Retaining nurses

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

The objectives of the NSW Nursing Re-Connect strategy is to encourage nurses currently not working in nursing to return to the nursing workforce using paid nursing employment opportunities and individualised tailored support.The scheme operates as an individually designed, clinically focussed "refresher" course for registered or enrolled nurses not currently working as nurses. It is funded by the NSW Department of Health and there are no course fees.

Purpose of health policy or idea

Over the last few years, Australian policy makers have become aware of the shortage of nurses in the public hospital system. A number of reasons for the shortage have been proposed including lack of places for nursing training at Universities, poor pay and conditions and the ability of nurses to switch their skills to other areas. In response to the shortage, a number of policies have been enacted including some aimed at encouraging nurses to re-enter the profession after time away from nursing. One such re-entry scheme, the NSW Nursing Re-Connect strategy will be described.

Main points

Main objectives

To encourage registered and enrolled nurses currently not working in nursing to return to the workforce in the public health system.

To deliver a clinically focussed, individually tailored refresher course on a full-or part-time basis in general or speciality areas.

Type of incentives

• The scheme is funded by the NSW Department of Health and does not attract course fees.
• As far as possible, participants are offered work in the hospital of their choice
• Full time or part time work is available
• The level of experience of applicants does not affect their particpation

Groups affected

Registered or enrolled nurses who are still registered as nurses but are not currently working in nursing, Public hospital patients, Other health care providers in the public hospital system

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Compared to traditional refresher courses, the Re-Connect scheme is innovative and more in line with adult learning practices. It gives each participant an opportunity to learn at his or her own pace in a practical fashion which also takes account their previous experience. However, a number of Australian states have adopted similar schemes so the degree of innovation is not extremely high. The scheme has not generated any opposition and is not highly visible to the public. Due to the small numbers of nurses entering the system through the scheme, its impact on the overall health care system is likely to be low. It does not change the structure of the system in any way. Such schemes are highly transferable as nurses are integral members of all health care systems and their re-entry in this way is able to be tailored to meet not just their needs but the needs of the health system in which they work.

Political and economic background

A recent Senate inquiry into nursing found that, although nursing represents the largest group of employees in the health sector, it is still overlooked in health policy development and workforce calculations. There is evidence of a critical shortage of nurses in all areas of health care services, although in some areas, particularly aged care and mental health, the shortage is acute.

There have been calls for the Commonwealth government to lead the way in taking responsibility for coordinating research and implementing the structural reforms needed to overcome the shortage. However, a range of jursidictions have responsibilities in relation to nursing including State governments and professional nursing bodies.

Nurses leave the profession for many reasons, including perceived poor pay, inflexible working conditions and the less than positive image of some aspects of nursing. Other reasons include the desire to re-train, to work in another area or to assume family responsibilities. In light of the high rates at which nurses leave the public hospital system, strategies to retain and recruit nurses have been perceived as important ways of overcoming the nursing shortage.

The NSW Health Department has, for a number of years, funded refresher courses conducted by the NSW College of Nursing for general registered nurses, midwives and enrolled nurses. However, these courses, which offer a mix of classroom learning and clinical experience only reach certain segments of the market for nurses considering re-entry.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

In 2002, within the NSW Department of Health, the Office of the Chief Nursing Officer prepared a report on the recruitment and retention of nurses which summarised the current situation and provided an overview of strategies and activities in the area. In addition to the Re-Connect scheme, strategies adopted to recruit and retain nurses include increasing rates of pay, the provision of scholarships for nurses to undertake postgraduate education, funding for a range of continuing education activities and initiatives to recruit nurses to the mental health area and to train aboriginal nurses.

Thus, the Re-Connect scheme is seen as one of a number of initiatives by the NSW Department of Health aimed at recruiting former nurses back to the public health system.

Stakeholder positions

The 2002 Senate inquiry is the latest of a number of State and Federal inquiries into the nursing shortage. However, its report is a comprehensive document which addresses all the substantive issues within this area such as the need for:

• coordination and cooperation betwen the States and the Commonwealth
• educational initiatives to encourage more people to train, re-train, re-enter and undertake postgraduate education in the field of nursing
• the adoption of "family friendly" practices in the health system
•  responses to violence against nurses

The NSW Department of Health is also committed to funding research into nursing workload, skill mix, staffing levels and models of care and one such piece of research has on Nursing Working Transition been presented to the Australian Health Economics Conference in September 2003 (Doiron and Jones 2003).

Influences in policy making and legislation

not applicable

Adoption and implementation

The NSW Department of Health, Area Health Services, academic and professional organisations are the most important stakeholders involved in implementing the re-entry strategy. By providing the funds for the scheme and indicating its support for the strategy, the Department is asking Area Health Services to follow its lead and identify appropriate positions in which participants in the scheme could work. Academic and professional bodies are required to support the initiative by developing individualised refresher courses and identifying appropriate support mechanisms for participants.

The number of stakeholders involved in the initiative means that the scheme has a higher likelihood of breaking down, particularly at the level of work experience where individual preferences may be difficult to accommodate. Although the level of funding and the incentives provided to participants by not having to pay fees are important, the amount of support required from Area Health Services and academic and professional bodies is also substantial. Area Health Services have been funded to provide a contact person for the scheme but little other direct support is available.

Monitoring and evaluation

Plans to evaluate the NSW Nursing Re-Connect scheme are currently being developed by the Office of the Chief Nurse, NSW Department of Health. However, details of the plan are not yet available. At a minimum, the evaluation should include an assessment of the costs of the scheme, the number of nurses who applied to the scheme, the number who completed the refresher course and their current satisfaction with their place of work as well as some process evaluation of the experiences of nurses involved and their colleagues.

Results of evaluation

The NSW Health Nursing Re-Connect scheme has not yet been evaluated.

However, research by Doiron and Jones into the factors that affect nurses moving in and out of the profession suggest that strategies to encourage retention will have a better likelihood of success than those aimed at recruitment or re-entry.  

Expected outcome

It is expected that the scheme will increase the number of registered and enrolled nurses working in the public hospital system in NSW. However, the long term success of the policy should also be assessed in terms of the cost of implementing the scheme and the rate at which nurses re-trained using the Re-Connect scheme are retained in the system.

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

If the scheme results in large numbers of nurses re-entering the system who have been well-trained in evidence-based nursing practice, the quality of care delivered to patients would be expected to rise. However, this is an optimistic scenario as the numbers may not be large and the quality of the training offered and its ability to assist particpants to re-enter the workforce successfully has not been evaluated. Similarly, if enough nurses are re-trained to meet the needs of the system, their presence across NSW public hospitals could be expected to improve the equity of access for patients requiring hospital care. However, the extent to which this occurs depends on the numbers of nurses attracted back to the nursing workforce through this scheme. While the impact of the efficiency of the system cannot be judged accurately at this stage, the costs are unlikely to be very high. Thus, if the number of participants is relatively small the impact on overall efficiency is not likely to be great.

References

Sources of Information

www.nsw.health.gov.au/nursing/refresher.html

Commonwealth of Australia. The patient profession: time for action. Report on the inquiry into nursing. June 2002. www.aph.gov.au/senate

NSW Health. Recruitment and retention of nurses. Progress report. October 2002. www.nsw.health.gov.au/nursing

Doiron D, Jones G. NSW Nursing workforce transitions. Paper presented to the 25th Conference of the Australian Health Economics Society, Canberra, October 2003.

Author/s and/or contributors to this survey

Marion Haas, Rob Anderson, Jane Hall

Empfohlene Zitierweise für diesen Online-Artikel:

Marion Haas, Rob Anderson, Jane Hall. "Retaining nurses". Health Policy Monitor, October 2003. Available at http://www.hpm.org/survey/au/a2/5