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Unregulated workers making up shortfall in RNs, inquiry hears


The percentage of registered nurses in the aged care workforce is decreasing despite increasingly complex patient needs, the aged care royal commission has heard.

And there are concerns the shortfall is being filled by unregulated personal care workers with minimal training, the Australian College of Nursing says.

Professor Deborah Parker at the royal commission into aged care

Chair of the college’s Ageing Policy Chapter, Professor Deborah Parker, told the Royal Commission into Aged Care Quality and Safety last week that the percentage of registered nurses has dropped by more than 6 per cent since 2003.

This was resulting in enrolled nurses and personal care workers filling the shortfall, she said.

“At a larger facility (RNs) may be tied up with other tasks in terms of in terms of doing Aged Care Funding Instrument assessments or other quality activities, and are not actually on the floor supervising and doing the assessments for the residents, and that might be falling to an enrolled nurse or an assistant in nursing,” Professor Parker said during questioning by Counsel Assisting Paul Bolster.

Registered nurses decreasing

Professor Parker said a survey by the Flinders University showed there has been a significant decrease in the number of registered nurses in the aged care sector.

“The percentage of registered nurses has gone down from about 21 per cent in 2003 down to about 14.9 per cent now.

“Correspondingly there has been an increase in what’s called the assistant in nursing, or personal care worker, the unregulated worker.”

Professor Parker said personal care workers do not have enough training to meet the increasingly complex needs of aged care residents.

“The unregulated worker with a very short certificate training, with approximately 120 hours in care in the facility, is not prepared and does not have the level of assessment and planning skills required to meet the needs of the current aged care clients,” Professor Parker said.

Personal care workers are only required to undertake a Certificate III or Certificate IV to work in the industry, Professor Parker said.

She said it is preferred that registered nurses undertake assessments for residents, including for pain, wound assessments and continence issues.

“Sometimes some of that information can be collected by an enrolled nurse or an unregulated worker, but putting that information together to then communicate with a geriatrician or with a general practitioner, who may be (responsible for) medication management for that person, should really come to the role of the registered nurse, because we have the skills sets to do that,”

In Professor Parker’s witness statement to the royal commission, she said there are concerns registered nurses are only utilised to fulfill legal requirements.

“Increasingly business models are being deployed where nurses are being utilised only for ‘legislative requirements’, with unregulated healthcare workers fulfilling most of the traditional care elements. This can be problematic, as they have a limited and varied degree of training and preparation,” Professor Parker said in her witness statement.

Professor Parker also said that she recommends the Australian Government mandate a registered nurse be on-site and available at all times and for unregulated health care workers to be regulated.

Staff overworked

Annie Butler

Elsewhere in the inquiry, Australian Nursing and Midwifery Federation federal secretary Annie Butler said workloads are turning nurses away from the sector and resulting in unsafe practices.

“What we hear most often from our members is now the increasing pressure they’re experiencing with workloads. So many of them across the country describe their workloads now as unsafe, they’re untenable,” Ms Butler said.

She said there has been an increase in staff leaving the sector.

“They report to us that that’s why they’re leaving the sector and increasingly leaving the sector, and that’s across both nurse and carer members,” Ms Butler said.

In these conditions, nurses are finding it hard to meet both their professional obligations and employer expectations, she said.

To stay up to date on the latest about the Royal Commission into Aged Care and Quality go to our special coverage. We will also be issuing regular Royal Commission Roundup reports which you’ll receive in addition to your weekly e-newsletters.

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8 Responses to Unregulated workers making up shortfall in RNs, inquiry hears

  1. PK1765 February 20, 2019 at 4:35 am #

    Reading over what is coming out of the Royal Commission into aged care when talking about staffing, having worked in the sector in In-Home aged care there is ONE glaring omission and that is the role legislation around support payments and job search requirements play in forcing people from the sector.

    Let me explain further, most In-Home aged care is casual employment and you are allocated set clients and times… but if these clients go into hospital or go on a holiday or die that puts the carer in the position that they may need a top up from centrelink as there is not always someone that will slot into that spot left vacant by that client.

    It may take several weeks/months to re-establish a set group of clients in the times that have become vacant… especially for those whose client goes into hospital. Often the agencies are reluctant to reallocate a hospitalized client times slots with another permanent client due to the fact when the client comes out of hospital that hospitalized client usually wants their services to return, with no changes, given they already have a relationship with their carer/s.

    In the meantime those carers who receive a top up from centrelink are forced to job search and attend other useless activities due to the job search legislation, this constant harrassment during these downtimes is what forces many good carers from the aged care sector.

    This is something that really needs to be addressed and talked about.

    Are you taking note…
    Ken Wyatt Minster for Aged Care

  2. Robert Farrow February 20, 2019 at 4:24 pm #

    Yes I totally agree and it is getting worse.

    If the figure published are true and there is no reason to doubt it, then the 800,000 currently using some sort of home care will continue to be disadvantaged if we do not do something quickly to tackle the growing crises.

    With regards to the “Unregulated work force.

    We need more of them, they were never meant to do assessments or give medication Cert 3 and 4 is there for a reason, to help the client through their daily routine and offer a level of companionship along the way.

    If the Nurse is only there for legal reasons then FIX it not blame the AIN and PCA with out them the mess would be immeasurable…..

    It’s a shame Mr Wyatt you and your government never read the results of the 2012 Living Better Living Longer program, we would now not be in this mess!!!

  3. Deborah February 21, 2019 at 10:32 am #

    Here, Here this problem is getting worse. Working in regional Australia it’s hard to recruit or replace RNs who leave and access to ‘agency personnel’ is near impossible without lengthy notice.

    As an RN I ask myself ‘Why work ‘hard’ without support and reasonable ‘patient loads’ for less money’. I find it hard to fit all the tasks expected of me into my day, often leaving work later than rostered in order to complete ‘expected’ work. I’m not normally one to support increases in wages but in order to retain RNs in RACF we need to operate on a level playing field and currently the acute care system has a distinct advantage.

    C3/C4 level training is lacking – this training does not equip a worker to function in the workplace. Courses are not longer enough. There is only certain tasks that students can undertake whilst on work placement as many workplaces will not permit students to undertake various tasks.

    The industry deserves this Royal Commission so long as the consumers, their representative and staff are given the opportunity to present their experiences and that Service Providers evidence isn’t given greater value than theirs.

  4. DB February 21, 2019 at 1:23 pm #

    Yes totally agree that the workload has increased on cert III care workers and many leave the industry as they are burnt out or go on sick leave which has increased and work place accidents are on the rise. The workers in the aged care sector are on very low wages and many are asked to do tasks such as medications which they are not confident of doing but are coerced by management to do. There are no mandatory staffing levels and many providers haved reduced staff on the floor and have two care staff do the work of three. Many EN’s are asked to do wound management, case conferencing and updating care plans as well as supervising staff and filling in forms for ACFI. RN numbers have reduced and there are providers that bring in RN’s from overseas who have limited English so residents can’t understand them and their skills are not at the same level as RN’s who graduate in Australia. The Aged Care sector needs a complete overhaul.

  5. Jane February 21, 2019 at 6:03 pm #

    And here is hoping that the government will make it compulsory to have a nurse onsite (24 hours) in an aged care facilities in rural areas rather than having an on call nurse that has just finihsed full day work. Worst thing is becuas there is no night nurse on site, tje on call nurse may have to go back in tje facility or could be woken up at 2 in the morning then go back to work the next day. So unsafe

  6. Son in-law March 1, 2019 at 9:19 am #

    My mother in-law was in a private Aged Care facility in rural location, 36 residents, staffing Saturday morning, one agency RN, one EN and one PC. IT system at the facility was down so Agency RN was using her own laptop and mobile phone.

    My mother in-law needed pain relief, doctor on call wouldn’t answer phone, Director of Nursing would not answer her phone, lucky an A&E doctor in a city an hour away was prepared to give a phone order (not sure how legal this was), Pharmacy in a town 30 minutes away agreed to remain open while I drove to pick up the medication.

    When I left the facility that evening neither the doctor nor the Director of Nursing had responded to the request for assistance.

    The staff working at the facility that day were great. The lack of support by management disgusting.

    Made numerous complaints and was just brushed off. Had their head clinical nurse phone me to justify the care provided. He was based in another state and had never seen my mother in-law. He said I can get everything I need to know from her history and the staff.

    Also found out later that the Director of Nursing at this facility was an enrolled nurse with only a few years of post registration experience.

    This is considered suitable staffing and care by private Aged Care Providers.

  7. Kaye April 28, 2019 at 8:15 am #

    As a SEN then RN I have been in Aged Care a long time and am totally burnt out. Generally the work load is unreasonable and unsafe
    I find I have to do 8-10 hrs work in 7 .5 hrs often staying back to complete documentation for notes, incidents, care plan reviews, wound charting, BlGLs
    20- 45 meds rounds depending where I am and if PCA meds on, GP rounds Order meds from pharmacy
    Staff ratios must be mandatory and must take into account the workload of all disciplines
    Yes I give acceptable care but often go home feeling I didn’t do enough Even to give acceptable care I have to run off my feet and stay back late Acceptable. is not good enough The residents deserve more.
    I am 64 and don’t want to retire but cannot stay in Aged Care much longer. It is untenable and puts my registration at risk.

  8. Jill Narciso November 21, 2019 at 9:41 pm #

    So true .pH rn here

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