Submission To
Review of Higher Education Financing and Policy

CHIEF NURSING OFFICER GROUP

Theme One
The role of higher education in Australias society and economy.

• The Australian higher education sector performs in an environment of accelerated change and complexity where an escalating demand for improved universal access to health services and equality in health status is subject to a number of underlying pressures.

• These pressures include
  • demographic and social trends that will cause changes to health service delivery and a re-engineering of care processes.
    eg. - An ageing population.
    - Increased hospital utilisation by the elderly.
    - Rapid escalation in demand for hospital needs and community services.
    - Increasing urbanisation.
  • epidemiology that creates new challenges for health carers
    eg. - increased chronic disease rates.
    - reimergence of historical diseases (tuberculosis, malaria) and emergence
    of new infectious diseases eg. (AIDS, hepatitis).
    
  • cost and service growth with a need to maximise the efficient use of resources.
    eg. - clinical practice and medical terminology developments.
    - extra-ordinary rate of change of technologies and their application
    to service needs.
    
  • consumer demand
    eg. - priority setting as a key agenda for health services as they grapple with
    the tension between community demand and finite resources.
    - increasing consumer drive for choice, equity, autonomy and flexibility
    in health care.
    
• Attributes needed by graduates of nursing programs in the context of these pressures, will be an intellectual preparation across a broad and diverse base, to degree standard, with a comprehensive grounding in the practice of nursing.
  
• As identified in the "Review of Nurse Education in the Higher Education Sector - 1994 and Beyond", there exists a duality in nursing education where there are both vocational and educational aspects that must be realised through the same process of assessment and learning.

• Nursing graduates must have achieved the necessary Australian Nursing Council Inc (ANCI) competencies, and also be aware of industry needs. Qualifications must have portability across states.

  These pressures are constantly changing in priority and require a nursing workforce able to deal with diverse and complex situations. To achieve this substantial clinical experience during the undergraduate program is essential. The health sector contributes to clinical education of undergraduates and postgraduates by supplying access to clinical situations across the health care sector in both metropolitan and rural settings.

  There is a need to fund such clinical education appropriately to ensure adequate supervision of students is available and that clinical sites can be accessed. For example funding for placements in rural and remote locations must include transport and accommodation costs along with supervision. It is our opinion that clinical education is currently not adequately funded and yet it is imperative if nurses are to graduate with the necessary competence to practice.

Theme Two
Factors affecting the demand for and provision of higher education over the next 10-20 years.

• The 1994 Census showed there were 227, 966 nurses employed in Australia, making it the largest group in the health service workforce.
• The nurse labor force system is volatile and extremely sensitive to changes in nursing requirements and patterns of workforce wastage and participation. State governments carry out detailed forecasting and planning of nurse requirements and advise the higher education sector of the undergraduate nurse intake numbers most suited to balance requirements and supply.
• Voluntary co-operation between health units, government and the higher education sector is vital to ensure adequate availability of nurses. There can be no place for reduction of nursing places to be made randomly and without consultation because of the significant impact on the health system of any undersupply of registered nurses.
• In April 1997 the Australian Institute of Health and Welfare released information that nurses are "older, more experienced and more highly trained". The worrying aspect of this trend is that this aging workforce, 94% of which is female, will revert to part time employment and retire within 10-15 years. With the deficit of younger nurses to fill the ranks along with the increasing demand for health care from a rapidly aging population, concern is expressed that supply/demand ratios are now, and will become, increasingly diverse.

  Each State/Territory was recommended to form a Health - Education Cooperative Planning Committee to oversee workforce projections and numbers of nursing students needed. This has occurred in most states however, despite the need to increase the student numbers in some States, this has not been achieved due, in part, to the decreasing school leaver pool.

  A strong marketing policy is needed in the education sector if students are to be attracted into nursing programs.

Theme Three
Regulatory and administrative framework for higher education.

• Twenty five percent of nurses are employed in rural and remote areas. At the post graduate level, the shift of specialty programs to the higher education sector has provided many financial and geographical difficulties to these workers. Appropriate distance education and other means of support for these students is critical to ensure specialty nursing skills for the rural and remote area communities.
• Accelerated recognition of prior learning by Universities would allow many nurses both rural and metropolitan to upgrade their qualifications and broaden their knowledge base.
• Given the pressures already identified on the provision of health services, systems need to be developed by Universities that allow for a more rapid response to changes in nursing practices and a redesign or development of new curricula as needed.
• Nurses are currently facilitating improved access tot he health care system for many people. The scope of nursing practice is being extended in many areas, to allow nurses to use all their skills and expertise legitimately. Education programs with a common core and specialist modules need to be established in the higher education sector in collaboration with the health system to prepare and support advanced practice.
• Quality issues can be readily assessed in terms of graduate performance, that is, the "product" of the university system being "usable" by industry. Currently this is not perceived as being the case and much debate on graduate performance (both from undergraduate and post graduate programs) ensues.

  Universities must listen to industry; should trial a variety of models of nurse education; encourage joint appointments so that rapid changes in the knowledge and skill base of the profession are quickly implemented into the programs.

• The notion of semesters does not sit well with health services when student access for clinical education is compacted into a few weeks per year. From a health service and student perspective use of the entire calendar year would be welcomed.

Theme Four
Financing higher education teaching and research training.

• In 1994, 11,581 students completed nursing courses at Universities in Australia.
• 7,279 (62.9%) completed basic nursing and 4,302 (37.1%) completed post basic nursing courses. Females accounted for 89.4% of all completions (National Health Labour Force Series No.9 Jan 1997)
• Given the number of nursing students in Universities, there is a legitimate claim to funded places being appropriately resourced and models of education changed as needed.
• Given that it is desirable to have membership of the profession as representative of the general community, and in order for nursing to be responsive to multicultural health needs, access of education must be equitable with a balanced undergraduate and graduate profile. Any change from maintaining the lowest HEC band for nursing will discriminate against a number of potential nursing students and further alienate school leavers from choosing nursing as a career path.
• The nature of preparation of the nurse requires quality clinical education across a broad range of acute and community placements. Pressures on health services to contain and reduce real health costs, have caused concerns about the adequacy of resources for clinical education and supervision where this has been reduced or eliminated for higher education programmes.
• There is in some States an undersupply in specialist areas such as critical care and mental health nursing and also in midwifery, all of which are at post graduate degree level. The introduction of fee for graduate studies will severely impact on labourforce supply in these areas.

Theme Five
Funding of Higher Education Research.

• Nurses deliver the majority of direct patient care, and have more influence over outcome management than any other health group. It is critical that nurses engage in a multidisciplinary approach to evidence based health care practices. To do so nurses need critical thinking and research skills and research experience. Support within the higher education sector for the development of these skills is crucial for nurses to deliver more effective and cost efficient health care.
• Scholarship schemes must be introduced to assist nurses obtain research degrees.

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