Aged Care Nurses Conference

[abbie]

These posts are so sad....good people leaving the system, skilled nurses no longer needed. No wonder we are all frightened that we might have to live in one of these homes. So sad and no-one listening.

[Snappo]

I don't believe it's solely up to the government to fix staff/resident ratios. All it really would take is a compassionate DON/facility manager who cared about her staff and residents. One good facility who really was 'not for profit', who put the bonds, rents, etc, back into the facility instead of the bank (or bosses pockets), who are prepared to pay decent wages for decent staff, and enough of them. Just because there is an award wage, it doesn't mean you have to pay it, offer more, and you will get the cream of the crop. Offer good working conditions and good resident/staff ratios, and you will get the creme de la creme of the crop. Aaahhhhhh, dream on.......

At work tonight, one of the residents showed me the minutes from the residents/managers meeting. One if the items on the agenda was that carers didn't have the time to 'care' anymore....they were too busy. It's just impossible to find the time to sit and chat with a residents, give them a foot or hand massage, paint their nails, talk about the footy, take them for a walk. There are too many beds to make, showers to give, food to serve, dishes to clean up, washing to do, and the ever present 'paper work' to get through. Sorry, darling, you got a problem, tell someone who cares, we don't have the time to...........God knows why we're called 'carers'....... you're right, it's all just so sad.....

[industrystandard]

I don't believe it's solely up to the government to fix staff/resident ratios. All it really would take is a compassionate DON/facility manager who cared about her staff and residents. One good facility who really was 'not for profit', who put the bonds, rents, etc, back into the facility instead of the bank (or bosses pockets), who are prepared to pay decent wages for decent staff, and enough of them. Just because there is an award wage, it doesn't mean you have to pay it, offer more, and you will get the cream of the crop. Offer good working conditions and good resident/staff ratios, and you will get the creme de la creme of the crop. Aaahhhhhh, dream on.......

I've done or am working toward all of this where I work (replaced ENs and medication credentialled carers with RNs, increased carer hours and we're currently working on increasing wages in order to attract better staff) but I'm just one person in one (not-for-profit and highly unusual) facility. I don't credit myself with this (though I am Superagecarenurse for suggesting it ), if I didn't work in an organisation which was open to spending money it would be Game Over for me.

Here's what it's like on the other side of the desk everywhere else; as a DON, you can be as compassionate as you want but you won't last a minute if you so much as look at increasing the budget. You'll be subject to bullying, threats and pressure before "resigning". All DONs I know do what very little they can to improve the lot of people in their care but without government support, it's like holding back the floodwaters with a stick.

A complete overhaul of the system would be nice but it won't happen in our lifetimes. While the private operators are here to stay and the not-for-profits are running as businesses, nothing less than legislation will persuade them to increase staffing levels and skills mix.

[Snappo]

Actually, Industrystandard, I can equate with this. Where I am currently working, the previous facility manager left as she was told to cut back staff, she said she had cut back all she could, if they want her to cut back more she would resign....they did, she did!!

We now have a manager who appears happy to do the bidding of the heirarchy. We have lost carer time, kitchen staff, activities officers. Staff still do 'no shows', leaving us short staffed and working like trojans. We rely a lot on agency staff who sometimes make the most appalling blunders (not their fault, they are thrown in the deep end and have no idea about the routine, or what's expected of them). I have also noticed that there is a cut back in some of the food items, and there is a lot of stuff covered with cheese!!

Another interesting point, due to the medication errors occuring, management put an EEN on morning shift solely to do the medications. Believe it, or not, there are as many, if not more errors occuring. Carers at least had a reason for making the occassional error, they were doing 10 things at once, but what excuse did the EEN have when all she did was meds?? I have also seen RN's making medication errors, so it all boils down to not necessarily your training, but the care you take when doing this role. RN's, EEN's,EN's, Medication credentialled carers, they all have to follow the same basic '5 R's', right resident, right route, right medication, right dose, right time. This is not hard, if you're careful....

[Sally]

Hi Snappo,

Sounds a lot like where I worked. We are all in the same boat and it is sinking fast!
God help those dear, lovely people who are so dependent on us. It's worse than cruel !!

[industrystandard]

Another interesting point, due to the medication errors occuring, management put an EEN on morning shift solely to do the medications. Believe it, or not, there are as many, if not more errors occuring. Carers at least had a reason for making the occassional error, they were doing 10 things at once, but what excuse did the EEN have when all she did was meds?? I have also seen RN's making medication errors, so it all boils down to not necessarily your training, but the care you take when doing this role. RN's, EEN's,EN's, Medication credentialled carers, they all have to follow the same basic '5 R's', right resident, right route, right medication, right dose, right time. This is not hard, if you're careful....

Indeed, you can teach any-one the five R's and no-one is better or worse at avoiding errors (my stats show an even spread across the three job descriptions*). My concern is around the pharmacology knowledge that carers and a lot of ENs lack. A good working knowledge of drug actions and interactions is essential to give excellent care to the elderly. Seemingly simple decisions about medications can have serious consequences. For example, recently I was called to look at a resident who was suffering from episodes of agitation. These had grown worse over the preceding fortnight and she was falling more frequently, becoming dehydrated and losing weight - well on the slippery slope of decline. The ENs had been trying to deal with it by giving PRN medication but the actual problem was related to alprazolam (ordered regularly) and it's short-term action with severe rebound effects. I fixed it by getting a psychogeriatrician in but it would have been better if that had happened two weeks earlier. The ENs weren't doing anything wrong - they were giving the regular and PRN medication as ordered. It was just a lack of knowledge about that particular medication which meant that the possibility of a drug adverse effect was being overlooked. GPs do rely on us to give them good feedback and that includes noting drug effects. I don't think the value of a greater RN to EN/care staff ratio can be downplayed wether it's actually administering medications or having enough hours to oversee clinical care.


* anecdotally, carers tend to be the most conscientious. I think it's the fear factor. They are so aware of their responsibilities and afraid of making a mistake.

[Snappo]

This is very interesting, Industrystandard. When I did my medication course, we were told that what the resident takes is none of our business, in fact, it is an infringement of their confidentiality for us to be aware of what they are taking. Our role was purely to assist them with the medications as prescribed by their doctor. This, of course, assumes that the prescribing doctor is aware of reactions to drugs, and drug interactions in general. Sometimes, if there is a medication change, we are asked to 'monitor' the resident and note any adverse reactions or behaviour changes.

This explains the memo sent around by our (RN) facility manager in response to several medication errors. We were told to be aware of the 6 'R's'. The last 'R' was right response. We were never taught this as, technically, we aren't supposed to know what the medications are for, therefore, how would we know what the right response is? This really doesn't make sense if we are asked to monitor them.

[Nurse Rosie]

As mentioned earlier, I am now working in the public sector in a Rehab Unit. They apologise profusely if I am buddied with an unendorsed Div 2 RN and have to do 12 patient medications. They don't understand why I have a giggle at this. LOL.

I'm still fortunate enough to work with elderly patients and get great satisfaction from seeing them progress to being well enough to go home and cope independently or with services. The private aged care sector almost did me in. I was going to chuck in nursing there for a while. Thankfully this job came along at the right time - I love it.

To all of you still working in private aged care, good luck for a huge battle on your hands in getting mandatory staff/resi ratios.