Nursing and midwifery registration fees have increased from $47 in 2003, to $80 in 2004, to $95 in 2009, to $115 in 2011 and to $160 in 2012. This is an increase of $113 or 340 per cent in less than nine years.
Despite the unprecedented registration renewal fee increases, the Nursing and Midwifery Board of Australia (NMBA) is yet to confirm it will fund and expand the successful, evidence-based Nursing and Midwifery Health Program, Victoria (NMHPV) that protects patients and keeps nurses and midwives well and in the workforce.
For the last six years Victorian nurses and midwives have had access to this confidential health program to help with alcohol and drug health issues and mental illness. The Nursing and Midwifery Health Program Victoria (formerly known as the Victorian Nurses Health Program VNHP) successfully encouraged nurses and midwives to self-refer early to protect their patients, to seek treatment and to save their career.
The program is unique to Victoria and was the first of its kind for nurses and midwives in Australia. The program was self-funded through annual Victorian nurses’ and midwives’ registration renewal fees at an annual cost of about $6 per nurse and midwife.
Things changed in July 2010 when state nursing boards were abolished and national registration was introduced with the Nursing and Midwifery Board of Australia now responsible for the registration of 343,703 nurses and midwives across Australia.
In late 2010 the then Victorian Health Minister Daniel Andrews secured funding from the sale of the Nurses Board of Victoria city property to operate the Nursing and Midwifery Health Program for the next three years. This enabled time for a smooth transition to the Nursing and Midwifery Board of Australia. However, this funding will run out in June 2013.
The Victorian Baillieu Government made an election commitment to Victorian nurses and midwives in October 2010 stating: “The Coalition is committed to demanding that the new Nurses Board under the Australian Health Practitioners Registration Authority [sic] fund in full and permanently the Victorian Nurses Health program, a uniquely Victorian program that is at risk under the new national registration program.”
Victorian nurses and midwives and nursing and midwifery students are calling on the Nursing and Midwifery Board of Australia (NMBA) to: Confirm it will provide ongoing funding and support for the Nursing and Midwifery Health Program in Victoria and extend the program to other nurses and midwives in all Australian states and territories so that all nurses, midwives, their patients and their employers can benefit.
Six years ago a nurse or midwife with an alcohol, drug or mental health issue could not seek help from their doctor without risking their registration to practise as a nurse or midwife, their job, their career or their ability to earn a living.
The incidence of drug and alcohol use and mental illness is no higher in the nursing and midwifery professions than in the general community. However, unlike members of the public, nurses would not freely seek help from their doctor or an emergency department because they feared being reported under the Medical Practice Act 1994. Another hurdle to seeking help is that nurses and midwives with sensitive health issues are often referred to the health service that is also their workplace for assistance.
Because of the consequences of seeking help, many nurses and midwives did not seek help until their health problems were so bad that they were called to appear before a formal hearing of the Nurses Board of Victoria.
This punitive approach, understandably designed to protect patients, actually encouraged nurses and midwives to hide health problems which could place patients at risk.
Recognising there were reasons why nurses and midwives were reluctant to seek help for sensitive health issues, ANF (Victorian Branch) worked with the then Nurses Board of Victoria to establish the Nursing and Midwifery Health Program in 2006.
The program, based on a similar program for Victorian doctors, has assisted many hundreds of nurses and midwives to become healthy, save their careers and protect patients. Based on early identification, intervention, support and rehabilitation, it has promoted a culture of early self-referral across the Victorian health system because nurses and midwives no longer feel they have to hide sensitive health issues.
Impaired or unwell nurses and midwives can seek confidential and independent support enabling them to remain at work throughout an episode of care or return to work when their health has been restored.
Colleagues, managers, employers, health professionals or family members may also refer nurses and midwives to the program or seek confidential advice on how to effectively approach a nurse or midwife they believe has an alcohol, drug or mental health issue. For more information visit the Nursing Midwifery Health Program Victoria website
The cost of the solution
The program’s annual operating cost of $560,000 has been self-funded through Victorian nurses’ and midwives’ registration fees - approximately $6 per nurse and midwife each year. There is no charge to government, employers or the individual service user.
The cost of not providing this health service is much higher. More than 80 per cent nurses and midwives who have used the program were supported to remain at work, have returned to work or have a plan to return to work. This is a significant workforce retention rate that has saved the Victorian Government and private employers millions of dollars. The Victorian Government estimates it costs $100,000 to replace a full-time nurse or midwife working in a hospital.
Lisa’s story: a Nursing and Midwifery Health Program Victoria case study
A Nurse Unit Manager’s account of her experience, using the Nursing and Midwifery Health Program Victoria, to manage and support one of her nurses with mental health issues.
“I’d suspected for a while that Lisa wasn’t functioning well. I knew she had been experiencing some personal relationship problems and that she’d had to deal with troubles in her family, but she hadn’t raised anything directly with me so I chose to hold off saying anything to her.
One afternoon my suspicions were confirmed. She’d arrived late for work, which wasn’t usual for her, and she was withdrawn and appeared disinterested. I approached her and asked her whether she was OK. Initially she fobbed me off saying she was just tired, but after probing she dissolved into tears and disclosed she wasn’t well and her health was deteriorating. She said she was really stressed and thought she might be depressed.
She spoke about the strain of her unhealthy relationship, that she was carrying the burden of expectation from her two sisters about her parents’ poor health and she had financial problems. I have a lot of time for Lisa. She is a valued employee and I was very worried about her.
I contacted the Nursing and Midwifery Health Program for help. I’d heard about them through my DON and knew that they would at least listen to me and hopefully help me to help Lisa.
I spoke to the staff there who took the time to hear my concerns and within minutes we’d set out a plan to help Lisa. They coached me on how to approach her and suggested I give her information about the NMHPV. They thought Lisa would benefit from seeing them so I insisted she call them that afternoon.
By this time Lisa was ready to ask for help. She took the information and called the NMHPV. Within a couple of hours Lisa had spoken to a case manager there, had been able to tell her story, receive reassurance that she wasn’t alone and was given an appointment for two days later.
This was three months ago. Lisa took a couple of weeks off work at the time and since this all came out her health has improved dramatically. Lisa tells me that she continues to see a case manager at the NMHP and attends a support group there. She has seen a specialist for help with her depression and is addressing some important issues in her private life.
NMHP suggested that she regularly catch up with me to make sure she feels supported at work. I’ve managed to do this and Lisa says everything she’s done in the last three months has helped her get back to her best health. I couldn’t be happier for her and I’ve got a great nurse back at full capacity!
The NMHP’s support and advice on how to best tackle this situation was vital. They gave me great tips on what to look for, how to help Lisa and about what our hospital can do to help other nurses in need. I couldn’t be happier with the outcome. Thank you NMHP!”
Any Victorian nurse, midwife or student of nursing or midwifery can call the NMHP for a confidential discussion and self-referral. There is no formalised referral process involved.”
Please fund and expand the Nursing and Midwifery Health Program Victoria
Each year I pay a registration fee so that I can continue working as a registered nurse/midwife. My registration renewal fees have risen from $47 in 2003, to $80 in 2004, to $95 in 2009, to $115 in 2011 and to $160 in 2012. This is an increase of $113 or 340 per cent in nine years.
I note that since 2006 the resources of the former Nurses Board of Victoria (NBV) covered the operating costs of the Nursing and Midwifery Health Program Victoria despite the then NBV charging significantly lower registration renewal fees. As a Victorian nurse/midwife I supported the use of a few dollars from my annual registration renewal fee to cover the cost of operating this important health program providing a safety net for me, my colleagues, my patients, my managers and my employer.
However, it is disappointing that more than two years since the introduction of national registration the Nursing and Midwifery Board of Australia is yet to confirm its support for funding or expanding the evidence-based Nursing and Midwifery Health Program. This is concerning because funding for the program, set aside from the sale of the former Nurses Board of Victoria property assets, will run out in June 2013.
No one is immune from developing a mental illness or an alcohol or drug health problem. But seeking help is difficult when your registration, job and ability to earn a living are on the line. When a nurse or midwife seeks support for this type of problem they need to know they will be helped, not punished. This approach in Victoria has created a culture of early self-referral that is clearly in the best interests of the nurse/midwife’s wellbeing and patient safety.
Since 2006 the Nursing and Midwifery Health Program Victoria has facilitated 814 individual episodes of care for nurses, midwives and nursing and midwifery students. More than 80 per cent of these nurses and midwives were supported to remain at work, returned to work or have a plan to return to work. This is a significant workforce retention rate saving the Victorian Government and private employers millions of dollars. The Victorian Government estimates it costs $100,000 to replace a full-time nurse or midwife.
The program costs approximately $560,000 (just a little more than the cost of replacing five registered nurses) to run in Victoria each year - that’s $6.20 for each of the 90,294 Victorian nurses and midwives.
With 343,703 nurses and midwives across Australia, the Nursing and Midwifery Board of Australia collects almost $55 million in annual registration renewal fees alone. Just $6 per nurse/midwife would provide more than $2 million recurrent funding to keep the workforce well, protect patients, save hospitals millions of dollars in staff replacement and recruitment costs and save both levels of government millions of dollars in nursing and midwifery education funding.
One of the benefits of national registration should be a national health program for all Australian nurses and midwives, particularly since my fees have increased by $65 since the introduction of national registration.
I call on the Nursing and Midwifery Board of Australia to confirm its ongoing funding and support for the Nursing and Midwifery Health Program in Victoria and to extend this program into other states and territories so that all nurses, midwives, their patients and their employers can benefit.