Aged care nurse Terri Burrell, who is in charge of 59 patients, is paid $12,000 less per year than a nurse with a similar job in a public hospital.

Ms Burrell, 49, is an experienced Registered Nurse who runs night and evening shifts at an aged care facility in Sydney’s inner west.

Late at night she must cope with just three other staff and no doctors. In the event of an emergency, Ms Burrell must decide if a doctor needs to be called or a resident needs to go to hospital.

She must also supervise the care of residents suffering from dementia and a range of physical ailments. “I don’t have a doctor there on the premises like we do in a hospital,” she said.

While hospitals and child care centres have staff-patient ratios, Ms Burrell said Australian nursing homes did not. This meant a night shift at her facility saw two nurses and two assistants overseeing 59 residents!

Compounding the problem, residents are now sicker and frailer when the reach nursing homes due to people living longer and staying at home longer with home help.

“They’re coming in so much worse off than they did before,” Ms Burrell said. “People are living longer. There’s nothing wrong with that … but when we get them their level of care is very high.”

This is the reality for Australia’s aged care nurses, who work just as hard and have just as much responsibility but are paid much less than their hospital counterparts.

The situation is putting pressure on an already stretched aged care system. A Federal Government spokesperson told Health Reporter the aged care system needed reform, but nurses like Terri Burrell say action is long overdue.

The Australian Nursing Federation recently welcomed the Federal Government’s $18.7 million plan to expand the role of Nurse Practitioners, who are qualified to treat clients in an advanced clinical role, in residential and community based care.

But the ANF’s Because We Care campaign also wants a better wage deal for all aged care workers.

Aged care nurses earn $168-$300 on average a week less than those in public hospitals – at a time Australia urgently needs 20,000 more aged care nurses.

An ANF online survey late last year found 78 per cent of aged care nurses and assistants, 90 per cent of whom are women, would leave if the wage gap wasn’t closed. Only 10 per cent wouldn’t leave.

ANF Federal Secretary Lee Thomas said the message was loud and clear. “The vast majority of low paid nursing and care staff working in aged care are very worried about the wages gap across the sector and are now prepared to leave their job because of it,” he said.

Will you leave aged care if the wages gap isn’t closed?

Source: ANF and Health Reporter

Image credit: NSWNA

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Most of the 110 nurses attending the NSWNA Annual Aged Care Nurses Forum last month were from the residential care sector and the majority were registered nurses (RNs).

The program included presentations from aged care nurses in clinical leadership roles, as well as sessions about aged care reform, industrial and campaigning matters, and regulation in aged care.

Presentations included falls prevention, nursing and medication management in people with delirium, better liaison between aged care and the acute sector, and quicker interventions to prevent unnecessary hospital admissions.

Geriatric flying squad

Amanda Klahr, a clinical nurse consultant, spoke to the forum about her award-winning Geriatric Flying Squad.

The Flying Squad is a geriatric assessment and management service that Amanda developed and manages, and which won a HESTA Australian Nursing Award for innovation in nursing.

Developed at the War Memorial Hospital in Waverly Park, the service provides comprehensive geriatric assessments, multidisciplinary care in the home, and referrals to appropriate services.

The team includes a clinical nurse specialist, a doctor specialising in geriatric care, a social worker, an occupational therapist, a physiotherapist and a clinical psychologist.

Amanda says the aim of the service is to help clients to live in their own homes while maximising their quality of life.

‘Our clients are community-dwelling elders who are failing at home for some reason.
They are referred to us by a concerned GP, neighbour, personal carer or family member, the department of housing or police,’ she said.

‘The Geriatric Flying Squad is a rapid-response service for sub-acute patients. The nurses triage the clients by researching their medical records and talking to family.

The squad typically works with a client for 12 to 15 weeks, including an intensive first month before discharge. If the client encounters difficulties again, they have the option of returning to the service.

What do you think of the geriatric assessment and management service?

Image credit: NSWNA

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The Department of Health and Ageing has recently developed a ‘What can we learn?’ report about residents who go missing from Australian Government funded aged care facilities.

The report is now available in the Industry toolkit on the Aged Care Complaints Scheme website.

Last week we talked about the risk factors that contribute to the likelihood that a resident may go missing. Today we discuss ways these risks can be addressed.

How can risks be addressed?

At entry

Close monitoring and assessment of residents following entry, especially on their first day of entry, may reduce the incidence of residents leaving a service unnoticed.

At the point of entry

An individualised, person-centred approach to the orientation and integration of a resident into a new environment may minimise the distress and disorientation associated with entering into a residential aged care service and reduce the desire for residents to leave the service.

This may involve family members or persons who are significant to the resident that can provide support to the resident and assist in ensuring that important risk factors are identified when the approved provider is developing a detailed care plan and management strategy.

Pre-assessment of permanent and respite residents entering a service

Screening new residents (including those in respite care) and assessing their care needs on the day they enter a service may assist approved providers to manage the risks factors associated with residents going missing during their initial stay in a service. This can be done in tandem with other assessments.

Ongoing monitoring

Residents’ care needs change over time. Ongoing monitoring of care needs may be beneficial in managing risks associated with residents going missing. Ongoing monitoring is particularly important when risk indicators such as a history of wandering are identified.

Caregiver and community education

Increased community and aged care staff awareness could prevent some instances of residents going missing.

Aged care staff and the community play a critical role in ensuring the safety of residents, especially those who are at risk of going missing.

Providing appropriate education to care givers and the community can: increase their understanding of behaviours that may lead to a resident going missing prevent some incidents where people have unintentionally assisted a resident to leave or have not informed the service a resident has left. In addition, education of the family or significant persons can assist in the development of effective resident care plans.

Through increased vigilance, anyone who visits a service can ensure that security measures are effective in residential aged care facilities. Care givers can accurately document resident movements out of the service and ensure they are returned to services on time.

Interventions

Aged care services can intervene in a number of ways to reduce the possibility of residents going missing without explanation. This can include environmental modifications, technology and safety monitoring, and physical and psychological activities.

The environment around a service may also pose risks to missing residents, such as a service’s proximity to bushland, bodies of water, or roads.

Interventions should be based on a case-by-case analysis of potential risk factors that apply to individuals and the service’s location.

Interventions may be particularly useful in managing the risks associated with cognitively impaired residents or residents who exhibit wandering behaviour.

Conclusion

Risk factors include cognitive impairment, a history of wandering, and residents entering an unfamiliar environment as a new entrant or for respite care.

Screening and assessment of the resident at the point of entry and education of caregivers and the community could reduce the likelihood of at-risk residents going missing.

There are a number of strategies that the industry could consider to manage and reduce the possibility a resident going missing without explanation, including environmental modifications, technology and safety monitoring, and physical and psychological activities.

We asked on our Nurse Uncut Facebook page and last blog post what your age care facilities do to reduce wandering residents – see some of the ways below.

“By having more staff”

“At our facilities we find that a plastic chain strung across the doorway can prevent some wanderers from trying to exit. Can be a useful strategy to keep them out of certain areas or rooms.”

What does your facility do to reduce wandering?

Image credit: Tom Beardshaw via Flickr

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The Department of Health and Ageing has recently developed a ‘What can we learn?’ report about residents who go missing from Australian Government funded aged care facilities.

The report is now available in the Industry toolkit on the Aged Care Complaints Scheme website.

This report is intended to be a useful resource for the aged care industry, and it:

• shares data analysis results
• highlights national trends associated with missing residents
• outlines potential risk factors that may be involved with residents going missing
• suggests interventions that may address these risk factors
• provides additional information about cognitive impairment, dementia and wandering behaviours.

The aim of the report is to provide the aged care industry with information relating to missing residents. Its contents should not be considered as instructions or advice.

What are the risk factors?

The report indicates there are multiple risk factors that contribute to the likelihood that a resident may go missing. These include where they have:

• a cognitive impairment
• a history of wandering
• recently entered a service
• been receiving respite care in a service.

The common theme of these risk factors is a behavioural element. Residents may be confused or challenged by unfamiliarity in their environment due to a change of location or a cognitive impairment.

In addition, a combination of elements can increase the likelihood a resident can go missing. These factors include:

• residents who are able to walk independently and are cognitively impaired
• residents with a history of wandering that are not in a secure environment
• residents that are new entrants and are cognitively impaired.

How does your work place prevent wandering aged care residents?

Read about how some of these risks can be addressed in Part 2 next week.

Image credit: Tom Beardshaw via Flickr

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The closing date has been extended to - Friday 16th December 2011.

We are seeking expressions of interest from mental health nurses who wish to further their professional and career goals by undertaking an innovative work experience program under the guidance of an experienced mentor.

Any mental health nurse who believes they or their service may benefit from the experience is welcome to apply.

If you know any mental health nurses who may benefit from this exciting initiative, please encourage them to apply before this final closing date.

Priority will be given to mental health nurses with less than 2 years experience who currently work in public mental health services in rural or remote locations in NSW.

The program offers for up to 20 successful applicants the opportunity to:

• Work with a mentor in an LHD other than their own for up to 5 consecutive days to pursue employment and career goals, e.g. within an inpatient mental health unit, a community-based service, Specialist Mental Health Services for Older People or an Emergency Department
• Have their air/rail transport, accommodation, meals and local travel expenses paid
• Have their position back-filled up to a total of $1500 (paid directly to the employing LHD) (The hosting LHD will also receive a small contribution to assist with the mentoring costs).

The program was developed in recognition of Mr Bob Fenwick’s long service to mental health nursing and the important role he played in mentoring less-experienced mental health nurses. Mr Fenwick was tragically killed in a work-related incident at Bloomfield Hospital, Orange NSW, in January 2011.

The application information can be downloaded from the NSW Nurses Association website or via this link.

The Mentee Information Booklet and the Mentee Expression of Interest Form can also be accessed via the following links:

Mentee Information Booklet 2011 (166kb)
Mentee Expression of Interest Form 2011 (263kb)

If you require more information or need assistance with the Expression of Interest form, please don’t hesitate to contact the Program Manager Marc Hopkins or Mary McLeod on: Metro: (02) 8595 1234; Rural: 1300 367 962, or via email mhmgrant@nswnurses.asn.au

Image credit: NSWNA

Bob Fenwick was a mental health nurse tragically killed in a work-related incident at Bloomfield Hospital, Orange NSW, in January 2011.

The Bob Fenwick Memorial Mentoring Grants Program 2011/12 has been developed to recognise Bob’s long service to mental health nursing and the important role he played in mentoring less-experienced mental health nurses.

Have you checked to see if you’re eligible?

The program aims to encourage experienced mental health nurses to mentor less experienced colleagues, for the betterment of mental health in NSW.  Funding for the grants is provided by NSW Health and administered by the New South Wales Nurses’ Association.

Who can apply?

Applicants for the grants must be currently registered nurses working in a public mental health service in NSW. Mental health nurses with less than 2 years experience working in rural or remote services will be given priority
.

Applicants must:

• have in-principle agreement from their organisation to participate
• be able to complete the mentorship
• experience in early 2012
• develop a plan identifying the mental health experiences sought through the placement
• articulate their objectives in undertaking the mentorship and how these relate to current employment and career goals.

How are grants awarded?

Up to 20 grants will be awarded. Priority will be given to applicants with less than two years experience, who work in rural or remote public mental health services in NSW.

The Program Steering Committee will determine the successful grant applications.
Successful applicants will be personally notified and awards announced in January 2012.

For more information download the information booklet and expression of interest from the NSWNA website www.nswnurses.asn.au.

Will you apply for a grant?

Image credit: NSWNA

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The NSWNA is surveying nurses working in the “for-profit” Aged Care sector to ensure we are well informed before we commence bargaining for new agreements Fill out the survey and you could win an Ipad2

The NSWNA has engaged a company called Essential Research to undertake the survey and to conduct an online focus group.

Nurses who complete the survey that is being mailed out or who complete the online version will have a chance to win an ipad2. For terms and conditions see below.

To complete the survey online please click here.

Terms and conditions for ‘for profit’ Aged Care survey, iPad2 draw

Key things you need to take note of:

1. The prize is an Apple iPad2TM (32GB, 3G).
2. The prize will be drawn on 14 December 2011.
3. The winner will be notified by telephone and/or e-mail and/or post.
4. Only one survey entry per person.
5. To be eligible to be in the draw your completed survey must be received by the Association prior to 7 December 2011 (via website or post).

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More than 90 employers, covering 176 facilities in the not-for-profit aged care sector have signed up to a new template agreement that delivers an average 9.2% pay increase to nurses over three years. For some the pay increase will be as much as 12.38%.

More than 1400 NSWNA members will benefit from a new agreement with employers in the not-for-profit aged care sector. Over 92 per cent of members have voted in support of the agreement.

RN Judith Nicholas (centre) wore her traditional nursing uniform to symbolise the importance of nurses in aged care

The three year agreement includes a 3 per cent pay increase in the first year (from 1 July 2011), 2.8 per cent in the second year and 3 per cent in its final year.

Wage increases are even higher for AiNs, with their wages to be at least 3.5 per cent above the Nurses’ Award minimum rate.

‘This is a big win for AiNs,’ said NSWNA General Secretary Brett Holmes.

‘In the past AiN wages have been very close to the minimum wage. There is now a clear increase above the minimum wage. This is well-earned recognition for the valuable work that AiNs contribute to the aged care sector.

‘The wage increase, along with salary packaging, now makes the not-for-profit sector more attractive than other parts of the aged care sector.’

‘Some RN classifications are getting close to public sector rates. This will make the not-for-profit aged care sector a more appealing place to work for many nurses.’

The first pay increase will be backdated to the first pay period on or after 1 July 2011, and paid after the agreement is approved by Fair Work Australia.

The employers have agreed that, if the Productivity Commission Report results in more funding for aged care, discussions about further wage increases will be held.

What has been won

Wage increases

• 3% first pay period on or after 1 July 2011
• 2.8% first pay period on or after 1 July 2012
• 3% first pay period on or after 1 July 2013

Other important conditions

• existing conditions, including penalty rates and leave entitlements, are protected
• overtime applies for part-timers and casuals after 10 hours
• under-18 AiN rates removed
• employer pays for cost of criminal checks
• casuals can request permanent employment after six months
• casual loading increases to 21.5% from
July 2011; 22.67% from July 2012; and 23.83% from July 2013.

Do you think this will make the not-for-profit aged care sector a more appealing place to work?

Image credit: NSWNA

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A new survey has revealed low paid nursing and care workers will leave the aged care workforce unless the Gillard Government urgently addresses the wages gap.

The Australian Nursing Federation (ANF) launched the on-line survey of aged care workers as part of its national “Because We Care” campaign aimed at fixing Australia’s under-resourced aged care sector.

Hundreds of aged care nursing and care staff are continuing to respond to the survey, which poses the question “Will you leave the aged care workforce if the Gillard Government does not close the wages gap?”

So far, results are showing:

• A majority 77 per cent of aged care workers responded they would leave.
• 12 per cent were unsure if they would leave.
• 10 per cent said wouldn’t leave.

“Although, the survey commenced only last week, there’s an emerging pattern showing that low paid nursing and care staff in aged care are extremely concerned about the wages gap they’re experiencing and are prepared to leave the workforce unless the Gillard Government steps-in and rectifies it,” ANF Federal Secretary, Lee Thomas said.

“How can the sector possibly expect to recruit the 20,000 extra nursing staff needed to meet the growing demand of Australia’s ageing population if aged care nursing and care staff are being paid significantly less than what they would earn in other health settings?

“The ANF and its growing membership are now seriously concerned that unless the Gillard Government acts, we will simply have no workforce left to deliver quality care for the elderly Australians living in nursing homes.”

The ANF is calling on the Government to inject $500 million to close the wages gap in aged care by making Budget 2012 the “aged care Budget”.

Will you leave the age care sector if the wages gap is not fixed?

Image credit: NSWNA

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A campaign of bed closures has delivered a major breakthrough for safer staffing levels in the Coffs Harbour Mental Health Services.

During a hearing in the NSW Industrial Commission, management guaranteed to roster eight nurses on morning and afternoon shifts and four on the night shift at the 30-bed acute mental health unit.

Sue Kendall, President of NSWNA Coffs harbour Mental Health Branch and Jack Schwartz, Vice President

In return the NSW Nurses’ Association mental health branch reopened six beds it shut during the campaign of bed closures.

The 8:8:4 roster was a key demand of the branch, which had been battling for more staff for at least two years. Previously the unit had seven nurses on mornings and afternoons and four at night.

NSWNA General Secretary, Brett Holmes, said management of the Mid North Coast
Local Health District also agreed to fast-track the implementation of nurse-to-patient ratios according to the Nursing Hours Per Patient Day (NHPPD) model.

The NSWNA secured these ratios for most NSW hospitals following a public campaign in 2010. They are due to come into effect in June next year.

Brett said the Coffs Harbour nurses correctly decided they could not safely continue their high levels of overtime and double shifts.

‘They were burning out and many were considering leaving, which would have made the vacancy situation worse,’ he said. ‘The safest thing to do, for all concerned, was to take this action (bed closures) while recruitment efforts were beefed up.

President of the union’s mental health branch at Coffs Harbour, Sue Kendall, said the branch voted unanimously to close beds after more than two years of fruitless negotiations.

Sue said nurses were concerned about working in an environment that was unsafe for both patients and staff. The branch had raised the issue at the Reasonable Workloads Committee as far back as November 2009.

She said two high dependency beds and four acute/sub acute beds were closed in the 30-bed unit. This meant only those beds that could be safely staffed remained open, after existing patients were discharged.

‘It wasn’t difficult to get nurses to agree (to close beds) because they have had to work in an unsafe environment under great stress for so long. Nurses were worried about what might happen to a patient as a result of the pressure,’ Sue said.

She said management had agreed to re-establish an active Reasonable Workload
Committee, where nurse and management representatives would meet fortnightly, to discuss issues such as rosters, recruitment and the skill mix.

‘We need to follow up the 8:8:4 agreement and make sure recruitment happens as quickly as possible.’

Are there nurses at your workplace who are burning out and considering leaving? Will you take action as Coffs Harbour have done?

Image credit: NSWNA