Unlocking the potential of our nursing workforce

The healthcare sector has a reputation for being slow to change — but it is capable of swift, decisive innovation when the need is clear. The need is clear now. Amid the colliding pressures of a rapidly aging population and surging rates of chronic disease, easing pressure on our hospitals is vital, and requires pulling every available lever to meet our population’s needs.

Models such as hospital in the home and virtual care are making a difference around the edges: the NSW Government has linked increased use of virtual care services to a fall in semi-urgent and non-urgent ED presentations. The Australian Government’s expansion of the Hospital to Aged Care Dementia Support Program should improve discharge rates for complex older patients. These are welcome developments — but they do not address root causes.

Consider the rapid rollout of testing and vaccination hubs during the pandemic, or — more recently — the surge in workforce to address the diphtheria outbreaks. As the largest segment of the healthcare workforce, nurses have been core to these efforts. They represent one of the most powerful mechanisms for health system reform. Smart investment in nursing roles can deliver outsized gains in both efficiency and quality of care, and the business case for investment in nurses will only continue to grow as workforce shortages deepen.

Advanced practice nursing

While medical practitioners have well-established pathways into specialisation, equivalent paths for nurses are far less defined. In effect, it means there is an unnecessary cap on the potential of highly skilled, experienced clinicians.

But some health services are already unleashing nurses’ expertise well. The Clinical Nurse Consultant-led gout telehealth clinic at Gold Coast University Hospital is one compelling example: nurse-led models consistently demonstrate better patient outcomes than traditional care, alongside cost savings and reduced unplanned ED presentations.

Endoscopy is another illustration. Demand for colonoscopy is growing as bowel cancer screening is now Medicare-funded from age 45, yet access remains heavily determined by postcode. This strengthens the case for investment in nurse endoscopy. There are some programs — though few and far between — which demonstrate the model is viable, and high-quality evidence shows nurse endoscopists achieve outcomes comparable to medical endoscopists.

The Victorian Government is now looking closely at how it can better unlock the underutilised specialist expertise of nurses and allied health professionals, via its Specialist Care Reform Blueprint. The plan acknowledges that nurses and allied health professionals have untapped potential and are clinically and cost-effectively capable of undertaking many clinical reviews traditionally performed by doctors.

Nurse prescribing

Hospital leaders should be actively considering how designated registered nurse prescribing can support their strategic priorities. Registered nurses with more than three years’ experience can now undertake education and apply for prescribing endorsement, enabling them to prescribe within a partnership agreement with an authorised prescriber.

Much of the discussion has focused on the implications for primary care — particularly in rural and remote areas. But the operational benefits in tertiary settings are equally compelling. RN prescribers could chart discharge medications rather than waiting on a junior medical officer, supporting better patient flow and bed management. There is also significant opportunity for hospital in the home. In palliative care settings RN prescribing could be transformative, enabling nurses to manage breakthrough pain, restlessness, secretions and dyspnoea promptly and with clinical authority.

Nurse practitioners

Australia has more than 3200 nurse practitioners — autonomous, highly qualified clinicians capable of independent practice. Yet the proportion practicing as nurse practitioners, rather than in registered nurse roles, has fallen from 67% in 2020 to 63% in 2024. For health service executives, establishing nurse practitioner positions represents a potential opportunity to deliver quality care more efficiently. The barriers are typically institutional — limited awareness of scope, or risk aversion that closer examination rarely justifies.

There are also structural barriers. Nurse practitioners’ ability to work to their full scope of practice is curtailed by their limited access to Medicare Benefits Schedule (MBS) items. Where an NP cannot bill for a consultation, a procedure or an order that sits within their clinical competence, the financial model for employing them as NPs — rather than in cheaper registered nurse roles — is undermined. Expanding NP access to the MBS is critical to unlocking the workforce capacity the system needs. Nurse practitioners are also underutilised in mental health settings, despite their capacity to support entire episodes of care — an area of particular and growing unmet need.

Conclusion

Taken together, advanced practice nursing, RN prescribing and the full deployment of nurse practitioners represent more than a set of incremental efficiency measures. They form a coherent response to a system under sustained pressure — one that draws on clinical expertise already present in the workforce, improves patient outcomes and reduces cost. For health service leaders, there is also a workforce retention argument: meaningful clinical career pathways for experienced nurses matter at a time when we can least afford to lose them.

Investing in leadership development is part of that equation. Supporting nurses to undertake formal leadership education — such as the ACN Institute of Leadership’s suite of programs — builds the organisational capability and confidence needed to champion and implement these advanced roles from within. And — acknowledging the tight nursing job market — it is not immaterial that health services with a reputation for developing their nurse leaders are attractive employers.

Australia’s complex health landscape is challenging all health administrators, and it only reinforces the need to evolve the role of our largest health workforce. The current constraints on doing so are often organisational. Implementing improvements to the way nurses work will not only ease the present burdens but improve health outcomes, increase the efficiency of care, and strengthen our health system for generations to come.

*Dr Zachary Byfield is Acting CEO and the National Director Education at the Australian College of Nursing.

Top image credit: iStock.com/DMP