After completing their degree, registered nurses and midwives are qualified to work. However, though not compulsory (like medical practitioners’ prescribed apprentice-model residency), it is increasingly difficult to find permanent employment without an intern or graduate year.

During a graduate year nurses and midwives work full-time at one hospital (either staying on one ward or rotating through two or three different wards and departments depending on the model used), consolidating their experience and expanding their knowledge through a combination of formal study days, workplace in-services, learning packages and reading. They have an initial supernumerary period, which is structured to transition them from watching the RN or midwife they’re with to taking care of a full patient load, are supported by a preceptor (often one for two graduates), and have an educator available for questions, issues and to oversee their progress.

This facilitated growth from a novice to a competent practitioner is resource-intensive: the supernumerary period means paying an experienced nurse/midwife for a fortnight or so without her or him counting in the ratio numbers; their training as a preceptor takes place in paid time, and includes the cost of a trainer and resources; all those education sessions take place in paid time; and the educators are paid as well. Those costs are funded by the State government, in addition to the hospital budget. How much less expensive to hire overseas-qualified nurses and midwives instead.

One of the attractions of nursing is its portability – it’s a tradition for Australian nurses to spend some time working overseas, so much so that perhaps half my colleagues have or intend too. And throughout my career I’ve had the pleasure of working alongside nurses from countries near (NZ, PNG, the Philippines, Malaysia, Singapore), proximate (Japan, Hong Kong, China, South Africa) and far (US, UK, Canada, Eire, France and more).

The process for recognition of international qualifications is extensive in both directions – to work in the UK non-EU nurses and midwives need to sit an English proficiency test even if all their education was in Australia, and the former usually need to increase their midwifery hours to comply with UK registration requirements. We need a global nursing and midwifery workforce – it adds to the robustness of our knowledge, reflects the diversity of our communities, and strengthens our connections.

Hiring overseas-educated nurses and midwives is not cost neutral – when local numbers are low costs include managers going overseas to recruit, advertising costs, application processing, assisting successful applicants through the registration process, sponsoring visas, support on arrival, and orientation to the hospital. There is a period of acclimation and adjustment. But that all costs less than supporting a graduate nurse or midwife for a year.

Which, I imagine, is why the Baillieu government has for the second year in a row, slashed the number of funded graduate nurse and midwife places – last year over 500 graduates missed out. This year it’s 805. That’s almost 40% of final year students; including NZ-trained final year nursing and midwifery students, 1142 applicants missed out.

Why? It’s not because they accepted more students into the program – place figures are determined based on forward modelling of need and attrition (from both the program and the existing workforce). It’s not that community need for nurses and midwives has decreased – the acuity of our patients is higher every year. It’s not because we’re awash with nurses and midwives already – when my ward divides next month we’ll have a shortage of 10-14 effective full-time staff. It’s not because nurses and midwives are staying in the system longer – a growing number of the next generation of nurses and midwives are leaving, often for good. And it’s not because there’s an inexhaustible pool of internationally qualified nurses and midwives who can fill the gaps – almost half of the UK’s nurses are predicted to have retired by 2021. As everywhere in the developed world, our nurses are getting older – by 2020 90,000 Australian nurses currently in the system will retire (many sources cohort nursing and midwifery figures).

For effective, efficient, safe nursing and midwifery workforces we need a combination of inexperienced and experienced nurses and midwives. Without career opportunities we won’t attract high calibre applicants to nursing and midwifery programs. Why would you undertake the time, effort and cost of a degree if you knew there was a risk of more than a third that, even after passing every test and placement, you wouldn’t be employed?

Graduate years used to be desirable but not essential. That’s changed – without a graduate year most newly qualified nurses and almost all newly qualified midwives find it impossible to get permanent work. They can join agencies, and join the insecure jobs workforce, with little career development opportunities, insubstantial consolidation of knowledge, and almost no support. They can’t work overseas – no country will accept inexperienced nurses or midwives. Instead they’re in career limbo – all the time, effort and money invested in their degree, by both them and the State, wasted.

Reducing funding for graduate nurse and midwife positions is short-term thinking that can only be based in saving money but that will cost us dearly in the medium- and long-term. It means nursing and midwifery are less attractive to VCE students, who will choose other health care professions. It means students already enrolled will drop out because continuing their degree is more likely to lead nowhere. It means that five years from now, as we approach the barrel of a global nursing shortfall everyone saw coming almost a decade ago, Victoria won’t even have a solid foundation of existing nurses and midwives to work from.

As Paul Gilbert, Acting Secretary, Australian Nursing Federation (Vic. branch) said today,

It defies logic to exclude up to 40 per cent of nurses and midwives successfully graduating from their courses when both the Baillieu Government and Health Workforce Australia are forecasting serious nurse shortages. Health Minister David Davis cannot afford to get this wrong now or we will lose hundreds of potential nurses and midwives.

The time to act is now. If you’re concerned about the future of nursing and midwifery in Victoria, please contact the Premier, the Health Minister, your local MP and the media. This is an issue that affects everyone who may need health care in Victoria in the future – next year, or in ten years, public sector or private, acute or rehab, midwifery or aged care.

And, in two years, one month and two days from now, when you cast your vote, remember.

1/11/12 Addit: and it’s not just Victoria – as Ian at ImpactedNurse writes today, the same thing is affecting graduates in Tasmania and (from readers’ comments) NSW, and medical intern programs have also been cut. We can pay now, or pay dearly in the future.