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Aged workforce increases in size

With more than 240,000 workers employed in the aged care industry, its safe to admit that the workforce has been increasing steadily over the last five years. 

According to The Aged Care Workforce 2012 survey, the number of registered nurses working in the field has dropped by 483 employees since 2007.

This has been the first year in which nurse practitioners were surveyed as an occupation in the field – with a total of 294 employees recorded.

And while many acknowledge this increase in demand for workers in the field, the number of registered nurses has actually dropped since 2007.

However, in the residential arena, two thirds of residential facilities reported registered nurse shortages, while 15 per cent of community outlets reported shortages of RNs.

The three main reasons for the skills shortages, as outlined in the report, were: lack of specialist knowledge, slow recruitment and geographical location.

Nursing Review sat down with an aged care nurse, a nursing student and a nurse educator to get their views, and gain their opinions on why nurses are, or are not, entering this expanding field.

Nurse perspective: Anne Mokos

At age 59, Anne Mokos has been working as an aged care nurse for over 20 years and is currently working as one of the many Division 1 and 2 nurses working for not-for-profit aged and disability services organisation Villa Maria.

She transitioned from general nursing into aged care, after caring for her mother for two years when she had cancer. After her mother passed away, Anne felt the experience and insight gained would be of benefit if she were working with the elderly.

NR: What are the main changes you have seen to your role in over the last 20 years?

Anne: The main change I have seen was going from very hands-on position to one of senior management/ supervisor with very little hands on. I started in a very small 30-bed facility, which was privately owned, but the trend these days is larger homes, and the RN role is to oversee the shifts rather than direct resident care. There is also the necessity for the RN to be able to maintain the enormous amount of documentation required in aged care these days and to be an educator to the staff on the floor.

NR: What are the main challenges you face in the aged care industry?

Anne: The main challenges in the aged care industry, for not only RNs but also all staff, is the staff shortage and the high workload. This makes it hard for RNs to want to stay in the industry.

I don’t think any of us are afraid of hard work, but sometimes it is just overwhelming, and you stop and think is this really worth it. The number of times I have heard RNs jokingly say “well, that’s it – I am going to be a checkout chick at Coles” is too numerous to mention, and sometimes I really feel it is how they are feeling as the workload gets too much.

The other challenge is the changing face of aged care in its cultural diversity for both staff and residents. We must be aware of the communication difficulties as well as being sensitive to the cultural needs of all concerned.

The expectations of not only the residents but also the relatives are another challenge, as they are quite clear on what they expect and what they want delivered. While I don’t see this as unreasonable, there are times when it makes it difficult to meet their expectations due to regulations.

NR: What do you think needs to happen to attract more nurses to the aged care field?

Anne: I believe that one of the incentives has to be making it attractive in monetary terms. Pay nurses in aged care for the management positions they hold.

I also think it would be good to offer more structured education for RNs to work their way into senior positions. We also need to ensure that aged care is promoted as a great career opportunity.

Student perspective: Samuel Tutty

Uncertain where he should steer his career, Samuel Tutty was first introduced to the idea of care work by his father-in-law, who was a community RN at the time.
Intrigued, he applied for and was successful in gaining a traineeship with Anglicare – who funded his Certificate in Aged Care. He worked for Anglicare for a total of four years and “loved every minute of it”.

To pursue greater career choice and understanding of aged care patients, Tutty enrolled with the University of Adelaide to become a registered nurse and is currently in his third year.

NR: What do you like the most about working in aged care?

Samuel: I love the fact that as a result of caring for people for such an extended period of time, you can tailor the care you deliver to each resident according to their preferences. But not only that, the relationships you form with those residents over time something to be cherished.

Some of the stories that they can tell you are amazing, if you only take the time to listen. I also thoroughly enjoyed taking part in their leisure activities, escorting them on outings and participating in activities and even on occasion, organising those leisure activities.

It is very fulfilling working with these people and endeavoring to make their twilight years as comfortable and enjoyable as possible, even if that is only brightening their day with a cup of tea, a biscuit and good conversation.

NR: What do you find the most challenging aspects of working in the aged care sector?

Samuel: The aspect that I find most challenging when working in aged care is probably due to the very reasons I enjoy working in aged care. When you spend so long looking after a resident, you do form bonds and in some cases, you may even end up as part of their extended family in a way. Not only do you form relationships with the resident but also with the rest of their family. And whenever a resident passes on, it is always difficult when you lose a friend. The continuation of care is by far my most favourite aspect of working in aged care, but it is also the part I find most difficult to deal with.

NR: What prompted your decision to gain formal qualifications in the field?

Samuel: I wanted to further my understanding in the field to better care for the people in my charge. Studying to become a registered nurse was the perfect way to reach that goal.

NR: What are your career aspirations within the industry?

Samuel: I would like to eventually end up as a clinical nurse so as to make decisions regarding the quality of the care being administered to residents. As it stands, aged care and the quality of the care being administered is going to need to change as the aged population grows.

NR: What do you believe can be done to attract more nurses to the aged care sector to meet future demand?

Samuel: Remind them that it is indeed a growing industry and there will be much demand for nurses in the aged care setting with the aging population increasing. Also there is plenty of scope to advance professionally in the aged care setting.

A career in aged care can be incredibly rewarding, both personally and professionally. There is a huge scope for professional advancement.

Academic perspective: Wendy Moyle

Director of the Centre for Health Practice Innovation at Griffith University, professor Wendy Moyle currently leads an evidence-based practice for older people research agenda.

For many years, Wendy’s focus has been on quality of life and finding evidence for managing agitated behaviours in people living with dementia, using controlled trials and psychosocial, complementary and alternative medicines.

NR: What are the main changes you have seen to the role of the aged care registered nurse over the last ten years?

Wendy: The main change is that there are fewer registered nurses in the industry. There has been a slight increase in enrolled nurses, but a significant increase in unlicensed care workers.

I believe this has happened because the environment has become what is termed a ‘home-like’ environment and so there was this belief you didn’t need highly skilled people to work in the area.

What has happened is twofold. One is that the population has changed, so the residents who come in to aged care – specifically residential aged care – are much frailer and have much more complex needs.

Alongside that, we have seen an increase in unskilled care workers and I think this has created a lot of tensions because the government has put a lot of emphasis on regulations and standards of care.

The emphasis has become on medications and adhering to paperwork – in terms of documentation – and this has taken the nurse away from the areas that they have the most skills and expertise in.

NR: How do you see the role changing as the industry tries to combat demand from an ageing population?

Wendy: The government’s emphasis on keeping people longer in the home had a very positive effect in terms of reducing the numbers of older people in residential care, but that also meant that people are coming in much frailer and needing more complex care.
The industry has been very slow to react positively to the role of the nurse practitioner – which the government has done fairly well in terms of putting up money, providing opportunities etc …

Facilities can’t see that they can afford to have a nurse practitioner within aged care.

However, we really do need that role because the complexity of these residents require highly skilled people that understand physiology, who understand how to actually treat, assess and evaluate the care processes and communicate with others and I guess, forge that very strong link with the medical profession as well – as well as family.

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