faculty focus
If I had a cardiac arrest, I would want an expert emergency nurse, if I was having a baby, I would want an expert midwife, if I’ ve had a stroke, I would want an expert stroke nurse.
The reality is that we are an ageing population. The Australian Bureau of Statistics states that 13.5 per cent of the population are currently aged 65 years and over.
By 2050 this age group will make up almost 23 per cent of the population. There will be just 2.7 people of working age( 15 to 64 years old) compared with five now for each Australian aged 65 years and over.
As we get older more illnesses and injuries occur and each year medical research makes discoveries resulting in new diseases coming to the fore requiring more specialist knowledge in that area.
This will flow from what children are immunised with to the way people are treated in hospital to the design and care of patients in hospitals in the future.
“ The advantages of nurses having specific knowledge is that they acquire in-depth knowledge and skills in their specialist area of practice and provide advice and support within their specialist scope of practice to other health professionals,” Smith says.
“ Of course there is the disadvantage of specialist knowledge and skills not readily transferrable to other areas of nursing practice, so this could result in the potential to lose skills.
“ Overall, their needs to be a sufficient mix of generalist and specialist nurses to ensure a flexible workforce that caters for the needs of the healthcare industry.”
The risk of having a stroke rises as you get older. Australians are exercising less, eating more junk food and obesity is on the rise, meaning that diabetes will only increase.
Thomas Harding, professional officer at the NSW Nurses and Midwives Association, believes that it has always been a trend for nurses to find a niche and stay there.
“ I don’ t think it is that different from other professions, where you find a niche within your field of expertise and choose to remain there,” Harding says.
28 | Issue 2 2013
Technological advances
This school of thought is backed up by the Australian Nursing Federation federal secretary, Lee Thomas, who says that like all occupations some nurses choose to stay in a particular area for many years of their working life.
She says this choice is not unusual and is made generally because of the preference for that type of nursing.“ Skills are broadened and many new skills learned over the years, as medical technology and techniques change. But nurses remain nurses with broad skills irrespective of the areas in which they might choose to spend their working life.
“ However, nurses in rural and remote areas, working in the outback and in small country hospitals don’ t have the same opportunities to stay in one area for many years. No remedy required to a situation where people for whatever reason are making a choice about their working life.”
Harding, however, points out that the general public fails to differentiate nurses like they do with doctors.
“ Most patients just see a nurse as a nurse,” he says.“ That is unfortunate in that all nurses should be recognised for the skills that they bring on board and specialised nurses do extra study and training.”
He does agree that processes in place within the healthcare sector don’ t make it as easy as once before for nurses to chop and change their career path.
“ There is no doubt that through all the processes in place these days it is harder for nurses to move from one area of specialty to another or even back to a general nurse once they have specialised,” Harding says.
“ The reality is that in the future we will need more specialised nurses due to the advancements in medical technology. Doctors too want more specialised nurses to work with. While this benefits the city we also need to take into consideration that in the country, with less medical assistance available in all areas, we need more general specialised nurses.”
Harding, who previously held a senior position at the Australian Catholic University, says that undergraduate and postgraduate degrees have developed substantially and offer more comprehensive learning, enabling students to better demonstrate their skills and knowledge.
“ Nursing degrees offer greater flexibility and improved learning facilities thereby enabling students to have increased knowledge. The result of that is students will then want to know more about speciality and there are greater opportunities for them now to undertake such post-graduate courses and training than there has been in the past.
“ Of course, this is all determined by labour market activity but the greater skillset one possess the more opportunities afforded to them.
“ I don’ t believe nurses lose skills if they specialise, they just acquire new ones and that is to everyone’ s benefit.”
Professor Ramon Shaban, deputy head of school of nursing and midwifery at Griffith University, actually believes there is less specialisation now than in the past.
“ I don’ t know that I believe that nursing specialisation is more common,” Shaban says.“ Specialisation has been so for many years, and in fact to some extent there is less specialisation.
“ Generally speaking, the growth of some specialty areas of practice has been supported by research and evidence-based practice, along with the move of nursing education from the vocational sector to the tertiary sector. These have afforded the development of specialist, research and evidencebased practice. There is a need for the specialist-generalist.”
Shaban says that specialisation offers mastery of skills, professional standing, expert patient and practice care and flexibility for nurses.
“ Increasing specialisation, and multiple specialisation, increases professional portability and employment,” he says.“ In addition, nurses change and expand specialisation as their careers evolve, as their personal circumstances change.
“ To some extent they lose skills, but they gain others. Their skill and expertise evolves – evolution is the best way to describe it. All skills and abilities acquired are relevant to future practice and specialisation. It adds to the individual’ s practice base. Specialisation is fundamental and important.”
Expect more of the specialised nurse and less of the generalist nurse in the future, though both are needed all around the country. The more money, effort and time invested into medical research means more discoveries and more knowledge acquired.
We all take relief when we hear that a specialist doctor is available, perhaps we should start doing the same with specialist nurses. After all, we generally end up spending more time with them than the doctor anyway. ■