Nursing in Australia

Two trainee nurses operating a neonatal incubator in 2011

Nursing in Australia has evolved in training and regulation since the 19th century.

There are many ways of becoming a nurse in Australia, including TAFE or university courses. There are many places in Australia where nurses can work, including hospitals and schools, with the opportunity to have flexible work hours. The salary of a nurse in Australia depends on what type of nurse they are and their years of experience. There are many career pathways one may follow within nursing, such as paediatric nursing, intensive care, oncology nursing, and emergency nursing.

History of nursing education

The Private Hospital, Wakefield Street in Adelaide became the first training hospital for nurses in South Australia under Alice Tibbitts (1854–1932) in the late 19th century.

Prior to the transfer of nursing education to the university sector, nurses were trained on the job in a three-year course of theory and practice instruction in hospital nursing schools and on the wards commencing with a 6-week preliminary training school (PTS) with the earliest accepted entry age being 17 years. First, second and third year student nurses were often distinguished by the number of stripes on their uniform caps and or belts. Hospital-based examinations were held each year and a successful pass meant progression to the next year and a fail meant a student nurse was cut, no second chances. Three years of student nursing culminated in final year exams. Student Nurses were paid employees of the parent hospital and there was no sick leave. If a student nurse missed time off through sick leave over the three years of training this time was added on to be worked at the end of the three years and if not worked a nurse was not allowed to graduate. Hospitals awarded distinctive badges and veils (think the flying nun) upon graduation. In addition, state registering authorities awarded a badge of registration. These were generally worn with pride on the uniform collars.

A nurse examining children at a school in Queensland in 1946

As early as the 1930s, attempts were made to establish university-credentialed nursing courses in Australia, most notably by then director of nursing at the Royal Melbourne Hospital and the University of Melbourne. As recently as the 1970s, Sandra Stacy, one of the first Australian nurses to attain a PhD enrolled in a school of anthropology to submit her thesis.

In the late 1970s, the Royal College of Nursing Australia pioneered a course that became the Diploma of Applied Science (Nursing), awarded by the Lincoln Institute in Melbourne (now part of La Trobe University and Cumberland College of Health Sciences in Sydney (now part of the University of Sydney). The transfer of nursing education to the university sector continued throughout the 1980s, and gradually hospital schools ceased operating. In the early 1990s, universities finally granted nursing education the same status as allied health, and granted bachelor degrees in nursing rather than diplomas for entry-level courses.

The first move towards baccalaureate recognition was the development of the Bachelor of Applied Science (Advanced Nursing), a postgraduate degree that required registration as a registered nurse as a prerequisite to admission, and completion of 16 units. This course is no longer offered, and has been superseded by the transition of "post basic courses" conducted by various hospitals as a form of in-service training to the tertiary sector. The College of Nursing still runs postgraduate certificate courses for nurses in many specialities.

The transfer of nursing education to the university sector from the hospital setting was the result of long-time efforts by leaders in Australian nursing, notably, pioneer nurse educator Merle Parkes. Predictably, it was opposed by the medical hierarchy who viewed the development of highly trained professional nurses as a threat to their monopoly on the delivery of high-level health care. Many nurses themselves opposed the transfer on the grounds that "hands on experience in hospitals" would be lost and this concern was subsequently validated by the gradual minimisation of hospital based practicum sessions from the University courses when the supervision of the nursing students became onerous. One underlying cause of the opposition was that of views rife in society, which were promoted by the medical profession, toward appropriate gender roles: nursing as a "female" profession and medicine as a "male" profession. Similar sexist biases came to the fore within the under- and post-graduate training schemes for doctors and which present an evolving source of contention

Historically, a "double-" or "triple-certificated sister" would have been a registered nurse who held general, midwifery, psychiatric, or other range of certificates. The post-nominal "RN (DC)" or "RN (TC)" was used by some nurses to signify this attainment.

Nurse practitioners

In December 2000 the first nurse practitioner was authorised to work in Australia. By 2015 there were approximately 700 practising throughout Australia. To become a nurse practitioner, application to the Nursing and Midwifery Board of Australia (NMBA) is required as a first step. The applicant is then required to provide affirmation of the following to be considered:

• General registration as a nurse;
• The required hours of experience in a leading practice, which is 3 years full-time within the space of the previous 6 years; and
• A masters degree from an approved provider.

Legal regulation

The practice of nursing used to be governed by state and territorial nursing regulation authorities. The Australian Nursing and Midwifery Accreditation Council (ANMAC) was established in 1992 and worked with those authorities to facilitate a national approach to nursing and midwifery regulation. ANMAC was superseded by the Nursing and Midwifery Board of Australia(NMBA).

As of 1 July 2010, nurses are regulated by the Nursing and Midwifery Board of Australia, an agency under the Australian Health Practitioner Regulation Agency (AHPRA) under the National Registration and Accreditation Scheme.

A Nurse Practitioner caring for a newborn

Types of nurses

Nurses fall into the following major categories:

• Nurse practitioner (NP)
• Registered nurse (RN)
• Enrolled nurse (EN)

An assistant in nursing (AIN) supports the above nurses.

Mandatory registration requirements

Before being able to work, nurses must become registered in Australia. There are specific registration requirements that all new applicants and applicants renewing their registration: must meet:

• Criminal history check (international since 2015)
• Professional indemnity insurance arrangements
• English language skills
• Continuation of professional development
• Recency of practice

Education

Registration as a registered nurse now requires a Bachelor of Nursing, considered the foundation for any future specialisation within nursing. Postgraduate diplomas provide further vocational training for specialist areas. Masters level courses are available in both research and course work streams; a specialist course has been developed to provide preparation for registration as a nurse practitioner. Professional doctorates are also available.

Australia has a long tradition of post-basic courses, usually of a six-month (minor) or twelve-month (major) duration, which included midwifery, maternal and child welfare, psychiatric, peri-operative (theatre nursing), intensive care, and coronary care in later years, as well as a myriad of other courses. They are now provided by the university sector as postgraduate diplomas or post graduate certificates, depending on the length and complexity.

There are options available for hospital-trained nurses to upgrade their qualifications to a Bachelor of Nursing (post registration). However, most opt instead to undertake specialist courses such as a postgraduate diploma or certification in the area of their clinical interest.

Enrolled nurses (Endorsed) complete a Diploma of Nursing and are trained in the "technical and further education" (TAFE) sector and also universities, although still obtaining the same degree. Course length is 18 months and includes a module that permits enrolled nurses to dispense oral, rectal and transdermal medications, as well as perform intramuscular injections, subcutaneous injections, and intradermal injections. Additional post-graduate certificates are offered, including administration of intravenous medications. Diploma (Endorsed) and Certificate nurses can attend university to gain a Bachelor of Nursing in just two years, as their previous qualification allows most to enter at second year.

Twenty-nine per cent of registered nurses in Australia received their first nursing qualification in a country other than Australia and nurse migration trends to Australia have seen an increase in international nurses from developing countries.

Professional titles

The professional courtesy title "sister" has fallen into disuse and disapproval, even though it was formerly used by both male and female registered general nurses. The title "nurse" was used when addressing enrolled nurses.

Salary

The salary of a nurse depends on two factors: the type of nurse and the years of experience in the position.

• Nurse Practitioner: $118,419 to $123,629
• Registered Nurse: $63,468 to $92,954
• Endorsed Enrolled Nurse: $54,701 to $68,216
• Assistant in Nursing: $52,228 to $57,182

The initial figure would be the commencing salary, then after years of experience the nurse could potentially receive the larger figure. Figures for registered and enrolled nurses range from the lowest graduate public sector salary to the top increment without higher level, advanced skill or senior roles. The salary rates above are the most current rates in Australia, which are from 1 January 2020.

See also

• Australian College of Nursing
• Nurses and Midwives Tribunal, superseded complaints forum

==References==

Further reading

• Chiarella, M. The Legal and Professional Status of Nursing. New York: Churchill Livingstone, 2002.
• Dooley, G. The Transfer of Australian Nursing Education from Hospitals to Tertiary Institutions: An Annotated Bibliography. Bedford Park, S. Aust: South Australian College of Advanced Education Library, 1990.
• Russell, R. Lynette. From Nightingale to Now: Nurse Education in Australia. Sydney: Harcourt Brace Jovanovich, 1990.
• Schultz, Bartz. A Tapestry of Service: The Evolution of Nursing in Australia. Melbourne: Churchill Livingstone, 1991.

External links

• Department of Health - Nursing