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Providers push to review RN staffing requirement


Aged care providers and nursing unions in NSW are set to clash over whether to keep state legislation requiring aged care facilities to employ registered nurses at all times to oversee high care residents.

NSW Health Minister Jillian Skinner wrote to the sector on 13 June announcing the State Government’s decision to grandfather existing arrangements which require a registered nurse to be in charge and on duty 24/7 in high care facilities for the next 18 months.

During this time a consultation process will be conducted with stakeholders to work out future arrangements following the removal of the low/high care distinction in residential aged care from 1 July, Ms Skinner said.

Currently NSW is the only state with a legislative requirement to have a registered nurse on duty 24/7 in a high-level care facility.

NSW aged care providers have denied claims by unions that they are seeking to cut back on registered nurses in high care, but argue they need flexibility to determine their own staffing levels and to target RNs where they are needed most.

Aged and Community Services NSW & ACT CEO Illana Halliday told Australian Ageing Agenda that ratios and staffing requirements were a blunt measure that did not respond to the actual needs of clients and would contribute to unsustainable costs.

The peak body estimated the direct wage costs of employing an RN 24/7, for a current low care 70-bed facility would be $500,000.

Ms Halliday said a requirement to have an RN on duty at all times in every facility with a high care resident would also be impossible to manage due to a lack of available staff and would be a waste of limited resources.

She said while skilled RNs were necessary in the provision of palliative care or short-term acute care in a facility, not all high care residents would require an RN to meet their needs.

“It is probable that many residents with a high score in ACFI may still not need an RN, as the care they require is not acute or curative, it is about comfort and quality of life,” Ms Halliday wrote in a ACS NSW & ACT position paper.

She said that industry, unions and government needed to work together to develop new models of care to best utilise available staff. “Nurses are a precious resource, which means they have to be deployed in the right place at the right time according to the needs of the client.”

Brett Holmes, general secretary of the NSW Nurses and Midwives’ Association, said providers were having a bet two-ways.

“The providers are telling government constantly that the acuity level of their residents is rising and they need more money to fund that care and yet they are often proposing that they don’t want a requirement to have registered nurses,” he told AAA. “They can’t take the funding but not be prepared to employ the staff.”

Mr Holmes said the union would continue to argue for a registered nurse to be on duty on each shift.

“We believe that it remains in the best interests of the residents to have their care overseen by registered nurses and for the workers in aged care to have the benefit of that professional level of oversight.”


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16 Responses to Providers push to review RN staffing requirement

  1. david June 25, 2014 at 1:31 pm #

    Ms Halliday’s assertion that “It is probable that many residents with a high score in ACFI may still not need an RN, as the care they require is not acute or curative, it is about comfort and quality of life,” indicates a poor understanding of resident care requirements.

    Comfort and quality of life are directly linked to the management of acute incidents and the provision of skilled curative treatment. Acute incidents are not planned; unless the ACS has discovered a method of accurately predicting when these incidents will occur it’s disingenuous to state that RNs are only needed for acute care.

    Without skilled care staff onsite, the default response will always be ‘call an ambulance’… Residents will be subjected to unnecessary and traumatic hospital transfers and Emergency rooms will be flooded with inappropriate admissions.

    The assumption that all resident care requirements can be quantified by their ACFI score further illustrates Ms Halliday’s unfamiliarity with real-world care demands; just ask care staff if those five ‘D’s and $31/day accurately reflect the care needs of someone with extremely challenging behaviors over a 24 hour period.

    The ACS website states ‘Our focus is on all aspects of support for older Australians…’ and ‘We have a long term commitment to older people…’ As a representative organization for service providers, the CEO’s comments are incongruous to that support and commitment, favoring only the bottom line.

  2. Rhonda Nay June 27, 2014 at 2:57 pm #

    To assume RN expertise is not required when care is not acute or curative demonstrates ignorance of end of life care. Given the number of older people requiring such care and the complexity of care needs generally in RACFs of course access to a highly qualified nurse 24/7 is essential. Nevertheless, the simplicity of the current legislative requirement does not ensure best care. I have argued many times that what is required is access to a NP with general aged and specific dementia care knowledge and skills.

  3. Felicity June 27, 2014 at 10:14 pm #

    I am disappointed in ms hallidays lack of understanding of the aged care sector and the current pressures experienced by RNs. 24/7 RN support is imperative if you actually want comfort and quality care. Carers although highly valued can never provide the clinical oversight needed. Most residents now come with multiple complex comorbidies, frailer, complex pain needs and with significant behaviours. Registered nurses also oversee too many residents from 70 to over 100 residents. Not one day goes by without an acute episode or fall for at least one of them. This is not even mentioning lack of time to give good palliative care or deal with constant family concerns and unrealistic expectations of us. So I am astounded that Ms Halliday can make this uninformed statement that just because their ACFI is high they may not need RN support. I challenge Ms Halliday to do an RN shift in Aged Care because I don’t believe she would have the same opinion

  4. Drew Dwyer June 30, 2014 at 7:01 pm #

    Disappointing to see the devalue in the role of an RN in the aged care setting. The role needs immediate review and change, and specialised nurses need to placed in care leadership roles. back them up with A GNP and goals will be achieved.

  5. Lisa December 3, 2014 at 7:41 am #

    I think Ms Halliday is not considering the bigger picture. By not having an RN in a facility 24/7 many unnecessary patient transfers occur to already stressed Emeregency Departments. This creates a waste of resources in the ED’s because specially trained ED nurses are looking after elderly nursing home patients who do not need to be treated there. The poor elderly client often with dementia has been shipped out of their comfortable bed at all hours of the night to the unfamiliar and unpleasant environment of an ED. They occur because AINs and ENs are not qualified enough to make patient assessments, not qualified or authorized to liaise with family members about their wishes and to make decisions on iif transfer to ED is really necessary!

  6. Karen December 3, 2014 at 12:08 pm #

    Just reviewed Ms Halliday’s Linkedin resume to find she is a hospital trained RN from the 70’s and has never really had much to do with a RAC. Narrow minded opinions like this do not assist the expertise, the majority of times clinical expertise from Registered Nurses, that older Australians deserve and continually ask for when entering a home. Shame on you. Up skill don’t down skill the aged care industry!!

  7. Sarah April 19, 2015 at 6:02 pm #

    Since Florence Nightingale and her band of nurses, caring for the wounded, nursing evolved and stood on its own feet and became a profession. Nursing goes back even further, the basic caring for those in pain, and in need of support and for the dying.

    To say that Registered Nurses are not needed 24/7 in Nursing Homes, is like having no Minister of Health to run that portfolio.

    Common sense must prevail in this matter. Nurses are vital for the well being of elderly residents, who take great comfort to know that a Registered Nurse is on duty.

    The carer or assistant in nursing is not trained to make the clinical judgements of a Registered Nurse, nor is the carer or assistant in nursing advanced enough in the caring role to make vital and quick decisions that would involve the life and safety of an elderly resident.

    It is simply madness to remove the Registered Nurse from their role. How will an emergency be dealt with, and what ethical/legal/moral questions will arise when the Duty of Care of the Registered Nurse is undermined and removed.

    No real thought has gone into this proposal.

  8. Tina April 22, 2015 at 1:51 pm #

    It’s time to reassess the qualifications of those running our peak bodies. The litany of uninformed and dollar-driven decisions is a consequence of having accountants and bureaucrats at the helm; not one has ever actually cared for an elderly resident.

    Until we cease the practise of remunerating board members, we’ll continue to be subjected to the drivel espoused by uninformed people motivated only by collecting as many board fees as possible.

    Why not spend all that money on employing a few RNs?

  9. Terry June 23, 2015 at 4:04 pm #

    I have worked in Age care for 6 years and in the largest company of Age care facilities and the one I work for is a 45 bed facility.
    We run a RN only on the day shift all the carers are trained to do medication and have a medication licence and we use the I care system so it gets watched and can be seen if there are issues with staff not correctly doing the right way. Really there are no need for a RN on night shift at all maybe yes afternoon shift in some facilities but at the facility I am at there has never been a need for a RN either afternoon or night. But I would make sure that carers are well trained are monitored always to be safe.

  10. Terry June 23, 2015 at 4:09 pm #

    One other point is that a carer understands the resident far better than an RN as they spend most of there time with them.
    I understand Sarah’s point but a good carer does know enough sometimes what is the issue with the resident most times and in the case a resident did get in trouble the manager of the facility is called and she/he would come or make a decision.

  11. Kaye July 15, 2015 at 5:45 pm #

    This is for Terry who thinks RNs are not required on nightshift but apparently only on every other shift. Are you crazy? When do you think most incidents/accident/sudden changes in health status occur. We night RNs work without back up from clinical staff. How dare you devalue the many years of experience and knowledge including a Masters degree that my aged care residents do not need me or my RN colleagues on nightshift. How dare you! Go and get some more experience before you make such assumptions.

  12. Dave July 31, 2015 at 6:07 pm #

    Nice work, Terry. Of course we dont need skilled nurses for the frail aged!

    You can dish out pilld from a pack (how’s your knowledge of pharmacology, by the way?)

    You know when a resident ‘gets in trouble’ (can you quickly run me through your anatomy & physiology expertise and emergency assessment and advanced resuscitation skills ?)

    Can you rattle off the residents’ diagnoses (and elaborate on all those acronyms too please?)

    And can you explain to me how the remote monitoring of iCare bowel chart entries equates to real-time acute incident resident management? (This is great news,,,we’ll never need to be at work again!)

    Mate…these are people’s lives you’re playing with. It scares me that you dont seem to be scared at all.

    Your lack of insight into resident care illustrates exactly why you shouldn’t be there.

  13. Janine August 23, 2015 at 5:12 pm #

    My husband is in an aged care facility. I am able to be with for many hours each day and see the absolute lack of staff, mainly AIN. I have complained bitterly for months about it, and keep getting told that the staffing levels are at normal levels. Thank goodness I am there to do a lot of his caring during the day, but I shudder to think what happens at night. The AIN’ is at breaking point trying to do the best for the residents, but are only human. The politicians need to get their head ot if the sand to rectify this frightening situation. Make them do a few shifts in a nursing home and see how easy it is. The amount of money we pay to have our loved ones being cared for in their remaining time is outrageous. Apparently child care has staff ratio regulations. WHY NOT NURSING HOMES?

  14. Mish Stanvic August 28, 2015 at 8:44 am #

    I have worked in aged care for the last 5 years. I have just moved into a role that sounds like Terry’s . This facility is supposed to be aging in place. I was led to believe it was low care, but now I realise that a large majority of the residents have high care needs.I have only been there for 2 weeks and I am very worried at the number of falls that happen every week. Just before I started a death occurred as a result of a fall!!! I can also see that the care staff lack understanding about the simplest of matters such as bowel care, they tend to make assumptions that are incorrect. Its very concerning!!
    At night there is one care staff on , to service up to 40 people from 11 -7am. This is wrong!!! The whole aged care system is being run by profits and bureaucrats!! The RN role has now become an after thought – this is appalling!!! We need more skilled labour not going backwards!!! Secondly I am sick of people saying this is low care, or aging in place – most of the time this is a crock!!! If anyone knows anything about aged care its has become a highly complex area to work in!! By trading in highly skilled labour over profits you are effectively saying as an employer that we don’t care about our residents or our staff!!!

  15. Debbie November 5, 2015 at 4:21 pm #

    I’m an RN who has a lot of experience working in rural nursing homes: most recently being the only RN for over 70 residents. One unintended consequence of devaluing nursing expertise to cut aged care funding even further (and isn’t that the only possible aim of this whole exercise?), will be the skyrocketing of unnecessary ambulance calls and Emergency Department presentations of distressed, confused and frail elderly residents.

    This will definitely happen wnen there is no expert RN on duty to assess residents’ pain/sudden change in mental state/onset of illness/unstable blood sugar/injuries post fall etc etc. Aged care is already given very low value by society and government. Frequently families are distressed and upset at the already low staffing levels and are not reassured by being told that staffing is adequate. Both care staff and families need the leadership and emotional support which a registered nurse can provide. Dealing with death and dying can be traumatic for inexperienced care staff – and frequently care staff rotate quickly in an out of the aged care sector. Most RNs have many years of experience dealing with both acute and palliative care, and the spiritual care needed for the dying, their families and other staff.

  16. Louise November 8, 2015 at 7:07 pm #

    Whilst I am not an RN, I work alongside with RNs daily in an aged care setting and I have the utmost respect for the work that an RN does on their shift. The work that they do to assist our elderly residents, manage expectations of families, manage expectations of management who do not have an understanding of day to day machinations, manage PCAs, work with visiting doctors, psychogeriatritions, pharmacists and other specialists, liaising with the end client – which is the resident – whose cognitive abilities change from morning to afternoon to night etc. This happens in just one shift – then there are the medications to administer – and not all dementia residents take these with ease – wound management etc! Oh and don’t forget the never unending duplication of paperwork and reports in a clinical sense. Then of course in assisting families whose loved one is receiving acute palliative care – there is so much an RN does that people just do not see. And don’t forget in the evenings most RN’s are doubling up as the receptionist – taking calls and enquiries!
    This article really burns me up … a nursing home environment is extremely stressful; the current new PCAs and other working staff – bless them – really do not have the ability to work without direction – and I have to include doctors here too.
    Australian Ageing Agenda has written many articles on how the training of PCAs is very very poor which reflects on providing Person Centred Care (another buzz word that is just that – it is a joke). This article really quite astounds me – please Ms Halliday and also the Minister for Health – get a reality check !!!!!

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