As a patient recovering from surgery I had more confidence in those nurses who had received hospital based training. Learning nursing through simulation exercises is no substitute for the real thing, on the job training, that's where you learn bedside care.

However the old hospital based training system treated the student nurses like skivvies.
How unfair to expect the girls to learn theory by day then supervise a ward by night. yeah, I know boys are nurses now.
Another advantage of the hospital based system was the nurses were paid, poorly, and had accommodation provided - a boon for country and outer suburban girls.
Today's nursing student in Victoria has a HECS debt then will probably do agency work until s/he passes the audition and gains a permanent position at a hospital. I have talked to young nurses who have years of agency work. This employment practice is unappealing.

In fact the extreme hours resident doctors have to work is questionable also, what does it achieve? When you realise the "old man" treating your 68 year old father is a haggard 28 year old resident you wonder whether he really is alert enough to exercise sound judgment.

Kevin - The point made about the same kind of turf war between Div1 and Div 2 nurses is well made and represents another part of the conundrum.

That demarcation dispute has been with us for a long time but the tension has increased over the years as the work force in broad terms has become more skilled - I had a major blue with a DON years ago when I taught SENs to perform ECGs - in her way of thinking it was a task well above their station - but at the end of the day it was a simple mechanical task.

The other problem relates to the ageing of the workforce - while it is all well and good for me to prattle on about nurses and other profesisonals to assume some roles undertaken by medicos we need to face the fact that that work force is ageing and shrinking as well.

Another impediment to skill shortages, for example, is the cost of post graduate training - with a relative crisis in obstetric services particularly in rural areas - RNs who wish to gain reigatration in Midwifery are up for a bucket of money for the education via the Universities either in up front fees or HECs for little finacial return at the end.

So even if there is an incremental shift in roles and responsibilities gaps will stil remain in service provision; some one made the point we do not have a health care system but a disease management system and until more money is put in at the fornt end on disease prevention and health promotion we will remain a long way from a solution.

Kym

Kym,

I agree with all of that.

WA recently had a session where they "educated" a panel of consumers about what the health issues were and what all the various constraints were. Their conclusion - we should spend considerably more on mental health and clear that awy; we should spend considerably more time and resources on preventative healthcare; and we should balance the budget by spending less on hospitals. A whole lot more of course but they were the community's conclusions at the end of even a relatively brief exposition. How much more enthusiasm for change could we harness if we began talking to people openly and honestly about what governments can and can't do and what the community/individuals are responsible for.

Role reallocation ** will ** happen, just as closer integration between private GPs and public hospitals will (and indeed I'm already seeing happening). People's own enlightened self-interest will dictate co-operation between healthcare providers over the near future. What we now need is to start appealing to the community's enlightened (and we need to do the enlightening) self-interest.

Regards

Kevin