Nurses’ dispute with Baillieu highlights pressure on Australia’s ailing healthcare system

Victorian nurses have been clashing with the Victorian government for months. AAP/Joe Castro

The dispute between the Australian Nursing Federation and Victoria’s Baillieu government is expected to be resolved today.

Nurses ceased industrial action two weeks ago. For the Victorian community it was a shocking sight to see nurses escalate that industrial action, walk out of their hospitals and away from their patients.

We have to ask – how did it come to this?

The origins of this dispute go back to the 1990s and the policies of the Kennett government which led to a demoralised and angry nursing workforce who were leaving the industry in droves. Nurse-patient ratios were first introduced in Victoria in 2000 by the incoming Bracks government through a decision in the Australian Industrial Relations Commission. The decision was popular with nurses in that it included a beneficial pay package and the first legally enforceable nurse-patient ratios in the world.

However, the ratios were a problem for hospitals. They were not properly costed, and centrally determined nurse-patient ratios are a crude measure. They are not sensitive to patient acuity and they can limit managerial discretion. In two consequent bargaining rounds the Labor government tried to dismantle the ratios without success.

The ratios are popular with nurses who have little trust in governments and believe that they need some protection and control over increasingly stressful workloads.

The ratios have also become a symbol of collective achievement by a female dominated workforce that is often undervalued. The nursing profession has a long history of struggle over professional status and career structures, over improvements in wages and conditions, and to protect and enhance nursing skills and roles.

The public will always pick nurses over politicians. AAP/Joe Castro

The Australian Nursing Federation has been at the forefront of many of these struggles and is a union that has grown against a background of international union decline. The Victorian branch of the ANF credits its growth to the fact that it believes it listens and acts on the concerns of its members and in the interests of patient care. Its resistance to the introduction of less skilled and lesser-paid health assistants instead of registered nurses is part of this philosophy. The ANF has had a lot to lose in the current dispute.

Ultimately however, it is the state government that has had most to lose. Healthcare was always the Achilles’ heel of the Kennett government. Nurses are popular with the community, much more so than politicians, and no one wants to see nurses ground into the dust. The Baillieu government’s enterprise bargaining approach linking a wage increase to productivity gains through rolling back the ratios is not new and it is not a positive strategy for change.

The leaked cabinet document containing government plans to grind the nurses into submission coupled with the premier’s second cousin and former politician Marshall Baillieu’s arrogant gesture to the protesting nurses did not help.

The problem is that there are no real winners in such a strategy – if the ANF is seen to have backed down and the ratios weakened there is a real risk that Victorian public hospitals will be left with an angry and demoralised nursing workforce and the danger of more nurses leaving the industry – creating even more work for those left behind.

If the government is seen to back down, employers will feel that yet again an opportunity is missed and yet again they will be expected to do more with less with little support from those who provide the resources. Trust on all sides will have been undermined in the process. The reality is that public healthcare it is still a system under pressure due to increasing healthcare demand and a shortage of skilled professionals in particular nurses.

The state government and hospital employers do have to act – they have to find new ways to organise health care work that is efficient, effective and provides a quality outcome. In other countries governments are looking at different approaches to skill mix and skills escalation between the professions.

Many hospitals in Australia are currently experimenting with different approaches to work process change some of these imported from other industries such as Lean production techniques.

At the coalface, multidisciplinary teams are working together to find better ways to provide good quality care for patients. It is a positive step that the state government has been seen to take charge to find a resolution to the dispute before more irreparable damage is done.

Both sides need to work towards a responsive and sustainable healthcare workforce. This cannot be achieved in an adversarial climate – only in one based on trust and mutual respect. There is much to be done whatever the outcome is today, the dispute isn’t over just yet.