Job Growth and Replacement Needs in Nursing Occupations
4. Concluding comments
This report has used unpublished ABS labour force and other survey data, and outputs from the MONASH model to analyse the employment changes and make projections for personnel in nursing occupations in Australia. These data provide consistent information over a long period of time. However they lack details about nurse specialities, such as clinical nursing, intensive care and neonatal care. The survey data collected at registration and archived at AIHW provide some details about specialities but do not have the other advantages of the ABS data. A national database on health personnel could be beneficial if detailed workforce planning is to be done in the future.
The analyses presented in this report show substantial changes in the employment and demographic composition of Nursing Workers and Aged or Disabled Person Carers in Australia over the last decade and a half. These changes are likely to affect the demand and supply for these workers. The ageing of the workforce means that replacement needs are likely to increase further. Policies need to be further developed for succession planning and training capacity building. Nursing has traditionally been, and continues to be, female dominated but with women now able to exercise far greater choice in choosing careers the pool from which nurses have been recruited has been shrinking. This raises problems for future recruitment. One possible solution is to encourage more males into nursing, but to do this will require the new policies and incentives. Another alternative is through increased immigration, which may not be all that straightforward as Australia will have to compete with other developed countries, including the UK, Ireland, USA and Canada which are also facing similar problems and can offer larger pay incentives.
The ageing of the population is likely to put more pressure on the demand for health services. The four-fold increase in the employment of Aged or Disabled Person Carers is an indication of the high demand that can occur in the very labour intensive industry sector such as the aged care. Given that other sectors in the health industry are also very labour intensive, it means a higher demand for Nursing Workers can be expected in the future. The effect of technological change on the demand for Nursing Workers is more complex. Recent advances in micro- and keyhole surgery and other innovation in patient care have enabled earlier discharge of patients and consequently a higher throughput of patients. On the other hand technological advances enable treatment of a wider range of ailments resulting in a higher demand for services.
The supply and demand is also affected by policies regarding the appropriate mix of different types of Nursing Workers. Even though employment of Nursing Workers per 100 000 population across States and Territories seem to be converging, there is considerable variation in the mix between Nursing Professionals, Enrolled Nurses and Personal Care and Nursing Assistants that are employed across jurisdictions. This is compounded by the high but variable rates of employment growth of Aged or Disabled Person Carers across States and Territories. These trends reflect differences in employment policies, standards and the roles of different Nursing Workers across jurisdictions. If a nationally consistent system is desired then as Duckett (2000) argues, the role of different health workers in the provision of services will need to be reassessed. There are already moves to allow nurses with advanced training (nurse practitioners) to assume some of the roles that have been traditionally performed by medical practitioners. The roles performed by different types of Nursing Workers and carers and the training they receive are tied to questions of quality of nursing care being delivered. All these issues suggest a more holistic approach to the delivery of nursing care.
The information in this report is subject to a number of limitations. The modelling does factor in data on changes in the economic outlook as soon as they become available but the impact of more recent policy decisions such as new agreements on staffing ratios are not incorporated until they are implemented and reported in employment and other economic data. There is a need to undertake sensitivity analysis of the effect on employment in nursing occupations of alternative scenarios on the growth of government spending, and in particular its expenditure on health.
On its own, information on demand is insufficient to determine if shortages are looming. Data on supply is also needed. Shortages are also difficult to analyse and determine because they vary enormously by regions and specialities
However the information on growth and replacement needs contained in this report is critical for developing policies on nurse workforce issues at the macro level. It is also useful in providing baseline data to complement other qualitative and local area information for making policy decisions at the regional level.
Any comments or queries should be sent to: highered@dest.gov.au
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