Fixing the Productivity Commission’s draft report. Part 2: skills mix and staffing levels.

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The Australian Nursing Federation has been given the opportunity to present its final submission on the Caring for Older Australians, Productivity Commission Draft Report. 

Last weeks blog post discussed why the wages gap needed to be fixed. This week we will discuss why a skills mix and staffing level tool needs to be implemented into the final report.

ANF Federal Secretary Lee Thomas presents the signed Because We Care petitions to Deputy Chairman Mike Woods.

Skills Mix and Staffing Levels

The Productivity Commission’s draft report acknowledges that personal care needs ‘do not generally require a high level of clinical expertise compared to the delivery of health care services, but caring skills and relationship skills are very important and play a significant role in the quality of the care experience’. The ANF argues that the ‘clinical’ and ‘personal’ are not so easily separated.

The draft report further states that aged care workers ‘will generally need to have a caring attitude, possess a broad range of skills and have undertaken appropriate training and experience to ensure that they can provide quality and safe care’.

While the ANF doesn’t disagree with these tenets, it highlights the nexus between a caring attitude and the ability to undertake work that requires a high level of interpretive skill. It is the difference between a trained workforce and one that is qualified.

Safe, quality care requires that health services have:

  • an adequate number of nurses;
  • an appropriate skill mix (proportion of registered nurses to enrolled nurses and nursing assistants);
  • nurses who are educationally and clinically prepared;
  • a manageable workload for nurses; and
  • sufficient resources to enable nurses to deliver the best possible care.

The Productivity Commission has acknowledged the growing gap between the escalating care needs of clients/residents along with the number of clients/residents in care and the available workforce, now and into the future. However, the Commission has not made any recommendation/s regarding staffing levels or skills mix that should apply – particularly in residential care.

The ANF believes that the Productivity Commission should make recommendations that will lead to the adoption of minimum staffing standards in the residential care sector as a requirement for care for every client/resident.

The ANF propose a skills mix for residential aged care facilities based on the following calculation method:

If one nurse is allocated to:

  •  4 residents per day shift (which would cover assessment, care planning and provision, complex and basic care including most showering, assistance with two meals, dressing, medications, etc.) on a day shift; and
  • 6 residents per afternoon shift (which would cover all assessment, complex and basic care in the afternoon/ evening period including showering, assistance with one meal, undressing and preparation for sleep, medications etc.); and
  • 15 residents per night shift (which would cover regular supervision, medications, care and assessment of new/ill residents).

In addition, time is required for indirect care responsibilities (eg: managing medication including counting controlled substances at the end of each shift, nursing handover and professional communication, quality assurance/accreditation activities, providing advice and information to families) and this would equate to an additional 20% loading per shift.

The ANF recommends based on the above method, that:

  1. A minimum of 4.5 hours of nursing care per resident per day should be recommended.

2. The development of a care staff/resident and skill mix tool based on ACFI funding tool which reflects the care needs and acuity of residents.

3. The ANF appreciates that in some parts of the industry there will be a requirement to increase overall staffing numbers and this may present difficulties for providers.

4. The Productivity Commission should recommend that these difficulties be addressed by the National Aged Care Regulation Commission in a relevant and practical manner which assists providers to meet their staffing obligations.

5. The staffing needs for each facility would be re-evaluated four times a year to ensure stability for residents, management and staff, unless there is significant and sudden changes in resident acuity.

6. That the staff/resident and skill mix tool be prepared in stage 1: expedited measures within two years of the Draft Implementation Plan (XLIV draft report).

7. The Productivity Commission recommend 24 hour registered nurse cover.

8. Each facility which employs nurses must employ a full time Director of Nursing (or classification equivalent).

What do you think of these recommendations? Would they make your career as an aged-care nurse easier? Would they attract more nurses to the sector?

Don’t forget to enter our latest contest – nominate your favourite nurse in celebration of International Nurses Day!

Image credit: NSWNA, and topnews.net.nz

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