Australian Nursing and Midwifery: Now more than ever, opportunities for access, influence and innovation

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Australian nursing and midwifery professions are at a most extraordinary moment in our history/future. There are times when the systems in which we live and work feel tightly closed and change is profoundly difficult and other times when it feels like the world has opened up to different possibilities and that significant change and innovation are possible. This is, I believe, one of those all too rare and precious moments for change. These are the moments when leadership is critical and in Australia, nursing and midwifery are displaying leadership, nationally, regionally and internationally.

Internationally, there is a changed consciousness in relation to health, with a global recognition that the acute services focus of past decades is not only financially unsustainable but is also not addressing our health problems. Dr Margaret Chan, the Director-General of the World Health Organisation (WHO) in her introductory words in the 2008 World health Report said:

We see a mother suffering complications of labour without access to qualified support, a child missing out on essential vaccinations, an inner-city slum dweller living in squalor. We see the absence of protection for pedestrians alongside traffic-laden roads and highways, and the impoverishment arising from direct payment for care because of a lack of health insurance. These and many other everyday realities of life personify the unacceptable and avoidable shortfalls in the performance of our health systems (WHO, 2008, viii).

She goes on to suggest four essential reforms which “reflect the convergence between the values of primary health care, the expectations of the citizens and the common health performance challenges that cut across all contexts” (WHO, 2008, ix). These four reforms include (1) universal coverage to ensure health equity and social justice; (2) service delivery reform to reorganize services around the needs of the people they should be designed to serve, (3) public policy reform to ensure cross sector health related collaboration; and (4) leadership reform, different from the current hierarchical approach, but inclusive and collaborative.

Within Australia the Federal (national) government is demonstrating its commitment to reform in health and education. In the past months a number of key strategic policy initiatives have been released which open new possibilities for nurses’ and midwive's contribution to a new healthcare landscape. These announcements are demonstrative of the huge amount of work that has been done by our professions behind the political scene.

There have been budget announcements enabling nurse practitioners and eligible midwives access to the medical benefits scheme (MBS) which provides fee for service and reimbursement for diagnostic testing, and to the subsidized medicines scheme, the pharmaceutical benefits scheme (PBS). This strongly lobbied for change is a critical element of new primary health care reforms and new models of service delivery.

A further enabling policy change has been signaled in the Maternity Services Review ( Bryant, 2009), a review led by our government chief nursing and midwifery officer (GCNMO) Rosemary Bryant, which heralds an increase in midwifery-led models of care, a greater emphasis on continuity of care and which has finally enabled indemnity insurance for midwives. This was followed closely by the release of the final report of the National Health and Hospitals Reform Commission: A Healthier Future for All Australians (Bennett, 2009). This landmark document seeks to put the community's health at the center of concern, emphasizing indigenous health, mental health, dental health, prevention and early intervention, integration of services and an emphasis on primary health care initiatives. Few of these reforms are possible to achieve without significant leadership and practice development by nurses and midwives.

Alongside these government healthcare changes are two further major health related developments. Firstly, the introduction of a new government body – Health Workforce Australia which has two major functions – (1) the funding of innovations which lead to transformative service delivery change and expanded inter-professional practice and (2) maximizing health workforce education capacity by the funding and data management of clinical practice experiences for all health professionals. The second major initiative relates more closely to the health professionals themselves and that is the introduction of national regulation for the eleven currently regulated health professional groups. Here nursing and midwifery have shown real leadership and collaboration. More than five years of hard work has underpinned our readiness to move to national regulation. Through the Australian Nursing and Midwifery Council (ANMC), working closely with the peak professional, educational and industrial bodies and all the State regulatory authorities, nursing and midwifery have a suite of nationally agreed documents which will guide us through this significant transition. In all four pillars of regulation the work has been done. (1) Registration, with agreed competency expectations and levels of English language attainment, (2) accreditation, where much work has been done on accreditation standards for courses and providers, (3) professional competence, where workshops have been held to determine the best of the State based processes for dealing with health impairment, conduct or performance issues and finally (4) professional standards, where we have agreed standards for practice for all levels of nurses and for midwives, decision-making frameworks and codes of conduct and ethics. All four of these pillars underpin public safety and our professional standing and trust and thereby enable us to step out confidently into new roles and responsibilities.

This confluence of openings of access to MBS and PBS funding, the refashioning of community based service provision, clarity around professional standards and standards for programme accreditation have presented us with a freedom to step into new modes of working with people to positively influence their health and the health of our communities. In this we are the creators of our own barriers or the dreamers and creators of new ways of working. These opening are a testament to the enormous work of our nursing and midwifery organizations behind the scenes and to impressive collective and collaborative leadership.

Australian nursing and midwifery leadership does not stop at our national boundaries, however, and we play a significant regional role. By no means exhaustively but rather as exemplars let me take two areas Vietnam and the Western Pacific. In Vietnam at the moment there is an enormous amount of work being undertaken. The South Australian Nurses and Midwives Board is leading a development of health professional regulation, Queensland University of Technology is undertaking a major project on nursing competencies and educational capacity building and the University of Sydney is leading national midwifery curriculum development. This work is being done with all parties cognizant and respectful of the work of each other. The University of Technology, Sydney, through its WHO Collaborating Center, is playing a major role in the leadership development of nurses and midwives from the Western Pacific and acts as secretariat to the South Pacific Chief Nursing and Midwifery Officers Association (SPCNMOA), facilitating the strategic functioning of healthcare in that region.

At an international level we could be seen as “punching above our weight” too. Some examples include Anne Morrison of Queensland leading the regulatory section of the International Council of Nurses (ICN) in Geneva, Rosemary Bryant recently named as ICN's new President, Professor John Daly is currently international president of GANES (The Global Alliance for Nursing Education and Scholarship) and Professor Alan Pearson's baby, The Joanna Briggs Institute (JBI,) is now a major international multi disciplinary player in evidence based practice and policy. Professor Mary Chiarella recently authored a report for WHO on global nurse-led initiatives in primary health care which is now published on the WHO website, and the University of Sydney is hosting an international policy and research roundtable to begin a multi country initiative to enhance nurses and midwives access, input and influence in health policy.

This is truly a remarkable time for Australian nurse and midwives, indeed nurses and midwives everywhere – there is an opening in the landscape for change, a moment in history to influence healthcare futures. We have the research, the experience, the grounded coalface knowledge and the maturity and we have the responsibility to try, to make known what we know, to access, to influence and to innovate, “Now more than ever”.

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References 

1. WHO. World Health Report 2008: primary health care—now more than ever. Geneva: WHO, www.who.int.
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2. Bennett, C. (2009). A healthier future for all Australians: final report. Canberra: Australian Commonwealth Government, www.health.gov.au.
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3. Bryant, R. (2009). Maternity services review: improving maternity services. Canberra: Australian Commonwealth Government, www.health.gov.au.
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