Nurses on the market: The impact of neo-liberalism on the Victorian maternal and child health service

Abstract

Objective: To examine maternal and child health (MCH) nurses' experiences of the implementation of the rationalisation processes and compulsory competitive tendering (CCT) associated with neo-liberalism. Design: Policy analysis, survey of all Victorian MCH nurses, interviews and focus groups with MCH coordinators and some managers of MCH services. Setting: Primary health care in maternal and child health services. Participants: Sixty MCH coordinators, 300 MCH nurses, six managers (95% female overall). Results: The Victorian MCH workforce is overwhelmingly female, with 30% over 50 years of age, and 53.5% working part-time. CCT processes in the mid-1990s effectively put maternal and child health services 'on the market', threatening jobs, and creating highly stressful work environments. Tenders for about 17% of MCH services were won by organisations other than local government, the traditional provider of MCH services. This created new challenges for MCH nurses. In spite of the enormous stress and confusion occasioned by the restructuring, improvements in strategic focus, skill development, teamwork and flexibility were also reported. Conclusions: CCT processes provided MCH nurses with greater transparency about management and budgets. Restructuring gave MCH nurses greater responsibility than they had earlier and they became more aware of the need to 'sell' their service and to understand management contexts. Major hurdles still to be overcome related to wage parity, workload discrepancies and a restrictive, policy legacy about the practice of MCH nurses.