"Gregory, are you trying to tell me I'm insane?"

Have you ever been gaslighted before? You know, when someone is clearly acting in a way that doesn’t correlate with what they’re telling you but they keep insisting you have it wrong. Even when their actions are flagrantly becoming the antithesis of their words they become more firm in their stance . After a while you start to think… do I have it wrong? Am I crazy?

Here are some examples. It’s Trump telling people over and over that a story is fake news, even when there is corroborating evidence, until people begin to believe it. It’s your partner promising there’s nothing going on, and getting mad at you for implying otherwise, when you’ve seen the texts from someone else. Or it’s the Australian government saying they really really value the nursing profession but then excluding us from the expert steering committee for the new 10-year Preventive Health Strategy, once again denying nurses a seat at the table of change. You know, it’s that feeling.

In August this year, Health Minister Greg Hunt announced a national ‘Preventive Health Strategy', a long-awaited commitment focusing on disease prevention, healthy lifestyle and well-being. The announcement, made via video-message at a Public Health conference in Melbourne, has been met with cautious optimism. Many are glad to see a much-needed focus on prevention, which has always been the answer to keeping people well. There are also reservations though that his message was very medication-heavy, and that unless the strategy focuses on climate change and social determinants of health then all will be for naught. Regardless, it’s a positive step forward and worth reading what the government claim they’re committing to. Here’s a wonderful article from Croakey News summarising the announcement and responses.

Unfortunately this is politics and nothing is as good as it appears. Last week Mr Hunt followed up his announcement by revealing the expert steering committee that would advise and lead this strategy alongside the government. It’s a lengthy list, 23 organisations will be on the committee! Plenty of room for everyone, right?

Not quite. Of those 23 organisations, how many do you think represent the nursing profession? I would have hoped at least 2, if not 3. The actual answer: not a single one. NOT A SINGLE ONE! Maybe there are nurses working within some of those 23 organisations (23!!), but it is not the same thing as having a voice on that committee whose primary interest is to advocate for the nursing profession and our vital role in providing preventive healthcare. I was genuinely dumbfounded when I read the list.

Now I know what you’re thinking: Robbie, that can’t be right. Nurses make up approximately half of the entire health workforce. General practice nursing, whose cornerstone is chronic illness management and disease prevention, is the fastest growing health workforce in Australia. Areas of focus within the strategy, such as immunisation, have nurses as some of the countries leading experts and clinicians. For goodness sake, nursing is consistently voted as Australia’s most trusted profession! Read it again, you must be wrong.

But alas, no. Nurses are once again Ingrid Bergman and the world is Charles Boyer; they want our loyalty, they want the money we can make them and the essential service we provide, but they don’t want to show us respect. It’s hugely disappointing for many reasons, the most obvious of which is that without empowering and elevating nurses we will never achieve the goals set out in the strategy. Without nurses we can’t achieve universal health coverage. To quote the Australian College of Nursing, “There is no preventive health without nurses.”

So why have nurses once again been left behind? Is it ignorance, a simple lack of understanding about the nurse’s scope of practice and the way preventive health is delivered? Possibly. Maybe it has to do with the fact that in order to utilise our nursing workforce to its full scope we need to innovate the funding models of healthcare, notably the fee-for-service model within general practice. There are some health professionals, primarily certain doctors* and the powerful lobbying organisations behind them (some of whom are represented on the steering committee), who incorrectly assume this will mean a cut to their income and therefore push back against greater nursing involvement. I think it runs deeper still. Nursing is a female-dominated industry and the hierarchy of healthcare is rooted in the patriarchy. Will nurses continue to be overlooked because society views nursing as feminine and therefore less worthy? It’s probably all of the above.

In case you think I’m over-reacting about being gaslighted I want to share an anecdote with you. The Australian Primary Health Care Nurses Association (APNA) is our national organisation for primary care nurses, like myself. I have been to three annual APNA conferences in a row and I have a distinct memory of each conference opening the same way, with a pre-recorded video message from the aforementioned Health Minister Greg Hunt. “I love nurses,” he decrees. “I respect nurses,” he reads off the auto-cue. “My wife is a nurse, my mother was a nurse,” he implores, trying to earn street credit. Cool, we all think, maybe this is a politician and a government who have our interests at heart! And they do! You know, after the interests of 23 organisations they care about more... Gregory, are you trying to tell me I’m insane?

I’m also upset because there is a bigger issue at play here. We are in the middle of a retention and recruitment crisis in nursing. According to Health Workforce Australia, we are currently short almost 80,000 nurses. In 2030, this is set to be a deficit of more than 120,000 nurses. A contributing factor for this is burnout, which is experienced at a greater rate for nurses than the general population. One of the major factors contributing to burnout is feeling a lack of control, or an ability to make decisions. You know what’s a real punch in the guts when you’re working tooth and nail trying to provide quality healthcare? Being told that you’ll never get a say in what that healthcare looks like. This decision won’t just negatively affect patient care, it may contribute to more nurses feeling disillusioned and leaving the profession. This decision is shameful.

Every healthcare profession has their role to play in preventing disease processes and promoting well-being. We are entering one of the scariest and most important moments in history. We are living in a climate emergency; preventable, lifestyle diseases are literally killing people; mental illness and psychological distress are incredibly prevalent. All of this is felt even more deeply by our marginalised communities, such as Aboriginal and Torres Strait Islander People and the LGBTQI+ community. We need everybody united in the fight for universal health coverage. I, and so many nurses, want to be a part of this fight; stop telling us we’re invited to the party and then slamming the door in our face.

To Greg Hunt, the Australian government, and everyone involved in making this decision, I ask these two simple questions. If the health of even one Australian is detrimentally impacted by this decision, which it will be, can you live with that? If you, or someone you loved, needed quality healthcare but there was no nurse to provide it, are you going to wonder if this decision played a role in that nurse leaving their profession?

At the end of Gaslight, when Ingrid Bergman learns that all along it was Charles Boyer who had driven her mad, she says to him, “If I were not mad, I could have helped you. Whatever you had done, I could have pitied and protected you.” You know what she does instead? Rejoices in his demise. When you push anyone enough they are eventually going to push back. A final thought on behalf of Australian nurses: stop pushing us.

The title and banner image are taken from the 1944 movie ‘Gaslight’ starring Ingrid Bergman and Charles Boyer. It’s the story of a woman who is systematically driven insane by her new husband as he plots to steal her fortune.

*Please note that I am aware many doctors don’t feel this way, some of whom are my friends and colleagues. Unfortunately, there are also many that do feel this way (I know them too).

Since publishing this article, many nursing organisations across Australia have successfully lobbied the federal government to include nurses as part of preventive health planning. This is confirmed by statements on social media from the Australian College of Nursing (ACN) and the Australian Primary Healthcare Nurses Association (APNA). Details of what this inclusion will look like, as well as an official statement from the office of Greg Hunt, have not yet been released.

I am very grateful to those organisations that fought to advocate for nursing, as well as the grassroots warriors all over the country who made their voices heard.