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Job Growth and Replacement Needs in Nursing Occupations

• 2 Employment patterns in nursing occupations, 1987-01 
  • 2.1 Introduction 
  • 2.2 Data source 
  • 2.3 Nursing Workers 
  • 2.4 Directors of Nursing

2 Employment patterns in nursing occupations, 1987-01

2.1 Introduction

This section presents analyses of employment changes in nursing occupations for the 1987-01 period. The analyses include differences across States and Territories, by gender, age and hours worked. Apart from one, all nursing occupations included are those defined at the four-digit level in the ASCO - Australian Standard Classification of Occupations (second edition) (ABS 1997). The one exception is that of the Directors of Nursing which is at the six-digit level. The occupations covered in this report are:

1. Directors of Nursing (1292-11);
2. Nurse Managers (2321);
3. Nurse Educators and Researchers (2322);
4. Registered Nurses (2323);
5. Registered Midwives (2324);
6. Registered Mental Health Nurses (2325);
7. Registered Developmental Disability Nurses (2326);
8. Enrolled Nurses (3411); and
9. Personal Care and Nursing Assistants (6314).

According to ABS (1997) occupations 1-7 in the above list are at the highest skill level under ASCO and occupations 2-7 make up the group of Nursing Professionals. Enrolled Nurses are at the second highest skill level and are part of Health and Welfare Associate Professionals’ group. Finally Personal Care and Nursing Assistants are at the fourth highest skill level.

It is possible that terms used to describe some of these occupations may not be universally acceptable and may have changed over time. However in order to construct time series of the data it is necessary that definitions do not alter over time, or if they do then a concordance exists between the old and the new. Therefore, for the purposes of this report the ABS terminology and definitions are adhered to. Analyses at the level of specialisation, such as intensive care, paediatric, etc. are beyond the scope of this report as reliable data at this level of detail are difficult to obtain from official statistics.

The Australian Institute of Health and Welfare (AIHW) does not include the first and the last occupations in the above list in their nursing labour force publication AIHW (2001b). This is because statistics compiled for the publication are largely based on data collected through surveys at the time of nurses’ registration renewal with the appropriate State or Territory body, and there are no registration requirements for the first and the last occupations. Some Directors of Nursing who have come through the ranks of Registered Nurses may continue their registration while others may not. Similarly, some Nurse Managers and Nurse Educators and Researchers may be neither registered nor on the roll and therefore may also not get included in the AIHW data. However AIHW’s report on the labour force in health and community services, based on the 1996 Census, includes all nursing occupations in the above list (AIHW 2001a).

An occupation that is not included as a nursing occupation by AIHW but that would be of interest is that of Aged or Disabled Person Carer (ASCO 6313-17). There is no rationale presented for its exclusion while at the same time including Personal Care and Nursing Assistants occupation. The roles of nurses and carers are to a certain extent blurred, particularly in the aged care industry, which has been growing rapidly in recent times. Therefore it is important to document and analyse this occupation. Since it is strictly not a nursing occupation, the analyses relating to it are contained in Appendix 1.

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2.2 Data source

The AIHW hold considerable data on registered and enrolled nurses in Australia. Each State and Territory health authority collects the data on behalf of AIHW at the time a nurse renews registration with the nursing board or council. At this time the nurse is requested to fill out a questionnaire on employment, specialisation, etc. These data, collected every two years, are deposited with AIHW. The survey is voluntary and there is significant non-response that varies considerably across States and Territories and time. Other problems with these data include the possible exclusion of nurses registering for the first time, nurses registering across multiple jurisdictions and the different timing of data collection in each State and Territory (AIHW 2001b). These problems prevent the construction of a consistent and reliable time series on employment in nursing occupations from these data. Therefore the analyses in this section relies mainly on unpublished data collected in Labour Force surveys. These have been supplemented by data on qualifications from Transition from Education to Work (ABS 2000d).

The Labour Force survey for the months of February, May, August and November report employment data by occupation.⁴ These have been averaged to obtain financial year data. The original data have been adjusted in three ways for analyses reported here.

First, the ABS changed the occupation classification from ASCO first edition to second edition for all data collected from August 1996 onwards. Therefore to have consistent data spanning both periods a concordance between ASCO first and second edition was used. The original concordance based on the 1996 Census data, and made available by the ABS, was modified jointly by CoPS and CEET to enable linking of data at the four-digit level.

Second, since April 2001 the ABS has implemented a redesigned labour force questionnaire to collect labour force data (ABS 2001a; 2001b). Some definitional changes on who is considered employed have resulted in a slight increase in employment. The ABS has revised the historical labour force time series for each State and Territory from 1986 to reflect these changes. The occupational data used in this report have been adjusted correspondingly.

Third, Directors of Nursing being a six-digit occupation meant that its employment series had to be estimated. This was done by apportioning employment in the four-digit occupation of Health Services Managers between Directors of Nursing and Medical Administrators, who collectively make up this group. The division was based on state by sex specific ratios, derived from the 1996 Census data (AIHW 2001a).

There are some obvious drawbacks in trying to estimate population sizes of groups that are relatively small from Labour Force survey data because of the large standard errors involved. However trend analyses of these data still do provide useful information.

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2.3 Nursing Workers

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Aggregate employment patterns

In this section aggregate employment in all nursing occupations is analysed. A Nursing Worker is any body employed in any one of the nine occupations listed in section 2.1. Table 1 shows the employment level in 2001, change in employment between 1987 and 2001 and the annual growth rate for the 1987-01 period for each group of occupations. The increase in employment of Nursing Workers has been considerably less than the increase in total employment in the Australian economy. Overall employment in Australia increased by 29 per cent to 9 090 000 in 2001, while employment of Nursing Workers increased by only 18 per cent to number 248 000. The annual growth rate for Nursing Workers was 0.8 percent which is half the rate for all workers. Nursing Workers have been mostly female, with only, on average, 11 per cent male. This proportion has changed little over the last decade and a half.

Table 1. Employment growth in nursing occupations, Australia, 1987-01

Note: The annual rates were estimated by fitting a log linear model to the annual employment data. Except for Personal Care and Nursing Assistants, all other estimates are significant at less than 10 per cent level.

In Figure 1 the trend in employment of Nursing Workers is compared to that of all workers. Three broad features characterise the patterns in this figure. First, Nursing Workers were affected by the recession of 1991-92, as were other workers, but the period over which they were affected appears to be slightly shorter. Second, there was an unusually large contraction in their employment in 1995. According to AIHW (2001b) the number of nurses working in nursing homes fell quite sharply after the introduction of the policy encouraging elderly people to be cared for in their own homes rather than in institutions in 1992. The policy changes were introduced via the Home and Community Care (HACC) program and community aged care packages. It is difficult to tell if the lagged effect of this policy caused a temporary fall in employment in 1995. Third, the second half of the nineties has seen a virtual stagnation in the employment of Nursing Workers.

Figure 1. Employment in all occupations and of Nursing Workers Australia, 1987-01

Figure 2 shows, the number of Nursing Workers employed per 100 000 population steadily declining in the 1990s. This decline occurred despite an ageing of the Australian population and increased treatment of patients. Between 1987 and 2001⁵ the proportion of the Australian population aged 50 and over increased by 3.6 percentage points to 27.9 per cent (ABS 2000c). There was a 75 per cent increase in hospital patient separations between 1986 and 1999 (AIHW 1999; 2001b).

There is no doubt there have been innovations in patient care and technological advances, such as keyhole surgery, that have resulted in shorter stays in hospital for a number of procedures. However other technical advances in medicine has allowed treatment of a wider range of ailments resulting in an increase in the demand for health services. Since there continues to be persistent reports in the press about waiting lists for elective procedures and emergency departments in public hospitals across Australia, there must be substantial unmet need for health care and for Nursing Workers.

Figure 2. Nursing Workers per 100 000 population, Australia, 1987-01

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Employment across States and Territories

Table 2 shows the employment of Nursing Workers by State and Territory. In South Australia and Tasmania numbers have declined at an annual rate of 1.1 and 0.9 per cent in the 1987-01 period. Queensland has recorded the highest change in employment (33 per cent) between 1987 and 2001. Its population also increased by a similar amount (35 per cent). The increase in Western Australia was 21 per cent, which is half the increase in total employment in all occupations. Figures 3 and 4 show that the changes in employment not only varying by jurisdiction but also over time.

A close examination of Figures 3 and 4 show that the sharp decline in the national employment in 1995 was largely because of declines in Victoria, Queensland, South Australia and the Northern Territory. In South Australia and Tasmania the overall pattern was that of decline in the 1990s. The pattern for Victoria is more complex. It is characterised by a distinct sustained period of growth - 1987 to 1991 - followed by two distinct sustained periods of decline - 1991 to 1995 and 1996 to 1999. These periods coincide with the Kennett Government incumbency and the reforms instigated by it.

Table 2. Employment growth of Nursing Workers by State and Territory, 1987-01

Note: The annual rates were estimated by fitting a log linear model to the annual employment data. Only estimates for Victoria and the Australian Capital Territory are not significant at less than 10 per cent level.

Figure 3. Employment of Nursing Workers in New South Wales, Victoria, Queensland and South Australia, 1987-01

Figure 4. Employment of Nursing Workers in Western Australia, Tasmania, Northern Territory and the Australian Capital Territory, 1987-01

Figures 5 and 6 show the number of Nursing Workers employed per 100 000 population by States and Territories. The ratios for New South Wales, Queensland, Western Australia and the Australian Capital Territory show the least amount of variation over time and seem to track each other reasonably well around a mean of 1 300. Second, the ratios for Victoria, South Australia and Tasmania, after having increased initially in the late 1980s and early 1990s, have been steadily declining ever since to the same level as that of the other states. Third, even the ratios for the two territories are generally showing signs of convergence to the common 1 300 limit. These patterns may reflect benchmarking of human resource policies, at least at the macro level, in nursing care across different jurisdictions.

Figure 5. Nursing Workers per 100 000 population, New South Wales, Victoria, Queensland and South Australia, 1987-01

Figure 6. Nursing Workers per 100 000 population, Western Australia, Tasmania, Northern Territory and Australian Capital Territory, 1987-01

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Change in age structure

The changing age profile of Nursing Workers is shown in Figure 7. The average age of Nursing Workers has increased significantly between 1987 and 2001. In 1987 a majority were under 35 years of age but in 2001 this group made up only 30 per cent of the total. The proportion in the 45 and over age group increased from 20 to 37 per cent. As will be discussed later the ageing of Nursing Workers has ramifications in terms of future replacement needs.

Figure 7. Age profile of Nursing Workers, Australia, 1987 and 2001

Note: The percentages for each year may not add to 100 because of rounding errors.

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Change in hours of work

A number of studies have reported full-time jobs disappearing at an alarming rate with a corresponding rapid growth in part-time and casual work (Australian Centre for Industrial Relations Research and Training (ACCIRT) (1999; Campbell(2000)). Overlaying this has been a concern for an increasing number of people working longer and longer hours that are often unpaid. Figure 8 shows the proportion⁶ of Australian workers who reported working 1-15 hours increased by three percentage points between 1987 and 2001 and those working 45 hours or more increased by five percentage points. At the same time the proportion reporting working the normal full-time hours declined by eight percentage points. The hours of work for Nursing Workers also changed over this time (Figure 9). However the change for them has been largely a re-distribution of the proportions in the middle of the hours of work spectrum. The proportion working 15-34 hours per week increased by six percentage points and the proportion working the normal full-time hours declined by eight percentage points. This suggests the average hours of work per Nursing Workers declined in the 1990s.

Figure 8. Hours worked in all occupations, Australia, 1987 and 2001

Note: The percentages for each year may not add to 100 because of rounding errors.

Figure 9. Hours worked by Nursing Workers, Australia, 1987 and 2001

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Qualification profile

A snap shot of the qualification profile of Nursing Workers as at May 2000 is shown in Figure 10. Although over 80 per cent of them have attained a diploma or higher qualification, 11 per cent have no post-school qualification. However a quarter of this latter group is engaged in some sort of tertiary education. A number of those with a diploma could also be engaged in upgrading that to a Bachelor’s degree.

Figure 10. Qualifications profile of Nursing Workers, Australia, 2000

Note: The Post-graduate category includes higher degrees and post-graduate diplomas, the Diploma includes undergraduate diplomas and associate diplomas. The percentages may not add to 100 because of rounding errors. (Source of data: ABS [2000d])

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2.4 Directors of Nursing

The employment of Directors of Nursing has seen strong growth over the last 15 years, and in particular in the early 1990s and then in the late 1990s (Figure 11). Their numbers grew at an annual rate of 5.4 per cent and numbered 2 700 in 2001. Most of them are female, although the average proportion of males (14 per cent) is higher than for Nursing Professionals.

Figure 11. Employment of Directors of Nursing, Australia, 1987-01

Figure 12 shows the age profile of Directors of Nursing in 1987 and 2001. Most of them are 45 years of age or older with over 70 per cent in this group in 1987 as well as in 2001.

Figure 12. Age profile of Directors of Nursing, Australia, 1987 and 2001

Note: The percentages may not add to 100 because of rounding errors.

Figure 13 shows the dramatic change in the hours worked by Directors of Nursing. Although there has been little change in the proportion working full-time, the proportion reporting working 45 hours or more, more than doubled between 1987 and 2001. Over the same period the proportion working the normal full-time hours dropped by 28 percentage points.

Figure 13. Hours worked by Directors of Nursing, Australia, 1987 and 2001

Note: The percentages may not add to 100 because of rounding errors.

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