Chapter 1 - Introduction
Terms of Reference
The Senate referred the matter to the Committee
on 5 April 2001 for inquiry and report by 25 October 2001. Due to the
Committee completing its inquiry into child migration and the intervention of
the federal election this reporting date could not be met. At the commencement
of the new Parliament, the Senate agreed to the readoption of the reference on
14 February 2002 with a reporting date of 27 June 2002.
The complete terms of reference for the inquiry
- The shortage
of nurses in Australia and the impact that this is having on the delivery of
health and aged care services; and
- Opportunities to improve current arrangements for the
education and training of nurses, encompassing enrolled, registered and postgraduate
That the Committee
specifically make recommendations on:
education and training to meet future labour force needs,
- the interface
between universities and the health system,
- strategies to
retain nurses in the workforce and to attract nurses back into the profession
including the aged care sector and regional areas,
- options to
make a nursing career more family friendly, and
- strategies to improve occupational health and safety.
In considering the broad range of issues
associated with nursing it was difficult to attribute many to only one of the
terms of reference. For example, the issue of nurse recruitment and retention,
while primarily a workforce issue, is affected by a number of factors including
the adequacy of educational preparation of nurses, models of nursing practice
and clinical leadership. The Committee was cognisant of the interrelatedness of
issues involved with the inquiry and their importance in drafting the report
Conduct of the Inquiry
The inquiry was advertised in The Weekend
Australian on 14 April 2001 and through the Internet. Invitations to
submit were also sent to Commonwealth and State governments and many
organisations and individuals within the nursing profession. The closing date
for submissions was originally 29 June 2001, although the Committee
continued to receive submissions throughout the course of the inquiry.
The inquiry attracted wide interest throughout
Australia with the Committee receiving 975 public submissions and 13
confidential submissions. Submissions came from every State and Territory with
many representing regional and remote areas of Australia and were broadly
representative of the entire nursing profession. Many organisations and
individuals also provided additional written information to develop the issues
raised in their submissions or oral evidence. The list of submissions and other
written material received by the Committee and for which publication was
authorised is at Appendix 1. Submissions that were received electronically may
be accessed through the Committee’s website at www.aph.gov.au/senate_ca
The Australian Nursing Federation circulated a
questionnaire based on the Committee’s terms of reference to its members in
some States for completion and submission to the Committee. 658 responses were
received by the Committee from individual nurses in response to this
questionnaire, with 624 accepted as public submissions. A summary is at
The Committee held a public hearing in Canberra
on 28 August 2001 before the federal election was called. Further public
hearings were held in Perth – 27 February 2002, Melbourne –
28 February, Hobart – 15 March, Canberra – 21 March, Sydney –
22 March, Brisbane – 26 March, and Adelaide – 27 March. A list of
witnesses who appeared at the public hearings is included in Appendix 2.
Having received over 1 000 submissions, the
Committee was again confronted with the difficulty of attempting to give as
many groups and individuals an opportunity to speak directly to the Committee.
The schedule for most hearing days was especially tight, and with many
witnesses being heard in a panel format a few received only a short time to put
their point of view. The Committee apologises to people who may have been
inconvenienced by these procedures or were unable to be accommodated within the
hearing schedule. The arrangements that are required to balance available time
with maximum opportunity for individual witnesses is an especially complicated
exercise in an inquiry that generates such interest.
The Committee places great value on submissions
it receives as primary sources of information. Many of the submissions made to
this inquiry, representing a wide range of organisations and individuals,
emphasised the same or similar arguments. In preparing this report, it has not
been possible to refer to all these submissions in footnotes. Thus, in many
instances, footnotes acknowledge submission/s which are representative only of
the point or argument being advanced. This in no way downgrades the importance
placed on the many other submissions that have reinforced the same or similar
point without being specifically identified.
The Committee found the range of titles and
variation of nomenclature used in nursing throughout Australia to be most
confusing. In this report the Committee has used titles and expressions as
described in the Glossary at the end of the report. The titles of some
Commonwealth and State departments have altered during the course of the
inquiry. The references in the report are to the title at the time a submission
was lodged or evidence presented.
The Committee considers that the range of titles
currently used in nursing across Australia, particularly to describe level of
nurse and qualification, need to be standardised to ensure uniformity and
Recommendation 1: That standard nomenclature be adopted throughout
Australia to describe level of nurse and their qualifications, and including
unregulated nursing and personal care assistants.
Previous inquiries and reviews into nursing
Nursing has been the subject of many reviews,
inquiries and research projects in recent years, canvassing all areas of
nursing, including recruitment and retention, workforce planning, education,
and aged care and other specialised fields of nursing practice. Issues relevant
to the Committee’s terms of reference were discussed, strategies to address
them identified and recommendations proposed.
Reference to this material was included in many
of the submissions received by the Committee, often with the submitters having
been involved in or having contributed to the work of an inquiry. Examples of
these reviews are referred to below with a more comprehensive list provided at
- Nursing Recruitment and Retention Taskforce, Final Report,
New South Wales Health Department 1996.
- Nursing Recruitment and Retention Ministerial Taskforce, Final
Report, Queensland Health, September 1999.
- Nurse Recruitment and Retention Committee, Final Report,
Department of Human Services Victoria, May 2001.
- New Vision, New Direction: Report of the West Australian Study
of Nursing and Midwifery, WA Department of Health, 2001.
- Rethinking Nursing, Report of the National Nursing Workforce
Forum, Department of Health and Aged Care, 2000.
- NSW Nursing Workforce – the Way Forward, NSW Department of
- Recruitment and Retention of Nurses in Residential Aged Care:
Final Report, commissioned study, Department of Health and Ageing, 2002.
- Scoping study of the Australian mental health nursing
workforce: Final report, M. Clinton, Department of Health and Aged Care,
- Rural and Remote Nursing Summit: Report, NSW Department of
- Nursing Education in Australian Universities: Report of the
National Review into Nurse Education in the Higher Education Sector – 1994 and
beyond, Canberra, 1994, Chair: Janice Reid.
- National Review of Specialist Nurse Education, L.Russell,
L.Gething, and P.Convery, Department of Employment, Education, Training and
Youth Affairs, 1997.
Implementation by the Commonwealth and States of
the strategies and recommendations from these reviews has varied across
The attitude of nurses to the degree of implementation was powerfully conveyed:
The nursing profession (and in this case – particularly the
ranks of rural nurses) is heartily sick of the number of inquiries which are
held but from which governments rarely implement any innovative recommendations
and strategies. There is a perception that inquiries are conducted, they are
shelved for a few years until the problems rise to the surface again, then a
further range of inquiries are conducted – but nothing substantial happens.
Shortly after the reference of this matter to
the Committee the Commonwealth established on 30 April 2001 a National
Review of Nursing Education. This Review is examining the effectiveness of
current arrangements for the education and training of nurses encompassing
enrolled, registered and specialist nurses; factors in the labour market that
affect the employment of nurses and the choice of nursing as an occupation; and
the key factors governing the demand for and supply of nursing education and
training. The Review has commissioned research projects on a range of nursing
issues, released a discussion paper in December 2001 and is due to complete its
final report by the end of July 2002.
The information available from these reviews,
inquiries and other research projects is simply voluminous. Strategies to
address issues have been identified and recommendations made. The Committee
believes that it is now time for concerted action.
The Committee expresses its appreciation to the
individuals and organisations who made submissions to the Committee or gave
evidence to the inquiry. As noted above, the Committee places great value on the
submissions it receives as primary sources of information. Many witnesses
provided additional written information and copies of articles or other
published material. This information was most helpful to the Committee during
its deliberations on the inquiry.
The Committee would also like to thank the staff
of the King Edward Memorial Hospital for Women in Perth, the Freemasons
Hospital in Melbourne and the Mater Misericordiae Hospital in Brisbane for
their assistance in enabling the Committee to hold public hearings at their
facilities. In particular, the Committee would like to thank Jim Swindon, Ro
Hogan and the group of nurse unit managers from the Freemasons Hospital with
whom it was able to meet and informally discuss nursing issues.
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