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Nurses in Australia: their role today and tomorrow

Elizabeth C Percival and Helen M Hamilton
Med J Aust 1996; 164 (9): 520-521.
Published online: 9 September 1999
Editorial

Nurses in Australia: their role today and tomorrow

The old stereotypes are long gone and the new nurse is developing swiftly

MJA 1996; 164: 520-521

May 12 is International Nurses' Day, in tribute to nurses and the role they play in delivering health care. In Australia, the nature of this role has changed significantly over the past three decades. The momentum for this change has come in response to forces from both within and without the profession: the women's movement of the 1970s dramatically altered expectations of work for this once almost totally female workforce;1 in the 1980s, tertiary education was introduced; and in the 1990s, nursing has not escaped the impact of deregulation of the labour market, multiskilling and the drive towards greater efficiency and productivity in the face of economic pressures.

Impact of tertiary education
Newly qualified nurses are now the product of a liberal education, quite different from the hospital-based education of the past. Indeed, all nurses have embraced the tertiary opportunities that the transfer of nurse education has provided. The demand for places to convert certificate or diploma qualifications to degrees remains strong in the 34 universities with faculties or schools of nursing in Australia.2 So, too, does the demand for places for graduate diplomas and higher degrees; about half the schools of nursing offer doctoral programs3 and the number of nurses who have gained doctorates is increasing. This has in turn led to the creation of more chairs of clinical nursing (18 as of March 1996, with more pending [Professor S McKinley, Secretary to the Australian Professors of Clinical Nursing Association, personal communication]).

As well as providing education, universities have promoted and stimulated research that is contributing to the developing knowledge base for nursing practice. This work, together with hospital-based research and that of newly established nursing research centres, is crucial to the evolution of the nurse's role and to the provision of evidence-based care unique to nursing. In fact, increased scientific knowledge and resulting new technologies and treatment methods are increasing the complexity of nursing practice. And in the constant interplay between education and research, education to maintain and develop new practical skills has become a critical necessity.

Other influences
Influences apart from those of education and research have led to further developments in the role of nurses. At times, blurred boundaries with the roles of other health workers have resulted, with accompanying dilemmas. For example, economic forces have led to the increasing employment of less skilled workers who have taken on some of the work of nurses, mostly outside the regulatory framework that governs nurses -- grave questions about accountability and duty of care need to be answered. For example, to whom and for what are personal care attendants, with no knowledge of drugs, accountable in administering prescribed medications without supervision? Indeed, the general decline in resources and the restructuring of service delivery systems will continue to impact on the role of nurses. Advancing technology is also associated with yet-to-be-resolved legal and ethical dilemmas in the role of nurses (as for all health practitioners) -- dilemmas, such as euthanasia and assisted suicide, that are no longer remote but immediate and omnipresent.

Expanding roles
The expansion of the nurse's role is challenging the existing statutory limitations on nursing practice. For example, nurses in intensive care units are at the cutting edge of technological innovation and often undertake activities once thought to be the sole province of medical practitioners.4 Nurses in remote areas have long been expected to act outside the boundaries of the nurse's role and have articulated the case for an expanded role (e.g., the right to prescribe some medications or to order pathological tests).5,6 Further, nurses in women's health services in most States and Territories find the absence of such rights (including also the right to refer clients to specialist services) prevents delivery of optimal patient care.7

A review of existing nursing roles with new and expanded boundaries is almost complete in New South Wales.8 The Nurse Practitioner Review, sponsored by the New South Wales Health Department, started in November 1993 and has included 10 pilot projects to evaluate three models of nursing roles with expanded responsibilities: Nurse Practitioner Remote Area, Nurse Practitioner General Practice and Nurse Practitioner Area and District Health. Within the context of each practice, extra responsibilities include ordering diagnostic procedures, prescribing and receiving or making referrals. The scope that the nurse practitioner role offers for advanced practice in nursing is a major attraction for nurses. And, given the developments in their preparation and the growth of nursing knowledge, it is a role that nurses are ready to fulfil.

Within the wider context of all health care professions, nurses wish to work collaboratively, as team members, and to be consulted about their views on people's health care needs. They wish to be acknowledged for the contribution they make to patient recovery and to maintaining people's health and for the care and support they give to the dying; nurses are arguably the health professionals most intimate with people's lives and they recognise their resulting position of privilege and trust. And, in the challenging climate of change continually impacting on so many aspects of the nursing role, at least one aspect will persist: nurses will continue to support the values of caring and comfort that have always underpinned their practice.

Elizabeth C Percival
Executive Director, Royal College of Nursing, Canberra, ACT

Helen M Hamilton
Project Officer, Royal College of Nursing, Canberra, ACT

  1. Beaumont M. The professional role of a national nursing organisation. In: Gray G, Pratt R, editors. Issues in Australian nursing 2. Melbourne: Churchill Livingstone, 1989; 247-261.
  2. Report of the national review of nurse education in the higher education sector: 1994 and beyond. Canberra: AGPS, 1994: 143.
  3. Royal College of Nursing, Australia. Directory of higher education nursing courses. Sydney: New Hobson Press, 1996.
  4. Bucknall T, Thomas S. Clinical decision making in critical care. Aust J Adv Nurs 1995; 13 (2): 10-17.
  5. Kreger A. Remote area nursing practice: a quest for education. Report to the Council of Remote Area Nurses Inc. CRANA, 1991: 57-60.
  6. Buckley P, Gray G. Across the spinifex: registered nurses working in rural and remote South Australia. Adelaide: School of Nursing, Flinders University, 1993: 143.
  7. New South Wales Health Department. Role and function of nurse practitioners in New South Wales. Discussion paper. Sydney: NSW Health, 1992: 7, 13-17. (NSW State Health Publication No. [NB] 93-120.)
  8. New South Wales Health Department. Nurse Practitioner Review Stage 2. Vol 2. Sydney: NSW Health, 1993. A1/1-A5/1-20. (NSW State Health Publication No. [NB] 93-120.)

©MJA 1999

© 1999 Medical Journal of Australia.

  • Elizabeth C Percival
  • Helen M Hamilton


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