Paid Work: Nursing Workers
Between 1986 and 2001 there was a 22% decrease in nursing workers employed in aged care, and an 8% decrease in nursing workers employed in hospitals.
Nurses play a vital role in the delivery of Australia's health, aged and community care. Demand for nurses is widely anticipated to grow as the Australian population increases and ages. The ageing of the nursing workforce is presenting challenges to the field of nursing. In addition, the move to increased part-time work within the profession means more nurses are required to provide the same level of nursing services. (endnote 1)
In the late 1980s and through the 1990s nursing grew at half the rate of all occupations. (endnote 2) Some studies have suggested there may be a critical shortage of nurses in the future, particularly aged care and mental health nurses, that could lead to reduced access to a range of hospital and residential aged care services. (endnote 1) In response, the Australian government has introduced a number of initiatives to attract and retain nurses, with particular emphasis on addressing shortages in rural and remote areas and in the field of aged care.
HOW MANY NURSES BY SECTOR?
While the total number of nursing workers has increased since the mid-1980s there has been a fall in the nursing workers to population ratio. The number of people reporting being employed in a nursing occupation in their main job increased by 10% between the 1986 and 2001 censuses, from 173,000 to 191,000. Over the same period, the ratio of nursing workers to total population dropped from 10.8 per 1,000 population in 1986 to 9.8 in 2001.
The two largest sectors employing nursing workers in 2001 were hospitals (employing 53% of nursing workers) and aged care (12%). The distribution of the nursing workforce across these sectors changed over the 15 years to 2001, largely through decreases in numbers of nursing workers in both these sectors, and in particular in aged care. Between 1986 and 2001 there was a 22% decrease in nursing workers employed in aged care while in hospitals the decrease was 8%. Over the same period, the proportion of nursing workers working outside of the hospital and aged care sectors in areas such as general practice medical services and specialist services increased by 105%. This may in part be due to initiatives that encouraged general practices to employ more nurses to reduce workforce pressure and improve access to primary health care.
Aged care nursing was singled out as the sector of nursing in greatest crisis in the 2002 Senate Inquiry into Nursing, with large numbers of nurses leaving the sector and not being replaced. (endnote 1) Steps have been taken to address nursing shortages, particularly in aged care. For example, in the 2004-2005 Budget, the Government announced its Investing in Australia's Aged Care: More Places, Better Care package. (endnote 3)
NURSING WORKERS BY SECTOR(a)
 | 1986 | 1991 | 1996 | 2001 | Change from 1986 to 2001 |
| ‘000 | ‘000 | '000 | '000 | % |
| Nursing workers | 173.4 | 179.1 | 186.2 | 191.1 | 10.2 |
| Hospitals(b) | 111.3 | 103.8 | 106.1 | 102.2 | -8.2 |
| Aged care(c) | 30.1 | 31.9 | 30.0 | 23.4 | -22.3 |
| Other(d) | 31.9 | 43.4 | 50.0 | 65.5 | 105.3 |
RATE PER 1,000 POPULATION(e) | |||||
| Nursing workers | 10.8 | 10.4 | 10.2 | 9.8 | n.a. |
(a) Hospitals and nursing homes undefined were pro rated across the hospitals and aged care categories. (b) Comprises hospitals and psychiatric hospitals. (c) Comprises nursing homes and accommodation for the aged. (d) Includes general practice medical services and specialist services. (e) Estimated Resident Population at 30 June each year. Source: ABS 1986, 1991, 1996 and 2001 Censuses of Population and Housing; Australian Demographic Statistics Quarterly (ABS cat. no. 3101.0). | |||||
| Nursing workers For the purposes of this article, nursing workers comprise people aged 15 years or over who reported being employed as a Nursing professional or Enrolled nurse in their main job. Nursing professionals mostly have a level of skill commensurate with a Bachelor degree or higher qualification. They include Nurse managers, Nurse educators and researchers, Registered nurses, Registered midwives, Registered mental health nurses and Registered developmental disability nurses. Enrolled nurses have a skill level commensurate with an Australian Qualifications Framework Diploma or higher qualification, or at least three years relevant experience. The article draws on data from the 1986, 1991, 1996 and 2001 ABS Censuses of Population and Housing unless otherwise stated. The classification for Nursing professionals and Enrolled nurses changed between the 1991 and 1996 censuses following changes in nursing accreditation. Between 1985 and 1993, nursing moved from hospital-based training to a higher education degree for nursing professionals. An implication of this change is that people undertaking hospital-based training are included as nursing workers, whereas people studying for a nursing degree are not included as nursing workers. |
NURSING WORKFORCE CHARACTERISTICS
Nursing has traditionally been a female sphere of employment. In 1986, 93% of nursing workers were female. While gender segregation of occupations has generally been dissipating over recent decades, nursing has remained an overwhelmingly female activity with 91% of nursing workers in 2001 being female.
Between 1985 and 1993, changes were made to training and accreditation for nurses, with a move from hospital based training to university accreditation. These measures were designed to standardise the quality of nursing to ensure a high standard of health care delivery. These changes were reflected in the nursing workforce, with 80% of nursing workers in 1986 identifying as nursing professionals, increasing to 90% by 2001.
With increasing proportions of nurses working part-time, nursing shortages may be exacerbated as more nurses are required to provide the same level of nursing supply. (endnote 1) In 2001, 49% of nursing workers worked part-time, compared with 37% in 1986. The hospital sector has seen the greatest increase of part-time workers, with 29% of nursing workers working part-time in 1986 rising to 47% in 2001.
While the proportions of full-time nursing workers have generally been falling since 1986, the proportion of nursing workers working long hours has increased slightly. Between 1986 and 2001 the proportion of nursing workers who were working 49 hours or more a week increased from 2% to 6%.
The most recent ABS Working Arrangements Survey indicated that in 2003, 67% of nursing workers worked shift work in the previous four weeks compared to 16% for the general population. With regard to overtime, 30% of nursing workers worked overtime on a regular basis compared to 38% of all workers.
SELECTED CHARACTERISTICS OF NURSING WORKERS
| 1986 | 1991 | 1996 | 2001 |
| % | % | % | % |
| Female | 92.6 | 92.2 | 91.7 | 91.5 |
| Part-time(a) | 37.0 | 44.9 | 47.7 | 49.2 |
| Full-time | 63.0 | 55.1 | 52.3 | 50.8 |
| Working 49 hours or more per week | 1.8 | 1.7 | 2.8 | 6.3 |
| Age groups | | | | |
| 15-24 years | 21.3 | 12.5 | 7.9 | 5.1 |
| 25-34 years | 35.9 | 33.8 | 26.5 | 21.8 |
| 35-44 years | 24.7 | 31.2 | 35.8 | 33.1 |
| 45 years and over | 18.1 | 22.4 | 29.8 | 40.0 |
| Nursing qualifications | | | | |
| Nursing professionals | 79.7 | 77.8 | 86.8 | 89.8 |
| Enrolled nurses | 20.3 | 22.2 | 13.2 | 10.2 |
| Total | 100.0 | 100.0 | 100.0 | 100.0 |
(a) Reported working 1-34 hours in all jobs in the week prior to census night. Source: ABS 1986, 1991, 1996 and 2001 Censuses of Population and Housing. | ||||
| State/territory comparison According to estimates from the Australian Institute of Health and Welfare (AIHW), in 2001 there were 10.2 full-time equivalent nurses per 1,000 population, down from 11.3 in 1995. There were decreases in each state and territory except the Australian Capital Territory where this ratio increased slightly from 10.2 in 1995 to 10.5 in 2001. Full-time equivalent(a) nurses(b) per 1,000 population
AIHW estimates of nurses per 1,000 population are not comparable with ABS estimates of nursing workers presented elsewhere in this article. This is due to differences in scope and methodology between collections used to obtain data on nurses. | ||||||||||||||||||||||||||||||||||||||||||
...age
Concern about a continuation of nursing shortages has arisen in part from the ageing profile of the nursing workforce over the 1980s and 90s. In 2001, census data showed 40% of all nursing workers were aged 45 years and over, an increase from 18% in 1986. Conversely, the proportion of nursing workers who were aged 15-24 years fell from 21% in 1986 to 5% in 2001. The fall in nursing workers aged less than 25 years may be related to the change in nursing training.
There were similar changes for full-time nursing workers. In 2001, 41% of full-time nursing workers were aged 45 years or older, up from 17% in 1986.
...regional differences
In 2001, 65% of nursing workers lived in Major Cities, compared with 22% in Inner Regional areas, 10% in Outer Regional and the remaining 2% in Remote and Very Remote areas. This is similar to the total population distribution in 2001. The location of specialist medical services in cities or larger regional centres attracts large numbers of nursing workers to these areas.
The profile of the nursing workforce appears to be ageing more rapidly in regional areas. Between 1991 and 2001, while the proportion of nursing workers aged 45 years and over increased in all geographic areas, the increase was greatest outside Major Cities. For example, in Major Cities the 45 years or over age group increased by 17 percentage points compared with 20 percentage points in Very Remote areas. Similarly, while the proportion of nursing workers aged 15-34 years decreased in all geographic areas over this period, the largest decreases were outside of Major Cities, with the 15-24 years age group falling by 10 percentage points in Very Remote areas.
In response to nursing shortages outside the metropolitan areas, the Australian Government implemented the Rural and Remote Nurse Scholarship Program in 1998 to assist professional development and skill training for registered and enrolled nurses working in remote and rural areas as well as those wishing to train and practice in these areas. (endnote 4)
Distribution of nursing workers across remoteness areas(a) - 2001
...earnings
Individual earnings for employees tend to vary widely according to the number of hours worked, the type of work done, the level of experience and the level of responsibility associated with a job. For this reason, the ordinary time earnings of full-time adult non-managerial employees are used to examine earnings of nursing workers. These are sourced from the ABS Survey of Employee Earnings and Hours.
In 2004, full-time adult non-managerial nursing professionals earned $1028.30 per week on average excluding overtime, and enrolled nurses earned $715.30 per week. In comparison, the average earnings per week across all full-time adult non-managerial employees was $867.50.
FUTURE SUPPLY
The future supply of nurses depends on a number of factors. These include the numbers of people undergoing nursing training, the retention of nurses in the nursing workforce, the enticement of qualified nurses either working elsewhere or not in the labour force to return to the nursing workforce, and international migration.
...people starting nursing study
The number of nursing workers in coming years will be influenced by the number of people who start at higher education institutions in courses for initial registration as nurses. The Department of Education, Science and Training estimates that commencements for nursing study declined from 1995 to 2000 but generally increased over the period 2001 to 2003. (Endnote 5) In 2003 there were 8,500 people starting courses for initial registration as nurses, an increase from 8,100 in 2001. Between 2001 and 2003, Queensland experienced the largest increase (29%) in new commencements of all states. All other states had smaller increases or remained the same over this period.
LABOUR FORCE STATUS OF FEMALES(a) WITH NURSING QUALIFICATIONS(b) - 2001
| | ||
| | Females | |
| | % | |
| | ||
| Employed | 83.5 | |
| Nursing professional | 61.3 | |
| Other occupation | 22.3 | |
| Unemployed | 1.0 | |
| Not in the labour force | 15.5 | |
| Total | 100.0 | |
| | ||
| | '000 | |
| | | |
| Total | 183.4 | |
| | ||
| | % | |
| Unemployment rate | 1.2 | |
| (a) Aged 15-64 years. (b) Bachelor degree or higher in a nursing field. Source: ABS Survey of Education and Training 2001. | | |
ALL COMMENCING STUDENTS ENROLLED IN COURSES FOR INITIAL REGISTRATION AS NURSES(a)
| 2001 | 2003 |
| ‘000 | '000 |
| New South Wales | 2.2 | 2.5 |
| Victoria | 1.8 | 1.8 |
| Queensland | 1.2 | 1.6 |
| South Australia | 0.8 | 1.0 |
| Western Australia | 0.7 | 0.7 |
| Tasmania | 0.2 | 0.2 |
| Northern Territory | 0.2 | 0.2 |
| Australian Capital Territory | 0.1 | 0.1 |
| Australia(b) | 8.1 | 8.5 |
(a) Students enrolled in their first year of study. (b) State totals when added may not equal Australian total due to rounding and revisions to yearly totals. Australian totals show latest revisions at November 2004. Source: Department of Education, Science and Training, Students 2004: Selected Higher Education Statistics. <http: //www.dest.gov.au/highered /pubgen /pubsalph.htm#S (2001)> accessed 2 November 2004. | ||
...people with a nursing qualification
One means of alleviating a current or anticipated nursing shortage is to entice people with nursing qualifications back to nursing work through programs such as the Australian government funded Metropolitan Nurse Re-entry Scheme providing 80 scholarships to encourage suitably qualified nurses to return to the field of nursing. (endnote 6)
In 2001, according to the ABS Survey of Education and Training, 84% of women aged 15-64 years with a Bachelor degree or higher in a nursing field (155,000 women) were in the labour force. This is similar to the labour force participation of women with a Bachelor degree or higher in any field and much higher than the labour force participation of all women (69%). Women with nursing qualifications also experienced lower unemployment rates compared with all women (1.2% and 6.3% respectively). Of women with nursing qualifications who were not in the labour force, 37% belonged to a family with at least one child aged less than 15 years.
Nearly three quarters (73%) of employed women with a Bachelor degree or higher in a nursing field were working as Nursing professionals, with the remainder working in other occupations. The retention of women with nursing qualifications in nursing jobs decreases with age. For example, of women aged 25-34 years with a nursing qualification, 92% were employed as Nursing professionals. However this had decreased to 66% for women in both the age groups of 35-44 years and 45-64 years.
...international migration
Future supply will also be affected by employers being able to retain existing workers in Australia and attract new nurses from overseas into the workforce. Local health care providers may face a difficult task in attracting nurses since they are sometimes competing against overseas employers. In this competitive environment, moves have been made to attract overseas nurses into the Australian workforce.
Along with permanent settlers, another group of interest to the nursing workforce are long-term visitors. Long-term visitors to Australia with nursing qualifications can obtain a working visa to gain employment while on a working holiday.
On balance, Australia's supply of nursing workers was depleted by permanent and long-term international movement of nursing workers in the last ten years according to the ABS Overseas Arrivals and Departures Collection. However, since 2002, there has been a turn around in this trend with more arrivals than departures on a permanent or long-term basis. Approximately 800 nurses arrived from overseas to work during 2001 - a small addition to the total population of 191,000 nursing workers for that year.
International arrivals and departures of nurses(a)(b)
| Migration Occupations in Demand List (MODL) The federal government has sponsored legislative and policy changes which have increased opportunities for various employers in the Australian health industry to recruit highly skilled overseas nurses. (endnote 1) People seeking to migrate to Australia on the basis of their work skills receive bonus points if their nominated occupation is on the Migration Occupations in Demand List (MODL). (endnote 1) At May 2005, Registered nurses, Registered midwives and Registered mental health nurses were on this list. (endnote 7) |
ENDNOTES
1 Report of the Inquiry into Nursing, June 2002, The Patient Profession: A time for action.
2 Shah, C & Burke, G 2001 Job Growth and Replacement Needs in Nursing Occupations, Department of Education, Science and Training <http://www.dest.gov.au/archivehighered/eippubs/eip01_18/2.htm> accessed 26 May 2005.
3 Commonwealth Department of Education, Science and Training. <http://www.dest.gov.au/>, accessed 4 November 2004.
4 Australian Government Department of Health and Ageing <http://www.health.gov.au/> accessed 17 November 2004.
5 Commonwealth Department of Education, Science, and Training, Students 2003, Selected Higher Education Statistics
6 E-mail, Nursing and Rural Workforce Strategies, 21 June 2004.
7 Department of Immigration and Multicultural and Indigenous Affairs 2005, <http://www.immi.gov.au/migration/skilled/ modl.htm> accessed 15 June 2005.
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