Nurse work force planning

INTRODUCTION

Victoria, along with most other Western economies, has experienced difficulties in recruiting and retaining nurses within the hospital system.

In recent times there have been increases in the remuneration of nurses in the Victorian public hospital system and improvements in their working conditions. The catalyst for these were:

• The ratification of the 2000 Enterprise Bargaining Agreement by the Australian Industrial Relations Commission (AIRC) which introduced, among other things, mandatory nurse:patient ratios; and

• The commissioning by the Government of a major report by the Nurse Recruitment and Retention Committee. Some of the Committee’s recommendations formed part of the AIRC decision.

The Government launched the Victorian Nurse Recruitment and Retention Strategy in September 2000 which included 10 work force initiatives. The major initiatives related to re-entry and refresher training aimed at re-skilling to work-ready level those nurses who were no longer working as nurses.

WHAT DID THE AUDIT ADDRESS?

The overall objective of this audit was to determine whether effective and efficient arrangements are in place for planning and managing the supply of, and demand for, appropriately qualified nurses across Victoria.

The audit assessed:

• whether the Department of Human Services is implementing appropriate actions to improve nurse work force planning processes;

• the efficiency and effectiveness of public hospital nurse work force planning and management at the local level;

• the efficiency and effectiveness of initiatives to encourage appropriate recruitment and retention of nurses; and

the efficiency and effectiveness of linkages between the Department, hospitals and nurse education providers in relation to work force planning.

This audit focused on acute public hospitals as they are the major providers of health services in Victoria. The audit included coverage of:

• the Department as the Statewide health policy-maker and planner;

• acute public hospitals as employers of nurses; and

universities as the suppliers of Division 1 nurse education and Vocational Education and Training (VET) providers as the suppliers of Division 2 nurse education.

AUDIT CONCLUSION

We concluded that the Nurse Recruitment and Retention Strategy has been successful in introducing additional nurses into the Victorian public hospital system, including nurses in hard-to-fill specialties. A full assessment of the Strategy’s impact was hindered by limitations in the data collected.

There has been:

• a significant increase in the ageing of the nurse work force between 1995 and 2001, with an increased proportion of nurses over 40 years of age;

• a large reduction in the number of nurses not working as nurses, thereby reducing the pool from which to draw potential candidates for future Refresher and Re-entry Programs; and

despite a heightened level of interest in university nursing courses as measured by increasing applications for places, total nursing enrolments have declined with only a slight increase in the number of full-time students.

This will make it even more difficult to meet the demand for nurses in future.

In relation to each audit objective, we concluded that:

• For the latter part of the 1990s insufficient attention was paid by the Department to the emerging shortages in nursing. While valid reasons existed for delays in conducting nurse work force studies such as the implementation of the 2000 Enterprise Bargaining Agreement, the Department now needs to give greater priority to formal nurse work force planning. The Department has confirmed this as a major priority area;

• Work force planning at the hospital level was generally limited, with little forecasting of work force requirements beyond the following year. Hospitals need guidance to improve their work force planning;

• While the Nurse Recruitment and Retention Strategy has resulted in additional nurses entering the public hospital system, a full assessment of the Strategy’s impact was hampered by data limitations;


• It is too soon to determine the impact of restrictions introduced by the Department to limit nurse agency usage and costs, given that nurse demand fluctuates seasonally and the effects of increased nurse demand over winter are yet to be felt; and

There were poor linkages between the Department, education providers and public hospitals in relation to nurse work force planning.

KEY FINDINGS

Department of Human Services’
work force planning

The Department commissioned an evaluation of the 1991 and 1993 nurse work force studies which reported in 1999. The last major work force study into supply and demand for nurses also reported in 1999. It is now important that priority be given to commence a further major work force study.

As the 1999 work force study used similar methodologies to the 1991 and 1993 studies, many of the shortfalls identified in the 1999 evaluation of these previous studies were evident in the 1999 work force study. This included the failure to identify nursing specialties and to distinguish between Division 1 and 2 nurses.

Work force planning is hampered by either unreliable or unavailable work force data. It is critical that basic data in areas such as staff turnover and the mix of full-time and part-time employees be gathered. In the meantime, smaller work force studies could be undertaken which would feed into a larger study.

Nurse work force planning by hospitals

Nurse work force planning by hospitals was generally undeveloped. Only 30 per cent had a formal work force plan.

Forecasting models were generally not rigorous or robust, with a limited number of data inputs and inadequate support systems. At the time of our audit, hospitals were dissatisfied with the performance of new payroll systems. The priority of hospitals was on ensuring basic payroll functions were properly undertaken, rather than the generation of work force reports.

Initiatives for nurse recruitment and retention

The audit examined 3 initiatives of the Department in detail. These were the provision of Refresher and Re-entry Programs, Postgraduate Scholarships and Continuing Nurse Education. These initiatives were found to be successful.

Potential improvements include the better linking of funding for Refresher and Re-entry Programs to actual hospital vacancies, and improved data collection processes to monitor and evaluate the initiatives.

There was also the potential to improve the targeting of initiatives through the expansion into areas such as the provision of additional career opportunities in non-managerial generalist nursing.

Restrictions on agency use

With effect from 4 April 2002, the Government introduced restrictions on the use of nursing agency staff in response to substantial increases in agency usage and costs. These increases were confirmed by this audit.

The assessment of the impact of these restrictions was hampered by the absence of regular Statewide data on trends in agency usage and costs. The audit recommended that existing indicators be bolstered by more agency-specific indicators.

Linkages between key stakeholders

The audit disclosed that there were existing communication linkages on the nursing work force between universities and hospitals and the Department and hospitals. However, there was no mechanism to allow co-ordinated decision-making by the key stakeholders involved in the supply of, and demand for, nurses such as the university and VET sectors, hospitals and the Department.