Expert warns of nurse shortage
THE World Health Organisation has named 2020 as the 'Year of the Nurse and Midwife', in recognition of the significant role of both professions in the health system.
In many countries, including Australia, nurses and midwives are the largest component of the health workforce, and an additional nine million nurses and midwives are required by 2030 to gain universal health coverage across the world.
In Australia, we have projections of an imminent and acute nursing shortfall due to an ageing workforce, population health trends and poor retention rates, will lead to a projected shortfall of approximately 123,000 nurses by 2030.
Regularly voted as the most trusted, ethical and honest professions, nurses and midwives are the backbone of the Australian health system.
In Australia, workforce demand does not always equal supply, with many communities operating under the 'inverse care law', where people who need the most receive the least.
This is particularly evident in rural and remote communities where there are high proportions of First Nations Australians.
Australia has better coverage of nurses across these areas, though not nurse practitioners who work at a higher level, and in many there are no midwives despite greater need and poorer outcomes for mothers and babies living in these areas.
While policy frameworks in Australian underline the right to equitable health care, in the words of Dr Margaret Chan, WHO Director-General, 2008 'Health systems will not naturally gravitate towards equity - unprecedented leadership is needed.'
Nurses and midwives need to provide this leadership.
To do this they need to be on the boards and executive teams of every health service helping to guide decisions on how the nursing and midwifery workforce is managed and resourced. Every jurisdiction should have a Chief Nurse and a Chief Midwife providing high level policy and strategic advice to government.
The Australian health system is slow to turn evidence into practice.
Research has shown the excellent, high value care provided when nurses and midwives are able to work to their full scope.
One example is when midwives work in continuity of carer models - evidence shows they provide better outcomes for mothers and babies at reduced cost.
One continuity service in Queensland, a partnership with two Aboriginal community-controlled services and a tertiary hospital, also resulted in a 50 per cent reduction in preterm birth for First Nations women.
As one of the few interventions that has been shown to reduce preterm birth internationally, this service should be rolled out across Australia immediately.
As First Nations mothers have double the rates of babies being born too soon, they should be the priority for these services that should be embedded in the Aboriginal community Controlled Health sector with midwives working side-by-side with family support workers. Research from the 2011 floods in Queensland also found that midwifery continuity protected mothers exposed to disaster related stress in pregnancy from anxiety and depression during the post-natal period, when compared to women receiving standard services Their babies also had improved neurodevelopment at 6-months of age. Disaster research has shown us the importance of addressing hardship as quickly as possible (e.g. shelter, financial support etc) and the health benefits that come from social support - nurses and midwives play an important role here.
Access to high value care would increase substantially if enablers such as Medicare rebates for care provided by Nurse Practitioners and Endorsed Midwives, and insurance for midwives to provide homebirth, were available.
This would deliver substantial savings to the health system and better use the skills and capabilities of nurses and midwives. Nurse Practitioners embedded in primary health care settings across Australia would help us focus on health promotion and continuity of holistic care for people with complex needs or chronic conditions.
They would be at the frontline of post disaster recovery efforts, ensuring that social support is provided on the ground and health needs are met. They would make 'Health in the Home' a reality for more people, strengthening our primary health care network, increasing quality of life and achieving better health outcomes at a lower cost.
As natural disasters continue to increase and the burden on the health system continues to grow, now is the time for policy makers to step up and fast track enablers for nurses and midwives to work to their full scope of practice, endorse the Medicare review recommendations and ensure quality health care is provided to all Australians, including our most vulnerable.
It is time to set targets to ensure every remote community has access to midwives and nurse practitioners, to take midwifery continuity services to every community, to take birth closer to home by establishing primary maternity services in multiple locations (birthing available but not caesarean) and to embed nurses and midwives in the highest possible leadership positions in health services.
Professor Sue Kildea is a researcher at Charles Darwin University