Annual APNA Workforce Survey 2023

Insights for advocacy and change

 

By Danny Hills, APNA Monitoring and Evaluation Manager

Source: APNA Primary Times Winter 2024

 

 

 

The APNA Workforce Survey is a unique and authoritative source of information about primary health care (PHC) nurses and midwives and the work that they do, which is fundamental to ensuring the health and wellbeing of the Australian population. 

Commonwealth and State Departments of Health, and leading policy, research and industrial organisations with an interest in the health and wellbeing of Australians come to APNA on a regular basis. This can be in relation to participating in expert advisory groups, partnering in research grant applications and accessing insights drawn from the APNA Workforce Survey. 

PHC nurses’ participation in the annual APNA Workforce Survey is very important. Insights drawn from the annual survey can make a significant difference in areas such as scope-of-practice advocacy, fair-pay negotiations and improved funding arrangements for PHC nurse- and midwife-delivered services. 

In 2023, APNA established an Advisory Board of experts to guide the development and implementation of the APNA Workforce Survey. The Advisory Board comprises leading nursing and health workforce researchers and policy-makers, including representatives from the Australian Institute of Health and Welfare, the Grattan Institute, the Bolton Clark Research Institute, Monash University, Federation University Australia, the University of Southern Queensland and the University of Queensland. The APNA Workforce Survey has received full approval from the Monash University Human Research Ethics Committee and it is regarded as an important research platform that informs and guides policy and practice. 

In the following sections, key outcomes of the 2023 APNA Workforce Survey are detailed. The results presented are descriptive in nature, and provide some insights into respondents’ personal profiles, their work and work lives, and their workforce participation intentions. No associations among the various questionnaire items (variables) have yet been determined. 

 

Part 1. What did Australian PHC nurses and midwives tell us about themselves in 2023? 

The 2023 APNA Workforce Survey officially opened on 16 October 2023 and closed on 31 December 2023. After the removal of duplicates and other data-cleaning operations, almost 3,000 Australian PHC nurses and midwives provided key information about themselves and their work, with almost 65% working through the questionnaire to the very last item.  

Here’s what we found: 

• Just over 57% of our respondents were current APNA members. 

• Almost 95% of respondents were female, with 5% being male – a very small proportion (0.3%) indicated being non-binary or gender diverse. 

• The respondents' ages ranged from 20 to 80, with a median (middle score) of 51.  

• The majority of survey participants were registered nurses (76.6%) or enrolled nurses (12%) – see Figure 1. 

• The majority of respondents came from NSW (26.8%), Victoria (24.4%) and Queensland (21.1%) – see Figure 2.  

In terms of metropolitan or rural location (Modified Monash Model), the majority of respondents (56.9%) were located in MM1 (metropolitan areas), with a good spread of respondents from MM2 (regional centres), MM3 (large rural towns), MM4 (medium rural towns), MM5 (small rural towns), MM6 (remote communities) and MM7 (very remote communities) – see Figure 3. 

Other key personal details from survey respondents revealed the following: 

• Ninety-three (3.5%) respondents identified as Aboriginal and/or Torres Strait Islander, with seven (a little under 0.3%) identifying as other First Nations (including Māori, Samoan, Filipino and East Timorese). 

• In 2023, we asked respondents to indicate their country of birth and their country of first basic nursing/midwifery qualification, with Australia overwhelmingly receiving the highest responses for country of birth (76.3%, Table S1) and country of basic qualification (87.4%, Table S2). 

• The median nursing/midwifery experience was 21 years (range 0–60 years). 

• The median PHC nursing/midwifery experience was 9 years (range 0–58 years). 

• Nursing and midwifery respondents are highly educated, with the majority of respondents (76.5%) holding an undergraduate degree or higher qualifications (Figure S1). 

• For the first time in 2023, we asked respondents about their general health—just 12.4% reported their health as excellent, with 68.4% reporting their general health as good or very good (Figure S2). 

• Also, in 2023, for the first time, we asked respondents about their satisfaction with life in general, on a scale from 1 (completely dissatisfied) to 10 (completely satisfied) – the median (middle) score was 8, with 81.6% of respondents rating their life satisfaction as 6 or above out of 10.

 

Part 2. What did Australian PHC nurses and midwives tell us about their work and work lives in 2023? 

We asked Australian PHC nurses and midwives about their main job in PHC and any secondary job. Respondents could choose one setting from a list of 26 settings or indicate ‘Other’. We also asked our survey respondents about their main employment status, hours worked, pay rate, satisfaction with a range of work aspects, extent working to full scope of practice and continuing professional development (all relating to the main job). Additionally, we asked respondents about their experience of stress and burnout, how valued they felt in terms of their work as a PHC nurse/midwife, and their desire to change work hours or focus of work and intentions to stay in PHC nursing/midwifery. 

In 2023, for their main job, 56.6% of 2,530 respondents worked in general practice, followed by community health services (8.1%), ‘other’ (4.2%), Aboriginal community-controlled health services (4.0%), residential aged care (3.9%), primary health networks (3.4%), schools/preschools (3.1%), and maternal and child health services (2.3%). There were 16 other settings accounting for the balance of responses. 

Of 2,473 respondents, 19.5% (482) indicated they had secondary employment. Most indicated their second job was in ‘other’ (29.9%), followed by general practice (18.3%), community health (8.7%), residential aged care (7.7%), non-government organisations (5.2%), and specialist medical rooms (4.2%). 23 other settings accounted for the balance of responses. 

In terms of employment status in their main job, more than 76% of 2,528 respondents had permanent positions, with 44.7% working permanent part-time (less than 35 hours per week) and 31.9% working permanent full-time (35 hours per week or more), while 16.5% held casual positions (Figure 4). 

• Overall, respondents reported working a median of 32 hours per week (range 4–76 hours per week). 

• Overall, respondents reported receiving a median hourly pay of $45 (range $26–$120). For more details, see the Money in May dashboards for APNA members.

We asked survey respondents about their work activities, what they undertake regularly or less regularly and whether they would like to continue doing these activities more, the same or less often. As shown in Table S3, indicating the top ten activities (currently doing frequently and wanting to do more often), PHC nurses and midwives overall want to do more health promotion, health education and illness-prevention activities and have more engagement in continuing professional development. 

The job satisfaction data are also illuminating (Figure S3). On the 10-item job satisfaction scale, the percentage of respondents indicating being moderately or very satisfied was greater than 70% only in relation to ‘colleagues and fellow workers’ (70.4%). The lowest percentage of being moderately or very satisfied was for ‘recognition for your work’ (45.0%) and ‘your remuneration’ (37.0%), with almost 21% of respondents being moderately or very dissatisfied with their remuneration. For ‘satisfaction overall’, 61.3% indicated being moderately or very satisfied. The mean (average) satisfaction score for this job satisfaction scale is 4.33 (range 0–6), reflecting a reasonable level of satisfaction overall, but a sizable proportion of respondents were not entirely satisfied with their work. 

Ratings for satisfaction with other key aspects of work were somewhat more positive (Figure S4): 

• In regards to work–life balance, 71.1% of respondents agreed or strongly agreed that the balance between their personal and professional commitments was about right. 

• More than a third (34.6%) of respondents agreed or strongly agreed that it is difficult to take time off work when they want to. 

• Well over 70% of respondents highlighted positive team interactions and collaboration, including in relation to communications among staff, multidisciplinary teamwork and managing patients/clients with complex health and social problems. 

• Nearly two-thirds (65.0%) of respondents agreed or strongly agreed that they were able to access good support and supervision from qualified nurses/midwives or other health professionals. 

• More than half (52.2%) agreed or strongly agreed that they often undertake tasks that somebody less skilled or qualified could do. 

In a separate question, we asked respondents if they had received financial and/or other support for continuing professional development (CPD) from their employer during the last 12 months (Figure S5). Almost half (48.4%) occasionally, mostly or always received some form of support, but almost a quarter (22.7%) did not receive any support. The remainder (28.9%) reported that they did not request any support for CPD. 

We also asked respondents about the levels of stress and burnout they felt in their work (Figure 5). A reasonably sizable proportion (27.6%) just a few times a year or never felt stressed from their work, while 45.6% rarely or never felt burned out from their work. Nonetheless, just under 30% of respondents frequently felt stressed from their work, with almost one in five (19.7%) indicating they frequently felt burned out from their work. 

Enabling health professionals to work to their full scope of practice (SoP) has been very much at the top of the policy agenda of recent times. We asked a series of questions about SoP:  

• Firstly, we asked respondents how often they work to the full extent of their qualifications, skills and capabilities (scope of practice). As shown in Figure 6, while over two-thirds (69.4%) of respondents work often or regularly to their full SoP, almost a third (30.6%) only occasionally or rarely work to their full SoP. 

• Secondly, we asked if respondents had requested to undertake more complex clinical activities or to extend their roles (Figure 7). More than half (53.5%) said they had made no request. For those who did request to extend their role, 13.2% were unsuccessful, 12.5% indicated their request was under consideration, and 20.8% indicated their request was successful. 

• Finally, for those whose request was unsuccessful, we asked about the reason/s they thought their request was unsuccessful (Figure S6). From 465 responses (multiple options allowed), the main reasons given in decreasing order were that there was no financial incentive, there was resistance to change, there was limited time and/or resources, and that the request was beyond the scope of the organisation.

 

Part 3. What did Australian PHC nurses and midwives tell us in 2023 about their intentions to continue participating in PHC work? 

Many of the questionnaire items (let’s call them factors) reported on in Part 1 and Part 2 of this article are likely to have some bearing on choices that PHC nurses and midwives make regarding their work. 

In 2023, survey respondents were asked about their intentions to remain working in PHC (Figure 8):  

• Nearly 80% said that they were likely or very likely to remain working in PHC within the next 12 months – 11.1% were unsure, and 9.4% indicated that they were unlikely or very unlikely to remain working in PHC within the next 12 months. 

• However, only 63.5% indicated that they were likely or very likely to remain working in PHC in the following 2–5 years – 19.7% were unsure, and 16.9% said that they were unlikely or very unlikely to remain working in PHC in the following 2–5 years. 

In 2023, we also asked survey respondents about the likelihood of them leaving nursing or midwifery altogether (Figure 9). 

• Nearly 80% said that they were unlikely or very unlikely to leave nursing or midwifery within the next 12 months – 12% were unsure, and just over 8% indicated that they were likely or very likely to leave their profession altogether within the next 12 months. 

• The proportions changed considerably when asked about their intentions in the following 2–5 years, with only 59% indicating that they were unlikely or very unlikely to leave their profession altogether – almost 19% said they were unsure and more than 22% indicated that they were likely or very likely to leave their profession altogether in the next 2–5 years.  

 

Conclusion 

The APNA Workforce Survey provides comprehensive information about PHC nurses and midwives and the work that they do. A substantial range of findings from the 2023 APNA Workforce Survey are reported here, but this report is not exhaustive. However, the report provides substantial information on – and hopefully important insights into – respondents’ personal profiles, their work and work lives, and their workforce participation intentions. APNA relies on the information that PHC nurses and midwives provide in the annual Workforce Survey to advocate on their behalf, to inform and guide policy and practice, and ultimately to support improvements to the health and wellbeing of all Australians. A current example, of high importance, is the significant contribution that APNA is making to the Commonwealth Government’s consultations on its Scope of Practice Review and proposed reforms. The need for and direction of reform is amply supported in the APNA Workforce Survey results. 

 

 

 

Tables

Table S1. Country of birth 

Country	N	%
Australia	2,044	6.30
United Kingdom	199	7.43
New Zealand	89	3.32
Philippines	51	1.90
South Africa	34	.27
India	32	1.19
China	22	0.82
Other	208	7.76
Total	2,679	100.00

 

Table S2. Country of basic nursing/midwifery qualification 

Country	N	%
Australia	2,346	87.37
United Kingdom	142	5.29
New Zealand	68	2.53
Philippines	37	1.38
South Africa	21	0.78
India	19	0.71
China	22	0.82
Other	52	1.94
Total	2,685	100.00

 

Table S3. Top ten activities that survey respondents currently do frequently and want to do more often 

Undertake a few times each week or daily (%)	Want to do more often (%)
Infection prevention and control (75.2)	Health assessment 45–49 years (42.9)
Wound care assessment/management (69.8)	Suturing (39.5)
Use of recall and/or reminder systems (69.1)	Health assessment other (e.g., intellectual disability, refugees) (36.6)
Adult immunisation administration and management (64.6)	Health education and promotion (including groups) (34.1)
Immunisation cold chain management (58.7)	Aboriginal and Torres Strait Islander health assessment (34.0)
Childhood immunisation administration and management (58.3)	Cardiovascular education and management (31.6)
Medication administration/management/review (57.8)	Women's health checks/screening (30.6)
Care plan preparation and management (56.3)	Accessing CPD/education and training (30.4)
Triage (54.2)	Asthma education and management (30.4)
Weight assessment/management (52.2)	Providing CPD/education and training (30.0)