The current world has become complicated in the face of the growing socio-economic problems that affect human beings from social, economic, to health affairs. With the unremitting challenges that are becoming more evident with all professional bodies, the global healthcare sector is not exempted from this confusion (Richardson, 1990). Health care departments across the globe are perhaps the most important professional fields that human beings cannot do without during their lifetime. In recent decades, the global healthcare sector has been experiencing a major nursing shortage that is growing at a high pace and thus posing a problem to the citizens who face a continuum of healthcare challenges (Littlejohn et al., 2012). In addition, there is another significant challenge that concerns the inadequacy of healthcare professionals that is occurring simultaneously in almost every country across the world. Coupled with diverse healthcare needs, the constant shortage of nurses is creating global reservations. Central to this matter, this paper seeks to analyze the problem of the growing scarcity of nurses within the Australian health care system while reflecting on health economic theory and practice.
Overview of the Australian Health Care System
In a bid to enhance the understanding of the contextual problem in the Australian health care system, one must first understand the backdrop to contemporary healthcare issues surrounding the Australian health care system itself. At the beginning of the 20th century, the National Health System (NHS) of Australia gradually evolved to become one of the largest health care systems across the world (Douglas et al., 2009). This globally renowned health care system came into subsistence after the aftermath of the Second World War and grew exponentially throughout the decades to become among the largest health care systems across the world. The Australian health care system, like many others, has been serving under the principles of universality with characteristics of free point of health care delivery, equity, and only funded by the central government (Duckett & Jackson, 2000). From its historical view, with its financial instabilities, the central government of Australia has been responsible for funding health care as well as developing and enacting regulations and policies governing the entire health care system.
Describing nursing shortage problem in Australian health care system
The nursing shortage has become a global problem in the contemporary world especially in industrialized countries and it is currently affecting both developed and developing economies across the world, with Australia not being exceptional as noted by Littlejohn et al., (2012). In essence, the problem has been more adverse in industrialized countries including Germany, the United Kingdom, the United States, and even Canada (Kingma, 2007). Notwithstanding their significance within the healthcare profession, (evidence reveals that Registered Nurses (RN) make the single largest working group in Australia and perhaps the most crucial within the healthcare sector) their shortage is threatening national healthcare delivery (Olshansky, 2011). Several studies have emerged in proof of this argument with considerable argument revealing a substantial nursing shortage in Australia. In fact, according to research was undertaken by Queensland Nursing Union (2012), in Queensland alone, there is a shortage of approximately 4000 Enrolled Nurses (ENs) and Registered Nurses (RNs) and it requires over 14,000 nurses by the year 2014.
Since the problem of shortage of the nursing workforce started intensifying, research in the health care department across Australia has shifted to this important matter with numerous future statistical estimations projecting from different studies. As per the estimations made earlier by researchers, in entire Australia, there is a lack of approximately 17,000 to 40,000 nurses with evidence revealing that over 80 percent of people interviewed by Queensland Nursing Union stated inadequacy of health care staff as a major challenge (Queensland Nursing Union, 2012). However, these projections have been differing from a continuum of strategies with estimations almost revealing the possibility of a similar situation in the future health care panorama. In another study undertaken by Twigg et al. (2010), the projections in this study reveal that there is a considerably high possibility that by the end of 2013, the nursing shortage would rise to approximately 61,000 in Australia. Despite varying estimations, the issue remains that there is a high shortage of the nursing workforce in Australia.
Major factors contributing to the nursing shortage
While trying to examine the nationwide nursing shortage that is impeding proper delivery of health care services, one must understand that numerous underlying factors are contributing to the ongoing mayhem (Hall, 1999). In what research has identified as nursing workforce migration, Australia is among the most affected countries across the globe, with working conditions, prevailing health care working policies, and other factors being central to the existing problem. One of the major causal factors of shortage of the nursing workforce is that the nursing profession is receiving little attention right from the tertiary institution level, with very few students enrolling for this profession within institutions (Mallik, Hall, & Howard, 2008). Just like its counterparts in the United States, the United Kingdom, Canada, and even Germany, the nursing profession is gradually losing its initial value in Australia with incumbent nurses citing workload, poor working conditions, and meager pay as common reasons scaring the young generation from joining the nursing profession.
Coupled with the diverse healthcare challenges that nurses are constantly encountering, another significant reason for the nursing workforce shortage is resignation, and reasons behind this trend might stream directly from the educational system. Mallik, Hall, and Howard (2008) posit, “nursing programs are designed to allow knowledge and practice experience to be accumulated and assimilated by the nursing student within the 3 or 4 year course period” (p.7). For long, nursing education provided by different institutions is more theoretical than practical, which troubles young nurses during the pre-registration period where nurses find the requirements of practice more advanced and needed than the theoretically learned stuff from institutions. However, during the education process, very little of the practical nursing exists within institutions, and given that professional learning is diverse and that learning process is assorted, little provided in these institutions may remain incompetent in the professional field. When met with the challenges in the nursing practice, newly graduated nurses feel scared of the challenges and quit the profession.
In recent decades, the Australian Nursing Federation has awakened to the realities concerning nursing shortage, and among the identified ones aging of the nursing workforce is a considerable factor (Stoelwinder, 2002). According to investigations carried by Queensland Nurses Union (2012), “based on a predicted retirement age of 65 years, over the next 20 years, Australia will lose 60 percent of the existing employed registered nurses and enrolled nurse labor force through retirement” (p.2). Coupled with a relatively low number of recruits in the Registered Nurses program compared to the numerous of them retiring annually, the nursing workforce may continue to face this shortage for quite a long (Minnick, 2005). The recruitment shortage of the nursing workforce (in nursing it is referred to as Enrolled Nurse (ENs)) goes simultaneously with the growing number of retirees within the nursing profession whose gap remains uncovered under such circumstances. Most worrying, the number of patients with chronic ailments is growing, while nurses enrolling in the profession are reducing and the registered nurses are retiring.
Retirement Nursing Policy in Australia
Several Australian health care policies might have greatly attributed to the underway nursing workforce scarcity with changes in regulations and policies constantly changing in the name of health care reforms across the nation (Scott, 2009). A continuum of studies across the health care paradigm has emerged strongly to condemn the Australian health care system that has been consistent in establishing and enacting policies that later ruin the system itself (Thorne, 2006). Unfortunately, notwithstanding its long survival and global repute for providing renowned health care professionals for several decades, changes in the Australian nursing education policy have attracted debates since it embarked on its reforms. Without struggling to understand factors attributing to the nursing workforce deficiency, the nursing education policies or simply one policy is attributed to such menaces. As aforementioned in the report documented by Mallik, Hall, and Howard (2008), nurses acquire knowledge and practical experience through their institutions in three to four year-course periods, with much of it being theoretical.
In Australia, there exist two categories of nurses as aforementioned earlier, viz. the Enrolled Nurse (EN) and Registered Nurse (RN). As the Australian Nursing Federation struggles with the three and four-year course requirement, a great contradiction arises given the retirement policies that are currently operational (Voit & Carson, 2011). The aging nursing workforce in Australia, which is based in the old educational system, seems more competent as compared to the modern nurses and the increasing number of retirees hence creating nervousness (Thorne, 2006). Coupled with the declining interest among students in undertaking the nursing profession within Australia and the aging workforce, the three to four-year institutional-based nursing education is not competent enough to cover the increasing nursing workforce demand. According to Sayers et al. (2009), the National Health and Hospitals Reform Commission (NHHRC) of 2009 is adamant on its policies including addressing inequalities, patient care safety, and quality in health care access while undermining the impact of poor nursing educational policies to the health care.
While trying to comprehend how the nursing education system in Australia seems insufficiently equipped to meet the mounting health care needs and the increasing workforce demand, one should connect the current nursing educational policies to several other contrasting policies (Scott, 2009). Given the complexities and requirements that determine the competence of nurses with stringent measures that link RN’s responsibilities to patient outcomes, with mortality and morbidity being critical matters, this form of nursing education remains questionable (Twigg et al., 2010). Currently, “all registered nurses in Australia practice by competency standards developed by the Australian Nursing and Midwifery Council of 2005” (Sayers et al., 2009, p.46). Enrolled Nurses and pre-registered nurses on the other hand perform under the nurse educators who are merely registered nurses and whose competence is currently questionable. Given that nurses must remain clinically competent, their knowledge and skills are still insufficient to impart the same to the freshly enrolled nurses.
Health care system reform
Given the pounding challenges that have become eminent with the public health care sectors especially those regarding funding, resource allocation, and even other integral support, there is a need to impose changes to the health care delivery (Woolhandler & Himmelstein, 2008). Since its beginning, the Australian public health care sector has relied extensively on government taxation to provide its services to the public. Grosios et al. (2010), in their analysis of the United Kingdom health care system, noted that numerous claims have risen on the extent to which the public is argumentative about the heavy taxation meant to enhance funding of the public health care system by the central government (Schansberg, 2001). Just like their counterparts in the UK, the Australian government spends greatly on public health delivery. In the United Kingdom, Grosios et al. (2010) assert that consuming a national budget of over £90 billion annually to support the continued delivery of services through public health care, almost all the amount raised through taxation is becoming a public concern amongst some individuals.
With the diversity of challenges facing the public healthcare system not only within the Australian health care system but also across the entire world, much has protracted on the effectiveness and competence of public health care systems in service delivery (Keenan, 2003). One of the possible challenges marring appropriate service delivery is health care funding, which has been a challenge for developed countries given the vulnerable, needy, and aging population that makes the highest patient populace (Schansberg, 2011). Currently, the Australian public health care system is gradually becoming incompetent and the government feels challenged to provide health care that meets international standards (Robinson, 2004). As noted by Herring and Pauly (2006), it has come to the knowledge of policymakers within the Australian government that imposing high taxes on civilians and even seeking international funding may not appropriately curb the rising incompetence of the Australian public health care given a continuum of challenges that keep on varying from time to time.
Using private competitive market in delivering health care
Suppose the government continues to struggle to fund Australian health care and the challenges that are currently persistent remain dexterous, probably the health care will finally crumple fully (Albreht, 2009). Currently, several studies are recommending privatization of the health care system and it has become a hotly contested matter within the global health care paradigm (Albreht, 2009). It should be agreeable whether the Australian health care system deserves to undergo privatization, failure to which controversies will ensue. The Canadian health care system, which is currently among the most successful health care systems in the contemporary world, has been successful only through privatizing the public health care system of Canada (ANJ, 2002). The Australian government must ensure the safety of its civilians from social security to healthcare affairs and while trying to justify the privatization of the health care system, and as noted by Coffman et al. (2002), the privatization aspect must be viewed from both the positive economic perspective and normative perspective as well.
Privatizing the Australian health care system from a positive perspective
For those who understand the challenges that the government undergoes to raise funds to support the Australian health care system, opting for privatization may be the best priority for the national health care system (Buerhaus & Staiger, 1999). Since funding of the public health care system is becoming a constant challenge, privatization of the Australian health care system may deem significant since the private sector normally proves financially stable as compared to the public sector (Wilcox, 2001). The health care department, just like other integral departments within nations, deserves a strong financial base to support its services, but this issue has become a confrontation with the Australian government (Eckermann & Willan, 2008). Privatization of the Australian health care department may remain imperative in several reasonable ways. When public health care undergoes privatization, efficiency in the provision of services may significantly improve since the private sector has been the most competitive segment across the world with proven evidence of effectiveness in service provision. Privatization will attract competition that further reinforces the system.
With the pounding nursing workforce shortage that the government has unlikely been capable to manage, privatization may attract significant enrolment of nurses and other health care professionals into the system (Coffman et al., 2002). This aspect will emerge based on several factors including improved facilitation of health care organization, enhanced funding of the systems, as well as integrated infrastructure that will be achievable given the strong financial base that the private sector possesses (Palmer, 2000). Globally, the private sector has been the most intensifying segment with evidence portraying that its financial potency assists its maneuver. The private sector normally intensifies competition for both services and products and this element might attract a workforce. Currently, the workforce in any department across the world seems more attracted by good pay and motivational factors within the workplace, and the private sector is currently using this strategy (Duckett & Jackson, 2000). When the government considers privatization, like its counterparts in Canada, the quality of service may improve, though depending on the class and wealth.
Using private competitive market from a normative perspective
As plans might be underway to privatize the Australian health care system, mixtures of responses are protracting and accumulating from the public about this idea. Albreht (2009) notes, “Driven by the political agenda, privatization as a general process in the society is often offered as a panacea for all sorts of problems, where health care is seen as one of the potential areas of implementation” (p.447). This statement may remain unpractical to the pros of privatization, but from the normative perspective, it carries great meaning and sense. While trying to privatize the health care sector, the Australian government may need to consider several factors that may potentially prove significant in the consideration within health care (Parrish & Pickersgill, 2005). Healthcare is an integral issue within Australia and by privatizing this sector, the vulnerable group, which in most cases is in dire need of healthcare, may suffer from unequal access to healthcare. Given the fact that currently, people possess health insurance provided by the government to enhance equitable healthcare, it may not apply in the private health sector.
Despite the government’s efforts to ensure that the Australian population remains insured through the health care insurance program, very few individuals currently can afford to pay and manage their insurances (Devers, Brewster & Casalino, 2003). When privatized, the government’s ability to oversee and examine service provision, activities of the private sector, and even implementing policies governing crucial health care matters may remain limited (Ginsburg, 2005). The government’s mandate and ability to examine and scrutinize aspects of insurance or facilities within health care may remain undermined while operating under the private sector. Given the fact that no laws are governing and controlling competition in the private health care sector relative to respect to the quality of life and quality of healthcare, privatization of the health care sector may intensify unnecessary competition that may hamper the quality of service provision (Douglas et al., 2009). Probably, the private sector may intensify its competence with intentions of making a profit rather than providing quality services that this may subsequently result in poor quality of healthcare services.
Conventionally, there has been an augmenting shortage of health care workforce almost in the entire world, though the greatest impact of this problem seems more precipitated within developing economies. Australia ranks among the developed nations and the national health care department of Australia is currently facing an acute nursing workforce shortage that is creating a looming danger to the entire nation. The Australian health care department receives funding from the central government and billions of dollars are channeled to health care, though the nursing shortage still prevails. In recent days, not only in Australia, very few learners are developing interest in the health care profession, and simultaneous to this trend, the health care department is facing high rates of retirements of the aging workforce. While privatization of the Australian health care department may deem imperative in terms of competitive service delivery and attract a considerable workforce due to its financial potency, equitable access to healthcare may be threatened as the private sector may become expensive only to suit the wealthy class.
Albreht, T. (2009). Privatisation processes in health care in Europe—a move in the right direction, a ‘trendy’ option, or a step back. European Journal of Public Health, 19(5), 448–451.
ANJ. (2002). Nurse Shortage Causes Chaos. Australian Nursing Journal, 10(3), 13-14.
Buerhaus, P., & Staiger, D. (1999). Trouble in the Nurse Labour Market? Recent Trends and Future Outlook. Health Affairs, 18(3), 215–22.
Coffman, J., Seago, A., Spetz, J. (2002). Minimum nurse-to-patient ratios in acute care hospitals in California. Health Affairs, 21(2), 53–64.
Devers, K., Brewster, L., & Casalino, P. (2003). Changes in Hospital Competitive Strategy: A New Medical Arms Race? Health Services Research, 38(1), 447-469.
Douglas, K., Rayner, F., Yen, L., Wells, R., Glasgow, N., & Humphreys, J. (2009). Australia’s primary health care workforce research informing policy. The Medical Journal of Australia, 192(2), 81-84.
Duckett, S., & Jackson T. (2000). The new health insurance rebate: An inefficient way of assisting public hospitals. The Medical Journal of Australia, 172(9):439-42.
Eckermann, S., & Willan, R. (2008). The option value of delay in health technology assessment. Medical Decision Making, 28, 300-305.
Ginsburg, P. (2005). Competition in Health Care: It’s Evolution over the Past Decade. Health Care, 24(6), 1512-1522.
Grosios, K., Gahan, P., & Burbidge, J. (2010). Overview of healthcare in the UK. EPMA Journal, 1(1), 529–534.
Hall, J. (1999). Incremental change in the Australian health care system. Health Affairs, 18(3), 95-110.
Herring, B., & Pauly, M. (2006). Incentive-Compatible Guaranteed-Renewable Health Insurance Premiums. Journal of Health Economics, 25(3), 395–417.
Keenan, P. (2003). The Nursing Workforce Shortage: Causes, Consequences, Proposed Solutions. Web.
Kingma, M. (2007). Nurses on the Move: A Global Overview. Health Services Research, 42(3), 1281-1298.
Littlejohn, L., Campbell, L., & Collins-McNeil, J. (2012). Nursing Shortage: A Comparative Analysis. International Journal of Nursing, 1(1), 22-27.
Mallik, M., Hall, C., & Howard, D. (2008). Nursing Knowledge and Practice: Foundations for Decision Making. New York, NY: Elsevier.
Minnick, A. (2005). Retirement, the Nursing Workforce, and the Year 2005. Nursing Outlook, 2000(48), 211-217.
Olshansky, E. (2011). Community/public health nursing: one way nursing can make a difference. Journal of Professional Nursing, 27(5), 265–266.
Palmer G. (2000). Government policymaking, private health insurance and hospital-efficiency issues. The Medical Journal of Australia, 172(9), 413-4.
Parrish, C., & Pickersgill, F. (2005). Home Office Considers Special Visa to Support Overseas Nurses. Nursing Standard, 19(46), 12-13.
Queensland Nurses Union. (2012). Urgent increases to nursing numbers across Australia. An additional 14,000 are required in Queensland alone by 2014. Web.
Richardson, J. (1990). Economic Assessment of Health Care: theory and practice. Web.
Robinson, J. (2004). Consolidation and the Transformation of Competition in Health Insurance. Health Affairs, 23(6), 11–24.
Sayers, J., DiGiacomo, M., & Davidson, M. (2009). The nurse educator role in the acute care setting in Australia: important but poorly described. Australian Journal of Advanced Nursing, 28(4), 44-52.
Schansberg, D. (2001).Fraternal Societies and Social Concern. Religion and Liberty, 11(1), 11–12.
Schansberg, D. (2011). Envisioning a Free Market in Health Care. Cato Journal, 31(1), 27-58.
Scott, I. (2009). Health care workforce crisis in Australia: too few or too disabled?” Medical Journal of Australia, 190(12), 689‑692.
Stoelwinder, J. (2002). The price of choice: Private health insurance in Australia. Australian Health Review, 25(6), 42-8.
Thorne, S. (2006). Nursing education: Key issues for the 21st century. Nurse Education Today, 26(8), 614‑621.
Twigg, D., Duffield, C., Thompson, P., Rapley, P. (2010). The Impact of Nurses on Patient Morbidity and Mortality – the Need for a Policy Change in Response to the Nursing Shortage. Australian Health Review, 4(3), 312 -316.
Voit, K., & Carson, B. (2011). Retaining older experienced nurses in the Northern Territory of Australia: a qualitative study exploring opportunities for post-retirement contributions. Rural and Remote Health, 12(1881), 1-10.
Wilcox, S. (2001).Promoting private health insurance in Australia. Health Affairs, 20(3), 152-61.
Woolhandler, S., & Himmelstein, D. (2007). Competition in a publicly funded healthcare system. British Medical Journal, 335(1), 1126-1129.