Recently we attended a meeting with a large corporate aged care provider who is considering changing their model of care for a number of their residential facilities. Aspects of the model of care are consistent with current evidence for quality care. However, these changes will also see the current 15-minute nurse handover time each shift abolished.
Already it is of great concern that handover for a large number of residents has only been 15 minutes. To consider removal of even this small amount of communication time between shifts is totally unacceptable.
There is extensive evidence to support the importance of clinical handover between two nurses providing direct care. The National Safety and Quality Service Standards of the Australian Commission on Safety and Quality in Healthcare, include a specific standard for clinical handover - Standard 6. The Commission identifies breakdown in the transfer of information or in communication “…as one of the most important contributing factors in serious adverse events and …a major preventable cause of patient harm” (Australian Commission on Safety and Quality in Healthcare, Clinical Handover Standard 6 factsheet). Many healthcare facilities are striving to improve clinical handover and are using all available tools such as care assessment and planning documentation, to complement direct handover. It seems incongruous then that a large corporate aged care provider should choose to remove handover time despite the identified safety and quality risk. This is but one example of a health system struggling to provide safe, quality care to our growing and increasingly frail, elderly population.
Recently, the Australian Nursing and Midwifery Federation (ANMF) prepared a comprehensive submission to the Senate Standing Committee on Community Affairs Inquiry into the Future of Australia’s Aged Care Sector Workforce. Addressing 13 terms of reference, the ANMF made six recommendations. Our submission identified the current workforce within aged care - residential and community care, is increasingly expanding in an attempt to meet demand. Although, the care required in residential and community settings continues to significantly increase, the numbers of registered nurses and enrolled nurses working within the sector continues to decrease. In the most recent figures from the Australian Government Department of Health and Ageing, 14.7% of the workforce are registered nurses (down from 16.8% in 2007), 11.6% are enrolled nurses (down from 12.5% in 2007) and 68.2% are personal care attendants (up from 64.1% in 2007) (King et al. 2012). The personal care attendant category includes personal carers, assistants in nursing and other unlicensed workers (however titled) working in aged care. Of concern, the decrease in the qualified nurse workforce coincides with a large increase in residential aged care places (25.2% increase from 2003-2014) and the number of residents being assessed as high care. The skill mix change illustrated above (less RNs and more PCAs), will result in less supervision and support for a growing PCA workforce providing high acuity care to an ever-growing elderly population.
A recent study identified the amount of nursing care residents received per day on average (Brown, 2015). Residents were divided into bands depending on their care requirements. Band 1 identified as the highest care category, where a resident receives a total of 3.18 hours nursing care on average for a 24-hour period. The care provided by a Registered Nurse for this type of classified resident is seven minutes and 19 seconds per shift. Is it acceptable for a person to receive, per shift, only seven minutes and 19 seconds of registered nursing care?
That this could be the accepted level of care by aged care providers is surely offensive to all nurses seeking to provide safe, quality nursing care. Accordingly, the ANMF made the following recommendation in its submission: the Australian government must fund and implement mandated minimum staffing levels and skill mix requirements for registered nurses, enrolled nurses and assistants in nursing in the aged care sector.
The submission also discusses the importance of closing the wages gap for nurses and AINs working in aged care and those in a public hospital. For recruitment and retention of nurses and AINs in the aged care sector, the wages gap and skill mix requirements need to be addressed as a matter of urgency (see full ANMF submission here.)
Caring for our growing elderly population is the responsibility of all nurses in all contexts of practice. Whether in the community, a residential facility or a hospital, nurses are caring for the elderly population. The interconnectedness of each area means that if quality care is not able to be provided in one area then it will directly affect the others. Nurses need to engage in, and be a part of, the ongoing solutions for the future challenges we all face as a community in the provision of safe, quality aged care.
Julianne Bryce, Elizabeth Foley and Julie Reeves
Federal Professional Officers