Aged care offers training answers

Providing clinical placements for students is essential and there is a shortage of places around Australia. One sector is underused in this area and wants to help. Linda Belardi reports.

In 2009 aged care delivered 4 per cent of all clinical placement days for health students across the country. Health Workforce Australia (HWA) says the sector is significantly underutilised and needs to play a much more prominent and consistent role in student training.

The growing importance of aged care in the health system coupled with the need to take pressure off the acute care sector necessitates a much larger role for the industry in the future.

Tapping into the aged care sector will require building stronger relationships between universities and providers and strengthening the capacity of providers – both its staff and infrastructure - to increase student placements.

According to analysis by HWA, aged care offers the greatest scope to boost clinical placements for students over the short to medium term. While 92 per cent of all universities currently offering nursing include placements in the aged care setting, the proportion of aged care setting exposure varies from 1 per cent for the University of New England, to 21 per cent for the University of Notre Dame.

In addition to extending the options available to students, there is also widespread acknowledgement that more student training is required to meet the huge demand for aged care nurses to support an ageing population.

Training and upskilling current aged care staff in management skills is likely to enable growth in clinical placement capacity, said the HWA report. However, despite these opportunities, the administrative burden on providers was identified as a substantial barrier to increasing student numbers.

Associate Professor Christine Neville, deputy director of the University of Queensland’s Ipswich Clinical School said the most significant barrier to expansion was access to quality supervision for students. Often universities struggled to find university educators suitably qualified in aged care and aged care staff lacked the time, skills and confidence to provide the mentoring themselves.

In a national stocktake of all aged care clinical placements in Australia in 2006, Neville found that 20 per of clinical placements used an enrolled nurse or assistant in nursing as a clinical supervisor.

“The challenge for the aged care sector is that the vast majority of their staff are not registered nurses, they are staff with a lot less qualifications like a Certificate III from TAFE,” Neville told Nursing Review.

Rob Hankins, National President of Aged and Community Services Australia (ACSA), said there was widespread support amongst providers but securing funding for clinical facilitation was critical to get more facilities on board.

In Neville’s study, about half of aged care providers charged universities for supervising a student on placement in the care facility.

“Given the cost pressures that the sector faces, having an additional cost can be a detraction for service providers wanting to take on students,” said Hankins. An appropriate allocation of funding would assist facilities to backfill seconded staff, and to free up the nurses’ time to spend with students.

“Staff respond very positively to these partnerships because they like to practice and upgrade their mentoring skills,” Hankins said.

He said clinical education in aged care offers students a broad range of clinical opportunities not seen in the acute care sector. It also helps students to understand the needs of older residents and helps to reduce the ageism that can be experienced between younger nurses and older residents, he said.

Darren Mathewson, chief executive of Aged and Community Services (ACS) Tasmania, said the state’s aged care providers had reduced student training in recent years. “In an underfunded and under-resourced environment, it’s very difficult to provide positive clinical placements when you struggle with limited resources just to deliver the care,” he said.

The existing workforce has been under immense pressure and the University of Tasmania has held back on placing students in aged care facilities because of concerns over standards.

However, in the past six months, ACS has been in talks with the state’s only university to accelerate the delivery of placements to students and late last year launched a graduate transition program for a cohort of 23 new nurses. Two teaching nursing homes were also set up in October to further support the role of aged care in education and training.

The state’s peak body is currently exploring options with the University of Tasmania to deliver placements as part of its honours degree transition to work program and through the Tasmanian Clinical Education Network.

However, supporting facilities to increase their capacity for clinical supervision and mentoring will be crucial, Mathewson said. “We’ve got to get to a point where we not only take clinical placements but they are respected and well-resourced clinical placements and students know that they will have a positive experience. We don’t want to overpromise and under deliver because poor clinical placements may mean that registered nurses chose not to enter aged care.”

Neville agrees. For students, the quality of the placement speaks volumes. “One of the biggest clinchers for a career choice is the experience that students get on clinical placement. If they have a really good experience that quite often lays the seeds for future employment,” she said.

Mathewson said students’ limited exposure to aged care at an undergraduate level had affected the sector’s ability to attract graduates, which is why the association has begun to prioritise this area as a matter of urgency.

“What we have do now is grab on to the opportunity and build our capability to attract and retain new graduates by creating the environment nurses want to be in, which is about evidence-based best practice, research and a multidisciplinary environment,” he said.

However, attitudinal change will take time, said Neville. Students’ often negative perceptions of aged care as “a dead end” career with limited career opportunities and the wages gap were other significant barriers, she said.

Neville is currently analysing the findings of a student survey which found that while undergraduates enjoyed working with older people, they perceived aged care as basic nursing and had little appreciation for the complexity of skills required to work in this environment.

In NSW, Illana Halliday, CEO of Aged and Community Services Association (NSW and ACT), said while larger providers were forging ahead, she was keen to facilitate an industry level response to clinical education. “We are very keen to build links with universities. This work is increasing in pace as it increases in importance for us.”

To explore the potential of the sector, a number of projects are currently being piloted across the country with funding from Health Workforce Australia. One example is a partnership between Aged and Community Care Victoria (ACCV) and Monash University which has developed a new industry association clinical support role.

“We know that the experience of coming into aged care for younger nurses can be fairly confronting which is why strategies are needed to make sure that it is a positive experience for them,” ACCV chief executive Gerard Mansour told Nursing Review.

This year 150 additional clinical placements in aged care will be offered to undergraduate nurses with the support of an “aged care clinical placement supervisor”. This industry role is a first for the sector, said Mansour. The registered nurses who will occupy those mentoring roles will do specialist preceptor training to boost their skills before taking on the students.

The ultimate goal is to employ and train specialist clinical placement support staff who will work for the industry association on a permanent basis, said Mansour. Once the 12-month pilot has been evaluated, a decision will be made about the feasibility of the role in the long-term.

Mansour said the program has already attracted strong interest from staff and facility management.

“For registered nurses it provides an opportunity to re-practice some of their skills, develop their mentoring capacity and provide a connection between the university and the workplace experience.”

Prior to applying for project funding, the Victorian Department of Health funded ACCV to undertake a scoping study into clinical placements in residential aged care. It found that while there was strong support amongst providers, there was a lack of clinical support and supervision for students. Interestingly, more providers said they would be willing to take on enrolled nurses than registered nurses. Of the 188 ACCV membership organisations surveyed, 131 said they would host enrolled nurses in 2011, and 91 said they would take on registered nurses.

The study found that aged care providers did not have the internal resources to cover a shortfall in clinical supervision and support, and external clinical teachers had minimal understanding of what an aged care placement can offer. It was found that 85 per cent of organisations said they provided their own supervision to students and 70 per cent said they did not receive financial remuneration from universities for accepting students.

As an interim strategy, aged care providers in Victoria were employing agency staff or relying on in-house staff to support students. Clinical teachers supplied by universities were sometimes found to not “value what aged care does” and providers said there was a “lack of respect” on the part of the clinical teacher.

The report recommended the development of aged care clinical teaching specialists, which it said could assist in the establishment of clear objectives and learning outcomes for students. There could also be flow on effects to students’ perceptions of aged care by maximising opportunities for developing specialist skills, specifically in palliative care, dementia care and complex wound management.

“It’s not a great surprise that having the extra time to spend with student nurses has always been a challenge,” said Mansour. “That’s why I think the model we are testing is going to prove to be right because it means having an additional staff member working with the students and almost acting as an intermediary between the university and the workplace.”

The clinical placements project with Monash University is also complemented by a new graduate program that has been built around an aged care specific curriculum. Mansour said the first intake this year of 28 nursing graduates will expand to an additional 40 in 2013. Demand for the positions was high with nurses applying for the available graduate position at a ratio of 4:1.

Recognition from the federal government about the need to drive expansion in aged care training and investment in innovative models bodes well for the sector, said Mansour.

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