Editorial
Towards Sustainable Nursing
Anne M McMurray
Emeritus Professor, School of Nursing and Midwifery, Griffith University, Gold Coast, QLD; Emeritus Professor, Faculty of Health Sciences, Murdoch University, Perth, WA
PP: 3
Article Text
As we sit on the cusp of two centuries, it is timely to reflect on the past and consider directions for nursing in the new millennium. Based on our accomplishments this century, how sustainable is our profession for the next? In ecological terms, we must ask to what extent we will have the carrying capacity; that is, the resources and capabilities, to respond to both other people's needs and our own.
Our politicians and policy makers espouse the goal of social justice; the greatest good for the largest number of people (Commonwealth Budget, 1999). So do we. Like them, we would like to see greater gains in indigenous health; equitable service provision to disadvantaged peoples, such as a the elderly and the isolated; appropriate clinical responses to lifestyle diseases, asthma, diabetes, dementia and mental illness; and effective risk management strategies such as breast feeding, immunisation, positive parenting, stress alleviation, occupational health and safety, environmental conservation and food security. Nurses have made significant contributions in all these areas.
As members of a profession that values thoughtful planning, we have tried to encourage public and professional perceptions of health that include the broader social and cultural circumstances of people's lives, as well as their physical status (McMurray, 1999). We have developed an expanding foundation of clinical research evidence from which to plan strategies for helping people meet and maintain their needs in illness and health. We have, under integrated models of service delivery, played an active role in shifting the rigid demarcations between hospital, community and residential care to a more person-oriented focus. We have replaced the paternalistic, top-down, consumer/provider approach with partnership arrangements, where the emphasis is on empowering others. All of the gains have been achieved in a rapidly changing clinical environment which has sometimes compromised the quality of our work-life (Mohr & Mahon, 1996). We have struggled with managerial control over our workplaces; increased patient acuity across all settings, the need for new knowledge and skills in the face of changing technologies; communication strategies for a sophisticated, knowledgeable public; shrinking educational resources; the 'greying' of nursing; and the turf wars that have often subjugated professional activities to those of other health professionals.
Despite these obstacles, we have been there for people; for example, as the most constant and instrumental means for maintaining the health of rural and remote living Australians (AHMAC, 1996). Our therapeutic and preventative actions have had an enormous impact on population health. And where has this left us as a profession?
In May, the 1999 Commonwealth budget for health and aged care identified government priorities for health in the upcoming year. The budget rhetoric revolves around ensuring access for all Australians to appropriate, quality care based on need. Predictably, health care is to be organised within a framework of outcomes and outputs for managing resources. The ten outcomes mandated the government are as follows:
- Population health and safety-to protect and promote health and minimise the incidence and severity of preventable mortality, illness, injury and disability. In 1990-2000 the major investments in population health are to be focused on reducing the adverse health impact of illicit and licit drug use, communicable diseases, and vaccine preventable e conditions in the community.
- Access through Medicare to cost-effective medical services, medicines and acute health care for all.
- Choice through private health insurance, encouraged through an incentive scheme.
- Quality health care emphasising integration and effectiveness of multidisciplinary, patient-centred care which incorporates consumer needs and views.
- Rural health care to improve health outcomes for Australians living in regional, rural and remote locations, to be supported by workforce training strategies in rural and remote areas.
- Hearing services that focus on reducing the incidence and consequences of hearing loss, particularly among the elderly.
- Aboriginal and Torres Strait Islander health improvements through primary health care infrastructure and services which use interdisciplinary approaches and strengthen partnerships between indigenous people, ATSIC and Commonwealth, State and Territory Governments.
- Enhanced Quality of Life for Older Australians through supporting positive and healthy ageing and high quality, cost-effective care for frail older people, people with disabilities and their carers.
- Health investment in knowledge, information training directed toward improving health outcomes by enhancing communication among health professional and community groups and providing better information to consumers.
- Portfolio leadership to ensure development and implementation of world class policy and practices in health and aged care.
The policy document goes on to outline specific initiatives that will ensure success in achieving these outcomes. It details improvement to the delivery of primary health care services, funded by an injection of $171 million, including funding for a 'new' model of team work, with GP's as the care coordinators; $40.8 million is allocated to 30 regional primary health care Health Service Centres for rural health promotion, GP services, services focused on illness and injury prevention, acute and palliative care, women's health, community nursing, aged care and mental health. It is interesting that this list contains the only mention of the word 'nursing' in the entire detailed budget document (Commonwealth of Australia, Health and Aged Care Portfolio, 1999).
Research is another area where nursing is notably absent. In response to the Commonwealth Health and Medical Research Review (1998), over the next five years there is to be a doubling of NH&MRC research funding. This includes $20 million for the new National Institute of Clinical Studies, to work with the medical profession to promote best clinical practice throughout the public and private health sectors. There is no mention of the role of nurses in primary health care. Nor is there any indication of the enormous progress members of the profession have made in paving the way for nurse practitioners to respond to the needs of our underserved population (Buckley & Hills Siegloff, 1998).
We often castigate ourselves for a lack of dialogue, a lack of unity. Perhaps we are too harsh on ourselves. It is one thing to have the right conversations with each other, but we have to ask whether anyone out there is really listening. Sustainability? As fully fledged, ecologically rationalised members of the 'new' interdisciplinary, collaborative, health care teams that will help sustain the health of our population? Or as life-long apprentices to those with a bit more political clout?
eContent Home
