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Introduction
The brief from the senate asked the committee to examine the shortage of nurses, its impact on health and aged care services as well as the education of nurses. Perhaps this was a response to the 2001 report from the Australian Institute of Health and Welfare
This was a truly massive inquiry. There were 7 people on the committee and many more contributing. There were 988 submissions and 8 public hearings. The nursing profession had been complaining bitterly about the deteriorating nursing situation across the country and the impact on the care of patients and residents. They mobilised very effectively and dominated the submissions.
The senate was once again dominated by the labor party who had 4 members on the committee. There were 2 liberals and one Democrat.
The 272 page report covered all aspects of nursing and there was no doubt about the extent of the problems. Falling numbers of nurses, deskilling, the use of agency nurses and excessive paperwork. The rapidly increasing patient acuity and advances in technology were having an adverse impact on the care given. The far greater problems in aged care were well documented as were many of the reasons for them. The figure of 1 nurse to every 5 untrained nurse aids across nursing services in some states was used to highlight the problem.
The majority labor party report
This was lengthy and comprehensive. It reviewed every aspect of nursing in every sector of care and in every setting across the country describing the situation that existed and making recommendations in regard to the nursing profession structure, undergraduate and postgraduate education, pay, image, working conditions and much more. The freedom given by opposition allowed them to tell it like it was and say what was needed. It is interesting that despite the shortage of nurses the report strongly supported the nursing administration in their desire to expand nursing into additional areas, but I am not sure that they fully understood the educational implications needed to meet these additional responsibilities safely. The nurses got a good hearing.
The sections on aged care emphasized the greater extent of the problems in aged care and the adverse consequences of this for residents. Skeleton staffing, deskilling, the use of agency staff, the substitution of nurses with untrained staff, the consequent disproportionate number of untrained people doing nursing, the pay disparity compared with other nurses, the unsatisfactory unfriendly working conditions, the burden of the regulations and documentation resulting form the governments ever more draconian legislation, and the rapidly rising number of much sicker and older residents creating unmanageable workloads were all highlighted. Many recommendations were made.
The minority report
This did not attempt to challenge what was found. Instead they criticised the decision to hold the inquiry, its timing, and the terms of reference. They indicated that there had been multiple recent inquiries into the issues at state and federal level. They suggested that most of what had been considered were state and not federal responsibilities. They claimed that the government was already dealing with the issues.
Comment
What was revealed and what the labor members disclosed and supported with facts and figures are what advocates had been complaining about for years before and for years after this inquiry. The minority report made no attempt to dispute the evidence. I have not looked to see how much of this was implemented but nurse shortages, wage disparity, deskilling, untrained staff and poor working conditions have not changed. While I accept the importance and the need to address wages and the other disincentives I have argued that the culture of the workplace, the ethos of the home, the working environment and the ability to express the values which drew nurses into the profession through their work are as, or more, important. Unless this is addressed aged care nursing will remain uncompetitive as a profession and care will remain suboptimal. While this probably was implicit it got little specific attention in the report.
The contrasting public claims to high quality of care and adequate staffing made by the Prime Minister, his various aged care ministers and industry groups in the years before and after this are a sad reflection on our political system and the way marketing and misinformation are used to stifle democratic debate.
When the labor party gained power at the end of 2007 the roles were suddenly reversed. To nurses and advocates disbelief, it was the labor prime minister and his new aged care minister who took up this refrain. The highly effective and motivated shadow minister for aged care was not given the portfolio and her staff were moved or moved on voluntarily. Labor did not see the implementation of its own recommendations as having a high priority.
The Coalition Government's official response
This finally came 3 years later in 2005. It drew attention to a number of other inquiries which it had initiated and which had been made by state authorities. It described a number of changes it had made, particularly in nurse education. It pointed out that many of the issues were state responsibilities.
The full report can be found at
http://www.aph.gov.au/senate/committee/clac_ctte/completed_inquiries/2002-04/nursing/index.htm
Click Here to go back to the main report page
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