By Associate Professor Maree Bernoth in the Charles Sturt University School of Nursing, Midwifery and Indigenous Health.
The COVID-19 pandemic has propelled a number of longstanding issues that have plagued Australia’s healthcare system to the forefront of national conversation, and one sector in particular that has received increased attention is aged care.
In July, the Royal Commission into Aged Care Quality and Safety released a commissioned report projecting the future impacts of changes in aged care; Aged care reform: projecting future impacts.
The report revealed the changes needed to the aged care workforce to ensure quality care. These changes involve a need for a tenfold increase in the numbers of registered nurses between now and 2050.
Currently there are about 22,000 registered nurses working in aged care but by 2050 Australia will need over 200,000 registered nurses.
It is anticipated that 30 per cent of the workforce will be derived from skilled migration, but where are we going to find the number of registered nurses to fill these positions, and what qualifications will they be required to hold?
Currently, there is no pay parity between the acute sector and the aged care sector, making working in aged care financially unattractive. Adding to this is the lack of career pathways and the reticence of aged care organisations to support their staff to engage in postgraduate education.
Registered nurses in some aged care facilities are responsible for large numbers of residents, making it impossible for them to work within their legal parameters and within their scope of practice. These factors cause too many to leave.
Before 1997, when I was working as an educator in a large aged care facility, for every 60 residents there was 308 hours per week of registered nursing time.
Today it is a meagre 168 hours per week, even though there are frailer, more vulnerable residents in residential aged care and more care workers with variable education and experience who need supervision.
With the depletion of the pool of experienced and qualified aged care registered nurses, where are the increasing numbers going to come from? What strategies are we currently working on to ensure there are appropriately skilled registered nurses to meet the demand of the reformed sector? Isn’t it now that this issue should be addressed?
To do so firstly requires a shift in attitudes that aged care nursing is ‘common sense’ and needs less sophisticated skills than the nurses working in acute care.
It fact, a registered nurse working in a residential aged care facility needs highly sophisticated skills.
As has been evident throughout the COVID-19 pandemic, illness in an older person presents in an atypical way, different from the signs a younger adult may display. Infection, pain, dehydration, delirium, dementia may all present with changes in communication or changes in the way the older person interacts with others.
There is no machine that can readily identify the cause of the change; rather, it is the assessment skills of the registered nurse that are relied upon to identify there is an issue, identify what the issue may be, and make the appropriate referrals. Getting this wrong can eventuate in reduced quality of life or death for the older person, and trauma for the family.
Growing the skills of existing registered nurses and attracting other registered nurses to aged care will require collaborations between the government, industry and the higher education sector to implement postgraduate and refresher qualifications for registered nurses.
It is incumbent on industry to encourage staff to engage in postgraduate education and provide them with scholarships and time to support them furthering their knowledge and developing their skills.
Universities need to be flexible in the programs they offer so that postgraduate education is not just research focused.
Universities also need to be prepared to work with industry to develop programs that meet industry needs and eventuate in skilled registered nurses who are able to provide quality care to older Australians and are skilled in leading teams.