Nursing is the most trusted profession, and here is an example of why.

 

An article in the Business Insider Australia has announced that for the 23rd year in a row nursing is seen by the Australian public as the most trusted profession! Australian healthcare enlarge takes out the top three spots with doctors being ranked as number two while pharmacists bring up third. However, the Australian public is not alone feeling in good hands with nurses around.

Roy-Morgan-image-survey-2017

Roy Morgan Research- Source: https://www.businessinsider.com.au/healthcare-remains-australias-most-trusted-profession-and-union-leaders-now-rank-higher-than-politicians-2017-6?r=US&IR=T

In 2016 Nurses and doctors ranked number one and two respectively in Brittan. A yearly Gallup poll conducted in the United States has had nurses ranked as the most respected in honesty and ethics since being added to the list since 1999, barring one year. In light of the September 11th attacks in New York that year firefighters took out the top spot. However, nurses were back in the number one position in 2002. According to GFK Vertrauen in 2013 both Japan and South Korea also ranked nurses as the most trusted profession.

But why is that? Look at a wonderful example of selfless commitment to society- Kristy Boden. An Australian who graduated from Flinders University nursing program and was working in London as a theatre nurse. She was killed not running away from the carnage that was happening during the attack, but towards it to try and help others. What she was trained to do, without fear for her safety. As nurses we know that we are trained to put others first in order to maintain health and well-being.

All of us in the healthcare profession: nurses, doctors, care assistants (AINs), radiologists etc. work tirelessly to maintain and promote optimal health in our society. We take those run-down and broken and mend them as best we can. I have always said that true nursing is not just a profession, it is a calling. And once you heed that call you are always a nurse or a doctor or a physio. And no matter where we may be in our daily lives should someone need our help we will be there to assist, whether we are in uniform or not. I have rendered assistance in a few cases in my career, however no where near the bravery that Kristy showed.

It makes me proud to know that my fellow nurses and I have gained the trust of the Australian people, and many others around the world. I am proud to say that I am a registered nurse.

References

Business Insider Australia: Healthcare remains Australia’s most trusted profession – and union leaders now rank higher than politicians- https://www.businessinsider.com.au/healthcare-remains-australias-most-trusted-profession-and-union-leaders-now-rank-higher-than-politicians-2017-6#Jduov1jC4UHu1Utb.99

Quartz Cannes Daily Brief: Nurses are some of the most trusted workers across the world, while politicians still languish at the bottom- https://qz.com/853048/nurses-are-the-most-trusted-profession-across-the-world-and-politicians-are-the-least/

Gallup poll: Americans faith honesty and ethics for police rebounds- http://www.gallup.com/poll/187874/americans-faith-honesty-ethics-police-rebounds.aspx?g_source=Social%20Issues&g_medium=newsfeed&g_campaign=tiles

GFK Verein: Trust in Professions- http://www.gfk-verein.org/sites/default/files/medien/1/dokumente/1403_vertrauen_in_berufe_downloadcharts_english_2.pdf

The Advertiser: South Australian woman Kirsty Boden killed in London Bridge terror attack-  http://www.adelaidenow.com.au/news/south-australia/south-australian-woman-kirsty-boden-feared-killed-in-london-bridge-terror-attack/news-story/07c8f1fbe255ee056aa7f36dab7f3fec

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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

Concerns raised about investigation of premature deaths in aged care facilities.

One day after this and other sites posted about Joseph Ibrahim’s calls to investigate the causes of what a coroner’s report called premature deaths in aged care two other articles have surfaced regarding the same issue.

Falls in residential aged care facilities

In an article in the Medical Journal of Australia Dr. Stephen Judd, chief executive of Hammond care- an aged care provider, discusses potential consequences if nursing home regulation were to be tighten in an attempt to lessen premature deaths from falls.

“If staff think they are going to get rapped over the knuckles if Mary falls over when she goes outside, they’ll lock the door so she can’t get out,” he said.

“All life is about risk; we have to encourage people to enjoy life, not just keep themselves hermetically sealed in a life of boredom,” he said. “Rather than trying to eliminate risks, we must manage risks intelligently.”

Interestingly I wonder if Dr. Judd is aware that most nursing homes do have locks on exterior doors to prevent residents with dementia from travelling outside? From my experience in aged care many, if not most falls, occur in the resident’s bedroom when the patient is found close to their bed. While I have not statistics evidencing this fact, I am sure Dr. Ibrahim’s report would reveal this.

Additionally, I also find it interesting that Dr. Judd stated that ‘staff’ would be responsible for denying freedom for fear of retaliation. Staff of nursing homes answer to the corporate bodies of said homes, so wouldn’t the fear they would be reacting to not come from the disciplinary action from corporate executives should preventable deaths not reduce? The article also reiterates the principles that I discussed in my previous post regarding the role of residential aged care. There exists a conflict between patient safety and freedom of choice. If a resident is unsteady on their feet and a falls risk but fiercely independent and wants to walk around a facility, does that facility have a right to restrain the resident to reduce falls?

Suicide prevention in residential aged care

Yesterday an article in the Australian Ageing Agenda by  Darragh O’Keeffe discusses the federal government’s stalemate on a decision of how to allow residents of Residential Aged Care Facilities (RACFs) to access the Better Access to Mental Health scheme (BAMH). The BAMH scheme, according to the federal Department of Health’s website

” Medicare rebates are available to patients for selected mental health services provided by general practitioners (GPs), psychiatrists, psychologists (clinical and registered) and eligible social workers and occupational therapists.”

However, according to Dr Margot McCarthy, deputy secretary of ageing and aged care, there is still discussion around how the scheme would be made available to residents in care facilities.

If an elderly member of the community was having depressive thoughts surely the GP would jump at the chance of engaging in this service to allow more treatment options for their patients. The same should be true for residents living in aged care facilities. The Medicare funding does change when a person goes into RACF care, however that should not change the available services to them. I hope that in the near future the Department of Health and Department of ageing and aged care can come to an agreement and make this valuable service available for residents in RACF homes, thereby moving towards reducing preventable deaths related to mental health conditions.

What does this mean for nursing staff and residents?

While the powers-at-be continue to struggle with how to research and tackle the issue of ‘premature deaths’ nursing staff in aged care facilities will continue to be in the firing line. Without clear-cut guidelines their actions and assessments will put the responsibility for minimizing the risks sits squarely on them. For residents and families the falls, suicides and choking will continue until the federal government and corporate aged care executives agree on a standard measure along with established preventative measures to minimize, and hopefully, eliminate the term premature deaths in aged care from existence.

References

The Medical Journal of Australia: Aged care falls deaths: a question of balance

The Australian Aged Agenda: No end in sight to aged care’s mental health blockage

The Department of Health: Better access to mental health care: fact sheet for patients

 

Telehealth to combat Australia’s growing demand for healthcare?

An article in IT Brief tackles the topic of how Australia is going to tackle the increased need for healthcare moving forward. According to a report in the Newcastle Herald Australian men are ranked in the top three countries worldwide in life expectancy, while women are in the top fourth. This is great news for Australians, and can cause sleepless nights for policy makers. The World Health Organization reports that currently Australia as of 2014 spends 9.4% of Gross Domestic Product on healthcare, that equates to approximately $4,357 per person. With the baby boomers expected to reach their senior age this figure is surely going to rise.

The IT Brief discussed several

items relating to IT and healthcare. One such discussion was over the My Health Record program by the federal government. I have previously discussed the My Health Record in another post. I believe it is a vital and important forward step in advancing the Australian healthcare system.

Another item discussed was the use of smartphone apps and other personal IT devices to aid in chronic disease management. This is a field that is sure to improve as our tech-savy population ages.

But the item discussed that interested me was that of individuals being able to visit with a doctor via an online medium. This was described in the article as a potential way for people to access medical care without needing to wait in a doctor’s office and would allow access in rural areas. In Australia we have a similar system in place in rural areas. However, looking to rely on this as a measure to markedly decrease the reliance on in-person healthcare is suspect.

While visual clues and interviews are important in assessing health concerns palpation, auscultation and the ability to have the patient in front of you make up much of both doctors’ and nurses’ assessments. Additionally, many presentations we see in hospital that have come from GPs requires further acute assessment not available in a doctor’s surgery: ultrasounds, CT scans, and urgent blood tests. These items would not be available to a patient sitting in their lounge room speaking with a doctor over the internet.

If there are chronic and stable conditions which only call for simple follow-up then online medical consultation would be fine. However, I wonder if that is not being done already? My concern is that moving forward the need for acute in-person healthcare will only increase. And with that increase will be the need for more acute beds in hospitals and more healthcare facilities to deal with demand.

Your thoughts?

References

IT Brief: Digital tech – the answer to Aussie healthcare’s biggest ailments?

Newcastle Herald: Australia about to lose top spot in this world health ranking

WHO: Australia

Australia, better healthcare than America- absolutely!

stethoscope-840125_1280

 

I came across this article and had to write about it. Marie Shieh, a doctor trained in America and now practices in Australia, has written a piece for the The Telegraph. In it she states emphatically that Australia’s health care is better than Americas. Full stop, no qualifiers. And as a former consumer and provider of America’s healthcare system I can agree.

Confession: my road to becoming a registered nurse started because of poor quality healthcare that my father received before his death. We were poor, not living on the streets poor, but we did not have a lot of money. My parents owned a printing business, and we did not have health insurance. When I was young my father was diagnosed with diabetes, then cancer and finally a heart condition. Because we did not have health insurance all of these medical conditions were treated very conservatively and without extensive examination. I believe, as a consequence of that, he suffered a major heart attack and died prematurely.

Now I know that he contributed to his condition with smoking and being overweight. But a lack of medical care significantly contributed to his death. From that moment on I was destined to be in healthcare, despite my attempts to move away from it. I have worked in palliative (hospice in America) care in the U.S. and now work in the Australian hospital system.

We have an amazing healthcare system. Yes, it is over-budget. Yes, there is over-crowding and never enough beds in our hospitals. Yes, people do (at times) come into emergency departments for things that could just as well be handled at their own doctors. But our system allows for every Australian the chance to have optimal health and to be free of medical issues, or at least have them treated to the best that our medical and nursing care can offer without fear of being unable to pay for such treatment.

I have always said that the Australian healthcare system would not work in America. The current push to repeal ‘Obamacare’ as it is called exemplifies this. Americans feel that they should be self-sufficient. And that is not necessarily a bad thing. Health insurance plans are out there to assist with costs. However, the American attitude of “if you can’t afford it we won’t pay for it” still leads to a class-based healthcare system. If you have money then you have health. As a nurse and believer in healthcare that is not right. Health is part of Maslow’s basic needs, and I feel it should be offered as a right just as security in the form of police and safety with firefighters.

maslow-pyramid

Maslow’s heirachy of needs- image source

Alas I do not feel that America will change their ways. The core beliefs of self-sufficiency go all the way back to revolutionary times. I am proud to say I am an Australian registered nurse. I am proud to say that the healthcare I and the thousands of other dedicated workers allows everyday Australians peace of mind and can allow us to continue to prosper.

 

The Telegraph: Trump is right about Australian health care, an American doctor in Australia says

Privacy concern or valuable tool: all Aussies can have an e-health record, would you?


The ABC network has written that with a new surge in federal funding the My Health Record project looks to provide all Australians with the ability to have an electronic health summary. This is a follow-on from other E-health projects trying to establish similar results. While I can understand the apprehension noted by some with regards to privacy and sharing of health information from a healthcare worker’s perspective it is a great leap forward.



In my history as a registered nurse I remember the days before electronic health records. The nature of our health system in Australia means that an individual can present at numerous public and private health institutions without any ability of those institutions knowing prior medical treatment. This is a safety concern for the patient at worst and could potentially prolong the time for effective treatment in the least.


With the implementation of the local electronic health record if I am looking after a patient who has visited another health facility within the same area, state, or even nationally connected the doctor and I can see previous treatments and tests, allowing for more accurate diagnosis and treatment. Expanding this nationally would allow those visiting or recently moved to the area to have better quality care by allowing information sharing.


It is also better for the GP. Now general practitioners must rely on discharge summaries for information about hospital treatment. However, with the electronic record the GP could access more complete information from hospital visits, aiding in their continuation of care at home. A GP could also review and place information for patients on the record in case they travel or are too sick to speak for themselves, vital information which could save their life.


There is always a potential for abuse of the system. However, I would trust that the powers-at-be would design safeguards to prevent unauthorized information sharing of electronic health records. I, for one, will be happy to welcome this advancement in Australian healthcare. According to the ABC report individuals would be allowed to ‘opt out’ of the program.

ABC news: Everyone to have a digital health record

The tragedy of Manchester brings out the true colours of emergency services

As a relatively short-lived member of an emergency department I can say I have never been through a horrific event like that which occurred in Manchester, UK. But the spirit behind all of the nurses in the six hospitals lives within all of us.

By default emergency nurses and doctors are trained to take a patient with little background and through systematic assessment treat the priorities to bring about the best possible outcome.

Nurses learn to act selflessly and tirelessly to get the job done. I am proud to consider myself a member of an elite fraternity called emergency room nurses. Absolute praise and respect to all those who helped in the aftermath.