Registered and enrolled nurses working in residential aged care hold grave concerns about delegating medication administration to unlicensed staff, according to a NSW Nurses’ Association (NSWNA) report released this week.
The survey of RNs and ENs in aged care was conducted by the association in March 2006 and the Faculty of Nursing and Midwifery at the University of Sydney was commissioned to prepare the survey report.
Over three quarters (75.4 per cent) of the 1062 survey participants said they would not agree to allocate medication management to personal care assistants (PCAs) or care support employees (CSEs) even if state legislation and the Nurses and Midwives Board’s policy permitted the practice.
The main concern with this model of care was that it would lead to a “high risk” of medication errors.
Participants said unlicensed workers did not possess enough knowledge of medication side effects and had limited English, literacy and numeracy skills.
More than a hundred nurses indicated they had witnessed an “adverse incident” related to unlicensed workers administering medication – 78 per cent of which had been reported.
One nurse told the story of an unlicensed worker who administered Sunday’s medication to residents on a Saturday.
“On realising her mistake she proceeded to give out Saturday’s as well, double dosing patients,” she said.
Four out of five nurses felt that completion of the ‘Provide physical assistance with medication’ unit did not provide enough training to enable unlicensed workers to dispense medications responsibly.
Instead, the participants said unlicensed workers would need to complete extensive training and assessment and would require supervision to administer drugs.
But some nurses felt enabling PCAs and CSEs to do more would help to free them from the pill trolley.
“It’s the way of the future,” said one participant. “We need to be progressive and have RNs’ skills better utilised thereby providing greater support to residents and their nurses.”
A major theme among the responses was the high workload faced by many nurses.
Just over 70 per cent of the participants indicated that current staffing levels posed a risk to the safety of medication management.
The demands on registered and enrolled nurses in aged care are also affecting job satisfaction.
More than half (56.1 per cent) of the survey participants said their job had become less satisfying in the 12 months leading up to March 2006.
The most common reasons given for job dissatisfaction were ‘workload’, ‘getting the job done in time’ and ‘staffing levels’.
One participant said: “[I’m] unable to complete tasks to my satisfaction in the time available.”
The nurses also compiled a list of issues they would like the NSWNA to pursue on their behalf.
Among the causes for concern were the need to protect the role of the RN in aged care which was perceived to be under threat, the wage disparity with the public health sector, excessive documentation requirements and greater funding.