Reform in public health: where does it take nursing?

Abstract

The Australian healthcare system is undergoing changes that are impacting tangibly on professional nursing practice. While the evidence is clear that the changes pose a challenge to maintaining standards amidst resource cuts and restructuring, the processes through which these changes occur and the decisions which drive the reforms remain complex and largely obscure. This paper intends to stimulate further thinking and debate among nurses about the effects of these reforms on the conduct of practice, both in terms of our emerging discipline and our ability to conduct clinical nursing practice. It offers a way of understanding the policy 'reform' process through an application of policy analysis grounded in critical social theory. The discussion sets out to apply these analytical propositions to specific events that constitute examples of change in the nursing workplace, and to focus on the implications for nurses and health service clientele.

5?20: a model of minimum nurse-to-patient ratios in Victoria, Australia

“…1993). Not surprisingly, the involvement of two levels of government in the administration of the health system has resulted in a highly complex structure in which there is a considerable overlay of government regulation (Gibb 1998).…”

The social production of an enterprise clinic: nurses, clinical pathway guidelines and contemporary healthcare practices

“…As Hindess contends, ‘indirect regulation operates through such means as the education of individuals so that they are able to analyse and thereby to regulate their own behaviour’ ( Hindess 1996, 130). Moreover, the governmental tendency to ‘devolve’ healthcare management is contemporaneous with a political need to maintain (and even reduce) health costs in an era of increasing demand and decreasing available funds ( Gibb 1998; Hancock 1999a). Within this environment of reduced direct regulation there is therefore a need for regulatory mechanisms that act indirectly on both clinicians and the recipients of heath‐care to link their conduct with the aims and objectives of contemporary government in order to control costs.…”

“…There is an increasing call for debate among nurses regarding the effects on healthcare practices of the use of economic/managerial strategies and techniques in the clinical situation ( Gibb 1998). In my doctoral study I sought to describe the networks of power that link nurses with the political objectives of economic efficiency and effectiveness and thus constrain their identity and practice within these boundaries.…”

Clinical nurses’ response to an environment of health care reform and organizational restructuring

“…Why clinical nurses accept organizational change with very little resistance is not clear. Experts in this arena recommend that the nursing profession carefully considers its position and the manner by which reform takes place because of the implications for practitioners' workplace performance (Farrell 1998, Gibb 1998, Parker 1999). An appreciation of the influence of political agendas on nursing may, however, be beyond the scope of many clinicians in the realm of everyday practice.…”

“…Before an understanding of clinicians' subservience can be reached, the nursing profession needs to reflect on recent trends in health care. It is interesting to note that the nursing profession and consumers alike are largely not involved in the debate surrounding changes in health care (Gibb 1998). Little is known regarding health care reform, the influence of restructuring or its subsequent effect on clinical nurses' patient care delivery.…”