Nursing and midwifery workforce issues are matters for both Commonwealth and state governments. As the major employer of nurses and midwives, the states and territories are largely responsible for recruitment and retention. The Australian Government has a less direct but very important role, contributing funding for the delivery of health services and for university education of nursing and midwifery students.152
The Commonwealth’s function in planning and investing in the nursing and midwifery workforce of Australia has emerged relatively recently. Initially, the majority of funding and policies were directed through the Education portfolio driven by the transition of nursing to the tertiary education sector in the mid-1980s. Later, investment through the Council of Australian Governments (COAG) 2006 Health Reform Agenda has resulted in a much broader role for the Commonwealth with the ability to impact on the workforce through education and training reform. A history of nursing investment is located at Appendix iv.
More recently the Commonwealth has invested in nursing and midwifery supply and support measures. These include investments under the Health Workforce Fund (HWF) in practice nursing and nursing and midwifery scholarships. These nursing initiatives totalled about 34% of the funding under the HWF in 2011-12. These are complemented by Department of Education, Employment and Workplace Relations (DEEWR) and Department of Industry, Innovation, Climate Change, Science, Research, and Tertiary Education (DIICCRSTE) measures and Aged Care–specific measures.
As indicated elsewhere, Health Workforce 2025 – Doctors, Nurses and Midwives Volumes 1 and 2 (HW2025) predicts a shortage of nurses after 2016, culminating in an estimated shortfall of 109,000 nurses in 2025 based on “as is” policy settings. Relevantly for the purposes of this chapter, the forecast was that with current policy settings, work practices and retention rates, an additional 10,949 nurses per year (registered and enrolled) would need to graduate from 2016 if supply is to meet demand by 2025.153 The findings of HW2025 are outlined in more detail at Appendix ii.
It is clearly very unlikely that an additional 10,949 nurses per year would graduate from 2016 under any circumstances. This means, among other issues, that there is a need for a policy focus on retention of the current nursing workforce; facilitating the return to the workforce of qualified nurses who have left the workforce, (often for family reasons) and addressing workforce rigidities. There is an ongoing need to test assumptions in the model and continue the drive for better and more reliable data.
While the total number of nurses predicted to be required is a growing concern, it should be noted the nursing and midwifery workforce is presently relatively evenly distributed across regions of Australia. Nursing and midwifery supply across regions ranges from 1,102 full-time equivalent nurses and midwives per 100,000 population in major cities to 995 in outer regional areas to 1,336 in very remote areas.154 As far as the future is concerned, HW2025 modelling suggested shortages of nurses in the aged care and mental health sectors and a shortage of midwives in regional and remote Australia.
152 Council of Australian Governments, Communique 14 July 2006, accessed at http://archive.coag.gov.au/coag_meeting_outcomes/2006-07-14/index.cfm
153 HWA, HW2025 – Vol 1, p. 98
154 AIHW, National Health Workforce Data Set: Nurses and Midwives 2011, Canberra 2012