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Same old won’t do

Aged care nurses are more stressed, make more medication errors and are less satisfied with their jobs now than three years ago, a new report reveals. Annie May reports.

Action must be taken to increase the ratio of registered nurses to aged care residents if the ongoing deterioration of the sector is to be halted, a new report has revealed.

Painting a bleak picture, the University of Melbourne longitudinal study found nursing staff working in the aged care sector are more stressed, make more medication errors, report lower levels of resident care and are less satisfied with their jobs now than they were three years ago.

These worsening working conditions are driving many workers away, with one in five participants reporting they had left the sector between 2007 and 2010.

“These participants reported that they could no longer bear the stress of having to work in environments that were chronically understaffed,” said lead researcher Associate Professor Leisa Sargent.

The research project – conducted over four years – collected data from registered nurses, personal care workers, directors of nursing, and residents from aged care facilities across Victoria.

It found evidence of a declining registered nurse to resident ratio in private sector facilities which, according to the researchers, was a likely cause of the large staff turnover.

One nurse left the sector after 20 years. She would have like to continue working, but was unable to due to bad health brought on by stress.

“I found during my time working that the standard of nursing deteriorated. I found myself working with untrained staff. Unless this situation is rectified more nurses will leave aged care,” she said.

For another nurse, the staffing ratios finally became too unacceptable to remain. “I was the only Div 1 in a 60 bed facility where 45 per cent of the residents were high care. I was on call 24/7 and was expected to do everything.”

In 2007, in private not for profit and private for profit facilities registered nurse to resident ratios ranged from 1:15 to 1:39, while in 2010 they ranged from 1:16 and 1:50. In 2010 the registered nurse to resident ratios in public facilities ranged from 1:7 to 1:17.

“Lower RN to resident ratios predict lower job satisfaction and commitment for RNs and personal care workers (PCWs), and higher levels of intentions to leave their employment, of emotional exhaustion and of depression. Having more residents per RN also predicts lower resident care and resident safety,” the report said.

Residents also reported that there is not enough staff to meet their care needs.

Between 2003 and 2007, the proportion of registered nurses in aged care facilities fell from 21 per cent to just 17 per cent. At the same time the number of residents has increased, as has the number of residents requiring higher level of care.

“So while the demand for aged care and the care needs of residents has been increasing, the capacity for the aged care system to care for the elderly has been going down,” said Sargent.
Speaking ahead of December’s Ministerial Conference on Ageing, ANF federal secretary Lee Thomas said Australia could no longer delay the process of reforming the sector any longer.

“No one can escape the reality that improving aged care requires significant reform and investment. We need enough nurses and assistants in nursing to care for the increasingly more complex care needs of our elderly,” Thomas said.

“In 2008, the then Minister for Ageing, Justine Elliot said that caring for our ageing population is one of the major challenges facing our nation this century and the Government takes that responsibility very seriously.

“Well, two years on, the government must act on this responsibility and address the issues affecting the aged care sector.”

While acknowledging that it would be no simple task to remedy the problems facing the sector, the researchers in the Working in Aged Care study said they had identified a number of measures that could, and need, to be taken.

Along with increasing the ratio of nursing staff to residents, the study recommended that employers in the industry be encouraged to improve management practices, specifically those concerning recruitment and selection, training, multi-skilling, performance practices and grievance procedures.

It also called for adequate resourcing and funding be provided specifically to the provision of nursing care, so that cost-cutting can be reduced.

If these changes weren’t made, staff would continue to leave and patients wouldn’t receive the care they deserved.

“The experiences of residents suggest that they have low expectations about quality of care and staff responsiveness to their needs, in a system which they see as overstretched.”

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