Sunday 16th July 2006
A presentation by Dr Sharyn Hunter, CNC of Anglican Care, revealed a varying picture of RN practice in aged care.
Dr Hunter’s presentation at the NSWNA Aged Care Nurses Forum was based on the findings of her research project examining the changing roles and practices of RNs working in aged care.
Her research aimed to explore the practice and role of RNs in the residential aged care sector.
The research revealed that some RNs working in aged care were still stuck in past practice, others worked within current roles and practice and some are looking ahead to a model where the RN role is that of a clinical manager, with ENs and EENs assigned responsibility for the hands-on delivery of care.
Dr Hunter’s project utilised a multiple case study methodology, with study participants from six different facilities across NSW.
According to Dr Hunter, both RNs and NUMs recognise that RN practice is evolving: they are more accountable, involved in decision making in relation to both the residents and the facility, and are responsible for a greater range of clinical and managerial activities.
RN education, support by the NUMs and GPs, and changing nursing structures have all assisted in the development of the RNs’ practice.
With their increased role, Dr Hunter’s research reveals that RNs working in aged care are now questioning why should they be classified as having less skill and being less able than RNs in acute care. ‘I mean, aren’t we RNs so we can make decisions,’ said one participant in the study.
The changing organisational structure of facilities in the aged care sector has also contributed to the changing role of the RNs in residential aged care. Present structures more commonly comprise the NUM, RN/s with a clinical management role, and ENs and EENs delivering the hands-on care. Previously, the organisational structure had many more levels of management and the RN had greater responsibility for the delivery of care.
All case respondents in the research study said education was one of the key strategies that had assisted in their development. The RNs reported they received education within the facility and were generally encouraged by the NUMs to undertake external training.
They also acknowledged that RNs are required to be more accountable in their practice, standards have to be met and can no longer be ignored.
‘When I first started we put the pills in egg cups, I can remember, and we put out the night before for them with little name tags on them. Now we use the Webster packs and they [the medications] are dispensed and signed for when the resident takes them,’ one respondent said.
The respondents expressed a high level of sensitivity about how others view them, reported Dr Hunter.
Despite improvements in their professionalism, RNs in residential aged care perceive a lack of respect from RNs in the acute sector. Nurses view RNs in aged care as the poor cousin of nursing.
The media are also perceived to be constantly presenting a negative, sensationalised portrayal of residential aged care.