Bottom lines : the influence of government funding on 20th century district nursing practice in Australia

Aims and objectives. To investigate the impact of past government policy and legislation on the practice of district nursing inAustralia.Background. Nurses have historically been politically passive and have not engaged in the political processes of policy development.However, legislation can have profound impacts on the daily work of nurses as demonstrated in this paper.Design. Historical analysis.Methods. The archival records of six district nursing services in Australia were analysed within the political, social andeconomic context of the 20th century, with particular focus on the 1950s and 1970s.Results. Two pieces of Federal legislation passed in 1956 and 1973, respectively, had critical effects on the work of districtnurses. Both resulted in significant expansion of district nursing in Australia; neither was formulated with input from districtnursing services. However, together these acts shifted district nursing from being a voluntary, charity based activity to one thatwas greatly controlled by government.Conclusions. Greater government funding allowed district nursing to expand beyond the capacity possible when funding waslocally based, but with government funding came other restrictions related to accountability processes and expectationsregarding services provided, and these had profound effects on nursing practice, including excess workloads to the point ofunsafe practice.Relevance to clinical practice. Nurses need to engage with the political processes associated with government policy formulationand implementation if they are to avoid placing themselves and their clients in vulnerable situations as a result of governmentdecisions.