Review of small rural health services in Victoria: how does the nursing-medical division of labour affect access to emergency care?

Aims This paper is based on a review of the Australian and International literature relating to the nursing-medical division of labour. It also explores how the division of labour affects patient access to emergency care in small rural health services in Victoria, Australia. Background The paper describes the future Australian health workforce and the implications for rural Victoria. The concept of division of labour and how it relates to nursing and medicine is critically reviewed. Two forms of division of labour emerge – traditional and negotiated division of labour. Key themes are drawn from the literature that describes the impact of a traditional form of division of labour in a rural context. Methods This paper is based on a review of the Australian and international literature, including grey literature, on the subject of rural emergency services, professional boundaries and roles, division of labour, professional relationships and power and the Australian health workforce. Results In Australia, the contracting workforce means that traditional divisions of labour between health professionals cannot be sustained without reducing access to emergency care in rural Victoria. A traditional division of labour results in rural health services that are vulnerable to slight shifts in the medical workforce, unsafe services and recruitment and retention problems. A negotiated form of division of labour provides a practical alternative. Conclusion A division of labour that is negotiated between doctors and nurses and supported by a legal and clinical governance framework, is needed to support rural emergency services. The published evidence suggests that this situation currently does not exist in Victoria. Strategies are offered for creating and supporting a negotiated division of labour

Shaping an Autralian nursing and midwifery specialy framework for workforce regulation: criteria development

One of the biggest obstacles identified in achieving Millennium Development Goals (MDGs) was the lack of available qualified health personal to meet the health needs of the global population. With nurses being the main workforce  component in health systems, the human resource challenge for most  countries is to address the reported shortage of nurses. Skill mix is one suggestion. In Australia, workforce projections indicated a shortage of 40,000 nurses by 2010. Toward the reform of the Australian health workforce, one project aimed to develop a nationally consistent framework for nursing and midwifery specialization based on knowledge and skills to generate the first national  database iteration for designated specialties. A literature review looked at the way nursing specialty practices were defined in the United Kingdom, the United States of America and Canada. Three international and three national sources of criteria for specialty nursing practice were mapped against each other. The result was six criteria synthesized to define nursing practice groups as Australian  nursing specialties. Each criterion was operationalized with criteria indicators to meet Australian expectations. The nurses in Australia commented on the criteria before they were finalized. An audit of national workforce databases identified nursing practice groups. The criteria were applied to identify nursing specialties and practice strands that would form a national nursing framework. This paper reports on the criteria developed to assess specialty practice at a national level in Australia