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Job Growth and Replacement Needs in Nursing Occupations

• 2.5.5 Registered Mental Health Nurses
• 2.5.6 Registered Developmental Disability Nurses
• 2.6 Enrolled Nurses 
• 2.7 Personal Care and Nursing Assistants
• 2.8 Summary

2.5.5 Registered Mental Health Nurses

Registered Mental Health Nurses are also known as Psychiatric Nurses in some jurisdictions. Their employment has averaged 4 600 per year. In the second half of the 1990s their employment declined significantly (Figure 29). Their numbers in 2001 are below the level in 1987. The delivery of mental health services has undergone restructuring. Many of them are now either integrated into general hospital services or community care services. This means that some of the work that Mental Health Nurses did is probably done by the Registered Nurse. In Victoria they are no longer registered as a separate group, they are now on the registered nurses (Division 1) roll (Department of Human Services 2001). The proportion of males in the occupation has not varied much over time and has averaged 45 per cent, much higher than for any other nursing occupation.

Figure 29. Employment of Registered Mental Health Nurses, Australia, 1987-01

In general, the age profile of Registered Mental Health Nurses has changed in similar ways to that of Registered Nurses (Figure 30). One noticeable difference is the substantially higher increase (37 percentage points) in the proportion aged 35-54 compared to Registered Nurses (18 percentage points).

Figure 30. Age profile of Registered Mental Health Nurses, Australia, 1987 and 2001

In contrast to Registered Nurses, Mental Health Nurses are more likely to be working full-time. This is partly explained by the fact that the proportion of males among them is relatively high, and in general males are more likely to work full-time than females. Two out of every three in the group worked full-time in 2001 (Figure 31). The proportion working full-time increased by a small amount between 1987 and 2001, and the proportion working part-time (16-34 hours) fell.

Figure 31. Hours worked by Registered Mental Health Nurses, Australia, 1987 and 2001

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2.5.6 Registered Developmental Disability Nurses

The employment of Registered Developmental and Disability Nurses did not change much between 1987 and 1996, but since then it has been quite volatile. In the last three years employment has averaged less than a couple of hundreds. About 1 100 were counted working in the 1996 Census and most of these in New South Wales or Victoria (AIHW 2001b). A closer look at the data by States and Territories shows that none have been employed in New South Wales, the Australian Capital Territory and the Northern Territory since 1998, and in Tasmania since 1998. In Victoria they no longer have their own register, but are included with Registered Nurses under Division 1 (Department of Human Services 2001). The very small numbers in this occupation prevents any further meaningful analysis.

Figure 32. Employment of Registered Developmental Disability Nurses, Australia, 1987-01

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2.6 Enrolled Nurses

The employment of Enrolled Nurses reached a peak of 35 600 in 1989. Since then it has gradually declined to 22 500 in 2001, with only a partial reversal in the downward trend between 1995 and 1998 (Figure 33). Part of the decline in the early 1990s was probably due to the significant restructuring of the nursing workforce during that period (AIHW 2001a). The proportion of males in the occupation has averaged 6 per cent, which is lower than for Registered Nurses.

Figure 33. Employment of Enrolled Nurses, Australia, 1987-01

The employment patterns of Enrolled Nurses by States and Territories are however not uniform (Table 6). Ignoring Tasmania and the two Territories because numbers for them are too small to be meaningful, a positive long-term trend is observed for only Queensland where employment increased by 27 per cent between 1987 and 2001. Although the trend for South Australia is also positive it is not significantly different from zero. Figure 34 shows employment declined in New South Wales each year since 1998. In Victoria the last four years has seen a rapid decline, such that in 2001 there were only half as many Enrolled Nurses in Victoria as in Queensland.

Table 6. Employment growth of Enrolled Nurses 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, Queensland and Tasmania are significant at less than 10 per cent level.

Figure 34. Employment of Enrolled Nurses in New South Wales, Victoria, Queensland and South Australia, 1987-01

Figure 35. Employment of Enrolled Nurses in Western Australia, Tasmania and the Australian Capital Territory 1987-01

Note: Data for the Northern Territory are highly volatile and. hence its graph is excluded.

The age profile of Enrolled Nurses changed considerably between 1987 and 2001 (Figure 36). Only three per cent of them were under 25 years of age compared to over a quarter of them in 1987. The proportion 35 years and older doubled to 80 per cent by 2001.

Figure 36. Age profile of Enrolled Nurses, Australia, 1987 and 2001

A similar shift towards working shorter hours is also evident among Enrolled Nurses as it is for Registered Nurses (Figure 37). A slightly smaller proportion worked full-time though.

Figure 37. Hours worked by Enrolled Nurses, Australia, 1987 and 2001

In May 2000, 57 per cent of Enrolled Nurses’ highest attained qualification was basic vocational, 24 per cent had attained a diploma and 12 per cent had no post-school qualification (Figure 38). Half of those without a post-school qualification were undertaking tertiary studies.

Figure 38. Qualifications profile of Enrolled Nurses, 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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2.7 Personal Care and Nursing Assistants

There are three clear phases in the employment trend of Personal Care and Nursing Assistants (Figure 39). The first phase, 1987-91, is a period of growth, which got interrupted by the 1991-92 recession. The second phase, 1992-97 is also a period of growth at the end of which employment reached its highest level of 49 000. The third phase, 1997-01 is period of sustained decline by the end of which employment had dropped to a level below that in 1987. There were 39 000 working in 2001, one in four of whom were male. In the 1996 Census just over 60 per cent of them were Nursing Assistants and the rest Personal Carers (AIHW 2001a).

Figure 39. Employment of Personal Care and Nursing Assistants, Australia, 1987-01

Not unlike all other major nursing occupations, employment of Personal Care and Nursing Assistants also vary considerably by State and Territory. In a way the patterns are similar to those for Enrolled Nurses. The summary in Table 7 indicates Queensland to be the only state that had significant positive long-term employment growth rate for Personal Care and Nursing Assistants. Apart from Queensland most other states experienced continuous decline in employment in the late 1990s (Figures 40 and 41). The pattern for Tasmania is a little more complex. Here there were big increases in employment in the 1996-99 period followed by sharp decline until 2001.

Table 7. Employment growth of Personal Carers and Nursing Assistants 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, Queensland South Australia and Western Australia are significant at less than 10 per cent level.

Figure 40. Employment of Personal Care and Nursing Assistants in New South Wales, Victoria, Queensland and South Australia, 1987-01

Figure 41. Employment of Personal Care and Nursing Assistants in Western Australia, Tasmania and the Australian Capital Territory 1987-01

Note: Data for the Northern Territory are highly volatile and plotting them produce little useful information. Hence its graph is excluded here.

A significant proportion of Personal Care and Nursing Assistants were still young (less than 25) in 2001, although the proportion had somewhat declined since 1987 (Figure 42). The proportion 45 years and older increased by 11 percentage points between 1987 and 2001, which is half the increase for Enrolled Nurses.

Figure 42. Age profile of Personal Care and Nursing Assistants, Australia, 1987 and 2001

The trend towards working shorter hours is also evident for this occupation. The proportion working full-time declined by 10 percentage points (Figure 43). Unlike other nursing occupations, there was a more substantial increase in the proportion working 1-15 hours per week.

Figure 43. Hours worked by Personal Care and Nursing Assistants, Australia, 1987 and 2001

A large majority of Personal Care and Nursing Assistants had no post-school qualifications as at May 2000, and only a fifth of these were engaged in tertiary studies. The highest qualification attained by most of the rest was vocational.

Figure 44. Qualifications profile of Personal Care and Nursing Assistants, 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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2.8 Summary

The changing patterns of employment by gender, age and hours worked in nursing occupations over the 1987-01 period are described in this chapter. The nursing occupations considered are Directors of Nursing, all Nursing Professional occupations, Enrolled Nurses and Personal Care and Nursing Assistants. Although there are similarities in the employment trends across different occupations and across States and Territories, there are also significant differences.

The employment in nursing occupations grew at an annual rate of 0.8 per cent, which is half the rate for all occupations, to total 249 000 in 2001. However not all States recorded a growth. In South Australia and Tasmania employment contracted while in Queensland the annual growth rate was 2.7 per cent per year.

Employment of Nursing Workers per 100 000 population, after initially increasing to about 1 400 in the second half of 1980s, has been steadily declining despite the ageing of the Australian population over this period and a 75 per cent increase in hospital patient separations between 1986 and 1999. It currently stands at about 1 300 which is just below the level in 1987. The analysis at the State and Territory level show that the ratios varied widely across jurisdictions in the mid-1980s but have been converging ever since to levels for New South Wales, Queensland and Western Australia for which they have remained relatively stable and close together.

There has been a shift towards shorter working hours among Nursing Workers. Unlike for the labour force in general, in which the shift in hours has been from the normal full-time hours towards very short or very long hours, in the case of Nursing Workers the shift has been more from the normal full-time hours towards working 16-34 hours per week.

The shift towards shorter working hours, the reduction in the ratio of Nursing Workers per 100 000 population and the increase in the hospital patient separations all point to an increase in labour productivity. However persistent reports of waiting lists for elective surgery and emergency department admissions suggest there is significant unmet demand for services. This raises issues of quality of services but they are beyond the scope of this report.

Overall, Nursing Workers are older now than they were in 1987. The proportion aged 45 years and over increased by 17 percentage points between 1987 and 2001. In general, the age profiles across occupations are similar, apart from profiles for Nurse Managers and Directors of Nursing who have a much higher representation in the 45 and older age group and Registered Midwives who have a much lower proportion in this age group.

The changes in the relative proportions of Nursing Professionals, Enrolled Nurses and Personal Care and Nursing Assistants employed suggest the growth of the first group has been at the expense of the other two groups (Table 8). However this pattern of substitution is not uniform across States and Territories. In New South Wales the substitution appears to be only between the Nursing Professionals and Enrolled Nurses. In South Australia the shift has been away from Personal Care and Nursing Assistants and towards the other two groups, and in Queensland there has been hardly any change.

Table 8. Proportions of Nursing Workers employed as Nursing Professionals, Enrolled Nurses and Personal Carers and Nursing Assistants by State and Territory, 1987 and 2001

Note: The proportions across the three occupation groups, for each State or Territory, may not add to 100 because the Directors of Nursing who are included in Nursing Workers are not in any one of the three groups.

Each State and Territory’s share of the employed Nursing Professionals changed little between 1987 and 2001 (Table 9). Victoria’s share, which was already higher than its share of the national population in 1987, increased two percentage points to 29 percent. On the other hand its share of Enrolled Nurses’ employment dropped significantly from 29 per cent in 1987 to just 12 per cent in 2001. The population growth in Queensland has undoubtedly increased demand for nursing workers, but the policy adopted there has been to use Enrolled Nurses and Personal Care and Nursing Assistants instead of Nursing Professionals to satisfy the extra demand. This has resulted in Queensland’s share of employment in these two occupations increase substantially above its share of the national population. The New South Wales’ share of Enrolled nurses’ employment fell but its share of Personal Care and Nursing Assistants’ employment increased. However the changes in South Australia and Western Australia seem to be opposite to those in New South Wales.

Table 9. State and Territory shares of employment in major nursing occupations, 1987 and 2001

Note: The percentages across States and Territories may not add to 100 due to rounding errors.

⁴ Data at four-digit ASCO are not published by the ABS but can be purchased from them as a special request

⁵ The ABS publishes estimated resident population data as at June of a giveJ year. The data for consecutive years have been averaged to give an estimate on a financial year basis. Since the extimate for june 2001 is unavailiable, the June 2000 estimate is assumed for the 2001 financial year.

⁶ The proportions are calculated with a base that includes only those who reported working one hour or more per week. This means that those who reported zero hours because they were, for example on leave, are not included in the calculation.

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