At a Watershed: Advanced nursing practice in Australia

There is no more gratifying labor in health care than nursing. The nurses have always been on the front line in a struggle for sound mankind. Oxford Concise Medical Dictionary identifies nurse as “a person trained and experienced in nursing matters and entrusted with the care of the sick and the carrying out of medical and surgical routines” (“Nurse”). This is true, but gives misdescription of this medical profession whose scope is much wider and complex.

Nursing is the largest health profession in Australia. Since the middle of the 80s last century the total number of employed nurses has been relatively stable, although the occupational composition has changed: registered nurses showed growth in comparison with enrolled ones. The recent reports by Australian Institute of Health and Welfare demonstrated such a tendency (qtd. in Hilless & Healy 64).

Despite of this fact we witness Australia–wide shortage of nurses, with no signs of improvement for many years running (Iliffe 4). One can say that nursing practice in Australia is at a watershed of its development. The outcome would depend on what public affairs will be undertaken to overcome the present situation.
The issue involves the necessity to implement advanced nursing practices, to lift up prestige of the profession, to review the system of remuneration of labor, to improve education standards as well. To find the ways to success in advanced practice of nursing in Australia we should examine its current position, indicators of quality, political and industrial contexts, and educational requirements, analyze them and make the conclusions.
Making the considerable part of medical professional workers, nursing in Australia seems to form an image of health care system to a considerable degree.
The community holds the Australian nurses in a high regard which reflects in “very positive public image” of this profession (Iliffe 5). But the very serious issue of shortages “in many areas of nursing, principally operating theatre, critical and intensive care, accident and emergency, cardiothoracic, neonatal care, midwifery and mental health” (qtd. in Hilless & Healy 64) contributed to some loss of health care services provide by advanced nurses due to associated excess workload combined with an ageing nursing workforce (Levett 3).
For instance, “in 1998, there were 9.5 nurses per 1000 population in Australia, which is around the middle range for western European countries […], but slightly more than in Canada and the USA” (Hilless and Healy 64).
Australian Institute of Health and Welfare in 1999 reported that the public hospitals were the largest contributors to nurses’ occupancy in the Commonwealth at a rate of 47% while 82% from a total number of nurses were registered ones (qtd. in Hilless & Healy 64). That means that Australia in fact has positive result in increasing number of highly qualified professionals in nursing.
The Federal Government recently pays much attention to this sector of health care. It defined nursing as a national priority area; provided scholarships for undergraduate and postgraduate nursing education; funded the clinical component of nursing courses (Iliffe 4). But government’s efforts are not sufficient to cardinally improve the situation.
The latest report of the Australian Institute of Health and Welfare has shown, that the amount of nurses workload “increased 8.9% between 1995-96 and 1999-00” (qtd. in Iliffe 4). The same report indicates that more than 50% of nurses work part–time to handle their schedule. As a result we see reducing rate of qualified nurses per 100,000 population from 1074 in 1993 to 1018 in 1999 (Iliffe 4).
In the hospitals the rate of the patients per nurse reduced “from 44.6 patient discharges per FTE nurse in 1995–1996, to 49.3 in 1998–1999” (qtd. in Hilless and Healy 64).
The Federal Government also set a goal to extend the supply of nurse practitioners in rural and remote regions. Now the situation is so that primary care professional workers’ number in urban and rural centers noticeably differs from those in remote territories. The government tries to encourage relocation of nurses to such territories.
Health services for rural inhabitants have become the main concern for it. “More funding was announced for medical schools in rural Australia, to pay allied health professionals to work with rural general practitioners, for the establishment of specialist outreach services for rural areas, more scholarships for rural students in Australian medical schools, and programs to attract pharmacists to rural areas” (Hilless & Healy 64).
The certain reducing of quality of medical services provided by the nurses due to their shortage raised the issue of indicators for advanced practice. Gavin Mooney affirms that “one of the central issues in health care is that of deciding how to value health” (22). Of course the high level of health is a major indicator for successful health care system.
Among the key criteria of assessment of health care system its satisfactoriness for public is of great importance. Recent public opinion surveys have shown that there is disappointment among the consumers with some aspects of this system, to wit consumer costs and hospital waiting lists.
“Only 18% of Australians thought the system worked well and needed only minor changes, compared with 34% feeling that way ten years ago” (Hilless and Healy 86).
To achieve good quality of health care services in Australia the regulatory agencies implement high requirements to competency of nurses.
They are required to maintain legal, ethical, and professional standards of nursing practice which includes, but is not limited to, confidentiality, professional boundaries, and mandatory reporting; to demonstrate accountability for maintaining current knowledge in the nurse’s field of practice.
To participate in self-evaluation and in activities to enhance life-long learning; to serve as a role model, especially in preventive care, forming public opinion and being leaders in all matters that influence health (Dobrossy 2).
The licensed practical nurses have to be well–educated to meet the basic needs of the client, to give nursing care under the direction and supervision of the registered nurse or licensed physician to clients in routine nursing situations.
Registered nurse should assist in implementing the nursing process while recognizing religious and cultural diversity; support patient’s autonomy (Mason and Smith 12); use communication skills effectively; assist in health teaching of the client, recognizing individual differences; utilize the nursing process, as a framework for critical thinking, in providing safe, goal-directed individualized care; direct health teaching to clients.
In the issue of advanced nursing practice the qualitative aspects of the nursing care delivery process are also of great importance. “Gaining understanding and skill at balancing professional relationships while also knowing the risks of caring are critical components of providing excellent supportive care to patients and their families” (Bakke and King 182).
As a manager of care, nurse should demonstrate responsibility for own actions by using common techniques of problem solving and decision making to plan and organize own assignment; recognize the need for change in a structural health care setting and demonstrate willingness to participate in effecting change (Grumbach 1518).
The observance of the above mentioned requirements forms the advanced nursing practice and is under control of statutory boards throughout the Commonwealth which also are in charge of registering medical professionals (Hilless and Healy 65).
The assessment of health sector performance is conducted by the Australian Institute of Health and Welfare, the National Health Performance Committee and the Australian Council on Health Care Standards. Also many state programs are devoted to elaboration and implementation of performance and outcomes. But till now the measurement of health care performance continue to be greatly complicated (qtd. in Hilless and Healy 29).

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New York University
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