RNs in aged care: stakeholders make their case to inquiry

Registered nurses tell NSW parliamentary inquiry they’re essential to quality aged care, while regional provider says mandating RNs 24/7 on site at all facilities would send them broke.

Registered nurses tell NSW inquiry they’re essential to quality aged care, while regional provider says mandating RNs 24/7 on site at all facilities would send them broke.

Veteran registered nurses working in aged care have told a state parliamentary inquiry that they are essential to providing high quality clinical care and governance to an increasingly acute resident cohort.

This has been echoed by personal care workers and family members, submissions to the inquiry show.

However, the NSW parliamentary inquiry into RNs in residential aged care has also heard from regional providers who said any move to mandate RNs on site 24/7 at all facilities would not be financially viable.

As Australian Ageing Agenda has reported, the inquiry is examining the adequacy of nursing staff levels in residential aged care facilities in NSW, as well as the need for wider regulatory reform and minimum standards for personal care workers.

In particular it is considering the impact of recent changes to the Aged Care Act on existing NSW legislation that required a registered nurse be in charge and on duty at all times in a high-level care facility. NSW was the only state in Australia with such a requirement.

The future of that provision is currently the subject of sector consultation with NSW Minister for Health Jillian Skinner, with a report due to her office in July.

RNs essential, inquiry hears

In written submissions several veteran RNs have told the parliamentary inquiry that residents deserved the best care which had to include access to skilled staff around the clock, as “medical issues don’t wait for office hours.”

Linda Langton, an RN with 30 years experience in residential care, said that complex care needs that required an RN were now common in aged care, including palliative care and administration of Schedule 8 drugs.

“A hip that feels sore after a fall may be broken, or bruised, or may be a previous hip replacement that has shattered. A wound can be infected, or need suturing or excessively bruised due to blood thinning medication… All can be assessed quickly by an RN but could be ignored by a less skilled staff member, or result in unnecessary hospital admissions,” Ms Langton wrote in her submission.

Similarly, Marie Scholes, an aged care RN of 17 years, said that while she had “the greatest respect” for enrolled nurses and personal care workers, they did not have the qualifications or education to “supervise and direct the high level of nursing care that our frailest aged and dying residents need and deserve.”

Bevlyn Grant, an RN with more than 40 years experience, including 11 years in residential care, told the inquiry that residents were often transported to hospital when RNs were not available. “Falls, complex pain, chest pain, shortness of breath or difficulty in breathing, wound care, diabetic care, aggressive behaviour and suicide ideation are some of the reasons I have observed people transported to hospital. If an RN is assigned to the care 24 hours/day, many admissions could be eliminated,” Ms Grant said in her submission.

Care workers, families support requirement

Linda Hardman, an AIN working in a 120-bed high care facility, told the inquiry it was “imperative that we keep RNs in aged care 24/7” as they direct the care provided by care staff. “Many of our residents suffer from conditions that require specific medication which must be given by qualified staff RNs,” Ms Hardman said in her submission.

Family members have shared similar views with the inquiry.

Margaret Zanghi said that over three years of visiting her husband in residential aged care she became aware of the complex needs of residents and their dependence on RNs. “In my husband’s case his condition led to frequent urinary tract infections and we had absolute reliance upon the RN in interpreting his symptoms,” she said.

Requirements unsustainable: rural provider

However, the inquiry has also been told that the future of regional and rural facilities, and standalone operators, would be in jeopardy if RNs were required to be on duty around the clock at all facilities.

Sunhaven Hostel, an 18-bed community-owned facility in the small regional town of Ashford, told the inquiry that there are very few RNs in its district and the cost of sourcing agency nurses would go beyond its financial capabilities. “The closest air services are three hours away in Armidale, Tamworth and Toowoomba if RNs had to be sourced from metro areas,” the provider said in its submission.

The operator said it had been successfully operating for 22 years and consistently met all accreditation standards. The facility’s care staff had obtained their Certificate III in Aged Care qualifications, had recently completed the certificate IV requirement to administer and monitor medications and were currently enrolled in Certificate IV in Aged Care. The organisation was also supporting one staff member through her RN degree and two others were studying their EN certificates, it said.

All treatments and medications were prescribed by the doctor in Ashford, who liaised with the community health nurse who visited the facility three times a week if required to supervise and review medications, the provider said.

As a solution, Sunhaven Hostel proposed that if access to its community health nurse became unavailable, the facility would contract an RN for a set number of hours to carry out the supervision, instruction and reviewing of treatments and medications where required.

State aged care peak bodies have argued that mandating an RN to be employed at all times in all facilities would be unsustainable, especially in hard to staff areas. The federal aged care accreditation system replaced the need for state-based legislation, which monitors industry compliance with quality standards and appropriate staffing levels, the peak bodies have said.

Submissions to the inquiry closed last week and it will begin public hearings on 5 August, with its final report due on 30 September.

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Tags: Bevlyn Grant, Diane Lang, jillian-skinner, Linda Hardman, Margaret Zanghi, Marie Scholes, Sunhaven Hostel,

1 thought on “RNs in aged care: stakeholders make their case to inquiry

  1. Age care operators simply do not want to provide RN’s 24/7 purely and simply because it is a cheaper option to supply medical endorsed PCA’s and Allied Health staff. All care workers do their best, Care operators would rather provide low paid PCA’s with a medical endorsement. The fact is that most care operators these days are for profit, therefore they will try to run at a lower cost, to provide the shareholders a dividend. The sector is heading more towards the American model of care – which is for profit.

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