When the Australian Nursing and Midwifery Federation (ANMF) launched its landmark Nurses and Midwives Work Value Case before the Fair Work Commission in June 2026, the industrial argument was straightforward: wages have not kept pace with the growing complexity of nursing and midwifery work.
But behind the wage case lies a broader question that every healthcare leader should be asking. Are the roles within their organisations genuinely becoming more complex? And if so, are their workforce structures keeping up?
A profession that has grown and intensified
ANMF Federal Secretary Annie Butler says the evidence is clear.
“Nursing, midwifery and care work has become more complex and requires higher levels of responsibility and skill than previously.”
The drivers are well documented.
Australia’s population is ageing. Rates of chronic disease are rising. Patients are presenting with multiple conditions, complex medication needs and a range of social and mental health factors that influence their care. The system is responding by shifting care closer to where people live, which means frontline healthcare workers are managing more, with greater clinical responsibility, than previous generations.
Butler says the profession’s value has long been misunderstood.
“The skills needed to provide nursing care have been characterised as ‘innate’ female qualities rather than skills. The work of nurses and midwives has grown and intensified over the years, yet their wages have failed to keep pace.”
What complexity looks like on the ground
Denise Lyons, President of the Australian Primary Health Care Nurses Association (APNA) and Nurse Practitioner, says the shift in role complexity is tangible for frontline nurses every day.
“The complexity of primary health care nursing has increased significantly over recent years, and it continues to grow.”
Lyons says the scope of what primary health care nurses are now doing extends far beyond traditional clinical care.
“Our members tell us through APNA’s Workforce Survey that they are undertaking activities ranging from chronic disease management, immunisation and preventive care through to care coordination, quality improvement, governance, research and supporting people through end-of-life care. The role is far broader than many people realise.”
She says the complexity is not purely clinical.
“It is about navigating systems, coordinating multidisciplinary teams, using data and technology effectively, supporting prevention and population health, and helping patients manage their health over time. Those are sophisticated capabilities that are becoming increasingly essential to a sustainable health system.”
The scope of practice gap
Despite the growing complexity of nursing roles, a significant proportion of the workforce is not being given the opportunity to apply their full capabilities. APNA’s Workforce Survey shows around a third of primary health care nurses are not regularly working to their full scope of practice.
Lyons points to the human cost of this gap.
“Nurses who are not regularly working to their full scope are 59% more likely to burnout, relative to those who are regularly or often working to their full scope of practice.”
That is not only a workforce sustainability issue. It is an efficiency and safety issue for healthcare organisations.
What this means for healthcare leaders
Lyons is direct about what the evidence demands of healthcare leaders. Workforce planning can no longer focus solely on filling positions.
“Organisations should be asking: How do we ensure nurses are working at the top of their scope? How do we create career pathways that retain experienced clinicians? How do we build multidisciplinary models where each professional contributes their full expertise?”
Bottom line
The ANMF Work Value Case has put nursing complexity on the national agenda. But the implications extend well beyond wage setting.
For healthcare leaders, the question is whether their organisations are structured to make full use of the workforce they already have. Investing in career pathways, enabling nurses to work at their full scope, and designing multidisciplinary teams that reflect what clinicians are capable of delivering is not simply good workforce practice. It is increasingly essential to building a sustainable, high-performing health system.
As Lyons puts it: “The conversation is not about whether nurses can take on a greater role in primary care. They already are.”
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