Sunday 19th November 2006
Quality care for the elderly is a priority for the NSWNA and our committed members who are the face of aged care.
The aged care sector in Australia has undergone a seismic transformation in the past 10 years.
This is in large part due to the federal government’s aged care reforms in 1997 and the introduction of the Aged Care Act 1997.
The legislation resulted in increased regulation of the industry and the introduction of an elaborate funding tool called the Resident Classification Scale (RCS), which has made funding contingent on the completion of extensive documentation for every resident.
The burden of completing this mandatory paperwork has fallen to RNs, meaning increased nurse workloads, less time for hands-on care of residents and less time to provide clinical support for nurses down the line.
But the tool poses further implications on the quality of care. Under the RCS funding arrangement, Commonwealth funding is allocated to owners as a general pool to run the facility, rather than as specifically quarantined funds for staffing and care hours. As a result, some unscrupulous operators have drastically cut costs by reducing hours of qualified nursing staff and not replacing RNs who leave the facility, further increasing pressure on nurse workloads.
The federal government will implement a new funding tool, the Aged Care Funding Instrument (ACFI), on 1 July 2007. The degree of paperwork burden that will be imposed by the ACFI and the ensuing impact on nurse workloads is unclear at this stage.
Another pressure impacting on the aged care sector – and directly on aged care nurses – is the exponential increase in the number of frail aged residents with more complex care needs. With our rapidly ageing population, the average age of residents is increasing and their care needs are greater and more complex than 10 years ago, requiring a more skilled and qualified nursing workforce.
In such an environment, how we ensure good quality care for the elderly is a critical concern for us all – as our parents age or as we age ourselves – but particularly so for nurses who are working in aged care.
Nurses key to quality care
According to NSWNA Assistant General Secretary Judith Kiejda, the key to high quality aged care is having adequate levels of skilled and qualified nursing staff who can respond to the care needs of individual residents.
‘Just as not all employers in aged care are the same in regard to how they treat their employees, not all operators are the same when it comes to ensuring the quality of care delivered to residents,’ she said.
‘Skillmix and staffing levels vary greatly among residential aged care facilities. For example, there are good facilities that have two RNs and four AiNs rostered on a morning shift for 46 high-care residents but there are also poor facilities that have only one RN and five CSEs for 120 residents including residents with dementia,’ she said.
Qualified staff essential for residents with complex health conditions and medication needs
Judith said it is important licensed nurses are managing residents with complex health conditions and medication needs.
‘Resident and nurse safety are put at risk when care staff are not qualified, or when care staff are pressured to do more than they are skilled and competent to do,’ she said.
A case of serious concern is advice issued by NSW Health that ‘there is no statutory requirement that registered nurses undertake distribution and administration of medication’.
‘The NSWNA believes this is poor public policy that places the aged at risk. It places RNs in a difficult professional dilemma where they are held professionally accountable for medications that they themselves didn’t administer,’ said Judith.
‘Not enough time to do the job’
‘Nurses are not getting the same enjoyment out of aged care because there is not enough time to do the job properly,’ said Sally Baker, RN, who worked for seven years at aged care facilities in Sydney’s Inner West.
‘There are good nurses working in aged care but they are under constant pressure. It was not like that at first,’ she said.
Sally said she was commonly working with staff shortages. ‘People called in sick and there was no-one to replace them. Staff shortages put other staff under pressure.
‘Workload pressure is constant in aged care but nurses just endure it. There’s a culture of just putting up with it – particularly in aged care.
‘People stay back, do unpaid overtime but it is rarely acknowledged by management. Not having enough time to do your work is just considered part of the job.
‘The facility I worked at underwent a restructure and the DoN position in my section was cut. This put extra management responsibilities on the RN.
‘I was told I had to attend an RN meeting but I refused because it would have meant the section would have been left unattended.
According to Sally, the impact of inadequate staffing falls not just on nurses, residents suffer too. ‘Nurses need more hands-on time with residents, more time to communicate. It’s important to have that time,’ she said.
It was Sally’s concern with the impact of inadequate staffing on the quality of care that spurred her to join the Quality Aged Care Action Group, a group initiated by the NSWNA to improve the quality of aged care.
‘There needs to be a really good look at the Commonwealth funding system to see how much funding is actually going to nursing staff and care hours,’ she said.
Sally said RNs play an important role in an aged care facility. ‘They are charged with responsibility for administering medication and managing medical conditions such as diabetes. We have responsibility for observing patients and referring residents to a GP if there are concerns. RNs also provide clinical support for other nursing staff.
‘The paperwork required for the RCS is very time consuming – it took about two hours every shift.’
Sally reflects that aged care has changed a lot over the past 10 years. ‘Acuity levels are much higher. A nursing home has become an extension of a hospital ward.’
After seven years in aged care, Sally is taking a break from the sector and is currently caring for a quadriplegic patient. ‘I liked my job but I was fed up with the heavy workloads and the sense that we weren’t being valued.’ According to Sally, nurses working in aged care are there because they want to be. ‘They love the job because they believe they are making a difference to residents’ lives.
‘However, it is a problem that nurses are not entering aged care. We need to attract younger RNs. But to do that we need to improve job satisfaction by having enough time to do our job,’ she said.