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1 Australia s Health Workforce Series Nurses in focus hwa.gov.au

2 Health Workforce Australia This work is copyright. It may be reproduced in whole or part for study or training purposes. Subject to an acknowledgement of the source, reproduction for purposes other than those indicated above, or not in accordance with the provisions of the Copyright Act 1968, requires the written permission of Health Workforce Australia (HWA). Enquiries concerning this report and its reproduction should be directed to: Health Workforce Australia GPO Box 2098 Adelaide SA 5001 Telephone Internet Suggested citation: Health Workforce Australia 2013, Australia s Health Workforce Series Nurses in focus, Health Workforce Australia: Adelaide

3 Contents Introduction... 2 How many nurses?... 4 What sectors and settings do nurses work in? Where are nurses located? How many nurses is Australia producing? How many nurses are from overseas? Summary Technical notes... 48

4 Introduction This issue of Australia s Health Workforce Series brings together information from various sources to provide a picture of the nursing workforce in Australia. The National Review of Nursing Education 2002 Our Duty of Care noted that: Nurses are a vital part of the health, aged and community care systems in Australia. The work they do not only supports those who have particular care needs but also underpins much of the social structure in communities and care facilities. This is reinforced by the fact that nurses comprise a substantial proportion of the health workforce 1. The health environment nurses operate in is changing, and nursing roles have, and are, continuing to evolve to match the environment. There is an ongoing trend for increasing hospital admissions, reduced lengths of stay, increased acuity and greater use of technology. More care and more complex care is being provided in the community, additional aged care beds are being opened and nurses are taking on more roles and more diverse roles 2. As well as providing care, the nursing role encompasses health promotion and prevention, education and management and for nurse practitioners, extends to providing primary care by assessing and managing clients including providing referrals and prescribing medications. For the essential role nurses play in Australian society, combined with the fact they make up a substantial proportion of Australia s health workforce, it is important to understand the characteristics and the supply sources of Australia s nursing workforce. 1 Australian Institute of Health and Welfare Australia s health Australia s health series no. 12. Cat. no. AUS 122. Canberra: AIHW. 2 Australian Nursing Federation. Submission to the National Health and Medical Research Council (NHMRC) on the research program to address issues of Preventative Healthcare and Strengthening Australia s Social and Economic Fabric. Australia s Health Workforce Series - Nurses in focus 02

5 Structure of the nursing workforce There are two levels of regulated nurses in Australia Registered Nurses (RNs) and Enrolled Nurses (ENs). A RN is a person who has completed as a minimum, a three-year bachelor degree and is registered with the Nursing and Midwifery Board of Australia (NMBA). RNs practise independently and interdependently, assuming accountability and responsibility for their own actions and delegation of care to ENs and other healthcare workers. An EN usually works with RNs to provide patients with basic nursing care, doing less complex procedures than RNs. ENs must complete a also registered with the NMBA. To maintain registration, both RNs and ENs are subject to a recency of practice standard where they must development standards set by the NMBA. publication. In this publication, 2011 National Health Workforce Dataset (NHWDS) information is used to describe the most recent characteristics of Australia s nursing workforce. To examine the characteristics of Australia s nursing workforce over time, information from the 2003 to 2009 Australian Institute of Health and Welfare (AIHW) Nursing and Midwifery Labour Force Surveys is used. This is because the 2011 NHWDS was collected using a different survey methodology to previous nursing and midwifery labour force surveys (refer technical notes at the back of the publication), and comparisons with previous years is not recommended. Data sources The main data sources used in this report are: The National Health Workforce Dataset (NHWDS): nurses and midwives The NHWDS combines data from the National Registration and Accreditation Scheme (NRAS) with nursing and midwifery workforce survey data collected at the time of annual registration renewal. The nursing and midwifery workforce survey is administered through the national registration body, the Australian Health Practitioner Regulation Agency, on behalf of Health Workforce Australia. The NHWDS is collected using a different survey methodology to previous nursing and midwifery labour force surveys. Comparison with data from previous survey years is not recommended, and in this publication, 2011 data is presented on its own. The overall response rate to the nursing and midwifery workforce survey was 86 percent in 2011, the highest ever recorded. Further information on the NHWDS can be this publication. The Australian Institute of Health and Welfare (AIHW) Nursing and Midwifery Labour Force Survey. Before the introduction of the NRAS, this survey collected information about the demographics and employment of individuals registered in the nursing and midwifery professions. It was administered by the nursing and midwifery regulatory authorities in each jurisdiction, usually in conjunction with the registration renewal process. Response to the AIHW survey was voluntary and in 2009 the overall response rate was estimated to be 44 percent. The response rate was lower for ENs (41 percent) than for RNs (45 percent). In 2003, the Nursing and Midwifery Labour Force Survey underwent major revisions to the questionnaire design, data processing and estimation method. As such, the time series analysis incorporated in this publication is from 2003 to 2009 (noting the survey was not run in 2006). The Department of Industry, Innovation, Science, Research and Tertiary Education, (DIISRTE) Higher Education Statistics Collection, which provides data for enrolments and completions of students in general nursing courses required for initial registration as a registered nurse. National Centre for Vocational Education and Research (NCVER) VET provider collection (also known as the Students and Courses collection). This is an administrative collection of information on students, the courses they undertake and their achievement in the VET sector. The information is sourced from student enrolment records and it is an annual national collection. The scope of the collection has progressively widened over time and broadly covers the public VET system. Department of Immigration and Citizenship (DIAC) administrative data, which includes applications granted to RNs and ENs for the temporary business long stay (sub-class 457) visa type and for permanent migration outcomes. Australia s Health Workforce Series - Nurses in focus 03

6 How many nurses? The number of nurses in 2011 In 2011 the total number of registered and enrolled nurses was 328,817. Under the NRAS, people can register as nurses, midwives or both. Nurses who were also registered as midwives (dual-registered nurses and midwives) are included in nurse registration totals in this publication. Those registered as midwives only (of which there were 1,863 in 2011) are not included in 2011 totals in this publication (refer technical notes at the end of this publication). Of the 328,817 nurse registrations in Australia, the majority were registered as RNs (82 percent or 268,883), while those registered as ENs accounted for 18 percent (or 59,934) of total nurse registrations. In 2011, employed dual-registered nurses and midwives who reported their principal area of practice as midwifery are considered to be midwives, and are excluded from the employed nursing population (refer technical notes at the end of this publication). Most RNs (87 percent) and ENs (95 percent) were in the labour force. Of those in the labour force, most were employed in nursing (94 percent of RNs and 93 percent of ENs), with small percentages on extended leave or looking for work (Figure 1). Australia s Health Workforce Series - Nurses in focus 04

7 Figure 1: Registered and enrolled nurses by labour force status, 2011 Nurse registrations {328,817} Registered nurses {268,883} 81.8% Enrolled nurses {59,934} 18.2% In nursing labour force {290,899} Not in nursing labour force {39,917} 234, % 56, % 34, % 3, % Employed in nursing {271,996} 219, % 52, % On extended leave {14,446} 11, % 2, % Looking for work in nursing or midwifery (a) {4458} 2, % 1, % Employed elsewhere and not looking for work in nursing {6140} 4, % 1, % 174, % 14, % 9, % Clinician {214,321} Administrator {15,700} 39, % 1, % Teacher or educator {10,196} % Employed or on extended leave in midwifery {13,803} 13, % 4, % % Not employed and not looking for work {5134} 1, % Employed in nursing overseas {10,628} Researcher {2531} 10, % % 2, % 18, % Other {29,248} % 11, % Retired from nursing in Australia {2213} 1, % % (a) Includes 332 dual-registered nurses and midwives who may be looking for work in midwifery. It is not possible to identify which area people are looking for work in, therefore the 332 dual-registered nurses and midwives looking for work are included in both the nursing and midwifery labour force. Note: numbers in brackets are total registered and enrolled nurses, numbers in bold relate to registered nurses and plain to enrolled nurses. Nursing role is based on main nursing job. Source: NHWDS: nurses and midwives Australia s Health Workforce Series - Nurses in focus 05

8 How does Australia compare internationally? International comparisons provide a useful means for examining performance against the experiences of other countries. In 2009, there were 10.1 nurses per 1,000 population in Australia. This rate was higher than the Organisation for Economic Co-operation and Development (OECD) average (8.6). Different allocations of tasks between nurses and other health professionals may contribute to variations in rates across countries. Figure 2: Nurses, density per 1,000 population (headcount), OECD countries, 2010 (or nearest year) SWITZERLAND (a) DENMARK (a) BELGIUM (c) ICELAND (a) NORWAY (a) IRELAND (b) GERMANY (a) LUXEMBOURG (a) SWEDEN (a) UNITED STATES (b) JAPAN (a) AUSTRALIA (a) NEW ZEALAND (a) (a) Practising nurses, those providing care directly to patients, unless otherwise indicated. (b) Professionally active nurse, which includes practising nurses plus other nurses working in the health sector as managers, educators, researchers, etc. (c) All nurses who are licensed to practice. Source: OECD Health Data UNITED KINGDOM (a) FINLAND (a) CANADA (a) FRANCE (b) NETHERLANDS (a) SLOVENIA (a) CZECH REPUBLIC (a) AUSTRIA (a) ITALY (c) HUNGARY (a) ESTONIA (a) SLOVAK REPUBLIC (b) PORTUGAL (b) POLAND (a) SPAIN (a) ISRAEL (a) KOREA (a) GREECE (b) MEXICO (a) TURKEY (b) CHILE (c) Australia s Health Workforce Series - Nurses in focus 06

9 Changes in nursing numbers 2003 to 2009 for multi-state registrations). RNs increased by a greater percentage (up 19 percent from 218,615 to 260,121) than ENs (up 11 percent from 54,762 to 60,861) over the period (Figure 3). RNs accounted for approximately 80 percent of all nurses in each of the six years from 2003 to Figure 3: Registered and enrolled nurse registrations Registered nurses Enrolled nurses All nurses 350, , ,000 Number 200, , ,000 50, Source: AIHW Nursing and Midwifery Labour Force Survey 2003 to The employment status of nurses is similar over time and across the two workforces. For RNs in 2009: For ENs in 2009: Australia s Health Workforce Series - Nurses in focus 07

10 Changes in nursing role 2003 to 2009 management of clinical nurses. This was further categorised into clinical nurses (direct patient care) and clinical nurse managers and/or administrators (managing clinical nurses and midwives). > Lecturer, nurse/midwife educator, supervisor of new nurses/midwives: a person who teaches or trains people in nursing for their initial > Researcher: a person engaged in nursing research. > Other: not any of the above, for example, industrial relations or public health activities in nursing. In the NHWDS: nurses and midwives 2011, the distinction between clinical and non-clinical nurses is still made. However clinical nurses only comprise those providing direct patient care. Those involved in the supervision and management of clinical nurses (which were included as clinicians in the AIHW Nursing and Midwifery Labour Force Survey) are now counted as non-clinicians. The non-clinician role In 2011, most employed RNs and ENs worked in clinical roles, providing direct patient care (4 in 5 of all employed RNs and 3 in 4 of all employed ENs). Most non-clinical RNs and ENs reported a role of other (18,123 RNs and 11,126 ENs), followed by administrator (14,498 RNs and 1,202 ENs), teacher or educator (9,612 RNs and 584 ENs) and researcher (2,398 RNs and 134 ENs) (Figure 1). The number of employed RNs increased across all nursing roles from 2003 to Almost all were in a clinical role in 2009 (90 percent or 203,636), with 86 percent (174,962) of these providing direct patient care. While much smaller in number, non-clinical RNs increased by a greater percentage from 2003 to 2009 (up 69 percent) compared with clinical RNs (up 15 percent over the same period). Those reporting as a lecturer/educator and/or supervisor increased by over a third (37 percent or 2,448), however most growth was in those reporting other. This category, which includes roles involved in policy, industrial relations, regulation etc, more than doubled from 4,170 in 2003 to 10,153 in 2009 (Table 1). The number of employed ENs also increased overall from 2003 to 2009, with the greatest increase in number occurring in those reporting as clinical nurses. Employed clinical ENs increased by approximately 2,200 (5 percent) to be 45,852 in Similar to RNs, there was also a large increase in non-clinical ENs, both in number (up by 2,129) and percentage (up 88 percent). This was also a result of many more reporting other. The remaining EN categories experienced small reductions in numbers from 2003 to 2009 (Table 1). Australia s Health Workforce Series - Nurses in focus 08

11 Table 1: Employed registered nurses and enrolled nurses by role, 2003 and 2009 Number Percentage {%} Change 2003 to 2009 {%} Registered nurses Clinicians Clinical nurse 152, , Clinical nurse manager/administrator 24,042 28, Total clinicians 176, , Non-clinicians Lecturer/educator and/or supervisor of new nurses 6,591 9, Researcher 1,940 2, Other 4,170 10, Total non-clinicians 12,701 21, Total 189, , Enrolled nurses Clinicians Clinical nurse 43,647 45, Clinical nurse manager/administrator 1,495 1, Total clinicians 45,142 47, Non-clinicians Lecturer/educator and/or supervisor of new nurses Researcher Other 1,769 3, Total non-clinicians 2,432 4, Total 47,574 51, Source: AIHW Nursing and Midwifery Labour Force Survey 2003 and Australia s Health Workforce Series - Nurses in focus 09

12 Nurse practitioners Since then, the number of nurse practitioners has increased, with 736 nurses holding a nurse practitioner endorsement in The National Competency Standards for the Nurse Practitioner 5 A registered nurse educated and authorised to function autonomously and collaboratively in an advanced and extended clinical role. The NP role may include, but is not limited to, the direct referral of patients to other healthcare professionals, prescribing medications and ordering diagnostic investigations. 6 and demonstrated competencies, to be endorsed by the NMBA as a NP. NP-led clinics now exist within Australia, and from 1 November 2010, NPs working in collaborative arrangements with medical practitioners are able to access Medicare arrangements demonstrated by: 7 Principal area of main job (clinical nurses only) user-pays basis. Completion is not recognised on a nurse s registration however it can be an employment requirement. Both the NHWDS and the AIHW Nursing and Midwifery Labour Force Survey reports nurses principal area of main job. This is the area nurses reported working the 3 Australian College of Nurse Practitioners website. Available at: Accessed 23 March Australian Health Practitioner Regulation Agency Annual Report Australian Nursing and Midwifery Council. National Competency Standards for the Nurse Practitioner. Available at: Accessed 16 November Ibid. 7 Collaborative Arrangements for Participating Midwives and Nurse Practitioners Fact Sheet. Medicare Finance and Analysis Branch. Australia s Health Workforce Series - Nurses in focus 10

13 Principal areas of main job from one area to another or work across areas. The question response options used in the 2011 Nursing and Midwifery Workforce Survey were different to those used in the AIHW Nursing and Midwifery Labour Force Surveys (2009 and previous years). The 2011 principal area of main job categories are outlined below. Aged care nurses provide nursing care to the elderly in community settings, residential aged care facilities, retirement villages and healthcare facilities. Community health nurses provide nursing care, health counselling, screening and education to individuals, families and groups in the wider community with a focus on patient independence and health promotion. Critical care and emergency nurses provide nursing care to critically ill patients and patients with unstable health following injury, surgery or during the acute phase of diseases, integrating new technological equipment into care in settings such as high dependency units, intensive care units, emergency departments or retrieval services. Education design, planning, implementation, evaluation and delivery of nursing education and staff development programs, and management of educational resources. Family, maternity and child health nurses provide nursing care to children from birth to school age and their families, with an emphasis on: the prevention; early detection of; and early intervention in; physical, emotional and social problems affecting children and their families. Care includes assistance with parentcraft, immunisation and developmental milestones. General practice/medical practice includes clinical care to patients, clinical organisation and practice administration, and the facilitation of communication within a general practice environment and between the practice and outside organisations and individuals. Management the management of a health service unit or sub-unit of a hospital, aged care or community healthcare facility, for a particular unit, and monitoring of quality, clinical standards and professional development of nurses. Medical nurses provide nursing care to patients with conditions such as infections, metabolic disorders and degenerative conditions, which need medical intervention in a range of health, aged care and community settings. Mental health nurses provide nursing care to patients with mental health illness, disorder and dysfunction such as schizophrenia, work in hospitals, community mental health services, residential mental healthcare services, welfare and aged care facilities, correctional services and the community. Maternity care (a) nursing care and advice to women during pregnancy, labour and childbirth, and postnatal care for women and babies in a range of settings such as the home, community, hospitals, clinics and health units. Mixed medical/surgical provide nursing care to patients with conditions such as infections, metabolic disorders and degenerative conditions, which need medical intervention in a range of health, aged care and community settings, as well as providing care to patients with injuries and illness that need surgical intervention. Paediatrics provide nursing care and advice regarding internal diseases and disorders in children from birth up to, and including, adolescence. Peri-operative nurses provide nursing care to patients before, during and immediately after surgery. They assess patients conditions, plan nursing care for surgical intervention, maintain a safe and comfortable environment, assist surgeons and anaesthetists during surgery, and monitor patients recovery from anaesthetic. Rehabilitation and disability nurses provide nursing care to patients recovering from injury and illness. They assist and facilitate patients with disabilities to adapt to their disabilities, achieve their greatest potential, and work toward productive, independent lives. Continues next page Australia s Health Workforce Series - Nurses in focus 11

14 Research the design, conduct and evaluation of nursing and interdisciplinary research projects, and promotion of the Surgical nurses provide nursing care to patients with injuries and illness that need surgical intervention. Other includes all other areas of nursing practice not covered above, such as nurses working in policy, industrial relations, regulation and other areas. (a) On the 2011 Nursing and Midwifery Workforce Survey, midwifery, rather than maternity care, was listed as an option for the principal area of main job. Most people who reported midwifery as their principal area of main job were dual-registered nurses and midwives, who are considered to be midwives, and are excluded from this report. A small number of people registered as a nurse only reported their principal area of main job as midwifery. It is assumed these nurses are providing maternity care as only people registered as midwives can provide midwifery services. As this publication provides information on nurses only, the principal area of main job has therefore been referred to as maternity care. For more information, see technical notes. Principal area of main job in 2011 The highest percentage of clinical RNs (14 percent or approximately 24,100) worked in critical care and emergency in Approximately one-quarter (26 percent or 44,654) of clinical RNs worked in medical, surgical and mixed medical/surgical areas (Figure 4). Almost one-third of clinical ENs worked in aged care (31 percent or approximately 12,300). This was more than double the size of clinical ENs second most popular principal area of main job medical with approximately 4,600 ENs. Figure 4: Employed clinical registered and enrolled nurses, by principal area of main job, 2011 Registered nurses Enrolled nurses CRITICAL CARE & EMERGENCY SURGICAL AGED CARE MEDICAL PERI-OPERATIVE OTHER MENTAL HEALTH COMMUNITY HEALTH MIXED MEDICAL / SURGICAL GENERAL PRACTICE / MEDICAL PRACTICE PAEDIATRICS REHABILITATION & DISABILITY FAMILY, MATERNAL & CHILD HEALTH OTHER AREAS (a) MATERNITY CARE Percent {%} (a) Includes the principal areas of management, education and research. Source: NHWDS: nurses and midwives Australia s Health Workforce Series - Nurses in focus 12

15 Changes in principal area of main job 2003 to 2009 For both RNs and ENs, the highest percentages of clinical nurses worked in medical/surgical in both 2003 (31 percent for RNs and 35 percent for ENs) and 2009 (31 percent for RNs and 39 percent for ENs). Medical/surgical is primarily hospital-based and covers many areas. Medical areas include cardiology, endocrinology, infection control and general medical nursing. Surgical areas include burns and plastics, ear, nose and (refer principal areas of main job box). The top two principal areas of practice most clinical RNs worked in were the same in 2003 and Medical/surgical, as noted above, had the highest percentage of the clinical RN workforce, followed by critical care, which increased from 14 percent of clinical RNs (22,732) to 19 percent (39,404). This increase was partially offset by a fall in the percentage of RNs working in aged care from 11 percent (or 18,313) in 2003 to 8 percent (or 16,431) in Similarly for ENs, the top two principal areas remained the same in 2003 and 2009 medical/surgical followed by aged care. However, the was offset by a substantial increase in the number of ENs reporting critical care as their principal area of main job, almost quadrupling from 1,079 in 2003 to 4,093 in 2009 (to be the third highest principal area of main job for ENs in 2009). Figure 5: Employed clinical registered nurses, by principal area of main job, 2003 and 2009 Figure 6: Employed clinical enrolled nurses, by principal area of main job, 2003 and REHABILITATION/DISABILITY FAMILY & CHILD HEALTH MENTAL HEALTH OTHER COMMUNITY HEALTH AGED CARE PERIOPERATIVE MIDWIFERY CRITICAL CARE MEDICAL/SURGICAL FAMILY & CHILD HEALTH MIDWIFERY COMMUNITY HEALTH PERIOPERATIVE REHABILITATION/DISABILITY MENTAL HEALTH OTHER CRITICAL CARE AGED CARE MEDICAL/SURGICAL Percent {%} Percent {%} Source: AIHW Nursing and Midwifery Labour Force Survey 2003 and Source: AIHW Nursing and Midwifery Labour Force Survey 2003 and As highlighted above, both aged care and critical care experienced substantial changes in workforce numbers between 2003 and 2009, with the number of RNs and ENs in aged care falling, while the number in critical care rose. In 2011, the Productivity Commission publication Caring for Older Australians 8 included an examination of the formal aged care workforce. Findings in the report included that: compared with those performing similar roles in alternative settings and working environments, and Critical care involves the provision of care for the most seriously ill patients, often on life support, and working in a variety of settings such as coronary care, emergency, high dependency, and intensive care units 9. The changing nature of care and hospital admissions, with more patients needing more intensive nursing care, may have contributed to increased employment in this area. 8 Productivity Commission Caring for Older Australians, Report No. 53, Final Inquiry Report, Canberra. 9 Queensland Health. Nursing and Midwifery: A career in health fact sheet series. Available at: Accessed 23 March Australia s Health Workforce Series - Nurses in focus 13

16 Residential and community based aged care workforce The National Institute of Labour Studies periodically conducts a survey and census of the national aged care workforce. Results of the collection demonstrate that RNs and ENs form a minority of the direct care aged care workforce. Together, RNs and ENs comprised less than one-third (26 percent) of the direct care residential aged care workforce in 2012, with RNs accounting for a higher percentage than ENs. From 2007 to 2012, RNs and ENs declined slightly as a percentage of the total direct care residential aged care workforce (Table 2). Most RNs (61 percent) and ENs (75 percent) in the direct care residential aged care workforce were employed as permanent part-time (Figure 7). Table 2: Direct care residential aged care workforce, 2007 and Figure 7: Direct care residential aged care workforce registered nurses and enrolled nurses, by form of employment, 2012 No. % No. % Nurse practitioner n.a n.a Registered nurse 22, , Registered nurses Enrolled nurses Enrolled nurse 16, , % Personal care attendant 84, , Allied health professional 9, , Total 133, , Permanent full-time Permanent part-time Casual or contract In the direct care community-based aged care workforce, RNs and ENs account for a smaller percentage of workers than in the direct care residential aged care workforce, comprising approximately 12 percent of aged care community-based workers (Table 3). Similar to the direct care residential aged care workforce, most RN and EN community based aged care workers were permanent part-time (with permanent part-time workers accounting for 53 percent of all RNs and 67 percent of all ENs, Figure 8). Table 3: Direct care community-based aged care workers, 2007 and Figure 8: Direct care community based aged care workers registered nurses and enrolled nurses by form of employment, 2012 No. % No. % Nurse practitioner n.a n.a Registered nurse 7, , Registered nurses Enrolled nurses Enrolled nurse 2, , % Community care worker 60, , Allied health professional 3, , Total 74, , Permanent full-time Permanent part-time Casual or contract Source: DOHA and NILS. The Aged Care Workforce 2012 Final Report. Australia s Health Workforce Series - Nurses in focus 14

17 While many professions have experienced increases in female workforce participation, historically the main source of recruits for nursing has been, and continues to be, women. This is evidenced by the fact that males comprised approximately one-tenth (11 percent or 28,553) of employed nurses in 2011 (Figure 9). This trend is likely to continue, with females accounting for almost 90 percent of all commencing enrolments in courses for initial registration as a registered nurse in recent years (refer How many nurses is Australia producing?). Figure 9: Employed registered and enrolled nurses by gender, 2011 Male Female 100 Percent {%} Registered nurses Enrolled nurses All nurses Source: NHWDS: nurses and midwives The nursing profession is facing increasing competition for its future workforce supply. Australia s population is ageing, which will result in fewer people being available to enter the labour force. In addition, female workforce participation is increasing across a range of professions. Consequently, adequate numbers may not select nursing as their profession of choice. Strategies suggested to help ease supply issues have included increasing migration, changing skill mix or nurses roles and redesigning work 10. Another potential supply pool for the nursing workforce is males. However, as highlighted in Table 4, there has been little change in the overall percentage of male nurses over time. Reasons contributing to this may include: 11 Males account for approximately 10 percent of employed nurses overall and some areas do have higher percentages of male nurses (Figure 10). In 2011, almost one-third (5,725) of all nurses (both registered and enrolled nurses) working in the mental health clinical area were male. The clinical areas of critical care and emergency (with 15 percent or 4,074 male nurses) and rehabilitation and disability (with 12 percent or 1,046 male nurses) also had higher percentages of males than the overall nursing population. Of the non-clinical areas, management (with 14 percent or 1,084 male nurses) and education (with 11 percent or 551 male nurses) had higher percentages of males than the overall nursing population. A range of reasons may exist for this, for example: Australia s Health Workforce Series - Nurses in focus 15

18 Figure 10: Percentage of employed male nurses by principal area of main job, 2011 MENTAL HEALTH CRITICAL CARE & EMERGENCY MANAGEMENT REHABILITATION & DISABILITY EDUCATION MEDICAL RESEARCH PERI-OPERATIVE OTHER SURGICAL COMMUNITY HEALTH AGED CARE MIXED MEDICAL / SURGICAL PAEDIATRICS GENERAL PRACTICE / MEDICAL PRACTICE MATERNITY CARE FAMILY, MATERNAL & CHILD HEALTH Percent male {%} Source: NHWDS: nurses and midwives While the number of males in the nursing workforce increased from 2003 to 2006, they accounted for less than 10 percent of the registered, enrolled and total nursing workforces in each year (Table 4). Table 4: Employed registered nurses and enrolled nurses by gender, Registered nurses (no.) 189, , , , , ,040 % Male % Female Enrolled nurses (no.) 47,574 48,577 46,044 50,990 50,263 51,711 % Male % Female All nurses (no.) 236, , , , , ,751 % Male % Female Source: AIHW Nursing and Midwifery Labour Force Surveys 2003 to Australia s Health Workforce Series - Nurses in focus 16

19 Average age (years) Percent aged 55 and over Registered nurse Enrolled nurse All nurses Source: AIHW Nursing and Midwifery Labour Force Survey 2003 and from the imminent retirement of older nurses. 12 increasing percentage of those aged 55 years and over. The average age of all nurses increased by approximately one year, from 43.1 in 2003 to 44.3 in 2009, with RNs and ENs experiencing similar increases in average age over the same period (Table 6). A greater percentage of RNs were aged 55 years and over compared with ENs in both years. The percentage of RNs and ENs aged 55 or more also increased (44,823) and employed ENs (3,491) were aged 55 or more. Average age (years) Percent aged 55 and over Registered nurses Enrolled nurses All nurses Source: AIHW Nursing and Midwifery Labour Force Survey 2003 and Most nurses commence their career in the hospital sector. Anecdotally, as nurses become older they move out of this area, with suggested support the view that nurses do move out of the hospital sector as they become older. Figures 11 and 12 show those principal areas where nurses average age is less than the national average. For RNs and ENs this included the principal areas of surgical (RNs 39.3 years, ENs 42.5 years), critical care and emergency (RNs 39.1 years, ENs 43.3) and paediatrics (RNs 38.5 years, ENs 43.1 years) all primarily hospital-based areas. This indicates there are greater numbers of younger nurses working in these areas. Aged care has the highest average age for RNs (49.8) indicating higher numbers of older RNs work in this area. 12 Australia s Health Workforce Series - Nurses in focus 17

20 Figure 11: Employed registered nurses, average age by principal area of main job, 2011 NATIONAL AVERAGE AGE {44.1yRS} AGED CARE FAMILY, MATERNAL & CHILD HEALTH MANAGEMENT COMMUNITY HEALTH RESEARCH EDUCATION MENTAL HEALTH OTHER GENERAL PRACTICE / MEDICAL PRACTICE REHABILITATION & DISABILITY MIXED MEDICAL / SURGICAL PERI-OPERATIVE MEDICAL SURGICAL CRITICAL CARE & EMERGENCY PAEDIATRICS MATERNITY CARE Average age {years} Source: NHWDS: nurses and midwives Figure 12: Employed enrolled nurses, average age by principal area of main job, 2011 NATIONAL AVERAGE AGE {45.5yRS} MATERNITY CARE MENTAL HEALTH MANAGEMENT REHABILITATION & DISABILITY EDUCATION COMMUNITY HEALTH AGED CARE OTHER RESEARCH MIXED MEDICAL / SURGICAL FAMILY, MATERNAL & CHILD HEALTH PERI-OPERATIVE GENERAL PRACTICE / MEDICAL PRACTICE MEDICAL CRITICAL CARE & EMERGENCY PAEDIATRICS SURGICAL Average age {years} Source: NHWDS: nurses and midwives Australia s Health Workforce Series - Nurses in focus 18

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