We are staring into the abyss, with a projected shortfall of nurses of nearly 71,000 in a decade.
Well may policymakers, like our Treasurer, quake when considering the care economy.
The tidal wave of ageing Baby Boomers is upon us, a generation which has used health services at far greater rates than its predecessors. And coming hot on its heels is Gen X – a group which records higher levels of illness than their parents at the same age.
But instead of bemoaning the care economy as a difficult-to-manage drain on productivity, let us look at the incredible opportunities for reforms that will not only benefit efficient and quality care, but also the economy and budget bottom lines.
There has been some angst about the labour-intensive nature of the care economy, and the rollout of staff-to-patient ratios across Australia, which, it is argued, hampers productivity. But this contention fundamentally overlooks the economic gains that are in fact delivered by investing in nurse-to-patient ratios.
The evidence is clear: well-staffed hospital wards equate to fewer falls, hospital-acquired infections, and adverse events – all of which are costly. All of which draw on precious health resources – not to mention the economic impact of longer hospital stays on patients and their families.
Further, a supported nurse is one that is likely to stay. Nurse turnover is expensive, with rates of 15-36% costing employers one to 1.5 times nurses’ annual salary in onboarding and recruitment.
All of this is underscored by the evidence that ratios lead to quality care and quality outcomes for patients. As anyone who has had a loved one in hospital would attest, a supported and vigilant nurse is far preferable to a stressed and distracted one.
Even better for productivity would be to prevent people from needing expensive hospital care in the first place.
Our primary healthcare workforce, however, is not working to its full capacity in this regard. The nurse practitioner role in Australia has been a regulated designation now for more than 20 years, a role in which nurses with advanced education and extensive clinical experience can autonomously deliver high-level care. Yet they routinely battle for their place in a system that sometimes seems to be stacked against them.
Governments are trying to grow this section of the health workforce with scholarships, yet there are still only 2000 nurse practitioners, with nurses deterred from seeking the designation by a lack of available employment opportunities in health systems, and funding models to enable financially viable private practice.
Of those who do carry the title, only 69% are employed in nurse practitioner roles. That means more than 30% of these highly qualified healthcare professionals, who often treat patients in underserved areas, are not using all their skills and experience due to regulatory and structural barriers.
Primary care sector registered nurses, too, are not working to their full scope of practice – many are tucked away in GP clinics, given discrete tasks and not able to use their full range of expertise to conduct holistic assessments of patients (let alone bill for their own work).
Nearly 500,000 strong, nurses are the biggest and the most geographically distributed workforce: imagine the productivity that could be unlocked if regulations and funding were reformed to enable advanced practice registered nurses to lead their own clinics, delivering preventive and primary care such as vaccinations, wound care and chronic disease assessment and management.
All of this is well within the RN purview and would reduce vaccine-preventable illness sick days and exacerbations of chronic diseases that lead to unplanned hospitalisations. Enabling registered nurses to provide more comprehensive care frees up the GP workforce, to work to the top of their scope of practice and focus on more complex and higher acuity presentations. It would increase access to quality care, yielding a healthier, more productive population.
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There are plans for removing the barriers that prevent health professionals from working to the top of their scope, which align perfectly with the government’s productivity agenda, as well as the Business Council’s call for new, responsive healthcare models.
Recommendations from the scope of practice report, released last year, must be implemented as a priority, supported by digital health reforms to enable care to be linked up between sectors.
Further, health systems should be invigorated by the efficiencies that could be generated by the health ministers’ agreement last year that registered nurses may seek endorsement to prescribe medications.
Nurses are central to delivering health productivity gains, yet we are staring into the abyss, with a projected shortfall of nurses of nearly 71,000 in a decade.
A nursing workforce strategy has been developed by the Commonwealth and Victoria and is awaiting formal approval – it must be considered as a key plank of productivity agenda in the health sector.
We now have no choice but to be strategic, with care and support spending poised to increase from 8% to 15% of GDP in coming decades. It is well past time to be wringing our hands over spiraling health costs and healthcare reform.
We have the plans, we now need clear-eyed decisions over how to best use our incredible healthcare workforce to not only enhance the delivery of safe, quality, and equitable healthcare, but the productivity of the health system and economy more broadly.
Frances Rice is the Chief Nursing Officer at the Australian College of Nursing and a former senior advisor in the Department of Health, Disability and Ageing.