Wednesday, September 30, 2009

NURSING "OUR FUTURE"

Recently, it was announced that the number of full-time Nurses had increased to 10,000 in Victoria, Australia over the last ten years. This increase in the numbers of Nurses in Victoria, who are actively employed in the profession, is indeed welcome news and a major accomplishment.

The announcement of the increase in the numbers of Nurses is not altogether surprising. Over the years, there has been a steady stream of advertising campaigns aimed at publicising via various “refresher packages”, re-entry scheme opportunities for Nurses who have left the profession. These packages have generally centred upon opportunities to update skills, whilst re-entering the workplace under various forms of “supervision”, facilitated over different periods of time. Many of these “refresher packages” have also reportedly, involved various initial financial “rewards”.

Arguably, the essence of Nursing “work” does not significantly alter over time, although there will always be changes in workplace policies and different procedures which reflect technological developments. Many, if not most Nurses continue to be employed in areas of clinical practice that involve adherence to rosters and “shift-work”. Shift-work often results in interrupted social relationships and challenges in maintaining and managing interpersonal relationships with partners, children, families and friends – all important factors in maintaining individual and community health and wellbeing. Many of these issues are also shared by other service professions, such as ambulance paramedics.

Factors such as the vagaries of shift-work, over-work, lack of appreciation and respect and access to appropriate professional development, have over the years driven many a “good Nurse” out of the work-place and out of the profession. Furthermore, Nurses in some instances may experience significant resistance in their attempts to pursue supported and subsidised professional development where it is perceived by administrators, to be “unrelated” to their “core duties” and not “Nursing work”.

However, Nurses do so much more than conduct clinical assessments and complete charts.

Nurses manage budgets, human resources and teams. Much of their work also has medico-legal elements. Nurses liaise with a multitude of community services and other health providers, in order to facilitate onward care of patients upon discharge and are the linchpin in often complex communications. Nurses work with families and relatives of patients to deliver holistic patient care and thereby, are also involved in counselling, community health promotion and education. Nurses also work with other health providers, including “allied health” (occupational therapists, social workers, psychologists) and medical practitioners and specialists, in “multi-disciplinary teams”.

Nurses are also often the front-line co-ordinators of health-care. Nurses have significant responsibilities in that they may be administering medications to patients, may be delivering highly technical and specialised clinical care and are also responsible for the ongoing monitoring of patients in these contexts. The very nature of their professional responsibilities mean that irrespective of whether Nurses are formally wearing the mantle of clinical coordinator, by virtue of their unique constellation of skills, expertise and regular contact with patients, they are often most strategically placed to do so and in any event, Nurses may actually be the professional discipline which is, in fact, co-ordinating care.

Nurses comprise the bulk of the healthcare workforce around the country. Mentoring programs can potentially be useful interventions for developing and supporting Nurses (and other professionals). Leadership and succession planning can potentially also be promulgated via sophisticated mentoring programs. However, systemic improvements within health-care require that there are tangible changes to different structures and the manner in which “core business” is undertaken.

In this context, there has been an increase in the numbers of Nurses in Victoria and what, if anything has changed for Nurses? More to the point, it would be interesting to hear the “first person narratives” of Nurses involved in these re-entry schemes, regarding what, in fact, attracted them back into active practice and what is different for them, “this time around”.


Next time you find yourself in a hospital / clinic, consider asking a few Nurses about the following:
At what stage in their career is your allocated Nurse (graduate program, recent graduate?
If the allocated Nurse is a recent graduate – how much exposure to and formalised “collaborative education” occurred with medical students during the university course – if any?
How many patients is your allocated Nurse caring for?
How many shifts is your allocated Nurse working per fortnight and what day is s/he up to?
What education and professional development is available to support your allocated Nurse? Does your allocated Nurse feel the professional development is adequate to meet their learning needs? Why, or why not?
When does your allocated Nurse attend professional development and training, during work and/or, after hours? If during work, does the Nurse feel rushed and/ or is backfill provided?
Does your allocated Nurse aspire to a further career in Nursing or, perhaps an apparently unrelated profession? If yes, how is this going to be facilitated?
Does your Nurse have access to independent mentoring programs outside of the workplace? If yes, is your allocated Nurse supported by the employer to attend independent mentoring? If yes, what form does this support for independent mentoring take?
Other issues to think about which may be more appropriate to put to Nurses that you may be acquainted with in your social sphere, include the following:
Does the Nurse intend to make Nursing, a long-term career? Why or, why not? '
If the Nurse has access to on-site mentoring at the place of work, is the nurse comfortable with this arrangement?
Does the Nurse feel respected in the workplace? Why or, why not?
Does the Nurse feel able to effectively influence key decision-makers within the workplace? Why or, why not?
Does the Nurse contribute ideas to quality improvement (innovate) in the workplace? Why or, why not? If yes, are the quality improvement ideas taken seriously by the Manager? What sort of feedback and acknowledgement does the Nurse receive after making quality improvement suggestions?
Does the Nurse feel valued and respected in the workplace as a professional? Why or, why not?
Social Sustainability, Health & Wellbeing...
Is the Nurse satisfied with their quality of life? Are the Nurses’ relationships impacted upon by shift-work? If yes, to what extent?
Is the Nurse able to access social groups of their preference during time off work? Why or, why not?
Has the Nurse been able to expand the social network to establish and maintain associations and friendships outside of the Nursing profession (and workplace) with other professionals, during time off work? Why or, why not?


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