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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2023-03-08 Daily Xml
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Motions

Regional Nursing Students

Mr BELL (Mount Gambier) (10:52): I move:

That this house—

(a) recognises that students studying nursing in regional areas are being disadvantaged by having to fund their own placement when undertaking this in metropolitan hospitals during their first three years of study; and

(b) calls on the state government to fund a regional nursing subsidy covering metropolitan placement costs to ensure regional students are given equal opportunities to those of city-based students.

I would like to talk about Mount Gambier's Belinda Myers, who has always wanted to become a nurse or midwife. After raising a family of three daughters, Belinda decided to study a Bachelor of Nursing at UniSA in Mount Gambier and become a registered nurse, which would give her plenty of career options going forward. Part of this study includes placement in hospitals during the second and third years of study. Placement is considered essential training for nurses to give them a broad spectrum of experiences across all disciplines at hospitals.

Being from a regional city, Belinda was interested to go to hospitals where she was likely to experience things that she would not see locally, including specialist surgery and paediatrics, so in 2018 Belinda undertook 20 weeks of placements. Twice that year she undertook eight-week placements at both Flinders Medical Centre and the Women's and Children's Hospital. Twice that year Belinda had to fund her own way to Adelaide and pay for accommodation and all living expenses for four months to complete her studies. Not only was she away from her family and not able to work but she was not paid a cent for her time away on placement despite already being an experienced enrolled nurse.

To cut down on costs, she arranged to live with her friend, paying them rent out of her own pocket. Other students in her year stayed at the Marion Holiday Park to work at the nearby Flinders Medical Centre, shelling out up to $5,000 in accommodation costs. To cover the ongoing costs of her placement and study, Belinda admits that she and her husband had to take out a $10,000 personal loan. When she graduated, she was also left with a $20,000 HECS debt to pay off.

Belinda is now a qualified registered nurse, working as a clinical nurse manager back in Mount Gambier. She is an excellent nurse: highly experienced and exactly the kind of person you want looking after you when you or a family member needs care. Belinda is the perfect example of why I am standing here, talking about these issues today. Right now, there are students beginning their nursing degrees all over our state in regional areas, and they, too, will face some of the same costs that Belinda did when trying to complete her studies.

If we want good people to pursue long-term nursing careers in South Australia, we need to support them at every step of their career and remove any roadblock that is apparent. At the moment, as I have explained, there is a huge financial barrier in their way. I am calling on the state government to establish a regional nursing subsidy to support regional students undertaking metropolitan placements. This is to ensure that these students are given the same opportunities as those offered to metropolitan students. The irony is that there are payments available to metropolitan students travelling to regional areas and regional locations under the federal government's Rural Health Multidisciplinary Training program, but there is no such equivalent for regional students studying or doing their placement in metropolitan areas.

Quite ironically, the program aims to address the shortage of healthcare professionals in regional areas and to improve access to quality health care for rural communities. Under this grant, student support funds can only be provided to domestic professional entry nursing and allied health students who go on rural placements. The rules, as I have stated, do not allow funding for regional and rural students doing a metropolitan placement, nor do they provide support for international students doing a rural placement. Since its inception in 1994, the program has been subject to several evaluations. According to a recent evaluation report, the RHMT program has positively impacted the recruitment and retention of health professionals in rural and remote areas.

Also raised was the issue of student travel from rural settings into city placements; however, there have been no changes made. Currently, a South Australian apprentice or trainee is eligible for an accommodation allowance of $60 a night and a 30¢ per kilometre travel allowance for travelling to an intrastate nominated training organisation or higher education provider. This is paid to the employer by the Department for Education to help cover the costs of their training. But who is helping to cover the costs of training one of our most in-demand skilled trades of all; that is, nursing in regional areas?

Here in South Australia, eligible students can apply for a Rural Health Undergraduate Scholarship or a Regional Local Health Network Scholarship. Across the whole state there are 16 scholarships—16 scholarships for hundreds and hundreds of students. Nationally and here in South Australia, there are also one-off payments, scholarships and grants available through universities and philanthropic organisations. However, the eligibility criteria are so strict on some of those that a lot of people are ruled out in the small print.

Some of the payments would be considered token and would only cover a fraction of placement costs. For example, one offered a lump-sum payment of $500 for students taking a placement over eight consecutive weeks or longer. When you do the maths, that works out to $62.50 per week. However, that other apprentice or trainee I just spoke about would be receiving $3,400 for the same time frame, just for accommodation.

We are in the fortunate position of having significant health commitments coming to Mount Gambier over the next few years, thanks to this state government. This includes more paramedics, more mental health beds, and new alcohol and detox beds. However, one of my concerns is how we are going to staff all these facilities once they are established? To recruit and retain a skilled and diverse rural health workforce, a long-term workforce plan is critical. Unfortunately, staffing shortages at the Mount Gambier hospital and many other regional hospitals have become the norm.

In May 2022, Australian Nursing and Midwifery Federation South Australia CEO Elizabeth Dabars made some comments relating to ongoing staff shortages at Mount Gambier, which I will read to you now. I quote:

…the strain and demand on the staff at the moment really is untenable. Sadly, this has been a long time coming and a failure of successive governments to deal with the issue of workforce planning.

For Mount Gambier Hospital to close beds, simply because it does not have enough staff to provide services, is an entirely avoidable tragedy that should never have happened.

But the sad reality is that the hospital is not alone. We have had months' worth of other organisations closing services, particularly midwifery services.

We have to turn it around because regional communities absolutely do need and deserve appropriate and well-resourced and supported health services.

Ms Dabars said all the research shows it is much better for people's health and welfare if they can be cared for closer to home because they can have better access to support structures such as family and friends. She said:

We are also urging [the state government] to put in place attraction and retention allowances to those country areas. When hospitals are working so short staffed, when people are being asked to work so many double shifts, it is not encouraging people to stay, not encouraging people to enter.

We need to turn it around from a downward spiral, from people so fatigued and looking to exit, to an upward cycle where people are feeling supported…[well] valued and being resourced and really wanting to stay.

They are quotes attributable to Ms Dabars.

We are in the midst of a national job shortage. Finding qualified health professionals is becoming increasingly difficult. At the moment, the Victorian state government is pitching an aggressive campaign to attract health workers from all over Australia. Ads are popping up on Instagram and Facebook offering one-off relocation payments, and making it free to study nursing and midwifery, if you commit to a two-year stint in public health after completion.

Former nurses and midwives are also able to update their qualifications for free to re-enter the workforce. For South Australian students facing hefty placement and HECS debts, you have to admit it is a pretty attractive offer. So, again, I call on the state government to be proactive on establishing a regional nursing subsidy to help students through their placement costs.

It is a well-known fact that regional students are more likely to return to a region if they have their qualifications, so if we want to really attract more people to regional nursing or nursing in regional areas it makes sense for us to provide as much support as we can for regional students to achieve those qualifications.

While South Australia continues to be affected by health staff shortages, this subsidy should be part of a larger scheme and statewide approach to both training and retaining the best staff for our state. We need to be doing all we can to support and attract skilled health professionals into our regions, and make that choice to live, study and work in regional South Australia.

Ms PRATT (Frome) (11:03): I rise today in support of the motion moved by the member for Mount Gambier, and I thank him for continuing to bring the most important matter of regional health in the South-East to our attention. When I reflect on the impact of the COVID-19 pandemic for the border communities, particularly in the South-East, and the pressure that that workforce was under, I take this opportunity to thank all the doctors, nurses and allied health professionals in that region who, to be quite honest, saved lives at that time. Noting that it is International Women's Day, I wish to recognise women who choose the nursing profession.

The Liberal opposition supports the need for interventions to ensure nursing vacancies are filled in regional South Australia, offering more incentives for health practitioners to practise in SA. Nursing plays a crucial role in health care and South Australia is no exception.

Nursing is the largest healthcare profession in South Australia, with over 35,000 registered nurses and midwives working in the state, which represents over 35 per cent of the total health workforce in SA. In regions such as Port Pirie, more people work in health and aged care combined. It is the biggest employer. In Mount Gambier, it is the same.

In South Australia, nurses and midwives provide the majority of direct patient care in hospitals and other healthcare settings. They are responsible for assessing, diagnosing and treating patients, as well as providing that very essential emotional support and education to patients and their families.

According to a report by the Australian Institute of Health and Welfare, nurses and midwives in South Australia provided over five million hours of direct patient care in the years 2018-19. Nurses and midwives are also vital in the provision of primary healthcare services in South Australia. They provide care in community health clinics, aged-care facilities and mental health services.

The demand for nursing services in SA is expected to increase significantly in the coming years. According to the South Australian Department of Health, there will be a shortfall of over 2,000 registered nurses in the state by 2025. These statistics, which are compelling, demonstrate the importance of nursing in South Australia and the critical role that nurses and midwives play in providing high-quality healthcare services to our communities.

Being a regional nurse presents unique challenges that differ from those faced by nurses working in metropolitan areas. Some of those include having limited access to medical resources and equipment, which makes it much more difficult for nurses to provide that high-quality care. We know that they experience geographic isolation, so being dislocated or further away from major hospitals and medical centres can limit their access to specialist care, support and training.

The member for Mount Gambier touches on staff shortages and it is a critical element for the national conversation about the healthcare sector. In some regional areas, we are experiencing a shortage of healthcare professionals, especially nurses, which is putting additional pressure on regional nurses who are currently in the profession and therefore they end up taking on more responsibilities and work much longer hours. We also see an increased workload for the regional nurses as they cover a wider geographical area and provide care to a larger and ageing patient population.

The social isolation that can be experienced by regional nurses is another element to recruitment and retention. Lifestyle plays a big part in how we attract more nurses to this field. So incentives are a really essential part of this. All these factors end up attributing to a cumulative impact on how we train our nurses.

Medical associations, such as the Royal Australian College of General Practitioners have reported their very serious concern that SA risks losing nurses across the border in the face of the health workforce incentives that the Victorian government have implemented, which are totalling over $100,000.

Unfortunately, nursing students in regional areas face a major financial obstacle when completing their clinical placement in metro hospitals. The cost of living, transportation and accommodation in these areas can be prohibitively expensive, which is leaving many of our future students and future nurses unable to complete their placement and unable to graduate.

According to a recent study by the Australian Nursing and Midwifery Federation, 80 per cent of nursing students in regional areas experience financial stress during their placement, with 30 per cent of them indicating that the cost of living and accommodation were the biggest barriers to completing their placement.

This is a significant issue that cannot be ignored, and we certainly are reflecting on bringing training to the regional areas where our nurses already live. A regional nursing subsidy would ensure that nursing students living in regional areas are given equal opportunities to those of city-based students, which would help to address the workforce shortages in regional and rural areas.

When speaking about nursing, it is really important to acknowledge that the royal commission into aged care has delivered mandated recommendations for increased care minutes per patient and 24/7 registered nurses in all aged-care homes. The federal Labor government's amendment to aged-care laws now requires a qualified and registered nurse on site in every residential home. With existing national pressures on the nursing workforce, training in the health sector is desperately needed.

In my own electorate of Frome, I am always fighting for greater opportunities to access vocational education, RTOs and higher education. The existence of the Spencer Gulf Uni Hub is really significant for the gulf and Yorke Peninsula communities, but if you live in the Mid North, if you live in Frome, then your training options are to travel, travel, travel, or study online.

I had the happy circumstance of meeting a mother and daughter duo when I was visiting the Spencer Gulf Uni Hub. Both of these lovely ladies are studying a Bachelor of Nursing through the Uni Hub, but they have to travel from Port Pirie to Clare to achieve this. I would love to see an expansion of training opportunities for men and women who live in regional South Australia to pursue a career in nursing. I commend the member for Mount Gambier for bringing this motion to the government's attention, and I commend the motion to the house.

Ms HOOD (Adelaide) (11:11): I rise today to speak on behalf of the government in reply to the member for Mount Gambier's motion, and I move the following amendment to the motion:

Remove paragraph (b) and insert the following:

(b) calls on the state government to work with universities to increase opportunities for regional nursing students and address disparities with city-based students.

Being a country kid, I directly understand the challenges that the member for Mount Gambier has raised within his motion. As a country student—I know the member for King had this experience as well—you do not get a choice with some degrees as to whether or not you have to leave your family, your home, your loved ones in order to move to the big city to undertake study. The challenges that come with that include renting, finding sometimes several housemates to live with in order to get down the cost of rental, and also the travel costs of coming back and forth between your regional town and the city.

I know my own sister-in-law, who is a midwife in Mount Gambier, was a regional nursing student. While she was lucky enough to be able to remain in Mount Gambier in order to undertake her study through the University of South Australia, she did have that challenge of leaving friends and family and also children—she was studying whilst also a mum—in order to undertake placements here in Adelaide. She was just lucky enough to have her sister-in-law, and also her best friends, in Adelaide to stay with.

I know during her nursing degree that was particularly challenging and had to be fully funded, but she was able to access scholarships for some specialist training that she was then undertaking as a midwife in regard to neonatal services. On one occasion she did receive an SA Health scholarship that provided support to come up to the city. For those who might not know, not being from regional areas, your degree might be in the city and you have to move for that reason, or in order to get the breadth and depth of experience needed for your degree you have to undertake placements in the city areas.

On the importance, though, of investing in health in our regions, I am very proud that the Malinauskas Labor government is absolutely committed to this, as the Speaker would know in his own community. We have invested $305.7 million in new health care and $58.6 million in new ambulance services in regional South Australia since coming into government. I am incredibly proud that we are investing $8 million in an upgrade of Naracoorte Hospital, where myself and my three brothers were born and where we said goodbye to two of our beloved family members.

We do remain committed to delivering on our investment commitments to invest and expand our public health services in the regions. We are recruiting more than 300 nurses across our health system and 100 more doctors, including 10 more medical specialists in our regional areas of critical need, over and above any existing growth of activity factored into the health budgets across the forward estimates. Speaking again directly to the member for Mount Gambier's motion, the critical work of our regional nurses cannot be underestimated, and encouraging and supporting people from regional and rural locations to pursue a career in nursing is so incredibly important.

In terms of some of the support that currently exists, the SA Health Better Placed Clinical Placement Coordination Team play an important role. They are there to provide support to students in various ways, including assistance in planning their metropolitan placement, guidance on scholarships, grant advice and locating accommodation. SA Health also offers Rural Health Undergraduate Scholarships. These scholarships provide funding to support a student's educational journey whilst encouraging them to remain in the region at the completion of their qualification, which is incredibly important.

In addition to the SA Health Rural Health Scholarships, various other scholarship opportunities exist, including the Australian College of Nursing scholarships, UniSA Clinical and Health Sciences Scholarships, UniSA Regional and Rural Scholarships and Grants, UniSA Joanne Megan Nursing Placement Grant and UniSA Leahurst Foundation Final Year Nursing Placement Grant.

Regardless of the fact that we do have those supports, I think the comments of both the member for Mount Gambier and the member for Frome have highlighted the challenges in this area and that we recognise there are barriers for students studying nursing in regional areas, as well as the added challenge of having to support themselves while undertaking placements away from home. That simply adds to that challenge.

The Minister for Health has already committed to working with universities to improve access to re-entry courses for South Australians. In addition to this, these discussions will be used to raise the important matter of supporting our regional students and addressing any disparities that exist between them and their city-based classmates.

Speaking as a regional university student, I thank the member for Mount Gambier for raising this important issue and for advocating for our regional students, and I also thank the member for Frome for her comments.

Mr BELL (Mount Gambier) (11:17): I would like to thank both parties for their genuine interest in this very important topic. As we evolve, having more university placements in regional areas is a fantastic initiative but sometimes you just cannot replicate a metropolitan model in a regional area, and this is a clear example of that. The nurses, the students, who we want to see back in our regions fully qualified, need this type of assistance.

The minister has been very good in discussions with me and in his commitment to seeing what he can do to address this. I congratulate him on that and look forward to working with him over the next couple of months. I thank both sides for their genuine interest in regional offerings and opportunities for our nursing students, and I look forward to the passing of this motion.

Amendment carried; motion as amended carried.

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