Shortage of ‘Nursing Practitioners’ in Australian Rural Area

This essay discusses the shortage of nursing practitioners in Australian rural areas and the challenges faced by the healthcare system. It also suggests strategies to attract people towards rural nursing care services.

Health workforce
Essay
System04104

Shortage of ‘Nursing Practitioners’ in Australian Rural Area
Lack of access to primary and preventive care services by people living in Australian
rural areas remains one of the main problems of Australian health care services, even the
government take several workforce initiatives in past. No one can deny that nurse
practitioners play an essential role in the nation's health care system by serving people.
Nursing practitioners serve as an alternative of medical physicians in scarcity of doctors or
physicians in both rural and urban areas (Campell & Merwin, 2009). Many such problems
arise in rural areas, where people fighting with lack of medical resources, equipment,
medicines, doctors, and even some people fighting with the unavailability of the hospital in
their locality. The rural nursing shortage is a challenge for the Australian government with
the shortage of other medical facilities in the rural and remote areas of the country. However,
the government initiated a large number of programs to fight with the shortage of healthcare
practitioners in rural areas, but still the Australian government is facing challenges to
eliminate this problem at the root level. In order to remove workforce shortage problem in
nursing practices, the Australian government introduced a number of initiative programs such
as regulatory restrictions and incentive payment systems (Buerhus, Donelan, Ulrich, Norman,
& Dittus, 2005). Some of the programs especially focus on increasing the numbers of nurses
and healthcare practitioners and remote in rural areas of the country. Practice nursing in
Australia usually has been a way of income for nursing practitioners through which nurses
have been accommodating for family obligations by engaging themselves in part-time work,
which has not involved in shift work. Consequently, there has been a lack of special skills
nurses who believe to work in general practice. One of the main problems is that most of the
nurses do not involve in any formal education to do such type of healthcare service work.
Nursing workforce in Australia till 2016
There are 311,697 primary health care nurses (including midwives) working
in Australian primary healthcare service till 2016, which is more than the nurses were
working in 2013. The number of nurses in 2013 was 292,845. In 2016, the number of
nurses increased by 0.4 % per annum. This compares to the total nursing workforce
including midwives in 2016 (311,697) which has increased by approx. 6.7% since
2013, with an annual average increase of 2.1% (Department of Health Australia,
2016).

Fig: Total number of nurses and midwives in Australia till 2016
(Source: Australian Government, Department of Health, 2016-17)
In the Primary Health Care Nurse workforce, there were 217 Nurse
Practitioners working in primary health care in 2016, compared with 135 in 2013.
Fig: Total number of Registered and Employed Nurses in Australia till 2016
(
Source: Australian Government, Department of Health, 2016-17)
According to the Australian Government Department of Health, total
Registered Nurses till 2016, in Australia were 1,417 and there were 1,340 nurses were
employed in the country. There are only 498 nurses registered for the Australian
healthcare service program in 3 years after 2013, where the number of employed
nurses increases by only 567 nurses. This shows the unavailability and slow rate of
unemployment in healthcare service in Australia (National Health Workforce, 2009).
Even though the Australian government initiates a number of healthcare program to
attract people towards the health care service job, but could not succeed to attract
candidate for future nursing work.
Geographically Distribution of Nurses
Most of the Australian primary health care nurses (63.5%) were located in urban areas
or in big cities of the country. If we consider the Inner Regional area, the numbers of total
primary healthcare nurses are 18.4% that is too low in comparison to major cities.

Fig: Total number of nurses and midwives in Australia till 2016
(Source: Australian Government, Department of Health, 2016-17)
If we compare with the rural areas, only 18.1% nurses working in rural areas. If we
compared with the number of nurses in 2013, the percentage of the workforce in the remote
area has remained almost same, while 71.5% of the workforce (210,994) working in the
developed area, it means there are a large number of the workforce employed in major cities
rather than rural areas or remote areas. This shows the unavailability of the number of nurses
in Australian rural areas. The distribution of nurses geographically not suited for Australian
Population because the availability of nurses according to the rural population density is too
low. One of the major problems behind facing scarcity of nurses in rural areas is no one
wants to work in the less-developed and ill-equipped area (Fitzgerald, 2007). The
unavailability of resources and poor working conditions for females in rural areas are two
main reasons behind the unavailability of the health workforce in Australia.
Fig: Some Facts about Australian Nursing in Rural Areas in 2016
(Source: Australian Government, Department of Health, 2016-17)

These are some quick facts about the Australian nurses employed and practising in
Australia. The average age of the nurses is 49 years who worked 39.6 hours per week, per
nurse. The average hours of work are too less. The government should increase the number of
working hours if we considered the scarcity of nurses in rural areas. While the percentage of
nurses if we considered 80.7 % nurses are female. Most of the nurses are between the age of
45-54 years (National Health Workforce Dataset 2013—2016, 2018).
Issues and Challenges in Rural Nursing care
Australia faces many issues and challenges in healthcare workforce and deliverance
of health care services to its rural and remote areas. Nurses are the core part of primary health
care services in Australia and play a significant role in providing better health care services to
the people. The majority of healthcare practitioners employed at least one nurse, where one
general practice nurse employed in a small health care system (Dickinson, 2004). The above
stats about the nursing Australia show that only 6% (remote and very remote area) nurses are
employed in rural areas. The nurses are the backbone of any country's healthcare programs.
Like any other countries Australia also facing the problem of shortage of nurses. The rural
population of Australia is considered as socio-economic underprivileged area by reason of
their lack in education and facing the problem of expert work (Joyce & Piterman, 2011).
The number of nurses increasing from last three years (2013-16) at very slow rate,
and create real trouble for the Australian government. Large numbers of nurses are more than
the age of 45 years and they are between 45-54 years that create a problem for quick
retirement from their service. The numbers of nurses are decreasing because the number of
registered nurses in Australia is growing at a very slow rate, as only 498 nurses registered for
the nursing services in 3 years. The number of employed nurses is another problem where
only 567 nurses employed by the government in 3 years of duration (Roberge, 2009). One of
the other problems in the Australian healthcare system is indigenous and non-indigenous
Australians. However, the nurses who are mostly over aged nurses, facing problem in rural
areas because of lack of resources and proper healthcare facilities. Nurses who are active in
remote and rural areas may find themselves with a conflicting mix of both social isolation
and social exposure as well (Manahan & Lavoice, 2008).
According to the Australian Institute and Family Welfare, the Australian government
consist of various communities and culture in the different geographic location of the

country. The current problem of workforce scarcity in the Australian healthcare system
consists of demographic, socio-culture, and both clinical and professional factors that
determine the demand for healthcare services and supply of healthcare workers. According to
the Australian Department of health, 80.1% of the nurses are females and thus government
need to attract males for the same work (Nurses in Rural Australia, 2011). The Australian
government needs to spread awareness among people about the various disease and all the
health hazards, which arises from alcoholism, obese, and smoking or overweight problems.
The awareness among people reduces the disease level and in results, it reduces the need of a
number of nurses. Australia is also suffering from high mortality rate in the rural areas. The
causes of high mortality rates are the cardiac disorder, road traffics, lung cancer and disease,
accidents, diabetes and high blood pressure. These increasing rates of mortality and the cause
factor need the high level of healthcare facilities. It is possible with an adequate health care
workforce, including nurses, medical practitioners, and doctors.
The shortage of other healthcare workforces also affects nursing works, because they
are the people who deal with the clients and patients. The Australian government failed in
staffing adequate numbers of nurses that build pressure in healthcare service in the country in
both rural and urban areas. Small numbers of nurses treated a large number of patients in
rural areas, because Australian government depends on very few registered nurses, although
the number of midwives is more than the number of nurses, but the nature of work of
midwives is different. A patient can be treated as the customer of the healthcare system, thus
according to consumer protection rights, they have their own right to get proper care and
facilities in hospitals. Thus, it is also a responsibility of hospital management to recruit nurses
according to the demand of healthcare services in both rural and remote areas.
One of the other causes in the shortage of Australian rural nurses is the resignation of
nurses from rural hospitals. The major cause behind this was ‘personal value’ of how nursing
should be conflicted with the hospital's organisational values. The conflict between rural
hospital and nurses creates the problem that leads to a high number of resignations of nurses
from the duty. The shortage of rural nurses forces the current nurses to work more. Nurses
play a diverse role in the rural areas. Even the new and un-expert nurses are working in the
rural areas that are not educated or expert in the nursing care work. This creates the problem
for providing proper nursing care for clients or patients. The Australian government should
not focus to fill the gap of required nurses. One of the major problems in Australian rural
healthcare services is access, particularly the physical distance between patient and service

provider (hospitals). This not only causes waste off time but also creates the problem for the
patient, as he/she cannot afford the money of treatment. As the 80% of the nurses are females
they do not even try to join the services in rural areas because of the lack of resources and
connectivity with the big cities. The socio-culture issues are another problem in Australia that
affects the nursing care staff. The socio-cultural difference creates poor communication with
the community of nurses.
Strategies to attract people towards the rural nursing care services
To short out the above problems regarding low nursing workforce, the Australian
government has to take several steps that attract young people towards the nursing care work.
The government of Australia and its department of health have to focus on medical colleges
and universities that provide medical and nursing education to the student and inspire them to
work in a rural area and serve those people who are facing critical health problems. Even the
Australian government operating a number of healthcare programs and incentive programs to
improve the intensity of the health care workforce, but it was not effective (Lynn & Brownie,
2015). In addition to this, the Australian government and various health authorities of the
country send nurses to the medical college and schools to tell their experience of nursing
work to the youths and about its value and benefits. The Australian government can also
provide all the school, medical colleges, and universities students to visit in hospitals and
observe the job of a nurse and his/her duty that how a nurse can save the life of patients.
These steps of the government inspire the youth to take part in nursing care work and it also
motivates them to do something for those rural communities who are facing many healthcare
problems because of unavailability of resource and healthcare staff (Kenney & Ducketts,
2003). Moreover, the Australian government should provide more benefits and incentives for
those nurses who took part in rural nursing care services.

(Source: Medical Deans Australia and New Zealand Inc)
With the aim of reducing the effect of workforce shortage, the Australian government
and other health authorities should focus on to retain old nurses and employment strategies.
The healthcare authorities should offer childcare services to reduce infant mortality rate and
provide cash incentives for both new and old nurses. The government should provide more
sick and casual leave for staff. In case of sick leave, the government should connect with
external agencies that fill the staff in case of emergency or unavailability of adequate nurses
in particular situations. Appoint nurse from overseas is another option for the Australian
government. The government should eliminate those past programs those are less effective
and not working. Instead of this government should launch new health programs that attract
youth towards nursing work (Hickey, Sumsion, &Harrison, 2009).

It is the high time to identify the problems of workforce shortage in Australia and it
should be noted that it is not the matter of financial barricade rather it is the matter of
Australian people and their well-being. If the government fail to find out the problems, not
able to provide proper resources and equipment to the rural hospitals, it will lead to the long-
term problems for the country in form of medical workforce shortage (Courtney, Nash,
Thornton, & Potgieter, 2015). The government should provide effective obtainable retirement
programs to stay skilled nurses and their service and knowledge from a long-term
perspective. The Government should provide more resources and funds for research and
should provide sufficient payments for the nurses who work in rural areas. Security is the
other big problem for female nurses, that should be encountered by providing them
accommodation and financial resources to leave and settle in rural areas during service period
(Nancy, 2007). Apart from this, the government should provide flexible working hours and
shifts for female workers, especially who are old age and sick, as most of the nurses are
female and above and between 45 years to 54 years. The government should reduce the
working hours from 8-12 hours to 5-6 hours for old age nurses.
In conclusion, while the nurses in rural areas facing most of the problems, they should
compensate with more benefits and salary, thus they give their best in healthcare services.
Working as a general-specialist, rural area nurses should have provided adequate healthcare
resources; proper infrastructure for healthcare services, good salary, and incentives for rural
area nurses, and provide advanced technological equipment for treatment of patient. If
government provide all the facilities to these nurses and attract those youths who are studying
medical and nursing care in different school and colleges of Australia, the number of nurses
should be increased in upcoming days in rural areas.

References
Buerhus, P. I., Donelan, K., Ulrich, B. T., Norman, L. & Dittus, R. (2005) Is the shortage of
hospital registered nurses getting better or worse? Nursing Economics, 23 (2). 61- 71.
Campell. C. L. & Merwin, E. (2009). Factors that Influencing the Presence of a Hospice in a
Rural Community. Melbourne, Australia: Sigma International.
Courtney, M., Nash, R., Thornton, R., & Potgieter, I. (2015). Leading and managing in
nursing practice: Concepts, processes and challenges. Leadership & Nursing
contemporary perspectives. 16(8), 55-68.
Department of Health (2016). Nurses Practitioners NHWDS 2016 Factsheet. Retrieve From:
http://hwd.health.gov.au/webapi/customer/documents/factsheets/2016/Nurse
%20Practitioners%202016%20-%20NHWDS%20factsheet.pdf
Department of Health Australia (2016). Nurses and Midwives NHWDS 2016 Factsheet.
Retrieve From:
http://hwd.health.gov.au/webapi/customer/documents/factsheets/2016/Nurses%20and
%20Midwives%202016%20-%20NHWDS%20factsheet.pdf
Dickinson, J. (2004). Letters to the Editor. Australian Family Physician, 33(1/2), 6-7.
Fitzgerald, D. C. (2007). Aging, experienced nurses: their value and needs. Contemporary
Nurse, 24 (2). 237-243.
Hickey, N., Sumsion, J., &Harrison, L. (2009). Nursing double degrees: higher education
initiatives in times of nursing shortage. Australian Journal of Advanced Nursing,
28(1). 52-61.
Joyce, C. M., & Piterman, L. (2011). The Work of Nurses in Australian General Practice.
International Journal of Nursing Studies, 47(6), 70-80.
Kenney, A. & Ducketts, S. (2003). Educating for Rural Nursing Practice. Journal of
Advanced Nursing, 44(6), 613-622.

Lynn, A., & Brownie, S. (2015). The Perioperative Nurse Surgeon's Assistant: Issues and
challenges associated with this emerging advanced practice nursing role in
Australia. Collegian, 22(1), 109-115.
Manahan, C. & Lavoice, J. G. (2008). Factors Influencing Rural Nursing Retention. Journal
of Rural Nursing and Healthcare. 8(2), 226-228.
Medical Deans Australia and New Zealand (2016) Medical graduates in Australia. Retrieve
from: https://medicaldeans.org.au/data/?
md_year=2016&data_type=Graduates&country=AU&students=Domestic&preview=
Nancy, L. (2007). Strategies to enhance retention and effective utilization of aging nurses.
Journal of nursing education, 46(4), 89-97.
National Health Workforce (2009). Health Workforce in Australia and Factor For Current
Strategies. Retrieved from: http://www.ahwo.gov.au
National Health Workforce Dataset 2013—2016 (2018). Registered and employed workforce
data. Retrieve from: http://data.hwa.gov.au/datasets.html
Nurses in Rural Australia (2011). The challenges of remote Nursing in rural Australia.
Retrieved from: http://www.ausmedonline.com/nursing
Roberge, C. M. (2009). Factors Influencing Rural Nursing Retention. Have Rural Nursing
and Health Care, 9(9), 46—54.
The Australia Department of Health Australia (2018). Nurse practitioners' and midwives'
access to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme.
Retrieve From: http://www.health.gov.au/internet/main/publishing.nsf/Content/work-
nurse