nursing profession is like a patient with a lingering ailment, constantly prodded by experts trying to work out a cure for its ills. The current report, Our Duty of Care, is the 12th review, inquiry or research project into the profession in the past six years. It follows a Senate inquiry report earlier this year that warned today’s 5000 vacancies already presented a crisis.

Across the Western world, nursing ranks are thinning. Young women have more careers open to them than previous generations of women, nursing leaders say, and the perception of nurses as low-status “handmaidens” rather than professionals does not fit the modern aspirations of either sex. The main problem has not been recruiting nurses, however, but retaining them in a system battered by a decade of budget cuts.

The existing shortage is creating conditions that lead to more nurses walking away. “It’s like a cat chasing its tail,” says Patricia Heath, chairwoman of the panel that produced the report.

She met one group of junior nurses who decided to leave in their first year of work. “They were only out of university for nine weeks and they were put in charge of a high-dependency surgical ward where the patients were very, very sick, and the only support they had was a student nurse. All of those nurses said they would finish off that graduate year and then leave.” Meanwhile, older nurses were often exhausted from working double shifts to cover for lack of staff, Mrs Heath says.

The shortage has been intensified by buckpassing by state and federal governments, which share different areas of responsibility for managing the profession. “I think generally there has been a lack of ownership about who should be doing the planning,” says Ella Lowe, a panel member and head of the school of nursing at La Trobe University. There has also been a lack of political foresight: “In the early ’90s, we were paying nurses to go away, offering them voluntary departure packages.”

In response to the report, the Victorian Government called on the Commonwealth to fund more training places. The Federal Government said no amount of places would be enough if the states did not hold on to nurses by giving them good working conditions.

Australia cannot train all the people who want to be nurses. According to figures from the Australian Vice-Chancellors Committee, this year more than a quarter of eligible applicants to nursing courses did not receive a place (2934 of 11,314). The nursing shortage is a crisis for state governments, which run the public hospital system, but most funding for nurses’ courses comes from the Federal Government, which is responsible for universities.

Victorian Health Minister John Thwaites says the state has fewer nursing undergraduates this year (2040) than it had in 1992 (2925). He sees the shortage as the biggest problem facing health in the next decade: “If you don’t have nurses, you can’t provide care, and the number of patients is increasing every year.”

A spokesman for federal Education Minister Brendan Nelson said the report’s recommendations about nursing education would go to the federal review of higher education, which is due to make recommendations to cabinet by the end of the year.

Victoria has managed to win 3300 nurses back to the system with a mix of incentives including nurse-patient ratios that limit workloads, pay rises, refresher courses and postgraduate scholarships. But Mr Thwaites warns that the supply of recruitable ex-nurses will eventually be exhausted.

It seems that Han-Wei Lee can look forward to a lifetime of job security. He acknowledges the job has its problems: shifts trash his social life, menial tasks detract from patient care, and he works an extra day a fortnight for the money.

But he feels he is in the right place: “One of the nice things has been seeing people come in for cardio-thoracic surgery, knowing they’ve only got months or weeks to live because of blockages in their coronary arteries, and seeing them go home six days later with a new lease of life.”

Our Duty of Care

The recommendations:

· An immediate increase of 400 training places in universities

· Low HECS fees for nursing

· Programs to lure back retired nurses

· Drives to recruit men, Aborigines and people from ethnic backgrounds

· A Nursing Council of Australia
· More funding for the clinical part of nurses’ training

First published in The Age.