Broad debate at Aged Care Forum

The training of carers in medication duties, the challenges of attracting new graduate nurses into aged care, and the unique issues of gay and lesbian residents were among the subjects addressed at our recent NSWNA Aged Care Nurses Forum.

Shortage of RNs highlights importance of training carers

Aged care facilities need policies and procedures for medication duties, and with the shortage of RNs, a delegation process, Carla Unicomb told the forum.

Carla is an RN, Oncology Nurse and Director of Training Beyond 2000, which trains assistants and carers in Certificate III and IV.

Carla said a lot of RNs feel the training of AiNs is important.

‘There are those who feel it is their domain to do the medications. However, due to the shortage of Registered Nurses, they don’t have that luxury,’ she said.

‘By getting carers to give medications, they’re able to use them for the lunch time medication round, which leaves the RNs free to do other things, which they have found to be very beneficial.’

Carla said it is important for facilities to have policies and procedures in place to do their own training and re-assessing of carers.

‘Obviously if they feel they’re not competent to do it, they shouldn’t allow them to do it.

‘It’s not good enough for us to do the training and a year later the facilities say, “Oh you’ve done that module.” It’s also important to have Medication Committees in facilities and make sure that RNs are represented on the committees so that their concerns are heard.’

Carla pointed out that short-staffing is a major issue when it comes to follow-up training.

‘Most employers are pretty good because of accreditation issues. However, they are also short-staffed and there’s no Registered Nurse so they want to make sure carers are trained properly.’

Increased demand in aged care and the challenges of recruitment

Betty Krstevska, RN, Nurse Manager at St George Hospital acute aged care ward, said the biggest obstacle to recruiting graduate nurses into aged care is the actual name itself. ‘The concept of aged care and whatever the graduate nurses’ understanding is of aged care is that it’s not really an exciting place to work. Everyone associates aged care with working in a nursing home as opposed to what it’s really about,’ she said.

Betty said on her acute aged ward there is a focus on the team model to ensure staff support in a busy challenging environment.

‘We see confused patients who are bed-bound, patients with dementia or have behavioural issues. The patients that are here as opposed to nursing homes are here with acute medical problems so we do a lot of interventions that are surgical or medical,’ she said.

‘From our point of view, that keeps the new nurses interested. The support and education we’ve been able to provide is important as well.

‘When I first came here we were so short-staffed, which could be a reason why people would want to leave. But now we’re fully recruited and the concept of team work especially has worked fantastically.

‘Aged care is just a name; it doesn’t matter whether it’s an aged care ward, a surgical ward or a critical care area. Because of the ageing population there’s always going to be elderly patients wherever you go to nurse. It makes you learn and appreciate having the experience so much, and it’s beneficial to any nurse,’ said Betty.

Ageing gays and lesbians still face discrimination

Discrimination is the main issue facing ageing gays and lesbians, said Russell Westacott, Director of Client Services at ACON, Australia’s largest Lesbian/Gay/Bisexual/Trans (LGBT) health and well-being organisation.

‘It can come from the actual service providers themselves or it can come from other people within the aged care facilities – other patients or clients. We also hear stories about people going back into the closet as they get older; not being open about their sexuality and needing to conform and have a more comfortable situation within the aged care facility.’

Russell said ACON has been trying to advocate for sensitivity training for aged care service providers particularly in areas where there are large gay and lesbian populations. It recently received funding from the Commonwealth Government to do this.

‘ACON has a work group that meets every second month and we try to advance the issue of LGBT and ageing on both the research and policy agenda and try to get funding as well.

‘ACON has started services that are providing support to people with HIV. We’d like to be able to get some funding to re-orient that program and help people in their homes who are ageing in the gay and lesbian community, but at the moment it’s been difficult to secure funding. The ageing work groups help do some cleaning and take the person to the supermarkets, or to the doctor’s office. We’d like to be able to provide that for the older gay and lesbian community who may not be comfortable with the existing services,’ said Russell.

Begin with the end in mind

Anne Meller, Clinical Nurse Consultant, Chronic and Complex Care, Advance Care Planning at South Eastern Sydney and Illawarra AHS spoke to the seminar about the process of preparing for possible scenarios near the end of life.

‘It’s quite likely that we’ll spend a longer time towards the end of our lives lacking mental capacity or not being able to make our own decisions. Therefore, it’s really important to think through those things beforehand and to have conversations with family or those close to you,’ she said.

‘Where possible, appoint someone who can make health decisions and personal care decisions that would accord with your wishes.’

Anne said one way of doing that is to write an advance care directive.

‘Often what happens is people haven’t had the discussion, and families don’t want to raise what may be perceived as an upsetting subject.

We’re all obliged to promote and maintain the health and well-being of the patients. As nurses we need to be vigilant; we are making decisions, we’ve got [to have] the best level of information and evidence.

‘We have to be on guard to act in the best interest of people and look out for people who are vulnerable and who might be at risk of abuse; whether that’s psychological, financial, or physical, it’s ensuring that people get access to treatment and services and they’re not denied that because they lack the required mental capacity to understand the situation fully,’ said Anne.