If the state government goes ahead with proposals to introduce low-skilled health care assistants in hospitals and “flexibility” into existing patient to nurse ratios to reduce labour costs, it should be careful what it wishes for.
A recent national survey of nurses’ attitudes to work and the workplace conducted by the Department of Management at Monash University revealed that a significant number of nurses intended to leave the profession in the next 12 months. The main reasons identified in the survey for this were unmanageable workloads and nurses feeling undervalued and underpaid.
Well over half of the 640 nurses surveyed indicated that they felt their employer did not value their contribution at work and that they did not trust their employer to meet their promises to them and other employees. These results are telling given this was a national survey and was conducted before the industrial dispute currently gripping Victoria. These findings indicate the dissatisfaction expressed by nurses over recent weeks in Victoria is not isolated and that in fact it is a national workforce in crisis. It is interesting to note 15 per cent of those surveyed indicated they intended to leave the profession in the next 12 months; this can be contrasted with the average turnover rate of four per cent nationally in all professions.
Importantly, the research indicates it is work conditions, and not just pay, that is driving nurses’ dissatisfaction, with workloads and the quality of management’s relationships with employees rating much more highly than pay among the nurses surveyed. Patient-nurse ratios are at the forefront of nurses’ concerns about unrealistically high workloads and a decline in their ability to provide patients with high quality care. It is perhaps therefore not surprising that the Victorian state government’s proposal to remove the existing fixed patient to nurse ratios has met with such strong opposition by nurses in the recent EBA negotiations. The government should perhaps be mindful of the consequences of such policy changes with recent history showing that such changes can have dire consequences on the nursing workforce. Similar changes made under the Kennett government in the 1990s resulted in a mass exodus of nurses from the workforce. It was only the re-introduction, under the Bracks government, of patient-nurse ratios that reversed this trend.
What is also of concern is that this increased push for flexibility appears to be driven by a cost-cutting rather than a quality health care agenda. It would be dangerous to assume that low-skilled health care assistants could adequately compensate for the likely exodus of nurses if ratios were to be removed. Nursing work is highly skilled (most registered nurses have a minimum of a bachelor qualification) and carries with it high levels of responsibility. It is likely the introduction of low-skilled health care assistants would reinforce the perception from the study that the nursing profession is being further devalued. It is worth noting that it takes over 1000 hours to train a fully qualified nurse and approximately 80 hours to train a semi-skilled health care assistant. While it is true that you don’t need registered nurses to do every task on a hospital ward, tasks such as wound care, nutrition, lifting and moving patients are all high level skills that need to be taught and not things that should be just learnt on the job. One also has to wonder who would be responsible for the on-the-job training and mentoring these low-skilled health care assistants would need. Already overburdened nurses?
Is it any wonder then that proposed changes such as these are likely to further exacerbate feelings by nurses that they are undervalued and underappreciated and would be better off leaving the profession. A health system already experiencing skill shortages in the nursing profession could become further stressed as these changes envisaged by the state government become the catalyst for accelerating shortages. A health system increasingly devoid of nurses seems like a scary future to contemplate, particularly with a growing and ageing population. The potential long-term consequences of this short-term solution might make those in a position to determine the new flexible patterns of work for nurses reflect on what they wish for.
Dr Belinda Allen and Associate Professor Peter Holland work in the Department of Management at Monash University.