UTS alumna Frances Hughes an advocate for nursing's global voice

Ninah Kopel:

Imagine if getting medical advice was as easy as going to the supermarket. Well, in the States, it is. With some stores taking on nurses as staff, this is just one of the ideas Dr Frances Hughes brought to her chat with Ellen Leabeater. Frances is the Chief Executive Officer for the International Council of Nurses. She has previously held senior leadership positions with the World Health Organisation, and most recently as the chief nursing and midwifery officer to the Queensland Department of Health.

Ellen Leabeater:

From your role as chief nurse in New Zealand, you went on to work for the World Health Organisation. What did that role involve?

Frances Hughes:

I worked for World Health on contract for Manila and also for headquarters in Geneva, and I established and set up the Pacific Island mental health network. And that was working with sixteen countries in the Pacific, to help them address the mental health needs of the Pacific.

Ellen Leabeater:

What sort of mental health needs do we see in the Pacific?

Frances Hughes:

They're similar to most other countries, it's just they have different challenges and complexities because they're smaller and often isolated and they've got cultural difference. But you have the same issues, you have the main mental disorders like depression and schizophrenia, bi-polar. You have mixed up with often addictions and drug issues and alcohol issues. You have, of course, the spectrum between young and old and you have the issues of access and affordability. So, that's a big issue in countries that have more money and a better infrastructure. You maybe have more access to talk in therapy, you have more access to treatments and you have follow-up.

It's got to be contextualised quite different in countries which maybe don't have clear mental health strategies and plans. Don't have protections for consumers by law, like mental health acts that protect consumers, as well as ensure that they have effective and adequate treatment.

Ellen Leabeater:

You said a lot of that work in the Pacific Islands is about getting governments on board ...

Frances Hughes:

Yeah, it is.

Ellen Leabeater:

Is it quite similar to, say, Australia and New Zealand in getting governments to implement policy, or are there separate challenges that you see in the Pacific Island governments?

Frances Hughes:

Well, you've got to realise, there's no one culture in the Pacific, so, there's four, well, five, I suppose. There's Micronesia, which is up the top, which was really under the auspices of the US, so this is Palau, Marshalls and a few other states in Micronesia. Then you've got Melanesia, so you've got the PNGs and you've got the Solomon Islands, Vanuatu, and then you've got the Polynesia, and then you've got Australia and New Zealand. Now, we're all very different cultures, so it really depends on values of the culture, understanding of mental illness.

Some of the understanding is still very much spiritual based, some of it is based on devils and spirits, which is a cultural understanding which you have to accept and that's a cultural issue. Some of it is that there is a ... The actions that ... No need for human rights protection because there's inadequate laws as I said before. So, all this is contextualised in countries, but regardless of the culture, individuals need to have some protection and access and affordable services if they are mentally ill.

Ellen Leabeater:

Talking about that cultural aspect of mental health, how do you balance the western treatment of how we approach mental health with balancing the spirits and all those cultural aspects?

Frances Hughes:

You work. I mean, east meets west, so to speak. We have the same in India, traditional practices. Every country that's got Indigenous people has traditional practices, and the western style of medicine and healthcare is only relatively new to these cultures. We can partnership with consumers and cultural leaders so that you bring the best of the best from both sides.

Ellen Leabeater:

So, after your work with the WHO, you then moved on to Queensland health and you were the chief nurse and midwifery officer for Queensland health. I understand that the nurses and midwives you inherited when you first started that, you managed to change it into something quite different by the time you finished there.

Frances Hughes:

I basically took the government agenda and operationalised it. And so, I showed evidence of nursing, I profiled what nurses were doing, I ensured I had good data and information, I dealt with, when there was arguments about whether they should slash nursing, cut nursing, I produced evidence about how foolish that can be for outcomes of consumers. How it's not cost effective to slash and burn nursing.

But I had to do that in an evidence based approach. You can't be emotional about this stuff, because it's often an economic argument, it's coming down from treasury or finance people, so I needed to write and be able to produce data and information. So I did a huge lot of work on profiling why we should be investing in advanced practise, nurse practitioners, why we should be reducing red tape around nursing, why nurses need to work to their full scope of practise, why we needed to look at how we could see nursing in a more economic modelling, not just a cost on the budget but actually an investment.

So, over four years I did a great deal of work and developed strategies, a nursing strategy, made sure that nursing was populated in all sorts of other government documents. We ended up, and I didn't do this alone, I had a very strong partnership, good partnership with the Queensland Nurses Union. Early last year, when the new government came in we got nearly half a billion dollars of investment into nursing.

Ellen Leabeater:

Wow, that's an excellent achievement.

Frances Hughes:

But that was through galvanising and bringing together the best of nursing from the state. The Queensland Nurses Union, working in partnership with them, we produced and were able to show that we should be investing in nursing.

Ellen Leabeater:

Where does this idea come from, that it is good to slash and burn nursing?

Frances Hughes:

It's because we're the largest item and salaries on the spreadsheets in any hospital health system. We are. So, sometimes it's low hanging fruit to people that don't know any different. They say the easiest things to cut is wages and salaries, so we either dumb down nursing or bring in cheaper people to do the same job. Well, that's just foolish. We have enough research around the world, with forty to fifty countries, where if you start reducing the role of the RN, replacing them with less skilled workers, you have a blow-out of quality and actually, you can kill patients. The registered nurse, the amount of clients and patients that they have, if you increase the numbers that they have, their mortality goes up by seven percent. And that's how we get the nurse ratio argument. So, there's enough evidence around that, through large data sets of information.

We also know that if you have less skilled workers and you don't have the RNs, you get other effects, like falls, medication errors, failure to rescue clients. So, we've got a lot of data and information. The issue was, why aren't the services taking any notice of it? Why do people still think they should slash and burn nursing? They don't do that. They're not thinking about models of care, they're not thinking about different approaches. They don't even think about why they keep having to do practises, which really, they could do better in the community.

So, there's a lot of things that could be done different through models of care.

Ellen Leabeater:

Do you think governments listen to evidence?

Frances Hughes:

Politicians do what they need to do to stay elected. That's what they're there to do. You do get alignment at times, where you get absolute alignment that they will put the belief about what they should be doing for the public, who voted them in, and good government strategies, good public policy, and it can do fantastic things. But at times, no, they turn over very quickly, politicians turn over, and they just get caught up in the politics rather than the policy. And they should be concentrating more on the policy. Because you can't turn on and off healthcare. You can't turn on and off nursing.

Ellen Leabeater:

Healthcare's one of those interesting things, because if you're a politician, it's highly, highly unlikely that you've never stepped foot in a hospital, and whenever you do go to hospital, it is the nurses that you see.

Frances Hughes:

I know. But the issue is, most of the time, it's organised medicine that they listen to.

Ellen Leabeater:

What's organised medicine?

Frances Hughes:

The medical AMAs of this world.

Ellen Leabeater:

The Australian Medical Association?

Frances Hughes:

Yeah. Yeah. They listen to them, and they're not actually seeing the full picture of healthcare. Nurses are not doctor's servants, they haven't been for centuries. We are legitimate, well educated, highly professional beings, functioning with or without medicine around us. We are naturally good team players, and we work well in MDTs, but-

Ellen Leabeater:

What's MDT?

Frances Hughes:

Multi-Disciplinary Teams, with others, like physios and allied health and things. But there comes a time when we cannot continue with the expenditure that's continuing at the moment in healthcare. No countries can afford it. Consumers can't afford the co-payments, they can't afford the private medical.

Ellen Leabeater:

Do you see the scope of nursing widening over the next decade?

Frances Hughes:

Nursing will go wherever the consumers are going. Nursing is totally the partnership role, and responsibility of the nurse is to have a partnership responsibility with the consumer or patient. As consumers start to get more literate in health, start to have different technologies around them, there's absolute big changes. I've been in the US and spent three days with retail health clinics. These are nurses who are functioning in Walmarts and shopping and big supermarkets, they are doing amazing things.

Some of those consumers may never go near a hospital or what we may see as traditional practices. And they're doing an amazing job. So, that's what's the most important. We've got chronic disease staring us down the barrel, of diabetes, and these illnesses are going to suck up all our resources in the system. We have to manage them better. We have to work with consumers differently, and nurses are key to that.

Ellen Leabeater:

In that American example, you're going to Walmart, grabbing some bananas, toiletries and go to see the nurse.

Frances Hughes:

Yeah. And it's a nurse practitioner. So, these are the advanced nurses, so they do assessments, they prescribe, they have time with consumers. It's called convenient care. They're not the medical home of the consumers, but they are there for consumers that need them. And that's what we have to get real about. We can't keep provider-driven services, ie. consumers can't always fit around when we want to look after them, and when we want to treat and when our opening hours. And what the retail health has done is flip that over. They're open from eight in the morning 'til ten o'clock at night. And that's what it's about.

Ellen Leabeater:

That's what the twenty-first century is all about.

Frances Hughes:

Well it is about it. You know what it's like, I mean, I'm now living in Geneva, and the whole place is shut on a Sunday. It's foreign to me. It's not convenient. If we want to actually address the issues, we've got the meet consumers where they are and what they're at. And not try and keep dragging them into our systems, making them drive miles, use more tele-health, use more technology. And nurses ... There's millions of us. There's not an area of the country that you can't find a nurse. And they will always be there. But, they need to be valued, they need better working conditions, they need their evidence, their models of care, the way they were educated. They need to be able to implement those.

Ellen Leabeater:

And this convenient care, that would drive down the costs of healthcare?

Frances Hughes:

Huge. The data that came out of those sessions was amazing. Absolutely amazing. So, of course, private insurers now are reimbursing clients who go to those nurses. Because that's always a big issue. It's not that nurses can't do the work, and it's not that we're not educated to do the work, but usually, people don't want to pay for it. Because organised medicine usually stops nurses getting reimbursed for doing the same services they do. Now, that's anti-competitive. But that's now been broken by this issue with the convenient care because Walmarts and these big, massive industries, they went and fought for it. And now the insurance industries and payers in the US now pay the nurse practitioner for the same service as they would if they had it elsewhere.

Ellen Leabeater:

Do we have any nurse practitioners in Australia or New Zealand?

Frances Hughes:

Yeah, we have a wonderful groups nurse practitioners here, and you know, the largest group is in Queensland, but they're all over the country. And they deserve to be able to meet the consumers’ need that they're educated to do. And the Medicare federal government has got to unleash the power to enable Medicare to reimburse nurse practitioners for services that they do. Not just feed them bits of money.

Ellen Leabeater:

Where do the nurse practitioners currently work?

Frances Hughes:

All over the place. They're in hospitals, in primary care, they're in mental health. You name it, they're there. The issue is, we need a bigger critical mass in Australia. But the needs of Australians are no different to other countries. Especially western countries, because most of our chronic diseases that are occurring are lifestyle related. It's what we've put in our mouths and the fact that we don't exercise enough. And we may have some genetic pre-dispositions. But it's all related to exercise and diet and the way we cope with stress.

Ellen Leabeater:

I'm just picturing the nurse practitioner in Walmart taking a look at your shopping trolley and saying, "Hang on a minute, do you really want those biscuits?"

Frances Hughes:

Well, there's thing about having convenient care. Having nurses located in this types of places, it's much more relaxed for consumers, often you can have discussions with them, and you've got to break the mould. And also, we don't need to keep building buildings for healthcare. We should co-locate where consumers are, and that's what I learnt from that. Why do we need to build big medical rooms when we can actually co-locate into other premises where there's more likely to be more consumers.

Ellen Leabeater:

Tell me about the new role that you've just taken up in Geneva.

Frances Hughes:

I've been the Chief Executive Officer for the International Council of Nurses, which is a hundred and seventeen years old. It was formed in the late eighteen ninety nine out of the suffrage movement. It's the first international professional woman's organisation. It is membership based, so it is about galvanising and bringing together nursing interests, advocacy issues across the world, through national organisations of nursing. They're our members. It is based in Geneva, primarily because that's where the UN and WHO are. We're global. And we have a key advocate for the voice- We are the voice of nursing across the globe.

Ellen Leabeater:

We kind of touched on the cost of healthcare blowing out as one of the big global issues. What are the global issues that you hope to tackle in this role?

Frances Hughes:

Universal health coverage. The sustainable development goals, they're our big, big issues. Health-wise, priorities would be things like antimicrobial resistance, HRH (human resource issues for nursing and workforce), mental health, ageing, immunisation – they are just some of the ones that we're dealing with.

Ninah Kopel:

And that's it for this episode of The Chat. If you're keen for more, don't forget to hit subscribe and leave a review, it really helps. This show is produced with the support of the University of Technology Sydney, and 2SER.

I'm Ninah Kopel, thanks for your company.