and PATIENT CARE…
How things have changed in the health field over the last 20 years or so and not always for the better. While medical science is developing at a pace that is at the same time absolutely breath-takingly brilliant, and enormously expensive, our ability to administratively manage health has actually gone backward, at about the same speed.
We all know that the cost of health care, along with everything else, is going up but hospital management is not exactly rocket science. It's simply a matter of optimising a situation by managing assets and resources and staying within the funding available. Certainly we appreciate the problems of hospital managers and we know it's not always easy and not always totally within their hands.
We understand that there is some very expensive equipment and drugs out there and it all has to be added to the complications that managers have. As far as the public is concerned there are four main ingredients to the mix, doctors, nurses, patients and outcomes.
Unless you're on a waiting list, or perhaps a list to get you onto a waiting list, then outcomes for the patients, once actually treated are usually reasonably good, though there are some rather outstanding and well-publicised exceptions. There is of course an understandable priority system for medical attention depending on the seriousness of the ailment but as Australia's population ages it's easy to understand that the waiting list can have a person getting further away from treatment rather than closer, depending on how "progressive" their condition is.
Once in hospital and under treatment it is very rarely that you will hear a patient complain about the nurses. If anything people come out of hospital amazed at the dedication and empathy of the nurses, always qualified with the rider that "under the circumstances and the impossible workloads that they have" they did such a wonderful job.
Similar comments are heard in relation to the medical staff but again qualified with the workload problem. So why is it that these dedicated people, many of them nearing retirement age, under such pressure when they are probably the least expensive people in getting good outcomes for patients.
It is probably easiest explained by saying that it wasn't always like this. We had a good system, and then some "think tank" or perhaps an individual bureaucratic genius came along and changed it, stuffing it up completely in the process.
Take the case of our nurses. Once upon a time a young person, usually a young woman, but not always, would decide that nursing was the career for her. She would apply to a teaching hospital for a trainee position and if she made the grade she was in.
There was an initial "trial" period, both for the individual nurse and the training hospital. Nursing was not, and never has been, all beer and skittles. After a period of a month or two a person may decide that nursing was not exactly what they thought it would be and they could bow out gracefully having lost virtually nothing, but certainly a little wiser.
On the other hand the senior nurses and teaching staff may decide that a person was not suited to the profession and their training and employment would be discontinued, and, after a few months the hospital would have the trainee workforce that it wanted and the trainees had had the opportunity of knowing exactly what it was they had chosen as their career.
This initial attrition rate was well known to the hospital and its educators with provision being made for it. There was also a second wave of adjustment when time and training were complete. Many nurses would leave to start families of their own, or pursue some specialist area but the system was flexible enough to deal with this, after all, training was in the hands of the people that did the "hands on day to day" running of the hospital.
There were of course, as is always the case, times where demand got a bit ahead of supply but within the nursing fraternity it didn't take long for the matter to be corrected by a few good and selected nurses being enticed back.
Then the genius struck. It was decided that nurses needed a "higher and better" education and that Universities were just the place to get it. There was of course no outcry at the time that nurses were performing poorly, and many claim that the move was simply an empire building exercise by the tertiary education sector. Consequently, nurses from that point on had to complete a three-year tertiary course where aptitude and suitability were not required or tested prerequisites and hospital administrators were plunged into a brave new world.
It was recognised that there was a transition period necessary and during this time hospitals could run "re-training courses" for nurses who either wanted to come back into the profession or maintain their nursing status. Many did and we can only be very grateful that they made that decision.
Not all went according to plan with the nurses in training at Uni. There was of course the substantial decrease in practical training but another factor, common within the tertiary field came into play. Nursing was not up there with engineering, medicine and law as far as course entrance "scores" were concerned.
However, there were desirable courses with a little higher entry score than nursing and this score could be attained with a little hard work, and probably a little more maturity on a student's part. And it was an opportunity they took. Consequently there developed a lag, or shortage in nurses, and particularly experienced nurses so the time for the "re-training courses" was extended.
If we look at the situation we have today we can understand that with tight university budgets, the ability of students to upgrade courses and those who won't enter the ward situation when they have completed it becomes a distinct possibility that we will never catch up. This situation has been remedied by the introduction of the "enrolled" nurse as opposed to the "registered" nurse whose qualifications are arguably not as good as the in-service training of years ago.
Now lets make this much clear. The "old system" catered for the needs and technology of the time when the top-end technology was the
CAT Scan. As we know technology has moved on and is doing so on a daily basis with the now
Scan being evidence of fact.
In using the term "old system" for today's training purposes we have to upgrade the standard of training, which can only take place at a recognised training hospital that has in place the latest technology, or at least be up there as far as is practical.
In fact, we are not far away from the point where nurse training could become as specialised as medical training but even base training [for which there is an insatiable demand] should only be undertaken at a hospital of a certain higher standard. One thing is beyond dispute… we are desperately short of nurses.
There are now foreign nurses working in Australian hospitals and while this will also go to relieve the mess, some of them do have English as a very second language and it's very obvious. Many doctors who are highly experienced in the hospital environment want a reversion to the "old system" and they can only be supported in this regard.
Our doctor shortage, which is just as acute as that of the nurses, has a little different history.
In the early nineteen eighties health care costs were rising. It was calculated for every medico who graduated and took up a "provider number" that gave the right to access Medicare payments, cost the then Government something of the order of $250,000 a year. Because of factors quite unrelated to this, such as population increase, better medical techniques and the higher cost of advanced equipment medical costs to the Government were on the increase.
So again, at the behest of some "think tank" or again, individual genius, a quick and sure-fire methodology was developed to solve the problem. It was fascinatingly simple, stop training doctors, then there will not be the expense associated with treatment and there will be a lot of $250,000's saved. It's hard to believe, and there will be no admissions but that's about the way it was.
And so we finish up with the system we have today. Someone however has to get up and say that we can't let this situation continue. We can't keep working our doctors and nurses at the level of stress that they are presently experiencing. It now appears that some effort is being made to recommence hospital training for nurses and it's not before time.
Similarly with our medicos, more places are being made available but in the years wasted we have lost a lot of good trainers. No one will take responsibility for this and now the great likelihood is that those great social architects have now moved on to weave their magic in other areas of their alleged public management expertise.
But not let's cry over spilt milk. Let's just bring back the old system, as upgraded and modified, to work as well now as the former "old system" did in its day, thus enabling our health care future to get better.
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