Mandated Nurse-To-Resident Ratios Not The Only Change Needed In Aged Care


There are a number of issues worth highlighting in Residential Aged Care facilities (RACF) such as the lack nurse-to-patient ratios, government funding not being tied to care and the overall public perception of aged care. However, this nurse describes their experience about what else needs to be considered. 

As an aged care nurse, I have worked as a Registered Nurse (RN) in charge, an Educator, ACFI co-ordinator and Clinical Care Manager. In my experience in these roles I have identified many issues.

The solution is not as simple as more staff or improved nurse/resident ratios. The overriding issues I have experienced relate to poor management with displays of bullying, harassment and a lack of appreciation of all levels of aged care staff, indicated by them not listening to or addressing their concerns. There are some managers in aged care that are either not nurses or are new graduate nurses with limited experience. Some managers are focused or forced to focus on cost cutting, this is evidenced by, not supplying staff and resources such as gloves and pads and pressuring RN to miscalculate ACFI claims.

Many new graduate and overseas working-visa nurses are also employed to work on the floor.  They are often task orientated and/or cannot understand the residents or other staff members due to limited English proficiency. The inexperience and lack of English language skills contributes to miscommunication between staff, residents and families.

There is also a lack of governance of the RTO’S that teach certificates in aged care, allowing inappropriate people to complete the course (not willing/forced by Centrelink to study or with minimal English language skills) to complete a substandard course that does not prepare them for an aged care role. There is of course not enough RNs in aged care, forcing Enrolled Nurses or Certificate IV Aged Care Workers/Assistants in Nursing to work beyond their scope of practice putting residents at risk.

And due to unclear handover/communication processes evident in aged care facilities, we see falls, infections and other crucial clinical information not being handed over. Some RACF allow only 5 minutes for an RN handover!

Nurses are also often exposed to resident and family member abuse, poor pay and poor attitude regarding the aged from doctors and ambulance officers if attending. This is evident by Registered Nurses calling doctors and their reluctance, delay or refusal to attend to the resident and ambulance officers being solely focused on whether a resident has an advanced care directive rather than their presentation/diagnosis/level of pain.

So, what is the answer? I suggest, an overhaul of RTO’s that provide aged care training, increased wages, clearer career pathways for aged care nurses, campaigns to highlight the advantages of working in aged care, greater appreciation of aged care nurses, more community education of aged care nurses’ roles and challenges, more accountability and compulsory education of aged care managers to governing bodies.

I am not denying that elder abuse does not exist, it does, but it is in the minority of cases. I love the aged, advocate for them, am passionate about aged care and work for an exceptionally outstanding aged care facility- they do exist. I work with a fantastic multidisciplinary team who focus on outstanding resident centred care.

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