NURSES form the largest health care profession in Australia. The profession is regulated, has a defined scope of practice and works to accepted, accredited standards providing safe, effective health care. Nurses are also Australia’s most trusted profession, rated the most honest and ethical profession 23 years in a row.
The latest National Health Workforce Survey identifies 379 699 registered nurses and midwives in Australia, of whom 348 928 are in the workforce and 323 122 are currently employed. More than 82 000 of these are primary health care nurses.
Primary health care nurses work in a diverse range of settings outside of the hospital environment including general practice, residential care, community health, correctional services, Aboriginal health services and the defence forces. They also work across a number of practice areas including aged care, general practice nursing, community nursing, child and family health, palliative care and maternity care.
Nurses bring a sophisticated skill set to the integral role they play in primary health care.
The Australian Primary Health Care Nurses Association (APNA) Workforce Survey has been run annually since 2004. The latest APNA/Health Professionals Bank Workplace Survey 2018, completed by 2052 primary health care nurses, including members and non-members of APNA, provides a snapshot of the primary health care nursing workforce in Australia.
According to the survey, the average nurse currently practising in Australia is 49 years of age, with a median age of 52 years. They have a wealth of experience, averaging 21 years in nursing.
The gender split in the workforce has remained stable and female-dominated, with just 2.3% of the workforce identifying as male. Nurse work hours have increased from 28 to 32 hours per week in the past 5 years and part-time contracts constitute the majority of employment agreements (56%), with full-time employment comprising 28% of contracts.
High levels of job satisfaction
Nurses like their work. The highest level of agreement in the survey (90.2%) came from the statement, “I feel a sense of pride in doing my job”. Overall career satisfaction is high, which comes from a positive relationship with other health professionals and feeling like they are having positive outcomes on patients’ lives. Some of the most satisfying aspects of working as a primary health care nurse that were reported were:
- relationship with other health professionals (88%), being a valued member of the primary health care team (78%);
- contributing to patient satisfaction and positive health outcomes (84%); and
- collaboration and effective team-based care (81%).
The lowest satisfaction came from concerns with wages, access to education and training, and autonomy.
In 2018, nurses were generally satisfied with their career (and intend to continue with a nursing or midwifery career in primary health care for the foreseeable future) (78%).
Primary health care nurses’ skills could be better used
Many survey respondents reported their education, training and qualifications were not used to the full extent in their current role. Approximately 27% felt they could do more and 12% of respondents indicated that most of the time, they didn’t get to use their knowledge and skills to the full extent.
Close to half of the respondents (47.5%) suggested to their employer or manager that they could better use their skill set to undertake more complex clinical activities, or extend their role in the workplace within their scope of practice.
Of those nurses who suggested to their employer or manager that they could perform more complex activities within their scope of practice, less than half (42%) were able to negotiate more complex tasks or extended roles.
A number of common reasons for the lack of change to more complex tasks or extended roles – such as staff and patient education, coordinating complex care needs across a range of diseases, and leading a nurse clinic – included lack of support by the broader health care team, and financial and resourcing challenges.
Lack of time and financial remuneration were the most commonly reported factors affecting the respondents’ ability to perform their roles.
- 85% did not have, or were not sure if they had a formal and documented appraisal of their work performance in the past 2 years;
- 25% of respondents had never been offered a pay increase; and
- 44% reported feeling isolated, alone or lacking support from colleagues in their roles, a situation that may be further compounded by a decrease in formal career planning and support, and decreases in study time.
There is no clear professional pathway for nurses in primary health care. While the recent development of a career and education framework has laid the groundwork, impactful change is still to come.
What’s next for primary health care nurses?
Australia’s health system is facing workforce shortages, shifts in the burden of disease and an ageing population. To sustainably manage Australia’s health, a strong preventive health focus is required with all health disciplines using their full skill sets to deliver high quality care.
Australia needs a strong nursing workforce to meet these health care challenges. Developing and using the full potential of its nurses will help to ensure we can deliver high quality, accessible and affordable primary health care to our community into the future.
Primary health care nurses working to their full scope of practice can improve the health of Australians through preventive health and chronic and complex disease management, to keep people well and out of hospital. Primary health care nurses are also ideally placed to play a fundamental role in addressing the current and future health needs of Australians.
However, they often find their roles are limited by funding models that restrict nursing input, and limited understanding among other health care professionals, patients and policymakers about their true capacity and professional scope.
The nursing profession is highly skilled and ready to tackle Australia’s health care challenges, and a little support will go a long way. Specific actions that will help nurses improve the health of Australia include:
- a change in the perception of nurses’ value – among their peers, policymakers and members of the public – and the adoption of funding models that support the optimisation of primary health care nursing, particularly in general practice settings;
- improving the profile of primary health care nurses and greater recognition of the contribution of primary health care nurses to patient care, team sustainability and the business potential for health service with nurses as part of the team; and
- improved understanding of the scope of practice of primary health care nurses and optimisation of the nurse role at the individual, business and system level.
Nurse earnings are on the lower end of the scale when it comes to health practitioners’ incomes. Nurses working in primary health care, often in private, small businesses, cannot access the same tax incentives as their colleagues in the public sector. Peripheral support, such as sound professional services – legal, accounting, banking – is another way of meeting the needs of this key workforce. Given the pivotal role they play in our community, we welcome any development in this area that values and supports nurses and midwives.
Nurses deserve the support of their peers, patients and policymakers. Primary health care nurses working to their full scope of practice as part of an interdisciplinary team can enable more integrated, efficient and accessible health care for all Australians.
Karen Booth is the Board Chair and President of APNA. She is a registered nurse working in general practice and has been a practice manager since 1998. Throughout her career, she has set up systems within general practices, including nurse clinics, to help support a team approach to coordinated care. She is also a graduate of the Australian Institute of Company Directors.
APNA is the peak professional body for nurses working in primary health care. Primary health care nurses represent one in eight of the 640 000 health professionals in Australia.
APNA provides primary health care nurses with a voice, access to quality continuing professional development, support, and networking opportunities. APNA strives to increase awareness of the role of the primary health care nurse, and is a dynamic and vibrant organisation for its members.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.