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Wednesday, 20 May 1970

Mr HAYDEN (Oxley) - I propose the matter of public importance which has been circulated in my name and read to the House. Only a fool would deny that a grave and deteriorating situation exists in the nursing services of our national public hospitals. Extreme disillusionment with remuneration, working conditions, education and training, and professional status have pushed nurses to the unparalleled position of threatening strike action. The nursing profession, more than any other group of employees in this nation, has been exploited financially and physically to prop up the nation's hospital services. It is disgraceful that this exploitation has prevailed for so long. To suggest that it should continue any longer is intolerable. These women and girls should not be called upon to make great personal sacrifices to help keep our under-financed, overstrained public hospital services in operation. It should be the aim in providing and maintaining health services to strike a high standard of excellence in this essential public service. Adequate public health services of this standard should be available to all according to need. The cost of maintaining these services should be the duty of all according to their means and it is gutless of any government - and all governments in Australia are guilty of this offensive behaviour - to try to evade this moral responsibility by gracelessly thrusting a large part of the burden of this cost on to the nursing profession.

Conditions of a nurse's employment involve certain undesirable indignities. For instance, nurses complain of having to mop floors, clean walls, wash dishes, wash linen, tidy kitchen cupboards, change bed side screen covers, perform central switchboard duties and messenger services, cook meals, undertake clerical duties outside those that are a nurse's responsibility and stoke boilers. What a miscellany. It is quite unreasonable that any group of people who are normally regarded as professionals in the community should be treated in this undignified manner. Often they are bowed down by petty procedural details, tyrannised by dated traditions and restricted in their liberty as individuals. In reality we ask of them on the one hand to fulfil the role of the hewers of wood and carters of water in the medical services, and on the other hand expect them equally to rise to the occasion in response to demands of a complex, technical and quite advanced nature in their role as professionals in our medical services. But these 2 roles are in conflict and inevitably lead to disillusionment and dissatisfaction for many nurses.

A nurse trained to perform complex, skilled techniques such as giving intravenous solutions receives a jar to her sense of professionalism and to her pride in technical skill when she is relegated to dull, intellectually undemanding tasks of a monotonous, repetitive nature such as cleaning bedpans or sputum mugs. Is it the measure of professionalism that our public hospital authorities seek to preserve for nurses to maintain for them an unwanted and offensive reputation for the calling as the bedpan brigade? Can there be any genuine quibble on the need for handsomely improved remuneration for nurses? For instance, a first year sister, that is, after 3 years training involving lectures, study and fairly regimented working hours and constricted private life, receives $48.40 per week in Canberra. After 4 years as a sister, she reaches the lavish heights of $54 per week. A Public Service Board Third Division base clerk, Class 1, female at 21 years, with no training, commences at $51.52 per week and at the fourth year rises to $59.31 per week. The clerk enjoys a 35-hour week - an unheard of luxury for the nurse who, as like as not, is working unpaid overtime. On this basis alone one finds dramatic cause for the current grave failure of the nursing profession to attract and hold adequate numbers of young women.

The 1969 annual report of the Conference of the Institute of Hospital Administrators emphasises this failure, reporting that a number of Victorian metropolitan public hospitals have recently had to close beds because of shortages of nursing staff. The governments of Australia continue to ignore the inadequacy of nurses' remuneration at the peril of our nation's public hospital services. How many more beds must be closed down before they act? To adopt a blinkered view of the role of the nurse as equivalent to that of any ordinary tradeswoman is certainly and surely to aggravate at a rapidly increased rate the current run-down in nursing services.

On the score of education and training of nurses, only now is there some activity to upgrade their standard and quality. This belatedness is in site of the references of the Martin and Wark committees on higher education. In any event it comes grudgingly and gracelessly in deference to the explicit threats of members of the nursing profession to take direct industrial action out of sheer frustration - a frustration born of generations of public exploitation of a nurse's sense of dedication and commitment to the sick. The Martin Committee urged, to use its own words, the provision of higher education for all who have the desire and capacity for it. That was several years ago but it is only in recent weeks that the Government has announced its interest in following this point up in relation to nurses.

The Wark Committee, as far back as 1966, urged positive action on higher education for nurses at colleges of advanced education. At page 50 of its report it stated:

The nursing profession in the community is directly influenced by the changes in outlook in the medical and para-medical fields. Entrance standards and training techniques and the possible employment of the resources of colleges of advanced education require further examination. The aim must be to have training suitable for all phases of nursing- to train some but not all nurses to a higher level than at present.

The Wark Committee was recommending a radical reappraisal of training for the nursing profession, lt is only in recent weeks that the Government has got around to announcing somewhat vaguely, but with some degree of concreteness, some proposals in respect of this important topic, it was the anger of the nurses which forced a grudging concession from the Government in this respect.

The 1967 report of the Institute of Hospital Matrons of New South Wales and the Australian Capital Territory entitled Report of the Committee to Consider all Aspects of Nursing' stated bluntly:

The present system of training is now producing a nurse who is restricted in outlook, resistant to change and unable to cope confidently with the scientific and technical advances in medicine and the social problems of the patients.

I stress that the Institute's report referred not to some recently innovated system but to one which, with modification, has been with us for a century or more. We should contrast the Australian situation with the situation in Canada where the responsible authorities are working towards university preparation of 25% of their professional nurses. This may not be the best answer, but at least Canada is acting positively and at a higher qualitative level than the responsible authorities in Australia are prepared to act. Quite obviously education for nurses needs radical recasting.

Not only must nurses be tenders of the sick and dying, giving their technical skill and even more importantly those invaluable ingredients, warm understanding and compassion; they must also be capable of administering staff and wards full of patients and meeting the requirements of those patients. A matron of a large public hospital has a very big and onerous administrative responsibility, although the extent of this is not reflected in her pay level. In spite of this there seems to be little preparation in the training of nurses essentially geared for this responsibility. Thus the Institute of Hospital Matrons, in a survey of 87 schools of graduate nursing, found 10% of graduate nurses employed in senior administrative positions but only 6.8% of this number possessed postgraduate qualifications.

In short, it is a cynical cruelty and a dishonourable deception for public authorities charged with conducting the nation's public hospitals to foster the fond belief in young women that nursing is an exalted position and then, once they are in the profession, to underpay, overwork and inadequately train them. The offence is doubly compounded by the lack of regard which these authorities display towards the need to elevate the status of the nursing profession. Already the wastage of entrants is high - indeed higher than in the United States of America or the United Kingdom. In the United Kingdom the wastage rate for student nurses over a 3-year course is between 30% and 40%. In the United States the wastage rate is about 33% for nurses in the 3-year diploma course. Robert Gillam's analysis 'Student Nurse Wastage in NSW' shows a rate of attrition for 87 training schools in New South Wales for the 3 intake years up to and including 1963 as ranging between 40% and 54%. Figures given to the Leader of the Opposition (Mr Whitlam) today by the Minister for Health (Dr Forbes) show an appalling wastage rate of 45% in the Australian Capital Territory and 64% in the Northern Territory for the 3-year training period ending in 1969. These 2 areas, clearly suffering the worst attrition rate in the Commonwealth, are the responsibility of the Federal Government. No public hospital in Australia has been able to restrain attrition to 10%, as has been done in some British hospitals. Additionally, the drain - a capital loss to the community because of the value a trained nurse represents - continues after graduation.

The Royal Australian Nursing Federation has published a study of the profession covering the years 1960 to 1967. This shows that 57% of trained nurses cease nursing within 4 years of graduation and 74% within 8 years of graduation. No doubt many retire because of marriage, but little is done to establish the best way of encouraging them back into the profession - for example, by the provision of re-training programmes at Government expense or child minding centres set up close to their employment. In any event, the Government seems' cavalierly unmoved by this phenomenally high rate of attrition at a time of developing crisis in Australia's nursing services. Gillam's work, which I referred to earlier, shows that the greatest source of recruits- to. nursing is the lower socio-economic groups, presumably because of the upward social mobility seemingly offered by the profession.

The development and better distribution of affluence in our society clearly indicates in the medium term that as other opportunities for this upward mobility present themselves to girls in this group there will be greater difficulties in attracting recruits from this area - that is. given the present extensive deficiencies in the appeal of the profession, this will surely be so. Consequently the long term prognosis for the profession in its supplying a public service of high standard is not good. Inevitably further overburdening of already tautly stretched womanpower resources will lead to collapse. Again, appointing full time specialist staff at public hospitals and eliminating the means test on public ward treatment, which are recommendations of the Nimmo Committee, currently being negotiated between the Commonwealth and the States will lead to a marked increase in demand for public ward treatment. This in turn will cause further stress on the already overstretched public hospital nursing services. All of this betokens a grave state in the nursing profession today. Remuneration, conditions of employment, education, training and, most importantly, professional status drastically need attention.

Who is to provide the cash, because it will cost a lot of money to rectify these failings as they have developed, been compounded and allowed to worsen over a very long time? Yet action is urgent if we are to stave off the collapse of important parts of our public hospital system. Clearly the States cannot foot the bill adequately. State finances are in a parlous condition. Applied Gorton centralism accentuates this situation. Health services lean especially heavily on State Budgets. The all States average per capita expenditure on hospitals alone was $14.14 in 1966-67. It is exceeded only by their average per capita expenditure on primary education, which amounted to SI 7.03. Each year the cost of the State health services spirals wildly. In 1966 an amount of $6.2m was written off as bad debts by the nation's public hospitals. Victoria alone writes off 30% of its public ward fees. Wages and salaries for our public hospitals assume the greatest proportion of total maintenance costs - between 65% and 70% of total cost. These facts indicate the magnitude of the challenge if we are to handle this problem.

Clearly the States need help, and especially do they need help for their nursing services. There is an SOS loud and distinct being sent out from all States, seeking Federal Government co-operation in funding and developing health services. If the appeal is ignored not only will the nursing profession experience a rapid movement into crisis but so, too, will our public hospital system, currently serving the nation. So far the Commonwealth has been cautiously restrained in its help of the State public hospital systems. Between 1964 and 1966 the Commonwealth increased its contributions to maintenance expenditure incurred by the nation's public hospital system by 9%. For the same period the State increase was 20% . This is public irresponsibility on the part of the Commonwealth Government but I regret that we have come to expect a reaction of this kind from this Government.

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