De-skilled?

[Maria]

When nursing in the UK as a CN in an Aged Care facility, we (the RN's) did: SPC, IDC's, Blood collection, and Dopler scans to name but a few. why is it here in Australia that if a resident needs there SPC changing they have to go off to ED? that pathology centres send in their own staff? etc
Seems a waste of resources to me?

Maria

[industrystandard]

It's partly rigid thinking, "We've always done it this way" but mostly it's the accreditation system. Introducing a new procedure involves ensuring that it will pass the three billion standards to which it pertains is deemed too difficult.

"De-skilled" is a word which will make me go off my nut every time. I am not deskilled. I have different skills. There's a a stigma to aged care nursing, usually reinforced by nurses themselves - sometimes nurses within the field too. Some nurses just don't get nursing which doesn't involve technology and complex procedures and see it a less valuable. It is a shame, because aged care nursing is a complex field of nursing which requires high levels of nursing skills.

[linda_m]

The difference between skilled and unskilled was palpable when my mother was in nursing home care. There were some staff who were able to ensure that she was comfortable and pain free and others who couldn't. I can't even begin to say how much both she and I valued and appreciated those skilled and caring staff. But they were few on the ground really. And everyone was so busy and stressed that it was often hard for her to receive the attention she needed in a timely manner. And the stress to her and to me of the long wait for her basic care needs was hard too.

The stigma attached to aged care nursing is part of our ageist society - where an old life is not as valued as a young life. I agree with you industrystandard - aged care nursing is complex important work and very undervalued. And I don't see this changing too much as most people don't think they will end up in a nursing home - being frail and helpless. That thought is not a good one, I guess - and people prefer to think that they will just drop dead in their sleep or something. And so the needs of the old and frail are put from the minds of most of us and there is little community pressure for things to change.

[industrystandard]

Just a fun exercise so others can see what we're up against; how many standards would venepuncture potentially affect?

1.2 Regulatory compliance
The organisation's management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards and guidelines
1.3 Education and staff development
Management and staff have appropriate knowledge and skills to perform their roles effectively
1.6 Human resource management
There are appropriately skilled and qualified staff sufficient to ensure that services are delivered in accordance with these standards and the residential care service's philosophy and objectives
1.7 Inventory and equipment
Stocks of appropriate goods and equipment for quality service delivery are available
1.9 External services
All externally sourced services are provided in a way that meets the residential care service's needs and service quality goals
2.2 Regulatory compliance
The organisation's management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards, and guidelines, about health and personal care
2.3 Education and staff development
Management and staff have appropriate knowledge and skills to perform their roles effectively
2.4 Clinical care
Residents receive appropriate clinical care
2.5 Specialised nursing care needs
Residents' specialised nursing care needs are identified and met by appropriately qualified nursing staff
3.6 Privacy and dignity
Each resident's right to privacy, dignity and confidentiality is recognised and respected
4.2 Regulatory compliance
The organisation's management has systems in place to identify and ensure compliance with all relevant legislation, regulatory requirements, professional standards, and guidelines, about physical environment and safe systems
4.3 Education and staff development
Management and staff have appropriate knowledge and skills to perform their roles effectively
4.5 Occupational health and safety
Management is actively working to provide a safe working environment that meets regulatory requirements
4.7 Infection control
An effective infection control program

....for a total of fourteen. Show me a nurse manager who has a week to ensure that the procedure complies with all fourteen.

[Maria]

It's partly rigid thinking, "We've always done it this way" but mostly it's the accreditation system. Introducing a new procedure involves ensuring that it will pass the three billion standards to which it pertains is deemed too difficult.

"De-skilled" is a word which will make me go off my nut every time. I am not deskilled. I have different skills. There's a a stigma to aged care nursing, usually reinforced by nurses themselves - sometimes nurses within the field too. Some nurses just don't get nursing which doesn't involve technology and complex procedures and see it a less valuable. It is a shame, because aged care nursing is a complex field of nursing which requires high levels of nursing skills.

I appreciate the comment on the accreditaion/standards, however the point regarding *Some nurses just don't get nursing which doesn't involve technology and complex procedures and see it a less valuable. It is a shame, because aged care nursing is a complex field of nursing which requires high levels of nursing skills* has prompted me to clarify one or two things

When i started my nurse training (many years ago) it was with one 'speciality' in mind, that didn't change throughout my training and i am still working in the aged care sector. I don't see it as being less valuable that any other nursing speciality, in fact being a techy minded nurse doesn't make anyone a good nurse. and finding a "good" aged care nurse with the right skills isn't easy.
My inital post was with regard to "CONTINUITY" for older people living in nursing homes. Why shouldnt aged care nurses be able to take routine bloods, change a catheter or god forbid do a doppler scan if they are needed? isn't that all part of holistic individualised care???
And well if there were some (even 1) that could say.... Doppler someone so that the resident recieved the correct dressings for their chronic venus ulcer thats been plaguing them for 2 yrs, instead of them having a "Basic, dry" dressing slapped on each day??? Becuase lets fae it how often have you known a resident be referred on for a doppler routinely ?
And then lets just say one nurse is able to change an SPC, wouldnt that save the resident ( and perhaps the family) the worry of having to attend a hospital appointment where you're just another number, sitting in the waiting room, hoping that the appointment time isn't going to run too long over because 'mum/dad' needs regular pressure area care, is starting to get anxious/agitated at the strange surroundings/people/noises.
My inital post was not a dig at the poor quality of aged care nurses it was simply a comment on what appears to be a waste of resources and the lack of continuity.

[wanda]

Maria wrote:

why is it here in Australia that if a resident needs there SPC changing they have to go off to ED? that pathology centres send in their own staff? etc

I think I can answer part of that. The doctors determine who collects the blood.

While you can look in the phone book and find dozens of pathology companies listed, too few people understand that most of these companies are now consolidated into a handful of national and international corporate giants. Pathology is a very lucrative business – but also a very competitive one. The companies have sales people on the road constantly, pushing their products to the doctors – and the doctors aren’t slow in making them work for their sales. In the pathology company I worked for, home visits, including to aged care facilities, was one of their major selling points – they sell it on the basis of speed and quality, the fact that their own phlebotomists can get out to the patient and get the sample straight back to the lab. exactly to specification and in the right tube. (In my experience, most RNs are good at collection, but you do get the odd wrong tube or poor quality sample.)

Maria, patient comfort and continuity don’t come into it when money is at stake!!

The company I worked for had already been caught, convicted, fined and publicly shamed for offering rent “kickbacks” to doctors (they set up a collection point and maybe a lab. within, or next to, a private practice – and pay the doctor/owner three or four times the going rate of rental – it’s a nice little incentive to get, and keep, a doctor’s business). It’s illegal and they’d been caught before, yet, where I worked, they were still doing it. It’s worth the risk. Pathology is that lucrative, and that competitive. And of course, what’s a few $100,000s fine to a major company.

Where I work now, RNs take blood – but then, it’s a rural facility and there’s only one regional pathology company, so no competition.