In more classic Howardism, he’s announced a plan to train 500 nurses, in a return to the hospital-based training system rather than university-based as nurses are now trained.
University-bashing – check. Bypassing the trade union in the area – check. Not actually having a comprehensive plan to solve the bigger problem – check.
But check the comments thread attached to this ABC news story. A lot of the commenters appear to be nurses themselves. Most – with the exception of a few older nurses who came through the old system – are scathing towards the idea.
To pick some choice quotes:
People don’t seem to realise that Nurses are highly educated professionals. Compared to many of the junior doctors staffing our hospitals who have 4 years of medical education, all nurse now have at least a 3 year degree and many have post-graduate qualifications in their specialty area. Yes nurses want opportunity for career development, but so does every other professional. Why do so many of the public find this distasteful?
It is hard to believe that Tony Abbott, a doctor (sic), is criticising nurses for not having enough time training in the hospital during their university degrees but I hear no similar criticism of medical students. Why is that?! Don’t medical students also have to look after patients?
Did Howard actually consult with ANY nurses on this policy?, this policy is a bad joke.
To get more nurses
(1) fund more places in the uni system
(2) attract more students into nursing by
(a) paying nurses more money
(b) put incentives in place to attract students (no uni fees)
(c) put childcare facilities for hospital staff into hospitals
(d) recognise many nurses have not only Bachelors degrees but also Masters degrees – Howard suggesting a TAFE course is an insult, and undoing all the work nursing has done for the last 20 years to be regarded as a profession
(e) fund continuing education for nurses specialist nurses (theatre, ED, ICU, etc. etc.) currently pay themselves to specialise, and get no financial reward for doing so
Personally, from this layperson’s viewpoint, nursing isn’t just about wiping brows and changing bedpans. It’s a deadly serious business – my friend Rachel could have died from a medical error, and was saved by the nurse observing carefully. That doesn’t mean that hospital-trained nurses are necessarily less capable of such. But changing training standards for such a critical job in such a cavalier way, without carefully consulting the professional bodies, seems like a terrible idea. As the poster on the ABC forum said, would you treat doctors in the same way?
I think this is Howard’s response to some clever Nursing Federation ads about Workchoices. The ads bemoan the resulting decline in nursing numbers, which would worry many elderly Howard supporters.
It’s likely Liberal polling has identified this issue as starting to bite in older age groups. So Howard pulls his usual cheap stunt of announcing a quick fix, happily pushing nurses’ career aspirations into the mud while doing so.
As is pretty well known, nursing as a profession fought strongly for both the status and the training benefits of being a university profession. That move was also an important part of correcting the traditional master servant relationship with doctors, which had irked nurses for a few decades.
So this plan of Howards is a blatant insult to the very people who are so important to his plans. Pure nastiness.
I posted this link the Howard Deluge thread, but the WA ANF did a deal with the WA Libs during the 2005 State Election. It’s Secretary, the odious Mark Olsen is scathing of the ALP here and I’m sure he’s secretly harbouring plans to seek ka safe Liberal Seat
Robert Corr summed it up quite well.
http://www.redrag.net/2005/01/28/nurses-liberal-pact/
I support this initiative in principle. I have heard the point argued very strongly by senior nursing professionals that the university path to nursing has some severe shortcomings.
University nurses are unavailable to the health system for the full three years of their education and are relatively useless in their first year of practise as they require extensive supervision while they learn to put theory into practise.
University nurses, who are in reality junior doctors, become less available to perform many of the “Nightingale nurse” traditional functions, the bed making, the cleaning, the caring, the hand holding, the brow moping, etc. Some of these functions are now performed by orderlies, but there is a void. It is true that hospital stays are now much shorter than they were 30 years ago and the companion role of the nurse has diminished with people convelescing at home, but there is still a need for this function. Good health is both physical and mental.
University nurses become specialists ie trauma, intensive care, theatre, neonatal, paediatric, etc, and lose their ability to free range within the hospital generally.
Many people who would become good general nurses are deterred by the prospect of spending 3 years in intensive full time study unpaid and accumulative significant debt from self support and fees in the process.
Nursing was originally a trade. It has become a profession. Nurses have upped their game, and that is both a good and necessary thing. But the trade nurse is as valid now as it was originally. The trade nurse offers people the opportunity to start down the path of the health operative, becoming a much needed more affordable workforce. People taking this path have the option of extending their education to move from trade nurse to professional nurse to doctor as their career develops.
I do not see this as a threat to the professional nurse, I see it as entirely complementary. It is also the shortest path to improving the manning of our hospitals. The thing to be guarded against of course is the reduction of university placements for nurses. This would be the true Howard/Abbott/Costello programme. But as they will not be around to fully implement this programme then I feel confident that it will proceed in the proper way providing us with a properly manned hospital system.
Bilb, you seem to be forgetting the Enrolled Nurses here. Orderlies definitely are not doing the Nightingale functions – orderlies do transport of patients and equipment.
The system needs both university trained RNs and TAFE trained ENs, and Howard is suggesting that RN training ought to go back to being just EN+, when it’s been far more than that for 20 years.
We currently have a shortfall, so they say, of 19,000 RNs. We also currently have approximately 25,000 qualified Australian RNs of working age who are no longer working as nurses, largely because of better pay and conditions in other fields.
The easiest way to fix the shortfall in current nursing numbers is to PAY them more and stop expecting them to work such INSANE rosters, then the RNs might stop finding other jobs and those already in other jobs might consider coming back to nursing.
It’s a dumb political move by Howard because health is an area of rock solid Labor strength in the voters’ perceptions.
Highlighting where your opponent is strong is never good politics. By all means, let him elevate health as an election issue.
I’m looking forward to hearing his plan to make all solicitors clerk for a few years before undertaking their law degrees part time, after all lawyers fresh out of the College of Law seldom have a lot of practical or life experience.
Surely the same principles apply?
Robert Merkel and Everyone:
This is nothing but a cynical, desperate last-minute trick …. another Non-Core Promise …. which will be ditched as soon as the mugs have voted. If anything, it’s a ploy to regain the wavering support for the Liberals of wealthy, very influential older doctors who might change their mind if they could see that Howard was going to “put nurses back in their place”.
Tigtog:
Enrolled Nurses? Most of them were ditched in the headlong greed-driven rush to credentialism in nursing. Link http://en.wikipedia.org/wiki/credentialism
That was one of the stupidest, costliest and counter-productive things that ever happened in Australia’s healthcare system. Chucking out so many experienced Enrolled Nurses is one of the causes of the shortage of nurses and one of the causes of the current low standard of Aboriginal health.
You are dead right about insane rosters!
[Disclosure - I was a first-aider, an Army medic, a hospital wardsman/orderly and a Registered Nurse (now retired) and I also have a degree and other "credentials". Is that trying to Argue-From-Authority?
]
There are two distinct sides to this story:
The political purpose and the issue itself.
Tony Healy (above) hit the nail on the head. This is a political stunt.
To be aware of a problem and wait till the election to announce a remedy shows no sincerity.
There was no consultation, no working party, no contact with the states. Any project of this magnitude would demand this.
The scheme may or may not have merit, but why wait till the election to announce a fix for something they, in some part, are responsible.
Would they be announcing this if there wasn’t an election around the corner?
The ‘master politician of his era’ seems to have struck on a brilliant new tactic: piss off as many special interest groups as possible in the name of being strong and decisive. Now he can add nurses to the list of groups he’s gone out of his way to antagonise, along with public school teachers, trade unionists, friends of the ABC, indigenous Australians, Australian Muslims, university staff and so on.
I’m just puzzled about who’s supposed to be impressed with all this divide and rule stuff … I mean obviously if the polls are correct not many people are impressed in fact, but I’m puzzled about why he ever thought it was a clever idea and what he hopes to achieve out of it.
Not officially but I have experienced them doing it particularly in nursing homes but also in public hospitals when I’ve been visiting elderly long-term patients.
These elderly patients need comfort-nursing (Nightingale) but today’s ‘professional’ nurses aren’t trained to provide it nor do they want to.
The retention period in hospitals for uni-trained nurses is not long as many of them leave to join pharma companies in sales etc. One of the reasons is that they find practical nursing demeaning and unpleasant. This is where the old style nursing had the benefit of sorting the ‘chaff from the wheat’ – student nurses soon decided whether liked practical nursing jobs and either stuck at it or left. For uni-trained the practical side of nursing is a shock to them after they graduate and start on the wards.
Perhaps we should be training more doctors and letting nurses be nurses not ‘junior’ or ‘pseudo-doctors’.
Ah well Graham , my last hospital posting as a physio was in 93, so I’m sure that I am somewhat out of touch, and bow to your superior knowledge.
Last time I was visiting people in hospital though there were still auxiliary nursing personnel running around with the RNs – what are they called now if not called ENs?
Sure, credentialism is overblown in importance generally, not just in nursing, but I dunno about charactersing the drive to increasing status for nurses as “greed-driven”. That seems too harsh for a profession that was also very aware of issues of respect and gravitas, the importance of which shouldn’t be waved away.
The problem with our nursing shortage remains: it’s not that there aren’t enough people training to become nurses, it’s that the system sucks so hard that the nurses we have don’t stay. It’s not a recruitment issue, it’s an attrition issue. Until they address the issue of pay and conditions, hardworking, clever, well-trained people, no matter how many of them are recruited into the hospitals, will continue to find that other fields of employment offer them much better prospects.
Bilb, peremptory much? Your comment above with the horizontal line I don’t know about. That’s all that’s there when I look at it via the admin interface. I’ll go and check the spam filter in case you’re talking about some other comment that’s stuck there, but not until I’ve had some coffee, seeing as I strangely don’t feel all that charitably inclined after your accusatory tone.
BilB, there’s no deep dark plot. I’ve just despammed all your comments. It seems not of my colleagues were on the job since 12.44am. This is not uncommon on Saturday’s I find.
I don’t have time to read through and see which ones are duplicates, but you are all over this thread now.
You weren’t the only one caught in the spaminator.
Thanks for that, Brian.
People, please don’t repost and repost and repost if a comment fails to appear. That’s exactly the sort of behaviour that makes the spaminator think you are a spammer, and then all your future comments are likely to go into the spambucket for at least a few days, until the spaminator algorithm recognises that it was just a flurry on your part and not a nefarious spam attack.
If a comment fails to appear, please email us.
the right seems to think that the howard government has been some wonderful monument to liberty, but this is just another example of the howard style – coast on the keating economy and bitch-slap every group of australians in the 49% who didn’t vote for you
freedom for a shallow greedy 51% and tyranny and persecution for the rest
Do the maths on this: at any one time about 40 of the 500 additional nurses will be on leave (one 12th of 500). The leaves 460. There are about 1300 hospitals in Australia, resulting in an average of one third of an extra nurse per hospital.
Yup, that’ll fix it, John.
A joke policy from a joke PM
BlB – your problem appears to be between the seat and the keyboard (old techie joke).
This policy is the new white elephant, last election it was the Australian Technical Colleges.
I know some people that were doing Nursing at UWS when it was right next to Westmead Hospital, and they seemed to do a fair bit of practical work, I’m sure there are limitations in hospitals not wanting too many inexperienced staff at one time for training, but this seems like a lazy new-jerk drunken sailor thing a government does when it is on the nose. Particularly considering
A) University places in nursings are well short of being filled
B) This course will be a three-year course (Why would you do this qualification for the same number of years as a university qualification?)
C) Where are they going to get qualified staff to train, the universities at least have both the physical and institutional infrastructure
D) $170m for 500 nurses, sure its inflated by it being created from scratch, but that’s (assuming full enrolment – unlikely) $340,000 per student, and while it will reduce over time, I can see some Department of Nursings in universities around the country wondering why they don’t get such a lavish offer.
E) As everyone mentioned this does nothing to confront issues like staff attrition
The only way this could work is if these centres
A) Created this qualification that was somewhere between the RN and EN qualifications
B) Provides a new-low option from the unis (but the unis are already on a very low subsidy per student, lowest on the HECs band), and if its low-cast how do you as a private business raise enough revenue to pay for qualified staff to teach. Its likely to be bottom-of-the-barrel training.
Dave from Albury: Solicitors don’t need any real world experience. They don’t deal in the real world. Their life is the law book and the courtroom.
Nursing is real however. Changing a law to say “bedpans are clean” (which is how the legal profession operates) does not get the bedpans clean. Likewise for stopping bleeding, injecting medicine, etc etc.
In short: Nursing is a practical profession, and whover had the idea to send nurses to university to become nurses was about as dumb as the person who had the idea to send cops to university to become cops.
Are you SERIOUS? Health is Labor’s achilles heel. It is state ALP govt’s who have absolutely stuffed their health systems. Health can only be pinned fair square on the ALP. Labour will have to spin like crazy if they are going to deflect any of the well deserved blame for rooting the health system.
Sans Blog:
Graham Bell: You are both 100% spot on with your comments above.
SATP, I can’t believe how much excitement there is about this issue. I thought eleven years of Dr Herron, Dr Nelson and the Mad monk would have bought some positive outcomes but obviously they were all duds.
Steve: Mad Monk is the best hope of some positive reform in the health system.
He is the first one with some “go” in him, and he isn’t afraid to tread on toes, to bruise egos, or to act and speak in a radical manner.
And in real life his ears are even bigger than in photos. He looks like a Landrover with the doors open.
I would hope that Rudd counters this absurd policy-on-the-run from Howard with a realistic guest worker as foreign aid strategy. Tertiary trained nurses should be encouraged and the general nursing arena opened up for our Pacific neighbours – something Howard is very prejudiced against.
We all know the historical hangover of master-servant relationship between doctors and nurses is one reason so many nurses get jack of it.
Filling the vacuum of the traditional on the job training would be ideal for our neighbours in the interim before somehow these two professions come to grips with their pride.
Let the serfs eat excrement [] Check. Now Steve at the Pub it would be nice if you knew what you are talking about. Taking nursing back as a non profession is not a forward step. There are numerous reasons why nursing is and should be a tertiary course. If you are taking about training nursing aides in hospitals there may be some argument to that. As it stands all I can see is the paw of the AMA ( the Doctors Union) trying to downground nursing in an effort to keep their exalted position. As for the Mad Monk being the only hope of reform Matey let go of it. He might not be afraid of upsetting people but it would help if he had a brain.
I have to laugh at the “health is Labor’s space” types. We are forever being told that the two issues that outstrip all others by a country mile in voter’s minds are health and education are “Labor spaces.” And yet John Howard has been elected four times, and parents are fleeing state-government schools in droves.
The retention period in hospitals for uni-trained nurses is not long as many of them leave to join pharma companies in sales etc. One of the reasons is that they find practical nursing demeaning and unpleasant. This is where the old style nursing had the benefit of sorting the ‘chaff from the wheat’ – student nurses soon decided whether liked practical nursing jobs and either stuck at it or left. For uni-trained the practical side of nursing is a shock to them after they graduate and start on the wards.
The attrition rate for hospital-trained nurses was just as high if not higher than it is for tertiary trained nurses. In those days (pre-’85), so many girls did nursing because that’s what girls did – teaching or nursing. I trained as a nurse in a hospital, worked for two years afterwards and haven’t done it since – that was 25 years ago. I constantly meet other middle aged women who are ex-nurses. None of us would go back to it – because it was authoritarian, we were often treated like servants, we had very low status within the hospital system and it involved shift work, which destroys your mental health. (Of course there was a good side to it, too, but that clearly doesn’t outweigh the negatives for the thousands of women who leave nursing.)
A few years ago the NSW government had a big scheme to encourage ex-nurses to go back. It was when I had a toddler at home, so I was interested in part-time work. After a few phone calls, I was finally put on to a senior nurse manager at a big hospital – obviously an old-school, hospital-trained nurse. She was very hostile to the idea that i only wanted to work part-time and stipulated that I’d have to get a reference from my last nursing employer – which was over 20 years before! Of course that was so ludicrous I didn’t bother. When I told my ex-nurse friends about this, they all groaned – it was such a familiar attitude. My point, in case it’s not clear, is that the hospital-trained heirarchy – the Florence Nightingale era – were a nightmare for most nurses and directly responsible for the attrition rate. Returning to that system is not going to solve anything. Status and self-esteem are important components of any job.
However, there is clearly a crisis in hospital nursing, in some areas at least. When my elderly father was in a big private hospital for several weeks a few years ago, I was shocked by how 90% of the nursing staff were agency-supplied – which meant they did not know the patients or build up any rapport with them. There was hardly any continuity of care.
My other experiences within the last decade, as a patient and with my child as patient, have been more positive.
I know two people aged 40+ who still work as nurses – neither of them is in the hospital system.
I reckon Howard might have made a reasonable political call here: although it will probably make more headway in those traditional Liberal seats that are looking a bit wonky (eg, North Sydney) than in the outer suburban marginals.
There is a strong feeling among many of the older folk in our community that nurses have been transformed from being primarily care givers into jumped-up pseudo-doctors running around with clipboards who expect relatives to dive in and do a lot of the dirty work in hospitals.
I’m not saying that this view is fair (although there is certainly some truth in it), or that the university training is really to blame, but it’s out there in the electorate.
The idea will also play well with many doctors of the old school, not to mention the celebrated “doctors’ wives”.
John Greenfield, Steve at the Pub and others: health is definitely a “Labor space”. The public still do not trust the Libs – or, for that matter, Tony Abbott – with the health system. People over the age of 45 can remember what Fraser did to the old Medibank after 1975, and would have at least a subliminal memory of Howard’s strong antagonism towards Medicare before he became PM.
Nor do they trust the Libs with the tertiary education system (which is an interesting shift, given that the Menzies Government gave it a massive boost, while the Hawke Government gave it a massive kick in the guts).
The public – particularly Catholics – have never really trusted Labor with school funding (and it was certainly an issue in 2004). People who talk about education as a “Labor space” really ought to distinguish between schools and tertiary education.
I wonder if the the claimed glamour of a university degree is necessary here. Is a 3 year training problem necessary to be a nurse?
Suz says she doesn’t want to go back to the olds system because nurses don’t have enough status and need to do shift work.
These suggests that ‘Bed Pans 1′ is not an important part of the university curriculum – just a form of credentialism and a means of getting status.
BTW how on earth are you going to provide 24 hour care to people without shift work?
Reading that comment, hc, made me wonder if the glamour of a university degree is really necessary in economics – maybe “Reductionism 1″ is not an important part of the university curriculum either.
Maybe you should visit a critical care ward, or the triage station of a public hospital casualty ward before you dismiss university degrees in nursing as credentialism and status seeking.
Bryce:
Well, actually, there’s a third side too; one that everyone ignores: the Historical side [or maybe, the socio-historical side].
Without going into a long essay, a few points to note are [a] Nursing used to be a nice respectable place to dump unmarriagable daughters of well-to-do families – attitudes left over from those bad old days persist even now. [b] We were stuck with the Florence Nightingale system because we were so terribly, terribly British and refused to look at any of those funny foreign health system …. and when we finally did so, we picked on one only and became fanatical disciples of the failing American one. [c] Nursing used to be very conservative – which is why, for example, that great pioneer of poliomyelitis treatment, Sister Elizabeth Kenny, got such a rough time. [d] Almost every aspect of health care in Australia was dominated by Australia’s most powerful and exclusive Union, far more powerful than the Wharfies or the B.L.F., the British Medical Association [which later became the A.M.A.]; they certainly did not want any rivals to their authority and especially from those they thought of as their inferiors and their servants, regardless of their level of skill. [e] The artificial division of nurses into Enrolled and Registered was counter-productive, harmful to patients and prevented many brilliant nurses achieving their full potential; a system of graduated skill-levels would have saved us a fortune over the years [and maybe a few lives too]. [f] i. Hospital-based nurse education in Australia was of a very high standard but did need some modest reform. ii. The setting up of integrated Faculties of Health Care in universities would have been the way to go …. except for [b], [c] and [d] above …. with Nursing as a Post-Graduate only study – initially with nurse educators and midwives being given priority and then gradually spread to all nursing specialities.
Tigtog:
L-O-L.)) The term “greed-driven” did not refer to nurses but to university administrators and their accomplices; it really was to hell with the needs of the profession and those of the community – just get all those bums on seats, chuck together a course and just wait for all that lovely Commonwealth funding to fill up the piggy-bank [and when the H.E.C.S. hex came in, it was just a case of same money, different suckers]. It was the rapacious, short-sighted WAY in which universities grabbed control of nurse education that underlie many of the current problems and that have led to negative attitudes towards the universities and the nursing profession. The cost of allowing that folly to happen is measured not only in money and dissatisfacion but in all the lost opportunities to become world leaders in both health care and health education.
((My respects to you; you have no need to bow to anything
You can blame the bean counters for that, meher baba. In the late 80s/early 90s, there was this drive for all hospital health practitioners to submit detailed statistical outlines of exactly how we spent our time treating people, divided up into 5 minute lots. Different types of treatment fell into different categories. As a physio, my stats sheet for a patient’s treatment during the day might look something like this:
Patient X
Type I 6
Type II
Type III 4
Type IV 8
Type V
Which would indicate that I’d seen them twice that day, spent 15 minutes both times on evaluation of their progress and instruction in an exercise regime, given them ultrasound therapy for 10 minutes on each visit and spent 20 minutes on each visit giving them connective tissue massage and joint mobilisation. I had to fill in details like this for every patient treated and hand my stats in at the end of the month, and then all the stats from all the departments would be collated. There was a huge push to “increase therapeutic efficiency”, to maximise the amount of patients seen per day with definite targets for each type of treatment, and nowhere on these statistic sheets was there a space for a whole lot of “the Florence Nightingale stuff” mentioned upthread, “the caring, the hand holding, the brow moping, etc.”
As for the bedmaking, cleaning and bedpanning, the beancounters have calculated to a shaved farthing just how few RNs they have to pay to do all the things that only RNs can do, and how they can employ lower-paid nurses’ aides to do everything else. There simply are not enough RNs paid to be on ward these days to do all that time-consuming intimate care stuff as well as the injections and medication checking that only they are qualified to do. This is not simply an excuse to not deal with people, this is a situation deliberately engineered to be exactly one where RNs don’t have time (and neither do the overworked aides) to actually provide a caring sympathetic ear for patients because the bean counters don’t think that matters.
They still won’t think it matters when these new nurses arrive on the scene either, and they still won’t pay to have enough staff on hand to provide it.
It’s not so much shift work per se that is the problem, Harry, it is the way that these shifts are rostered so that nurses never end up with a regular sleep pattern. But I’ll let one of the actual nurses tell you all about that.
Tigtog:
Hospital administrators were as much to blame as anyone – they got rid of their Nursing Schools, their nurses’ quarters, etc. and their “savings” cost us a squillion.
Steve At The Pub:
Nothing wrong with nurses …. or cops …. or RPT airline pilots going to university but AFTER they have got themselves plenty of hands-on experience in the real world so that they can get full benefit from what they are studying.
What do you think of having all cadidates for admission to Faculties of Medicine do two years as an “Enrolled” Nurse beforehand? Met a few doctors who had done just that and that made them far superior medical practitioners than the ones who had only done Medicine because of their parent’s need to be seen indulging in conspicuous consumption [Yeah? Buy the drongo a big yacht instead, he'll kill fewer people
]
It’s not, is it?
tigtog,
RNs and ENs are a thing of the past. They have been re-badged Division (Div) 1 and Div 2 respectively. Both are regarded as too expensive by hospitals, which prefer to employ, whenever they think they can get away with it, totally untrained Personal Care Assistants (PCAs) who naturally cost them much less.
btw, I know many nurses who trained in hospitals under the old system and without exception they regard the new university-trained Div 1s as almost completely useless. For example, in aged care, under the old regime bed sores were virtually unknown (so I’m told) because nurses were invariably trained on how to regularly turn bed-ridden patients. Now I hear appalling stories about hideous bed sores requiring very expensive treatments, skin grafts or even amputations because such basics are no longer part of basic training.
I for one fully support Howard’s initiative on this.
It is probably true that the retention rate of nurses (still around five years for new graduates, I think) is little changed from a couple of decades ago, prior to the industrial campaigns that resulted in RN training becoming university based and which resulted too in significant, and comparative to teachers, good wage increases for nurses (if not better conditions).
For conditions have changed so little in terms of rostering requirements which make it very difficult if not impossible for nurses wanting to work full-time to not undertake shift work, and in the hierarchical Victorian-era bullying work culture which persists in the hospital system, that it is here we find the reasons for the ongoing exodus of nurses. Equally strong negative factors are the heavy, onerous, endless reporting requirements placed on nurses by government and hospital administrators, the frustrated desire of nurses to care for and enjoy relationships with sick people in the way they had hoped when they chose nursing as a career, the expectation that as university graduates they will be afforded more respect than is the case (not only from doctors, but from the bureaucratic, authoritarian array of new management levels within nursing itself) and, finally, the frustrating and exhausting reality of working within a system that is ill-equipped to deal with the demands placed on it because of lack of government funding.
The hospital system is full of nurses who are not nursing but working in a variety of other non-clinical administrative roles, but are enjoying the same or better wages and far better conditions. NSW Health for one is looking at ways of forcing these nurses back to nursing but I don’t like its chances. All of the experienced RNs that I know and hear of will leave the public health system rather than return to nursing by bureaucratic fiat.
An additional factor expanding work options for nurses today is that a high and growing proportion have more than one and often several tertiary degrees or post grad qualifications. Law, public admininstration, Masters in Public Health, teaching degrees and diplomas, etc., are commonplace among even still practising nurses.
The Howard government bears major responsibility for the dire state of the hospital system today, and the crisis in nursing because of the way in which it has for the past 11 years withheld from the states the funding needed to make the lives of nurses bearable and has thwarted their ability to care for patients in the way in which preserves the dignity of all.
Abbott couldnt think his way out of a puppets hand.What sort of half-baked moron would decide another attempt at administration and credential seeking is the only answer.? If, overwork in whatever form that takes..and its effects are a problem, that has to be considered along with other issues including is there ,in fact, any medical standard of efficient therapeutic result!? Personally, I think the whole hospital and who works there thing needs to be taken over from any form of government, and placed in the hands of those who are willing to reduce complexity, there, and anywhere else in our civilisation.!? There has been a reluctance, to even use natural sunlight for healing purposes in building design ,let alone the vexed medical question of more direct and clinical use. Many medical inventions do not get used in Australia, whilst general standard motors,get the payments for the introduction into hospitals..I do not think Australia s innovations medically are very high, but, shit, is it loaded with conservative status driven bloat, that disallows people to see how useless it all really is. So the bed pan brigade becomes the divisional matter of what skills for nursing should be readily accepted. The public needs first and foremost to be able to see a recognisable principle at work,rather than the floaties across ones eyes of is it really as good as it can be..considering everyone can get very tired. That principle must include, a quick assessment, born of both desire and design, that some work needs to be reassessed now. You can see the failure of the economic principle acting foremost and first, when Harry Clarke finds voice on matters of shift work..I think, the general populace has to tell these pushers of a candy that sticks in your throat..we cannot suck on this and see if it does any good right now! Maybe the hospitalised should have the choice between complex medical treatment an d analysis from less complex forms of service..running both in the same hospitals.This may mean ,if, the patient opts for simpler treatment the electronics etc. are not necessarily engaged.
As a practising RN in a tertiary hospital, I would like to add my thoughts to those here.
I don’t like the common slur put about by doctors and others, mostly older people about uni trained nurses not wanting to perform the ‘menial, unexciting or bedpan/bottle tasks’.
The fact is, with the workloads placed upon nurses, something like 1:6 or so, it is not physically possible for the nurse to be all to everybody at once, and she may expect the family to provide support. After all, why sit there at the bedside all day and not want to assist your own family member anyway?
The nurse has to prioritise her work, firstly the most important, urgent tasks down to the least important. So many duties performed are unseen by the general public.
- checking drugs for herself and making herself available for others. Checking medications, making sure the doctors or pharmacists have it right, as the administration of medication is the nurses responsibility and they will be held liable for the mistakes of others.
-paperwork! do you realise how much of her workoad is in mandatory reporting, mostly to reduce liability for hospital managers and covering doctor’s arses. When does she do this, after her shift ends, on unpaid overtime?
-assisting the new grads, those in their first year out. Yes, some older nurses do have attitudes, but that is dying out I believe, most are very supportive, as much as they can be. You see, the experienced nurse is not given a reduced workload herself when she is expected to supervise others, she has to do her own work plus be available to support others.
-doctors come along in numbers (usually all at once) and expect the nurse to just drop everything and attend to whatever new changes in treatment that they instigate immediately. Now it’s OK for a quick change in care for one patient, but when you have to do so for four or six patients, all at once? We only have one pair of hands! The other patients are ringing bells and wanting to know why you’re not attending to their needs. In a dynamic, changing environment (in the middle of all of this, there could be a MERT or Medical Emergency on the ward too). Everyone tries to work as a team, and pick up for others if they can, but often, everyone is just frantically busy providing direct patient care (it might not seem to be direct, but if it relates to the patient needs or nursing care, then it is the nurse’s responsibility).
-if other areas of the hospital are shortstaffed, or just too busy to get to the bedside, they just place the burden upon the nursing staff, because, they are the ones responsible for the direct care of the patient. No pharmacists, nurses have to take the med sheets to pharmacy and spend time getting drugs etc. No domestics, nurses will give out meals etc. No allied health eg speech pathology, physio, occup. therapist, well just leave instructions for the nurse to perform the tasks. No available doctor, well the nurse will have to take care of it.
-patients themselves, and their families can be very demanding. If someone is overly anxious or obsessive, they can demand all the time of the nurse just for themselves and expect her to just neglect her other patients. Some people are on the bell every five minutes demanding a nurse presence for every little thing that pops into their head. The same attitides in society, the selfishness and consumer demand is taken into the public hospital system, they believe that they have a right to treat nurses like their personal slave.
-Nurses actually do want to bathe and dress and care for their patients, give them devoted time 1:1, but they are not staffed to do so. Usually this just makes them feel incompetent and inadequate and they want to leave the profession and re-train for something else. I constantly wish, that I had the time to spend with my patients, talk to them and do the little things that mean so much, but, I’m too busy running around like a chook with it’s head cut off!
-Usually our own meal and rest breaks are forfeited because there’s no time to look after our own health. the hospital should have a duty of care to their employees also, but it is only the duty of care to the patient that is reinforced.
-Many nurses are in the management of the hospitals, they are the ones that don’t want to do the shiftwork, don’t want to feel constantly stressed, anxious and exhausted, they are working toward a career path of better pay and better conditions. And you know what? most of them couldn’t give a damn about the ones on the wards, they usually end up selling out completely and assisting in making life worse for the rest of us at the bedside, yes, I’m looking at nurse managers.
- Exhaustive and punishing rosters, I am in the middle of performing 3 x shifts in 3 days. Evening shift 1300 to 2130 then I come back for morning shift next day 0700 to 1530 and today I am on one of my two consecutive 12 hr night shifts, 1900 to 0730 (two half hour breaks, one of them unpaid and they don’t care if you get it or not)
-abuse, bullying and intimidation by all, the patients and families, the doctors and hospital management and the horizontal violence to ourselves. Nurses are an oppressed group within the heirarchy and they need autonomy urgently.
Sorry for lengthy post, there’s so much more that I want to say but that is just off the top of my head at the moment!
I wonder if the the claimed glamour of a university degree is necessary here. Is a 3 year training problem necessary to be a nurse?
It’s nothing to do with “glamour”. When nurses talk about status, they’re not just talking about an image – they’re talking about their authority (or lack of) in the hospital workplace.
Suz says she doesn’t want to go back to the olds system because nurses don’t have enough status and need to do shift work.
These suggests that ‘Bed Pans 1? is not an important part of the university curriculum – just a form of credentialism and a means of getting status.
It’s nothing to do with bedpans. Nurses don’t resent emptying bedpans – it’s only the non-nurse imagination which is fixated on that part of the job.
BTW how on earth are you going to provide 24 hour care to people without shift work?
Of course there have to be shifts, but the same people don’t have to do all the shifts – there can be permanent night workers. And shifts can be worked out in a saner way than when I did hospital-based training.
I agree with most of what Rob said, having a Div 2 nurse in the family. All that’s really needed is a 6 month stint in the wards before starting the University Course which will let students make up their minds if they’re cut out for nursing.
Time after time, my sister has trainees come onto the wards who have no idea how to touch a patient or have empathy with them. She has 28 years of hands on experience that can’t be taught in a classroom. Nursing is so complex now that we do need University graduates but they have to be sure that they can look after people as well as machines.
Deborah is right too about abuse and intimidation of nurses by families who can complain long and loudly about any nurse but that nurse can’t do it back.
Great comment, Deborah — excellent to hear from someone who’s in the middle of it.
My sister, who works as a rehab nurse, would be chewing pieces out of the furniture by now, if she’d read this thread — and she’s one of the conservative older nurses who bemoan the university-trained era, not because she thinks it’s unnecessary but also because it unlooses upon people like her — often the only experienced RN on a ward in any given shift — the extra responsibility of supervising new graduates who have next to no real hands-on experience. The solution is more consultation with working nurses and a different ward-experience set of requirements in the course of nursing students’ academic training, and I understand those things are starting to happen.
Nurses have always had, and needed, three years’ training; in the old system they trained mainly on the wards, interspersed with 6-8 week ‘blocks’ of lectures and exams. For those who think it’s still a matter of Bedpans 101, I can only assume you haven’t been in hospital for a couple of decades, or that if you were you kept your eyes shut the whole time. Hospital nursing has changed beyond recognition — nurses now need to be right on top of the drugs and the technology, and both are constantly changing.
They need to be smart enough to pass three years of university exams and at the same time to still be willing not only to put up with the conditions Deborah describes, but (warning: disgusting anecdote, and hearsay to boot) do things like put on their rubber gloves and fish cheerfully around in the pre-loved breakfast some unwell patient has barfed up to find whatever’s left of the pills and capsules so they can try to work out how much more of each drug the patient ought to be given.
It may be that some people think less of someone who is willing to do such things — things that have got to be done by someone. Or, indeed, to think less of someone who has to clean bedpans. Personally I think that no matter what the people who do this kind of work are being paid, it isn’t enough. To belittle them and the work they do is unforgivable.
Deborah is right and also JahTeh and jinmaro.
jinmaro said:
Absolutely right. My wife (who’s a very experienced Div 1) is obliged to spend more time on paperwork than on patient care. With staffing shortages being what they are, this is completely insane, especially as the paperwork is only for show, is meaningless in terms of the provision and planning of care delivery, and is never read by anyone. But it has to be done so the hospital can get its annual accreditation.
I’m not sniping at university-trained nurses, I’m just saying the current system is wrong. During their university training nurses are given carefully controlled hospital assignments, usually in charge of only one patient. When they emerge with their degrees, they are expected to manage a ward of say 30 patients – by themselves, assisted by agency staff (who don’t know the patients or the hospital) and PCAs who are completely untrained. Say some of the patients are demented, some have Parkinson’s, which requires very carefully regulated medications keyed to variable patient behaviours, demanding and aggressive relatives, and all the rest — no wonder so many just exit out.
Hospital-trained nurses I know believe that nursing graduates today know less than the old school of nurses did at the end of their initial 12 week Preliminary Training School. PTS also had the benefit of weeding out those who could not handle the physical pressure of nursing (it’s difficult, demanding, often dirty and unpleasant).
I don’t think it’s nostalgia that prompts these nurses to say that if people think the nursing crisis is bad now, just wait for a few more years when the last of the hospital-trained professionals have retired.
My wife and I have been discussing this problem since she graduated from the Royal Melbourne Hospital over 25 years ago. We listened to a speech from Health Minister Drian Dixon on the virtues of on the job training. The following year on the job training was screapped!
Her vote is to bring it back.
I think university training is great for nurses. But I think the issue is that there simply are not enough of them. If you want to get more, you have to lower(or alter) the threshold a bit. I doubt pay increases would be a very effective way to increase nurse numbers. A lot of people just don’t want to be nurse (I would never be one, no matter what the pay is). Pay increases are extraordinarily expensive, because they apply across the board, while the gains in enrolments are often minimal.
I thought the ‘new’ nurse training policy sounded familiar, and I was right: it’s Pauline’s:
http://workers.labor.net.au/85/news72_nurses.html
Writing as someone who’s spent some time seriously ill in hospital, I can only say that my care was very much dependent on nurses with excellent training spotting incipient signs of infection. This is just a horrendous pile of stinking cynicism made up on the run. The Howard government’s approach to policy is just a sick joke.
Pavlov’s Cat
Thanks for your support (others here too).
I’m one of the older hospital trained nurses too, actually I have both, I’ve done a post grad degree in paediatrics, in my own time, at my own expense. But, keeping up your skills is a mandatory reqirement for competency and annual licence – go figure!
My constant refrain – I’m getting too old to work like this any longer!
I believe that we should look after the young ones, so that they might stay in the profession. I want them to have better working conditions and wages than I have.
The worst of all though (Qld health is my employer) is when nurses are not supported by their own. I know where I work, that if you speak up for yourself and others and try to demand better – you are treated as hostile to the establishment, forget about career advancement, they only want yes people.
The bean counters rule everything. Even if the nurse managers are on our side, they are quickly disciplined or taken to task if they stray from the budget demands and use extra agency than permitted, which is why we are constantly short staffed.
For the query on night duty, some staff like to do permanent nights because they have child and school demands, but, that is not allowed anymore. Apparently, they lose their skills from sitting on their arses all night, doing nothing (so the nurse directors think) consequently, we lose good staff. Easy to see that the people who make the policies, don’t do any shiftwork or work on the wards.
They just do not care and don’t even try to make flexible rosters for staff. It’s budget, budget, budget (well for nurses anyway, the doctors have lunches paid for by drug companies and some seem to get lots of trips overseas).
Gotta go, night duty, I’ll be late – cheers!
Trade Qualification vs. University Qualification – a personal anecdote
My mother in law was a hospital trained nurse and my little sister has just started working after university training.
The mother in law has often lamented about the state of nursing today and she blames the shift to university for it. That said, she wouldn’t go back to nursing for quids… she is one of the countless thousands of former RN’s who do something (anything) other than nursing.
When she and my sister talk about nursing it’s very clear that my sister works in a vastly more complex world than the one my mother in law left in the 80′s. Just the range of specialisations that my sister can chose is testament to this. And remember, specialisation and higher skill levels are where the productivity gains are.
My sister is already looking for a way out of hospital work, the conditions are pretty crap. I did shift work myself for about 6 years and tried to explain to her virtues of shift, unfortunately all the things I loved about being on shift don’t apply to her. For example, in the hospital:
– Rosters are not structured so you get 4-5 days off in a row every month or two
– Shift’s start at unfriendly times, eg. Instead of 3pm for an 8 hour shift and 7pm for 12 hours shift, it’s more like 1pm and 9pm.
My $0.02 is that Howard’s plan does nothing to raise the productivity of nurses and more importantly it does nothing to keeping the ones we’ve got inside the profession. These are the 2 most cost effective ways of getting more nurses.
You’re lucky if you have nursing care in regional areas as my most recent needs in the local hospital was covered by nurse zorronsky!
I don’t agree. I think this is a very good policy proposal. I remember Peter Walsh, the former Labor Finance Minister, arguing along the same lines a few years ago.
As SATP said above, teaching nursing in universities makes about as much sense as teaching policing there.
I’ve spent most of my life in the uni sector and agree the govt has on the whole shown it nothing but contempt. And yesterday’s headline-grabber, with its emphasis on private tuition, reinforced this.
But I don’t automatically agree every professional education has to be university based.
My sister, a graduate with significant experience in caring/palliative, was turned away from nursing when it moved into a university-only entry system. Not every domain is fundamentally an academic one.
I also don’t see why an apprentice style system locks unions out: the sooner student nurses share experiences in hospitals, with other nurses, the sooner they are exposed to the culture that keeps the nursing federation strong.
Mark,
Like most of the things you say there is an odor of glibness. You claim the Howard policy on nurses is nonsense because of the good treatment you received from nurses which (despite your serious illness) you were observant enough to be able to relate to their ‘excellent training’. You clever boy!
Its nice the way you implicitly suggest that because you have suffered a serious health problem you are an expert on this issue. Sorry, mate this is pure illogic.
You have not contributed in any respect to the question of whether nurses in hospitals need university training.
If they do it should not be for reasons of status or other such nonsense – it should be because they cannot pick up the skills they need on the job with less formal training.
None of you commentators have really addressed this. Howard is proposing to train 500 on the job. Is that so wicked? Does every nurse need a uni degree?
The short answer – given the responsibilities that nurses have, I’d sure want them to have university training, or something that’s effectively its equivalent. I want them to understand the biological background behind the drugs they are responsible for managing the administration of, for instance.
As others have noted, most of the scut work has already been farmed out to unqualified nurses’ aides.
Deborah, I for one am grateful that you and people like you exist.
I’ve had about 5 admissions to a large public hospital in Sydney over the past 3 years and without fail have found the nursing staff to be incredibly overworked, but dedicated, emphatic and caring. The same, unfortunately, cannot be said for the doctors.
I was aware during a couple of admissions of added pressure on the nurses due to the reduction of housing for the mentally ill in the community. During one long stay I shared a ward with a schizophrenic girl who constantly buzzed the nurses with her delusions. The nurses had actually arranged for her to stay longer in the ward as they suspected the girls partner was physically abusing her and had caused her original injury, and so were trying to arrange alternative care for her in another institution.
I also witnessed the kind of rude, demanding and unreasonable behaviour by patients and their families that Deborah mentioned.
My sister is a nurse who went through the old block system straight from her HSC. I left school 3 years later, landed a cushy job in a government department, and within twelve months was earning more than her, which even then I recognised as being grossly unfair.
I wouldn’t be a nurse for any money and I can’t think of anyone I respect more than those who have the backbone and integrity to take this job on. And a pox on any politician who tries to demean them.
“Are you SERIOUS?”
Labor comes out ahead in every opinion poll that asks who which party is better at health. Always has. It’s the Liberals with economic management , deserved or not.
Remember JWH became a solicitor through the the “clerk system”, just another idea to take us back to the 1950′s. By the way his Leaving Certificate pass would not got him to any degree at Sydney by to-days standards!
“Howard is proposing to train 500 on the job..” but I read this thread and wonder why isn’t it 10,000 ?
Mark may have signs of residual, post illness glibness but this government’s tendency for making policy decisions on the fly is hopeless. Distracting, cynical and driven by a short term media news cycle .
Pathetic.
Rob, you said
Bad news for you, mate: it’s NOT! Kindly scroll back up to Resin Dog’s comment at 9:47am. You might try that link by Guise at 5;51pm; whether good, bad or just plain awful, at least that was an actual policy by a political party and not just, as I called Howard’s nursing stunt earlier “a cynical, desperate last-minute trick”. Wonder what a Howard-free Liberal Party policy on nursing education would be? [Guess we will never know now]..
Suz, Tigtog, Deborah, Pavlov’s Cat:
Thanks for all the reality you have posted …. and reality is what is nowhere to be seen in this bit of election[?] ad-hockery.
Tigtog, you reminded us of that horrible time-waster
Wonder how many patients died as a result of that Stakhanovist “efficiency”? Link http://en.wikipedia.org/wiki/Stakhanovite
Thaleia:
Thanks a lot for your insights too.
What Robert Merkel said.
What some of the posters fail to recognise is that nursing has changed over the last 20 years or so, mirroring the increasing complexity of medical treatments. In short; it ain’t just about wiping arses and turning patients to prevent bed sores. Nor are nurses mere obedient servants of doctors any more than todays patients unquestioningly accept their doctors advice. That isn’t a time and place that we should be returning to but some clearly prefer their “Carry On Nursing” view.
This policy, like most of the electioneering policies of the libs is made on the run to grab a headline and fool a few fools.
RF:
Of course there is increasing complexity in nursing …. but there are a lot of things that have become very much simpler in recent years too …. and the time-wasting “cover-your-ar*e-against-litigation” essay-writing that has become a substitute for record-keeping isn’t one of them!
The politics of all this is well out of my range of frequency; so all I can say is, God bless all nurses! And nurse’s aides, too, who get little money and little respect for doing difficult work, but which in my experience, they mainly try to do well and cheerfully. I’ve met a lot of nurse’s aides who are smart, good-humored people, and it’s quite beyond me how anyone has the fortitude to continue at that level of caring for very sick people after more than a couple of years. They’re all heroes, I say. God love ‘em.
Graham Bell:
erm, well yeah, and your point is…?
Well, you’re sort of right and sort of wrong there, rf.
Unhappily, some of the modern generation of nurses think their job is looking after complicated machinery, not the people who are attached to it.
Oh and guess who supports Howard’s plan ?
The WA head of ANF, Mark “Harry Potter” OLsen.
http://mpegarchive.abc.net.au/news/stories/2007/09/15/2033736.htm?site=wa
Gee whiz that learnin’ gets ‘m all uppity with that electrickery don’t it Rob?
RF:
Some aspects of nursing have become more complex whilst others have become simpler: this is called “change” at it happens all the time. Clear enough? I don’t buy the arguement that technological change alone is responsible for so many of the problems in the health care system. What about bad administration, inapprpropriate financing, rigid attitudes, vanity, greed, stupid regulations – don’t they cause a lot of problems too?
Rob and Anthony:
There are a few nurses who forget that it is the patient they are looking after, not the IV drip and and the cardiac monitor; that comes right back to inadequate training.
Everyone:
Two ways to stop such a cheap political stunt popping up again [whether from Liberal or from Labor] is for all sectors of health care to accept criticism for what it is and then do something about the problems that have been brought to light …. and to be proactive so those problems don’t arise in the first place.
So according to the link from Frank, it is not an argument about whether Nurses will be trained for three years at University. It is a proposal for Nurses aides currently going to TAFE. Howard has done nothing to support TAFE since he has been in power.
I don’t inadequate training is the issue in whether or not nurses (or doctors for that matter) tend to treat a patient as a part-object, or as a specific illness or disease and often refer to them in a dehumanised or generic way among themselves, rather than by their names (e.g.). And while increasingly complex technology and the ability to use it is an unavoidable given in modern nursing, perhaps in some ways the technology per se is part of the problem within the overall context of a system that is overstrained and under-resourced on all levels.
Perhaps the natural human tendency of nurses to disassociate from patients’ bodily pain and distress is not countered or addressed, but rather encouraged and faciliated too by a system that relies so much on periodic, ever changing agency staff, on permanent staff who are overworked, over-monitored and over-scrutinised by even more distanced and disassociated bean counters and authoritarian managers, and who in addition to their own clinical responsibilities and the fundamental tasks of patient care have to try and fit into their daily schedule the sort of administrative reporting and auditing work that should be done by non-nurses. But the latter have been obliterated as a layer of workers (to the extent they ever existed) each time state governments announce a new round of public servant cutbacks in the name of prioritising only “front-line” staff.
Graham Bell, I think the point I was trying to make was that the change from hospital based training to a uni degree was in response to the changes in medicine (in it’s broadest sense). Sure some things may be less complex but a whole lot more are more complex. The argument is not about the problems in health care – it’s about whether hospital based training is better than a uni degree. As far as I can see the arguments for consist of asserting that uni trained nurses are too up themselves to do the ‘hard stuff’ of looking after the patient holistically. Evidence for this? A few lame anecdotes – which in evidence based medicine isn’t considered evidence at all. And yeah there are lots of issues with health administration in the public health sector and I could give you lots of examples from the rural hospital where I work.
But who says university is the only place to learn complex information?
Some – even highly technical people – just aren’t very good academically. Surely it’s wise to access this potential source of labor, especially when there are chronic shortages. I think most nurses should be uni trained, but perhaps it’s not the best way for *some* people. Why be so dogmatic?
Incidentally, you certainly don’t have to go to uni to be a fully qualified lawyer. You can do a four year dip law. I think diverse entry pathways are good things.
The main driver for pushing nursing training into the universities was professionalisation. Nurses were sick of being regarded as non-pros, unlike OTs and physios, who all had tertiary qualifications and their own professional association. That’s why the union supported the move — to improve the status of nurses by making nursing a tertiary-qualified profession.
It didn’t work, though. Nurses are still regarded by doctors and relatives as hospital handmaidens (although there has been an influx of male nurses over the past couple of decades).
It’s quite true, as David says, that you don’t need a uni degree to do complex work or operate complex machinery. Last time I checked, you didn’t need a degree to fly a F-111 fighter-bomber.
Quite right, Rob. And by some bloggers too, apparently.
Well, there’s a singularly inapt analogy. As far as I know, an F-111 fighter-bomber, when its in operational use, isn’t hooked up to a human body – unlike your typical machine that goes ping. It has human designed and engineered control systems that are intended to make the pilot’s task easier – not an unreliable and sometimes unpredictable individual physiology that might respond to incompetent care by dying.
BTW, why choose expensive military hardware as the acme of complicated technology?
I think that the crux of the debate which Howard has started, without actually having the courage to openly state (because he’d be crucified and would offend most of the Australian population) is:
Women’s work and worth is not valued in this society, that is the central truth, before you even wonder about uni vs hospital qualifications.
All professions and industries that are female dominated, are grossly underpaid.
I remember (in my uni course, you wouldn’t get taught it in the hospital system, oh no)) my lecturer telling us about the early days of the uni/hospital debate. The doctors and men who administer and control the health services, thought that nurses only performed the role of mothers. They believed that you don’t need higher education (and obviously decent pay) for performing the work of a mother (and mother’s don’t get paid do they, they do it for love!).
The doctor’s union would be absolutely silent on this I’d say, maybe the Doctor’s reform Society would be more supportive, I don’t know. A lot of doctor’s just want nurses to be their handmaidens and resent any autonomy of our profession. They want their own personal little slave who runs to do their every bidding with a a smile and a bow (who wouldn’t!).
Now, it is my belief that many people still think like that today, even mother’s work is undervalued, though men like to get all misty eyed when they talk of their mothers. Well, women don’t need the pedestal or the paternalism (despite the best efforts of some females), they need equality and validation of their worth in society.
All occupations which are female dominated are grossly underpaid compared to male dominated fields.
Nothing about what he wrote implied it was the “acme” of complicated technology, as opposed to merely an example of complicated technology.
Flying – especially of planes in combat – can be highly predictable. A plane can respond to incompetence by crashing. Once again, why assume that the university is the only place to learn the complex?
*correction: predictable = unpredictable LOL.
Everyone:
Larvatus Prodeo is a forum of ideas …. so here is my own suggestion for improving all the health care professions:
{i]. Have everyone seeking to become a health professional of any kind – paramedic, occupational therapist, nurse, orderly, surgeon, whatever – complete a full year of formal study and practical real-world work experience in the same standard elementary course. Learning and experience that includes basic duties and skills such as feeding patients *, dressing wounds, laying out the dead, assisting with mobility, changing shitty beds, dealing with confusion, conducting an initial examination of a patient * [systems review] and so forth.
[ii] Once they have gained that formal elementary experience then encourage them to go on to learn more in whatever field they prefer and for which they have a talent. The needs of each part of health care are different so the amount of time and resources allocated would be different. For an orderly, such further training would consist of several short courses to attain a specific set of skills; for a physiotherapist, three years of a bachelor-level course; for a neurosurgeon that would probably involve another nine or ten years of comprehensive study and supervised experience …. whatever. However, each health professional would have that same foundation training to help them understand patients’ * basic needs.
[iii]. A few of the advantages: a..Those who have no talent or liking for health care would be weeded out at an early stage, before they could do any serious damage and yet with sufficient training to make them quite useful to the broader community. b..That first year of generalized health care training would allow astute senior staff to spot real talent among the students, to encourage that talent and to advance it. c..That proportion of very intelligent high-school graduates bereft of any aptitude for health care and incapable of being anything more that mere bio-mechanics would be discouraged from becoming health professionals and so would direct themselves to professions or occupations where their traits/deficits are an advantage.
Utopian? Not really. Attainable? My oath! Leading to major cost-cutting, improved efficiency, happier staff and greater patient * satisfaction? You bet! [Now, have I missed out on offending anybody with my suggestion?
]
The whole point is that Howard’s proposal to fund positions for hospital rather than TAFE based training for ENs in no way addresses the nursing shortfall or the reasons for it.
What it does reflect and reinforce is the not uncommon view held even by eminent, well-meaning female Professors of Nursing and senior public health administrators, many of whom are former (non-university trained) RNs, that even prospective ENs (let alone university trained RNs or their equivalent) have unreal work expectations.
It is a belief based on the defeatist notion that the hospital system cannot and will not ever afford to provide the pay and conditions that people have come to expect should fall due to the crucial, difficult, demanding work which nursing, at all skill levels, entails.
The nurses’ unions and professional organisations are right to reject this preposterous and obnoxious proposal. As Deborah rightly explains, it represents just another brick in the wall effecting (and accepting) the super-exploitation of predominantly female labor.
It’s one small measure to reduce the shortage. A small-moderate increase in nurse wages would have an even smaller effect, I’d think. A massive increase might produce some noticeable changes, but that would cost a huge amount. Where is the money coming from? Tax increases?
As I suspected, it’s the testosterone thing.
Now, here’s a question – how many F-111 pilots are there in Australia whose lives depend on their ability to handle a plane in the highly predictable – oops, unpredictable – conditions of combat? Now how many patients are there in hospitals around the country whose health and welfare depend on the competence of nurses?
And while I’m by no means rusted on to the idea that university is the only place where complicated skills can be learnt, I don’t think anything is gained in this discussion by -
- dismissing university nursing training as “Bedpans 101″;
- reducing the job to a mere matter of learning how the machine that goes ping works, and then comparing it with bigger more expensive machines that go whoosh, occasionally ack-ack-ack and on really special occasions get to drop the machine that goes ka-boom.
Kev’s Mum retrained as a nurse after his dad died in hospital, the family relied on a nurses wage, and her prospects for re-building her career.
I reckon he’ll have some deep opinion about nurses being used as a political football.
Got it in one. Non-regressive, actual tax from those who pay little to none, comparatively.
You’re not gonna start bleating about capital flight now are you, David?
Deborah
Ah, I think you will find that both men and women regard mothers as society’s most respected and admired people.
RF:
Much of the complexity in health care is artificial and unnecessary and horribly costly and of little-or-no benefit to the patients *. Some is caused by counter-productive administrative policies, regulations and practices. Others arise from completely preventable technical causes such as the lack of commonality in equipment and disposables by which some suppliers of “ethical” equipment [how's that for an oxymoron?] lock their
suckerscustomers into buying only their company’s products.As for the differences between university and non-university trained nurses: there are sometimes obvious difference and no good is served by anyone pretending that complaints about the diffences are merely vexatious or anectdotal. Find out what the complaints are about and then do something about them, that’s all.
Having worked with both university-trained and non-university-trained nurses before I retired, I can only say that much depends on the personal qualities of the individual. Where problems have arisen with university-trained staff, it has usually come right back to their initial selection [did they want to become nurses or did they just want a job-ticket degree?]and to the quality [or lack thereof] of their instruction and supervision.
Ah, I think you find that that’s not was actually said and that being a mother is not the end all and be all of women’s contributions to society. Why not try actually reading what people write before responding to them?
I’ve got nothing against the flip one-liner. I’ve certainly guilty of more than my fair share but for fucksakes mini-J, the whole point of the exercise is that it should be funny and/or relevant and/or genuinely provocative, not some toddler’s attempt to get the attention of grownups.
OK, now I’m up, what part of you needs changing first?
Robert Merkel:
This whole impractical and opinion-poll-driven election[?] stunt needs to get the boot. So too its nasty division of the public into those either completely FOR or completely AGAINST university training of nurses
Howard’s stunt was able to happen because although the putative alternative government, the Labor Party, readily scores political points against the Liberals on health care, it is otherwise quite happy with the present system, including nurse education and the appalling attrition rate of highly experienced nurses. Labor is quite happy to simply chuck a bit of money at any problems that cause headlines as a substitute for policy and reform.
Not only does the Labor Party lack the guts to even suggest any fundamental reforms in health care [perhaps they feel it might cost them a few votes, the poor darlings] but they are also contemptuous of anybody who criitcizes or complains about the manifest inadequacies and dangers in the current health system. Recent scandals showed that Labor was as bad as the Coalition when it came to long-overdue fundamental reform.
I had better stick up for poor old Florence Nightingale here. She saw nursing as a profession dedicated to the management of patient hygeine, diet and well-being in order to assist recovery. She saw the “traditional functions” of nursing as you describe them as necessary incidents towards that end. Her Notes on Nursing written in 1860, although a document of its time, makes it clear that “brow mopping”, except to the extent that it aided in the patient’s recovery, was not an important part of nursing. It is well worth reading. http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html
She strongly believed in the use of statistical methods to analyse the course of disease and to manage it for the improvement in patients’ recovery. I think that in the twenty-first century she would see a place for both the university educated nurse and the EN.
First she’d have to do a Lazarus.
Student nurses, in the hospital-training days, were seen as work fodder to do the dirty work in hospitals. The system assumed a high attrition rate ie there was only room for a certain number of trained nurses, it was students who did the basic nursing tasks. It was an extremely heirarchichal system and the work was extremely heirarchichalised too – the most junior nurses made all the beds, the next higher up took the blood pressures, the third years were allowed to give out drugs. The move towards university training wasn’t just a matter of more intellectual training for nurses, but a revision of how they approached the patient – there was a move to seeing patients in a wholistic way, rather than seeing a ward full of beds which had to be made.
A return to hospital-based training is really a ruse to get back to using student nurses as work fodder – ie people who’ll do the dirty work while not being paid as much.
As Deborah says, all of this is predicated on nurses being overwhelmingly female.
True Steve, as she’s been dead for nearly a hundred years. Still it says something of her that even in 1860 she held more advanced views on the purpose of nursing than some commenters here have shown.
It’s a pity that they don’t take the time to inform themselves about a person who made a pretty remarkable and beneficial contribution to the way our society operates today but who are happy to go along with uninformed stereotypes.
Suz[at 10:24am]:
You said it!
However, the transition to university-based training was thoroughly bungled [mainly due to the greed and the lack of forethought by university administrators] and we are now really paying the price for allowing that bungle to happen.
Instead of waiting for politicians, spin-doctors and “health” fund CEOs to come up with one ratbag or momey-grubbing scheme after another [especially just prior to elections], why don’t we all take a good hard look at what we really do need in our own health care system …. then go around the world cherry-picking the most appropriate bits for Australians out of each country’s health care system.
Maybe it’s polyclinics in Singapore; maybe it’s disabled care in Hungary; maybe it’s hospital management in the Philippines; maybe it’s A&E in South Africa; maybe it’s the ambulance system in Russia; maybe it’s optometry in China – who knows? But whatever we do, we must break out of that narrow vision of health care imposed on us by the Florence Nightingale mob and by the Australian arm of the old British Medical Association and we must also break away from all that slavish adherence to the failing American one …. and that will mean swallowing our pride then trying to learn from people which Australia’s failed elite usually assumes are our “inferiors”.
GregM:
Florence Nightingale certainly did make a great contribution to some aspects of health care in the former British Empire and her ideas certainly did have influence throughout the world in her time and for many years afterwards …. but just because there is a relative paucity of historical material in English about French and German nurses prior to Flo’s time, they tend to be overlooked.
David [at 6;27pm last night];
Wages? Taxes? How about, just for a change, SAFE staffing levels, rosters that don’t break up marriages/relationships, predictable hours [great for doing part-time courses to advance onself], professional respect, autonomous decision making, meal breaks that actually do happen, being firm with pharmaceutical and ethical supplies corporations, SAFE staffing levels, TWO professionals on every ambulance and in every community nursing vehicle, SAFE staffing levels, cracking down on Rort Central [the exclusivemedical specialist colleges/societies], post-discharge follow-up for all patients, time to sleep and recover after night-shift, an emphasis on realistic health education, SAFE staffing levels?
Once those things are given attention, the money will roll in …. and you won’t have to worry much about wages and taxes – or staff retention.
The Federal Parliamentary Library has issued a report on Practice nursing in Australia.
Graham, I know it’s attractive and much more manageable mentally to concentrate on one thing at a time and try and fix it (and your solution-focussed brainstorming is laudable) but there can be no fixing of the situation for nurses while ignoring the state and mindset of so many hospital patients and their friends and relatives.
Bullet-proof glass in emergency departments in city hospitals is now an OH&S requirement. Surgeons, radiologists, radiographers, nurses, night duty staff all face an increasingly violent, demanding, litigious citzenry demanding non-problematic, successful medical treatment. And why do you think that is? And what can be done about it?
Not by her though, Graham. If you read her writings you’ll see her acknowledging the contributions of German and French and Italian nursing and recommending the adoption of their practices. She is a victim of her PR, not of her making, in Victorian England where she was sentimentalised as “the Lady with the Lamp” while her real agenda was to bring scientific method to nursing in England and to drag it out of the medieval state it was in.
She gets much disservice done to her by those who know about the Victorian sentimentality and therefore in these times see her as a candidate for cheap shots rather than making the effort to find out what she was on about. If they weren’t too lazy to make the effort they’d be surprised at just how much she said and did one hundred and fifty years ago is relevant today.
But then, as I often find here, the easy path of cheap shots born of sublime ignorance is the easy and fashionable one. Doing the hard yards of finding out about people like Florence Nightingale is not so much in evidence, to put it kindly.
Please try to stick to the argument. The fact that flying an F111 is complex has nothing to do with testosterone or the number of people whose lives depend on their services.
Can you try to make it clear what commenter you are talking about, because it certainly wasn’t me who said that. I don’t think that kind of contemptuous reduction is helpful. But perhaps you should follow your own advice before you parade your own ignorance by reducing piloting to:
I agree we should look at ways to improve rosters, etc. However, I can’t see how this would make money roll in. But either way, this is irrelevant to whether Howard’s measure will also mitigate the problem (albeit only slightly). I think we need to look at lots of measures.
GregM:
Indeed. You are right about her image [including a few unpleasant traits] being morphed by sentimentality …. and it was also morphed by the socio-political needs of the time. Some people do imagine that Florence Nightingale invented nursing – which was certainly not the case.
David:
Whopping great big savings. When huge amounts of money are not being dumped down so many plug-holes, they will be available for effective health care. Howard’s stunt [for it is nothing but an ad-hoc stunt] will only exacerbate the current problems and make it harder for those seeking workable reforms.
Jinmaro:
Didn’t ignore them. It was the brevity of a blog post that compelled me to omit mention of relatives’ [and patients'] attitudes and expectations, headhunting of staff by the corporate world, the influence of TV, litigation and several other important aspects and issues. Violence? Sorry but there are some staff who do bring it on themselves by neglecting to look at the situation from the patients’ perspective, especially if patients are in pain. Much violence is also caused by bad administration, bad policies and by bad architecture. I had a lot of violent, noisy or confused – even murderous – patients over the years and managed to get all of them calmed enough to be assessed and treated; since I didn’t have any magical powers at all there must be something people like me did right …. and just maybe it was in using a set of easily-learned skills and attitudes that did not wind-up the patient or put myself at risk.
Doubt it. These things always have the habit of costing more money than they save.
David:
Not if you have someone committed to efficiency through frugality and with a firm grip on the purse-strings,; someone with a hands-on understanding of all parts of the health care system..
That would make such a nice change after all the squanderng of health budgets by the slash-and-burn cost-cutters and by the money shovellers.
If any of you are interested in what nurses think, this ACIRRT report (commissioned by NSW Nurses Assoc. -pdf doc 65 pgs.) entitled “Stop telling Us To Cope: NSW nurses explain why they are leaving the profession” tells it all, in their own words.
In my own experience, it’s not “you’ll just have to cope” it’s “you’ll just have to stretch yourselves”.
Just a couple of excerpts to whet your appetites! I’ve finished my night duty and am enjoying some wine and some dvd’s to get me through a long, sleepless night (quick turnaround to get back to the land of daylight).
Stop Telling Us To Cope:
“Student enrolled nurses who basically go to TAFE for a year – when they finish and come to the workforce they’re part of your workforce and you’re responsible. They are unskilled but you’re responsible so with your delegated work load and highly acute patients you have to take care of the ENs as well.”
Current Nurse, Westmead. Female, Surgical Nurse in Western Sydney.
“There was an agency nurse that went to a hospital and put a medication through an IV. It was an oral medication, opaque, everything and he put it through a line. And apparently, they were short staffed, he was an agency nurse and supposedly didn’t know what he was doing and killed a patient. But you finish a shift at 11.00, you don’t get home till 12.00, they expect you up at 5.00 or 6.00 to be at work by 7.00 and you’re not supposed to make mistakes? It’s just ludicrous.”
Ex Nurse, Camperdown.Female, General, 2 years in nursing. Two young children. Left nursing when husband transferred overseas. Currently works as an administrative assistant in the medical field.
“Quality care? In the last years there is no quality. We do clinical stuff we need to do but there is no quality. We had a woman last week who was incontinent of faeces and her daughter told us but it took us 20 minutes to get there because we had all these post-op people and obs and spewing and bleeding and god knows what. 20 minutes she had to wait before we could get her out of her own faeces!”
Current Nurse. Male, Orthopaedics Nurse.]
“Those that come [into Accident and Emergency] because they’re not going to pay the doctor [General Practitioner] they’re the ones that are abusing you because they’ve got to wait for 4 or 5 or 8 hours. In the 80s people actually respected us as nurses. Now they walk in the door and say ‘well how fucking long do I have to wait?’ That’s how you get greeted.”
Current Nurse. Male, Orthopaedics Nurse.
Sorry for lengthy post, phew, I really needed to get this stuff off my chest (consider yourselves my therapists for tonight!)
Over and out now.
Well Graham, call me a paranoid cynic (even if life *does* suck and people *are* out to get me) but I am not the only one to observe that male workers in the hospital system are much less likely to be verbally or physically attacked or complained about than women workers. And if you are Asian or dark-skinned as well as a woman then the likelihood is even higher. Oh and yes, the lower down the food chain, the likelihood of attack or formal complaint increases too: sweet-as-pie to the nice manly white doctor and bared teeth, flailing arms and foul-mouthed complaint to the Indian radiographer, mature-aged Lebanese EN or newly graduated whitebread RN – again, usually women.
Ethnic abuse goes both ways. Muslim families are sometimes openly contemptuous of and abusive towards nurses, on the grounds that working women are whores and prostitutes. Nurses who speak Arabic have described situations where they’re at the bedside tending a patient and the surrounding family are abusing the nurse in Arabic, unaware she understands everything.
Also, Indian and Chinese doctors often see work relationships in strict hierarchical terms, where nurses are at the bottom. That was a factor in the Jayant Patel case. Patel mocked and scorned the nurses who complained about him, and the hospital administration followed his lead.
Emma, you said
That is one of the reasons I proposed, some time ago, a COMPULSORY!! MANDATORY!! YOU-DON’T-GET-A-PRACTICING-LICENCE OR ENTRY-TO-STUDY UNTIL-YOU-DO fortnight-long intensive Australian Cultural and Social Awareness course!! I got really fed up with arrogant, ignorant and sometimes downright incompetent twits treating me [an experienced R.N.] like a mongrel dog and yet crawling and grovelling to white Australian residents and registrars!!; their attitude to ordinary patients was often much worse. Recent scandals have shown that the ones who decide who does and who does not get to work in the Australian health system are the ones far removed from the harmful effects of their flawed decisions; this is one of the reasons health administators too should be made to do the year-long compulsory basic health care course I suggested above]..
Jinmaro:
]. Another time, in a major city hospital, I overheard lurid, grossly offensive descriptions of my hard-working, highly-qualified colleages by a bunch of relatives. It was with some pleasure, a perfectly straight face and a dignified voice that I asked them to kindly stand back so that I could close the curtains and give the patient an injection – and that polite request was in the superior register of their own language 
L-O-L. [Somebody should compile an anthology of funny nursing stories].
It all depends on the situation. For instance; if you are a male “F.W.C.” alone at night in an Aboriginal community that had recently had the benefit of hit-and-run upper-class white do-badders sharing their views of how Aborigines should conduct themselves towards white invaders and oppressors, then things can get really exciting. [fortunately, that particular night, the worst that happened was a lot of commotion - and the good thing is that the patients did get treated and they did recover .... and nobody landed a punch on me at all
I saw the nurses union electoral advertisement a few days ago where they are saying that under Workchoices they face having their penalty pay abolished. My immediate thought was that is terrible, but then the light went on – exactly, which state ALP government was thinking of abolishing penalty rates of pay for nurses? Because when you think about it, most nurses are employed by state hospitals and those who are employed within the private sector must have in recent years achieved pay parity due to the skills shortage. So, nothing more than an ALP fear campaign of the kind that has driven people away from union membership IMV. I reckon it will backfire but am definitely currently in a minority on that – especially as the Libz seem to be running their own fear campaign to turn electors off them as well.
My sister is a nurse educator and is currently training personal carers for work in the home for the aged and disabled. She talks about how difficult it is to teach something properly when there is often 6 months between theoretical knowledge and actually carrying the task out. She is obviously thinking about the skill level her students will have when they eventually get work.
As well, I’ve had a friend go through a lower level personal carer training program as run by an employment agency, and she described the lessons in learning to shower clients where they had to team up with a fellow student and have them undress and shower each other. It was a joke nothing like the actual experience of caring for a sick person in a home setting.
When you think about all of the tasks nurses need to perform it is easy to see the benefits of hospital based training and the wisdom of re-introducing these kind of programs.
Not if federal funding for hospitals is made conditional on nurses being pushed onto AWAs
Which, for example, federal university funding has been. So its not out of the question.
Robert Merkel and All:
This blatant poltical stunt will be the start of a series of outstanding commercial windfalls …. and the Howard government won’t even have to implement it at all. All they had to do was to put it up and watch the reaction.
What?
Nurse, patients and other individuals did react, of course. However, the universities and the professional bodies, hitherto the monopoly suppliers of certain professional qualifications and credentials, hardly uttered a squeak …. and nor are they likely to.
The Howard government got the signal it was waiting for.
The highway is now clear for private corporations to become the issuers of professional qualifications in competition with [or instead of] the universities and professional clubs. Do you fancy putting FRASFO behind your name? Fine. Just front up with the dough, fill in the tick-and-flick exam paper and – Shazam!! – you become an instant Fellow of the
RoyalRegional Australasian Society of Feral Onanists; you can hang out your shingle, hire a Senior Counsel to tell you how close to the wind you can sail with you advertising claims and then charge thesuckerspatients a fortune, all with the full blessing of the health insurance corporations and the government. Meanwhile, the government will have a green light to slash university funding even further [and perhaps even abolish it altogether].There will be the inevitable angry letters-to-the-editor, petitions with thousands of signatures and street demonstrations by university staff [good target practice for water-cannons] …. but all too late.
I know this is a little old but to add to the checklist.
Not knowing the difference between an EN and an RN – check.