Nursing in Australia

Historical
Prior to the transfer of nursing education to the university sector, nurses were trained in a course of instruction in hospital nursing schools that awarded a certificate in general nursing. These courses were generally for a three year period, and nurses were paid employees of the parent hospital. Hospitals awarded distinctive badges upon graduation. In addition, state registering authorities awarded a badge of registration. These were generally worn on the uniform collars.

It is interesting to note that as early as the 1930s, attempts were made to establish university credentialed nursing courses in Australia, most notably by then director of nursing at the Royal Melbourne Hospital and the University of Melbourne. As recently as the 1970s, Dr. Sandra Stacey, one of the first Australian nurses to attain a PhD enrolled in a school of anthropology to submit her thesis.

A comprehensive history regarding the development of nursing, including registration and education in New South Wales is available from |NSW Nurses Board.

In the late 1970s, the Royal College of Nursing Australia pioneered a course that became the Diploma of Applied Science (Nursing) awarded by the Lincoln Institute in Melbourne and Cumberland College in Sydney. The transfer of nursing education to the university sector continued throughout the 1980s, and gradually hospital schools ceased operating. In the early 1990s, universities finally granted nursing education the same status as allied health, and granted bachelor degrees in nursing rather than diplomas for entry-level courses.

The first move towards baccalaureate recognition was the development of the Bachelor of Applied Science (Advanced Nursing), a post graduate degree that required registration as a registered nurse as a prerequisite to admission and completion of 16 units. This course is no longer offered, and has been superseded by the transition of "post basic courses" conducted by various hospitals as a form of in-service training to the tertiary sector (see above).

The transfer of nursing education to the university sector from the hospital setting was the result of long-time efforts by leaders in Australian nursing. It was opposed by the medical hierarchy who viewed the development of highly-trained professional nurses as a threat to their monopoly on the delivery of high-level health care. Many nurses themselves opposed the transfer on the grounds that "hands on experience in hospitals" would be lost. One underlying cause of the opposition was that of societal views toward appropriate gender roles: nursing as a "female" profession and medicine as a "male" profession. These views are evolving.

Historically, a "double" or "triple certificated sister" would have been a registered nurse who held general, midwifery, psychiatric, or other range of certificates. The post nominal ‘‘RN (DC) or ‘‘RN (TC) was used by some nurses to signify this attainment.

Legal regulation
The practice of nursing is governed by state and territorial nursing regulation authorities. The Australian Nursing and Midwifery Council (ANMC) was established in 1992 and works with these authorities to facilitate a national approach to nursing and midwifery regulation.

Types of nurses
In all states other than Victoria, nurses fall into the following major categories:
 * Nurse practitioner (NP)
 * Registered nurse (RN)
 * Enrolled nurse (EN)

Victoria
Nurses and nursing were first regulated by statute in 1923 in Victoria. In 1993, the legislation was revised, and all nurses are now termed registered nurse classified according to their educational preparation by the Nurses Board of Victoria (NBV). Since December 2005, all Victorian health registration boards (including the NBV) are governed by the |Health Professions Registration Act 2005:


 * RN Division 1 are first level nurses comprehensively trained with the potential ability to work in any branch of nursing.


 * RN Division 2 are second level nurses that work under the direction of a division one or three nurse, equivalent to an enrolled nurse in other Australian states.


 * RN Division 3 are nurses formally trained solely in psychiatric nursing. This is not to be confused with general nurses who undertook "post basic" training in psychiatric nursing and were thus able to work in both general and psychiatric nursing settings.


 * RN Division 4 nurses formally trained solely in institutions that cared for people with an intellectual disability.  It was possible (but unusual) for general nurses to undertake post basic training to attain this as an additional qualification.  Mental retardation nursing (as it was then known) is no longer considered the sole domain of nursing, and courses are available such as the |Graduate Certificate of Disability Studies (Positive Behaviour Support) designed to meet the needs of practitioners in a variety of disciplines.


 * RN Division 5 are mothercraft nurses, who had training postnatal care and early parenting ('mothercrafting' generally describes the skills needed to care for a newborn baby). Mothercraft nurses worked under the supervision of midwives or registered nurses in postnatal wards of public or private hospitals, or occasionally in childcare centres or early childhood centres. This vocational activity is no longer considered the sole domain of nursing, and courses are available at TAFE/VET level designed to meet the needs of practitioners in a variety of disciplines and settings.

Divisions 3, 4 and 5 are now closed to new applicants. The effect of this policy is that there will be, in time, only division one and two nurses, with a separate foundation qualification pertaining to each type.

Midwifery
Until relatively recently in the United States, unlike the United Kingdom, midwifery training required registration in nursing as a prerequisite. At least one course has been established that will qualify a person as a midwife, but not as a registered nurse.

Victoria ceased to list midwives in 1993 as a separate register on the presumption that all midwives were also registered nurses. However, in latter years Victoria now "recognizes" additional qualifications provided they are midwifery, maternal & child health nursing, or psychiatric qualifications.

There is a philosophical argument that child birth and reproduction are natural conditions and should not be treated as a disease or ailment, and that since the "disease model" permeates nursing, midwifery is and should be considered a separate discipline. Opponents to this argument counter that many other specialty areas in nursing support a natural process such as palliative care.

Nevertheless, it is likely that independent practice midwives will continue to develop as a profession despite the current issues relating to the availability of malpractice insurance.

Nurse practitioners
Nurse practitioners are being introduced into the Australian healthcare community.

In some instances, it could be argued that this is as a natural professional evolution and recognition of the outstanding clinical expertise some nurses have attained over the course of their careers in areas such as wound management.

The formal recognition of nurse practitioners permits duly educated and credentialed health care nursing professionals with autonomous practice rights within their particular area of expertise. This may include — but not necessarily — medication prescription rights. The development of nurse practitioners is opposed by the |Medical Australian Medical Association Stand.

Education
Registration as a registered nurse now requires a Bachelor of Nursing, considered the foundation for any future specialization within nursing. Postgraduate diplomas provide further vocational training for specialist areas. Masters level courses are available in both research and course work streams; a specialist course has been developed to provide preparation for registration as a nurse practitioner. Professional doctorates are also available.

Australia has a long tradition of post-basic courses, usually of a six month (minor) or twelve month (major) duration, which included midwifery, maternal and child welfare, psychiatric, preoperative ("theatre nursing"), intensive care, and coronary care in later years, as well as a myriad of other courses. They are now provided by the university sector as postgraduate diplomas or post graduate certificates, depending on the length and complexity.

There are options available for hospital trained nurses to upgrade their qualifications to a Bachelor of Nursing (post registration). However, most opt instead to undertake specialist courses such as a postgraduate diploma or certification in the area of their clinical interest.

Enrolled nurses are trained in the "technical and further education" (TAFE) sector of approximately twelve months duration. In some states, this length has been increased to 18 months to include a module that permits enrolled nurses to dispense oral medications.

Professional titles
The professional courtesy title "sister" has fallen into disuse and disapproval, even though it was formerly used by both male and female registered general nurses. The title "nurse" was used when addressing enrolled nurses. The term "matron" is inadvisable.

In keeping with the relaxed attitude to formalities in Australia, most nurses are happy to be addressed by their first name and describe themselves either as "an RN" or "an EN". In Victoria, a registered nurse will commonly describe themselves as a "Div. 1", and an enrolled nurse as a "Div. 2".