I wrote recently about the (distressingly quiet) furore over Victoria’s public health funding – the Federal Labor government says it’s provided agreed funding, the Liberal State government says we’re $455 million short over the next four years and have to save just over $107 million by June 30 2013, with more cuts to come. This disparity is something I’ll discuss in more detail tomorrow.

Tonight, though I want to look at what kind of support our public hospitals are getting from those who ought to be pushing hardest for the public we all serve – senior management.

For the most part we all understand that everyone has a role to play, particularly during periods like the 2011/12 EBA negotiations – senior level managers have to toe the company line with only little room for their own positions to come in to play – the extent of that is going to be dictated by a combination of the line being taken by their negotiators (in this case the Victorian Hospitals’ Industrial Association, or VHIA), the culture of the institution, the personal opinions of the managers, and their comfort or courage in broadcasting these.

We saw some of this range at different workplaces during the dispute – from the DON of one hospital only authorising docking of striking nurses once the Federal court declared it unlawful action (and then spreading the docking over several pay periods, to minimise financial disadvantage), through unit managers at another hospital being directed to tell their staff that taking strike action could result in their assets being seized, to the CEO of a third hospital suing a nurse and the ANF for a post on Facebook.

And we’ve seen the startling reverse, of no fewer than three CEOs speaking out against government cuts, and the same CEO now suggesting staff members ask their unions to intervene in the cost cutting.

This next section will seem like a bit of a diversion – bear with me.

Staff comprise the biggest part of any hospital budget, and nurses/midwives form the overwhelming majority of that cost – there are more of us than any other group or combination of groups, and for good reason: if you don’t need nursing or midwifery care, odds are you’re not going to be a public hospital inpatient.

I understand the temptation to cut nursing numbers when times are lean – though I’d like to point out that, since I was first registered in 1992, I’ve yet to hear of a time or a hospital that willingly took on more nurses and midwives in celebration of prosperity, or even recognition of increasing acuity. As I was saying, I understand that impetus. From accountants and business folk, who don’t have the experience or education to appreciate the cost-saving outcomes of skilled care – shorter inpatient stays, fewer mistakes, few errors (including medication errors), fewer falls and pressure injuries (each of which contribute to injury, longer stay, poorer outcomes, and death), a reduction in failure to rescue, a decrease in preventable transfers to ICU, and a lower death rate.

Like Australia’s population in general, or health professionals are getting older – young nurses and midwives are leaving their professions faster that we’re being replaced, and experienced clinicians are edging closer to retirement. In addition, despite aggressive attempts at balance, some 90% of nurses are women, and that figure jumps even higher when we look at midwives. Though progress has been made in equitable partnerships at home, in the majority of cases women are still the parents who spend most time with young children, and are more likely than men to reduce employment hours, forgo promotions, and work unsociable hours (weekends and nights predominantly).

We know from American research that it costs up to twice a nurses’ annual salary to replace a practitioner. Benefits of nurse retention (and I think we can assume they’re similar for midwife retention) include

Nurse Retention Benefits
  • Reduction in advertisement and recruitment costs
  • Fewer vacancies and reduction in vacancy costs
  • Fewer new hires and reduction in hiring costs
  • Fewer orientees and reduced orientation and training costs
  • Maintained or increased productivity
  • Fewer terminations and reduction in termination costs
  • Decreased patient errors and increased quality of care
  • Improved work environment and culture, increased satisfaction, increased trust and accountability
  • Preserve organizational knowledge
  • Easier nurse recruitment                                                              (source)

At a time when demands in the workplace are higher than ever before, when an increasing number of people are juggling commitments, when we expect nurses and midwives to upgrade and update their education qualifications – why are employers making it harder, not easier to strike a work/life balance?

Today, not for the first time, I heard about a colleague who is going to have to leave a workplace where she’s very happy – not because of a problem with clinical practice, not because of completing family demands, not because of an issue with attitude, not because of unreasonable demands, not because of lack of aptitude or enthusiasm, not because the ward is over-staffed…but because management has decided, without warning or notice or obvious rationale, to cap part-time hours.

This nurse is continuing her professional development by undertaking a post-graduate qualification in a specialty area of the ward where she works. Though tax-deductible, she’ll be paying for the course herself, with no employer or government funding. In order to meet the demands of class time, home study, assignments and clinical placements she has chosen to reduce her income for the better part of a year, and drop her hours.

Going part-time only advantages her in terms of available study time – she gets the same hourly rate and penalties, and actually loses potential time off, including ADOs and study leave.

Her plan was to do this for a year, then return to full-time work on her ward, equipped with greater knowledge, updated information, and technical skill. A Graduate Certificate would net her around $20/week extra, a Graduate Diploma around $30, and in exchange her hospital would have a dedicate, invested, interested, experienced and knowledgeable practitioner.

However, on approaching her manager, this nurse was told that it’s now hospital policy (apparently – this doesn’t seem to be written anywhere) that nursing staff at that hospital can not work less than .6, which is 60% of full-time, or 24 hours a week. This is despite the fact that there are currently nurses working one day a week or less, and several nurses on her ward working fewer hours than that.

So instead of maintaining links and a presence on her ward, instead of spending the next year implementing what she’s learning, instead of having a career goal that includes returning full-time to this work place, my colleague looks like leaving – with no sense of loyalty to or from the hospital, and a harbinger of things to come.

We are having trouble retaining the next generation of nurses, a problem only exacerbated by inflexible workplaces. Casualised workforces are beloved by a growing number of employers – I am opposed to them anyway, because I believe they’re pay for employees, but they have no place forming the bulk of hospital workers. We need experience, continuity and education to ensure our patients have the best possible care, the fewest preventable adverse effects, and the most advantageous outcomes. And if none of that is important to the Powers That Be, this is also the least expensive model.

In Australia a lot of energy has been expended ensuring that the Directors of Nursing, Midwifery and Medicine must be clinicians – the idea is that this means they’ll have greater insight into the complex aspects of hospital and resource management. Hospitals don’t make widgets, productivity is more than throughput, and we are tasked with the wonderous task of caring for our community members at their most vulnerable, during their greatest times of need.

Policies like that my friend and colleague has encountered indicate short-term thinking, and no regard for even the next twelve months, let alone the long-term vision and planning our health care system not only deserves but needs. Every nurse and midwife who leaves is a loss we can ill afford, financially or as a resource, and instead of holding on to them, too many hospital managements are acting as though this workforce is inexhaustible. It’s not, we’re not, and if we can’t get even those who’ve risen from our ranks to understand that then it’s no wonder we have a State government who neither understands nor respects our work.