Are we taking care of our new nurses?

As I sit at my computer I ponder what to write. Then I think to the new graduate nurses who I work with every day. In a previous life I was a university lecturer, and the same statements I hear each day from my new graduate nurses I heard from those students: “I can’t find a new graduate position”. So I wonder, what is the current state of new graduate registered nursing uptake in 2017?

This question should be an easy one to answer. The Australian Health Practitioner Association (AHPRA) agency is requiring all student nurses to be registered with them in order to fulfill clinical placements. So finding out the number of students enrolled in accredited nursing programs in Australia should be easy, right? Not so fast. I search of the AHPRA website revealed NO data on the number of student nursing registrations. Despite this AHPRA quite easily detailed a report about the number of nurses registered in Australia all the way back to 2012, along with pertinent demographic data which I used in an earlier post. So why has AHPRA not bothered to reveal student nursing numbers?

So why does this matter?

Because nursing is a profession which cannot be automated and is increasing in demand! You cannot simply create a machine to do what a nurse does, despite some attempts otherwise. In our most vulnerable state nurses provide the personal care we need. And nurses need the complexity of thought needed to provide intricate assessment of a patient’s needs and identify problems before they cause serious life-and-death situations such as those of Vanessa Anderson.

And let’s face it, the Australian public is becoming older and needing more healthcare. Modern healthcare is allowing for longer life expectancy, and with that older adults will utilize more healthcare. Additionally, the baby boomer generation will expect greater results in terms of customer care which will require adequate numbers of appropriately trained and attentive nurses. So where will these registered nurses come from?

Will there be a nursing ‘shortage’?

Last year Monash business school did a study on on the climate of the nursing and midwifery workforce. The Monash report determined that an occupation which is demanding, such as nursing, should likely see between three to six percent of its workforce intending to leave. However, this study showed that 32% were considering leaving the profession, with 25% determined to do so. Even the Department of Health in a report filed in 2013 stated their figures indicated Australia had adequate numbers of nursing staff only up to 2016. Another poll found that 100% of nurses surveyed stated that the government undervalued their role.

Ah, but overseas nurses can fill the void? It is true that a significant number of nurses are overseas-trained? The Australian Bureau of Statistics reported in 2013 that one-third of nurses (33%) were overseas-trained, up from 25% in 2001. This fact has been highlighted as a reason why Australian new graduate nurses cannot find post-registration employment. But with 33% of the 342,221 nurses registered in Australia overseas-trained in 2016 is the overseas nurse a threat to our domestic nursing cohort? Some may think so. The Australian Nursing and Midwifery Federation feels that the 457 visa program for overseas nurses is “… being taken as a shortcut and that employers see it as a quick fix.”

Troubles post-study for nurses

Publicity around newly registered nurse employment seemed to peak in 2014-2015. ABC news reported that ” thousands of nursing graduates are unable to find work in Australian hospitals.” Even in 2016 the rumbling of underemployment of nursing graduates continued. In West Australia a WA Today article reported that only 500 of about 1500 (33%) newly graduated nursing students secured a nursing role. The Health Times reported that of the new graduate nurses in 2007 97.4% were able to secure full-time employment; however, in 2014 that figure dropped to 80.5%.

So where do we go from here?

Firstly, we need to have clear evidence as to the extent of the problem. I would call on AHPRA as the registration body to release statistical figures about the number of student registrations, just as they have done for registered and enrolled nurses. With that information we can clearly see how many students we have in nursing programs in Australia. Additionally, I would call on AHPRA to include a statistical figure on the number of overseas-trained nurses registered in Australia. As they are the governing body and provide the certification that overseas nurses are able to work in this country they would be able to provide figures as-such.

Secondly I would suggest the Department of Health re-visit their strategy paper on nursing retention and recruitment. This report is from 2013 and stated the nursing workforce was only adequate until 2016. If the government does care about the potential nursing workforce into the future reviewing their strategies and making a future policy framework would be necessary. It would also be helpful for the Council of Australian Governments to convene on this issue as they are the primary employer of a large number of nurses through the public health hospital system.

Without adequate statistical data there can be no informative discussion regarding the debate over new graduate nurses in Australia. One thing is certain, without adequate places for these energetic and qualified nurses to go the profession will continue to struggle in providing adequate healthcare to the increasing ageing population of Australia. Policy makers and statisticians need to act now in preventing a healthcare crisis in the future.

References

AHPRA: Student registration-  https://www.ahpra.gov.au/Registration/Student-Registrations.aspx

Advantech: Industry 4.0: It’s happening – Nurses are replaced by Robots- http://www.advantech.com/machine-automation/industry%20focus/206d0919-7a6f-4c80-9caa-cdfd662bd712/

The Australian: Coroner blames hospital for death- http://www.theaustralian.com.au/archive/news/coroner-blames-hospital-for-death/news-story/3d9318ea30f206211774e7931bd6526e

Sydney Morning Herald: Healthcare is a booming industry and Australia is in the box seat-  http://www.smh.com.au/comment/the-care-boom-20160928-grqqzv.html

Sydney Morning Herald: With an ageing population is healthcare sustainable?-  http://www.smh.com.au/comment/with-an-ageing-population-is-healthcare-sustainable-20160319-gnm98t.html

Monash University: What Nurses & Midwives Want: Findings from the National

Survey on Workplace Climate and Well-being-  https://business.monash.edu/__data/assets/pdf_file/0004/624127/What-Nurses-And-Midwives-Want-Findings-from-the-National-Survey-on-Workplace-Climate-and-Well-being-2016.pdf

Department of Health: 7.2 Nursing and midwifery retention-  http://www.health.gov.au/internet/publications/publishing.nsf/Content/work-review-australian-government-health-workforce-programs-toc~chapter-7-nursing-midwifery-workforce%E2%80%93education-retention-sustainability~chapter-7-nursing-midwifery-retention

Australian Bureau of Statistics: 4102.0 – Australian Social Trends, April 2013-  http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features20April+2013

Sydney Morning Herald: Nurse graduates ‘locked out’ of workforce as migrants get jobs-  http://www.smh.com.au/business/workplace-relations/nurse-graduates-locked-out-of-workforce-as-migrants-get-jobs-20150606-ghi9c8.html

Health Times: Generation Next – Helping Graduate Nurses and Midwives Find Jobs-  https://healthtimes.com.au/hub/nursing-careers/6/news/nc1/generation-next-helping-graduate-nurses-and-midwives-find-jobs/1422/

ABC News: Thousands of nursing graduates unable to find work in Australian hospitals: union-  http://www.abc.net.au/news/2014-05-24/thousands-of-nursing-graduates-unable-to-find-work/5475320

NSW Nursing and Midwifery Association: Nurse graduates unemployed or underemployed-  http://www.nswnma.asn.au/nurse-graduates-unemployed-or-underemployed/

Health Times: Nursing shortage expected to worsen-  https://healthtimes.com.au/hub/workplace-conditions/60/news/nc1/nursing-shortage-expected-to-worsen/490/

WA Today: All trained up with nowhere to go: WA’s hundreds of unemployed graduate nurses-  http://www.watoday.com.au/wa-news/all-trained-up-with-nowhere-to-go-was-hundreds-of-unemployed-graduate-nurses-20161211-gt8qkz.html

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Comparison of nurses and doctors registered in Australia

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Quick Facts

  • According to 2016 AHPRA data there were 342,221 nurses and 104,102 doctors practicing in Australia. This means more than three nurses for every doctor.
  • The gender of doctors was roughly equal as 58.2% were male, compared to the female-dominated nursing which encompassed 12% identifying as male.
  • Investigating age practitioners in both groups showed a majority were under 50- 65.6% of nurses and 72.9% of doctors. Both groups also showed the highest number of practitioners were in the 30-34 year age range.
  • The number of nurses state-by-state was not suprising with NSW showing the largest share (27.4%) followed by Victoria (26.3%) and Queensland (20.1%).
  • NSW showed a low density of people per kilometer but the highest number of nurses compared to other states and territories.  

The inspiration for my post this morning was a tweet by the Australian Health Practitioners Association (AHPRA) for International Nurses Day which stated that nationally there were 375,528 registered and enrolled nurses in Australia currently. This includes practicing and non-practicing nurses. An advantage of AHPRA becoming the central body for clinical registration is to allow for national statistics for registrants which can be compared. So I investigated some statistics regarding nurses in Australia and how those statistics compare to equivalent doctor numbers.
Both sets of figures were taken from comparable AHPRA reports; for nurses it is the Nursing and Midwifery Board of Australia registrant data, and for doctors it is the Medical Board of Australia registrant data. Both reports were for the 1st of October to 31st of December 2016 date range and all figures excluded practitioners who were not practicing their particular clinical area at the time of the report (therefore excluding non-practitioners). The results were surprising in some areas, while expected in others:
A total of 342, 221 nurses were practicing in Australia during the report, while only 104,102 doctors were licensed at the time. Therefore for every doctor there were over three nurses licensed. The gender gap for doctors was quite narrow with 58.2% being male, however nursing continues to be a female-dominant profession with only 12% being listed as male. This, however, shows improvement from the year I graduated in which less than 10% of nurses were male.
Age was also an interesting read. To allow for easier comparison I broke the data into two age ranges: under 25 to 49 and 50  to 80+. These ages seem to represent two classic working demographics, prime working years (U25-50), and those approaching retirement. A common statement heard amongst critics of the current nursing workforce is that the nursing cohort is ageing, however according to the reports investigated nurses over 50 only accounted for 34.4% of workers with the vast majority (65.6%) under the age of 50. Doctors showed even more youth with 72.9% being under the age of 50. Nurses over the age of 65 were double that of doctors (4.2% vs 1.9%). The largest decade-cohort was identical for both at 30-34 with nurses representing 13.5% and doctors representing 14% of this bracket.
A state-by-state comparison of nurses showed, to me, an expected result. The highest number of nurses was found in New South Wales (NSW) with 27.4%, Victoria seconding (26.3%) and Queensland in third-place with 19.7%. The other states and territories accounted for 26.6%. Doctors showed similar trends. This trend closely coincides with population statistics taken in September 2016 which showed NSW having 32.0% of the population of Australia, Victoria having 25.2% and Queensland again in third with 20.1%.
An insight into the difficulty of providing healthcare in Australia could be identified by looking at population density during the same September 2016 period. The Australian Capital Territory (ACT) ranks as the most dense state with 171.40 persons per kilometer meaning that the residents would be in close proximity to health facilities. Victoria is second with a density of 26.11 persons per kilometer showing more difficulty of providing healthcare services in a less urban environment. New South Wales shows that each kilometer only holds 9.52 persons, providing for vast rural area to cover.
So what does all of these numbers mean? Well there are over three nurses for every doctor in Australia. Both are showing younger cohorts with the largest number being in the 30-34 year old range. Within nursing this is a shift from the threat that the nursing population is becoming older and therefore going to retire soon. Medicine is showing to be an equal mix of male and female, however nursing is still female-dominated.

The numbers of nurses by state closely match that of population. However, when compared to density the ACT showed less nurses were required to take care of a highly dense state area showing a specifically urban landscape. While in my home state of New South Wales we had the highest number of licensed nursing staff and a very sparse 9.52 persons per kilometer, meaning a large rural component when compared to the ACT.

All in all the numbers renew my faith that nursing in Australia is not currently a profession of elderly women as it is sometimes portrayed, but a vibrant profession which attracts young (and male) talent. I am proud to be called a registered nurse, and I hope that all 375,528 licensed nurses can say the same.

What do you think of these figures?

 

References

Nursing and Midwifery Board registrant data

Medical Board of Australia registrant data