Introduction
A healthcare professional’s unique role is shaped by the healthcare system. This system consists of leadership and governance, information systems, health financing, human resources, and service delivery among others (WHO 2010). Understanding one’s professional role is part of transitioning and is, in part, achieved by acquaintance with the health care system. Such knowledge places one in a position to fulfil the tasks and responsibilities attached to the role, as well as successfully confront issues and challenges. Moreover, familiarity permits one to explore the bounds of the profession and see how to fill the gaps in service delivery by expanding current roles.
Components of the Health Care System
The federal government and eight state or territory parliaments have the mandate of governing Australian health care system (Doorslaer et al. 2008). By definition, governance means “the structures and processes by which the health system is regulated, directed, and controlled” (Dwyer & Eagar 2008). These are the functions of the Australian Department of Health and Ageing, Australian Health Ministers Conference, Council of Australian Government, and other agencies. They work to create and implement laws, regulations, and standards to eliminate obstacles, grant authorizations, set directions, guarantee better resource allocation, and facilitate reforms (Dwyer & Eagar 2008).
Information systems that gather, analyse, and monitor health-related data allow the creation of sound laws, policies, and standards. There is a wealth of information on topics such as demographics, epidemiology, intervention research, population needs, and health disparities from public and private sources (Australian Government 2013). It is necessary for systems to validate and synthesise data for purposes of regulation and practice. For example, the National Health and Medical Research Council maintains a clinical trial registry. The implementation of electronic health records, meanwhile, facilitates the timely use of patient information for better, more efficient care (Sweet, 2010).
Financing is another health system component. Medicare enables universal health coverage funded by the federal government with private insurance and out-of-pocket spending as other options (Connelly et al. 2010). Costs are free or subsidized for a variety of services. To achieve cost efficiency, public hospitals operate within annual budgets and offer Medicare-covered services and treatments decided at the national level. Use of technologies and specialists is regulated by gatekeeping and stringent eligibility criteria to ensure medical need. Another cost-reduction strategy is enhancing primary health care, services that are financed by both federal and state governments (Keleher, Parker & Francis 2010).
Service delivery is through a mix of public and private entities (Connelly et al. 2010). States own and operate public hospitals for in-patient services and emergency surgeries, long-term care facilities, mental health programs, and preventive programs. Private hospitals and clinics provide similar and complementary services such as elective surgeries and outpatient care. General practitioners provide primary care and referral to specialists. Further, GPs are organised into groups called Medical Locals that assist in local health planning, foster multidisciplinary collaboration, advocate better chronic illness management, and promote efficiency in resource use to improve community health outcomes (Healy & Hall 2011).
The Health Care Workforce
The healthcare workforce is the backbone of service delivery. However, a workforce study commissioned by the government shows that there will be a significant nurse shortage of about 109,000 by 2025 (HWA 2012). By the same year, the country will be short of 2,700 physicians. Further, there is inequity in workforce distribution between urban and rural favouring the former (HWA 2012). Demand for aged care, primary care, and primary health care nurses are also expected to rise but the training system is deemed inefficient with bottlenecks in the pipeline. The current labour situation fosters continued dependence on the international migration of health care professionals.
The health care system is in a period of reform spurred by the pressure of increasing costs brought about by an aging population. Demographic changes, high incidence of chronic illnesses, increased health care spending, and labour shortages highlight the inability of the system to provide integrated and cost-effective care that sufficiently meets demand (Betihavas et al. 2011). Many layers of bureaucracy, with funding divided between state and federal governments, created complex processes with no clarity in accountability giving rise to a culture of blame (Kirby, 2010). Moreover, with states managing hospital operations in lieu of hospital boards, there is little authority on the ground which stifles innovation.
Health Care Reform
Currently reforms include funding for more promotive and preventive programs especially in rural areas. Other reforms align health care professional education with population demands and create programs for recruitment and retention (Dwyer & Eagar 2008). Hospitals are being organised into local networks with management that utilises more input from direct care clinicians. Standards increasingly reflect evidence-based practice and implemented through the Commission on Safety and Quality in Health Care (Healy & Hall 2011). Reform goals are to increase equity in healthcare access, respond to challenges, and create stability through self-improvement (Betihavas et al. 2011).
Practice Setting, Roles, and Responsibilities of Nurses
For transitioning nurses, reforms point to greater demands for nurses in practice settings such as general practice, community health care, and home care (Keleher, Parker & Francis 2010). These cater to vulnerable populations including Aboriginal peoples, women, rural residents, older adults, and people with chronic illnesses. This represents a major shift from hospital to community-based services and nursing care must be delivered in a holistic way, involving families and addressing both psychosocial issues and cultural differences. Several roles of nurses gain significance: nurse specialists such as for heart failure and diabetes, nurse practitioners to lead chronic illness management programs, general practice nurses, nurse educators, case managers, and community nurses (Betihavas et al. 2011).
Reforms further shape the responsibilities of nurses that include increasing health literacy to enable self-management of chronic disease, prevention of illness, and health promotion (Betihavas et al. 2011). It is also the task of nurses to coordinate multidisciplinary care, especially for elders and persons with long-term illness, to avoid inefficiencies, poor outcomes, and unnecessary costs at a time of financial resource scarcity. Another responsibility is to raise the levels of safety and quality of care in rural areas to be at par with urban health care. Moreover, roles and responsibilities must be expanded to include leadership in policy reforms (Sweet 2010). Nurses must develop the necessary knowledge and skills to enable successful role fulfilment and participation in governance.
Conclusion
The practice of nursing is influenced by the health care system. Nurses are bound by laws, regulations, policies, and standards that shape scientifically, ethically, and legally accepted practice. They must make use of information systems to access reliable evidence that will guide professional practice in planning and implementing community-based programs, designing materials for patient education, coordinating care, or providing care for diverse patients across the continuum. Nurses further need to promote increased safety and quality of care while reducing costs. Exercising greater leadership and innovation facilitates efficient resource use.
Nurses play an important role in health services delivery at a period when changes are shifting to general practice and primary health care. They must face the challenge of taking on new and expanded roles by undergoing further education and training. They must possess the competencies to help eliminate disparities affecting cultural minorities, rural populations, and the poor through innovative care. Nurses should likewise meet expectations in providing aged care and chronic disease management in the context of families by developing expertise. Finally, nurses should advocate for a nursing education system that responds to population needs, encourages more people to enter and stay in the profession, and resolves bottlenecks.
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