[Previous article][Contents][Next article]
The dynamic nature of the health care system in Australia over the past decade has resulted in the considerable evolution of all health care occupations. This study uses literature published since 1985 to examine the sociological implications that recent changes have effected for the nursing profession in Australia.
|
Julie Purcell, RN, Cardio-vascular and Thoracic Nursing Certificate. Julie's recent experience includes holding the position of Clinical Nurse Co-ordinator, Cardiac Surgery and Transplant and Nurse Unit Manager, Cardiac Intensive Care Unit. Julie is currently in 2nd year in the Bachelor of Social Science at the University of New South Wales. |
[top]
The health system in Australia is dynamic; rarely more so than in the last decade, with major changes occurring in the health care professions, particularly nursing. Issues such as AIDS (Autoimmune Deficiency Syndrome), the transfer of nurses' education to tertiary institutions, specialisation of health care, disparate supply of staff across health care occupations, and new technological advances have irrevocably altered health care for both those employed, and clients of the system.
[top]
The increasing incidence of people with the Human Immunodeficiency Virus (HIV), both in institutions and at home, has resulted in major changes across all health care areas, procedures, organisation, education and, above all, attention to attitudes - particularly those of the primary health care givers, nurses. The care of AIDS patients introduces moral and legal issues, which makes it the greatest ethical dilemma facing the nursing profession today (Dobson 1988). Coates (1990) suggests that the major issue for health workers is that of human rights obligations with relation to AIDS. An overview of medical, nursing, and social aspects of AIDS focuses on the home care provided by community nurses (Bick 1990). AIDS is misconceived as being a 'gay' disease and nurses suffer stigma and resentment in patient care (Kelly, St. Lawrence, Hood, Smith and Cook 1988). All (1989) proposes that appropriate education of nurses may facilitate a change in the perception of AIDS.
[top]
Medical and other health-related research has provided advanced specialist techniques such as organ transplantation and improved immunosuppression, along with an overwhelming number of new technologies which have resulted in an increased life expectancy for the populations of advanced countries such as Australia. Bandman and Bandman (1990) present a cost analysis of life-supportive procedures and a discussion on rights based ethics. Ethical issues within the health care system in Australia, (in relation to AIDS - see above), include those relating to refusing and withdrawing treatment for extremely low birth weight and spina bifida babies and the sick elderly, human rights, and living wills (The National Health and Medical Research Council 1989). Marles (1988) discusses the role of the nurse in ethical decision making on issues raised by current medical technology and practice.
[top]
The transfer of nurses' education from hospitals to tertiary education centres in 1985, which will be complete by 1993 (Biscoe 1989), has had wide ranging effects on the entire health care system. A report prepared by The Australian College of Health Service Administrators N.S.W. (A.C.H.S.A.), College of Nursing N.S.W., Hospitals and Health Services Association N.S.W., Institute of Nursing Administrators N.S.W. and A.C.T. and Royal Australian College of Medical Administrators N.S.W. (1986). suggests reasons for deficiencies in nursing education: insufficient student quotas, decline in in-service education, lack of specialty post-basic courses: and proposes solutions. Comments of both hospital and tertiary trained nurses in public hospitals regarding the ramifications of transfer include: a shortage of all registered nurses (RNs), particularly those with experience, lack of practical ability of new RNs, increased responsibility for senior RNs and premature responsibility for new RNs.
[top]
The increasing specialisation and use of advanced technology in health care has resulted in the requirement that nurses undertake specialist post-graduate courses in highly refined areas of patient/ technology care. The A.C.H.S.A. et al (1986) suggest improvements to specialist nursing education, such as adequate remuneration for post-basic and post-graduate nursing qualifications, access to study leave for upgrading and an insurgence of additional funds for the purpose. A new career structure, implemented in 1985, and professional rates of pay implemented in October 1990 (N.S.W. Nurses' Association 1989) has resulted in recognition of nurses as 'specialists in a field' by virtue of post-basic qualifications and/or years of experience in a specialist field, rather than being paid on the strength of years of service alone.
[top]
New-generation technology, including the computerisation of many (and increasing) facets of health care facilities, highly technical monitoring techniques and machinery in neuro, renal and cardiac areas, and extremely sensitive patient nutrition and fluid delivery systems, is requiring further skills for health personnel. Romano (1990) addresses the management of 'innovations' (social, organisational and technical), particularly with relation to computers and nursing.
[top]
The reasons for the undersupply of nurses, as described by Davis and George (1985), were low pay, inflexible hours, dissatisfaction with intrinsic rewards and lack of positive feedback. The result of student nurses being removed from hospitals was merely anticipated by Davis and George (1985). Public Hospitals are required, at certain periods of the academic year, to restrict the employment of any nursing personnel other than new college graduates to ensure adequate numbers of graduating nurses employment: a situation which, at these times, exacerbates the problem of critically low numbers of registered nurses in hospitals. The Australian Bureau of Statistics (ABS) (1990) provides data relating to the number of qualified nurses who have a job, work in nursing, have left nursing, and changes across time, of the nurse to population ratio in Australia. Information relating to the rate and patterns of nurses' turnover, reasons for nurses experiencing low job satisfaction and leaving the profession is provided by Battersby, Kermode, van der Wal, Boylan, Kerr and King (1989). Diaz (1990) suggests that attention to the unique needs of afternoon and night shift workers may facilitate retention of nurses. The A.C.H.S.A. et al (1986) suggest that the shortage of nurses is due to lack of job satisfaction, lack of professional recognition, inadequate pay, no career path, little effective workforce planning by statutory authorities and lack of continuity of staff (due to nurses working for private nursing agencies).
[top]
Davis and George (1985) provide information on the employment of nurses in health areas other than hospitals, suggesting that private agency nurses earn more pay and have greater flexibility. The increasing shortage of nurses in hospitals has necessitated the use of increased numbers of agency staff on a 24 hour basis. Hospitals can no longer function adequately without using agency staff and frequently, even with such staff, run dangerously short. Agencies can, furthermore, often not supply sufficient numbers of nurses. The A.C.H.S.A. et al (1986) suggest the elimination of the use of private agency nurses, proposing the establishment of a nurse administered central agency under the auspices of the Health Department.
[top]
The perception which nurses and others have of nurses may also contribute to deficient potential numbers entering the nursing profession. Nurses have been and are seen as falling into 4 stereotypic groups: 'the ministering angel' 'the battleaxe' 'the naughty nurse' and 'the doctor's handmaiden' (Bridges 1990). Bridges suggests that these stereotypes may affect nurses and the services they provide; finding little evidence for attempts to dispel these images. Kalisch and Kalisch (1985) propose several ways in which nurses appearing in the media can improve the image. In a later publication, Kalisch and Kalisch (1987) discuss the ways in which fiction has portrayed nurses and the nursing profession. Bessant and D'Cruz (1989) examine the public perception of the first ever nurses' strikes in Victoria in 1986, suggesting that the image of nurses has been dramatically altered.
[top]
Davis and George (1985) suggest that, although male health care personnel are in the minority, the positions they hold are more likely to be those involved in the decision making process. The ABS (1990) provides recent data on the gender inequality of RNs In 1989: of the 187,300 RNs in Australia, 16,000 (or 8.5%) were male. Beaumont (1989) suggest that the traditionally female occupation of nursing is doomed to subservience unless the organisational structure undergoes change. Sex discrimination in nursing is discussed by Ellis and Hartley (1988).
[top]
Literature reviewed reveals the volatile nature of the health care system over the past five years relative to the nursing profession. As changes continue. the next 5 years promise the emergence of a no less dynamic picture.
[top]
[top]