Aged Care Nurses Conference

[Nurse Rosie]

I am no longer working in the aged care sector, the myriad of issues re staffing, morale, staff mix, lack of support from management and the inability to spend time with my residents because I was doing paperwork to bring in money for the operators finally got to me (and 18 other Div 1 nurses in a 6 month period, at my old workplace).
Today the ANF is holding its yearly conference for Aged Care Nurses. Newspaper reports say we are leaving the sector in droves. Is it any wonder? I wish the blinking government would open their eyes and see what is happening. I wish there were enough people out there who gave a damn about our elderly and the way they are treated as commodities by these operator leeches.
I now work in the public sector, which is by no means perfect but is a little slice of heaven compared to the private aged care sector.

Rant over. For now....

[Administrator]

Hi there Nurse Rosie - You're right - we receive so many emails that echo your sentiments.

We wish more people cared too - our guess is that they will when it matters and starts to affect them, but unfortunately, so much damage to the sector will be done by that time, it will be even more difficult to fix. When I read some of the stories usually instigated by provider groups that say that they need bigger/better/ facilities, or that they "need more money" to appease the baby boomers, they are saying that the baby boomer generation are "demanding" and will want more.

Well - if you have a high-care classified resident who is wheel-chair bound, has had a stroke and is limited in their movement or capacity, or a mixture of medical ailments (blindness/deaf/diabetic/etc.), then someone please explain what is so "demanding" of these high care residents? Aren't providers supposed to provide "appropriate care" to residents in their charge? Don't providers promote that Australia has a "world class system" with aged care? If we did, this website would not exist.

Are residents classified as "demanding" because they want to be assisted with being fed, hydrated, given their medications safely, their privacy and dignity upheld, and turned in their beds (to avoid bedsores)?

Surely providing basic care is a human right?

Much of our correspondence points to there just not being enough time for staff to fulfill their duties, or the "dumbing down" of staff - replacing of skilled workers with unskilled workers. And no, you can't blame aged care workers for leaving in droves. It's of detriment to our frail and elderly, and it's demoralizing for staff.

[Sally]

After what they put my dear mother through for four rotten years, I can only say it is much more than staffing issues. Put bluntly... they 'don't give a DAMM !!!

[Nurse Rosie]

A report was tabled at the Conference yesterday.
The University of Melbourne report titled "Working in Aged Care: Medication Practices, Workplace Aggression and Employee/Resident Outcomes" said:

[i]1 in 3 nurses are thinking about leaving their jobs in aged care.

Medication errors are more likely where there are poor registered nurse to resident ratios, cost cutting practices and higher role conflict and co-worker aggression.

Facilities with heavier workloads, resident aggression and resident/staff quality of living cost cutting are more likely to report negative work related attitudes and poorer health outcomes.[i]

This is nothing that we don't already know. The question is how do we solve it? Nurses working in aged care are mostly of an age where they will be looking at retiring in the foreseeable future - who will take over from them? I certainly don't see too many of today's younger nurses jumping in to fill the void considering the work conditions they would face in aged care. There is a big enough problem retaining them in the public sector as it is.

Sally, I know there is much more to this crisis than staffing issues. However, you have to realise that the well being of and care given to the residents depends greatly on staff well being. It is darn hard to give your best when you are constantly called upon to do double shifts and work short staffed.

[Sally]

I'm sorry if I gave the wrong impression with what I said, I was referring to those who we all know 'Don't give a DAMMMMM' !
I keep saying "THANK YOU TO THOSE WHO DO A FANTASTIC JOB AGAINST ALL THE ODDS". I've been one of them!!! and "THEY DIDN"T GIVE A DAMMM!!! That's why I had to 'get out'. Broken mentally, physically and emotionally!!

Sorry Sally

[industrystandard]

[i]1 in 3 nurses are thinking about leaving their jobs in aged care.

Medication errors are more likely where there are poor registered nurse to resident ratios, cost cutting practices and higher role conflict and co-worker aggression.

Facilities with heavier workloads, resident aggression and resident/staff quality of living cost cutting are more likely to report negative work related attitudes and poorer health outcomes.[i]

This is nothing that we don't already know. The question is how do we solve it?

This, in a nutshell, is why I will be leaving aged care. Carers and ENs are capable of giving good care but neither have the medical or pharmacology knowledge to deal with the complex health issues of the older person. The research says it: the better the RN to EN/carer ratio, the better the outcomes for both staff and residents. Yet the industry continues to employ as few RNs as possible and rely on ENs and carers to make medication, health and care decisions. All the indications are there that in the future we will see even fewer RNs and ENs than we have now, with facilities staffed possibly even wholly by medication credentialled carers.

We solve it by insisting on mandatory staffing levels.

[Nurse Rosie]

No, don't be sorry Sally. I had forgotten you have actually worked in aged care and are aware of the problems staff face.

I noticed Uniting Care has made redundant 10 RN's in a few of their high care facilities in Melbourne. Division 2 RNs (ENs) will be filling these roles...

[Snappo]

Industrystandard, the 'insisting' part is easy, it's the 'getting' bit where we are having difficulties. Who, exactly, do we insist to? The facility manager? the DON? Fat chance, when all they're concerned about is profit. Umm, what about Ms. Justine Elliot? Yeah, right!! So who else is there? Who cares enough? Who is in a position to be able to fix it?

[Sally]

Thank you Nurse Rosie, I do appreciate your reply.

I along with many others got accused of doing wrong even when I was 'just doing my job'. It is so very hard to be trying one's very best to care for these lovely people. Information was not always passed on and we were chastised when we made a mistake (a mistake that would never have occurred had important information been passed on). We were then told what we should have been told long before the event!! Sound familiar??
And on the issue of food... Where I worked there was no alternative when anyone couldn't stomach the food put out for them... For dinner sometimes all they got was a small stuffed tomato (not much stuffing)!! I got really sick of seeing the poor souls hungry and given nothing else. How cruel is that for the elderly??
Everything goes on as usual except it is getting WORSE !!

[industrystandard]

I noticed Uniting Care has made redundant 10 RN's in a few of their high care facilities in Melbourne. Division 2 RNs (ENs) will be filling these roles...

Just appalling. Uniting Care have also refused to continue with EB negotiations due to the "global financial crisis" (!). The article says the RNs have been replaced by care workers. Does any-one have any more information?

Industrystandard, the 'insisting' part is easy, it's the 'getting' bit where we are having difficulties. Who, exactly, do we insist to? The facility manager? the DON? Fat chance, when all they're concerned about is profit. Umm, what about Ms. Justine Elliot? Yeah, right!! So who else is there? Who cares enough? Who is in a position to be able to fix it?

Unfortunately, it's the government who is in charge of legislation and therefore it's the government whom we have to pressure. No politician will ever care about anything other than votes/popular opinion so the key is to make mandatory staffing levels a popular opinion. The question is, how do we do that? As I said, only 5% of people cared about aged care as an issue last election.

Thank you Nurse Rosie, I do appreciate your reply.

I along with many others got accused of doing wrong even when I was 'just doing my job'. It is so very hard to be trying one's very best to care for these lovely people. Information was not always passed on and we were chastised when we made a mistake (a mistake that would never have occurred had important information been passed on). We were then told what we should have been told long before the event!! Sound familiar??

Overly familiar. Every day I deal with issues arising from sub-standard care that is a direct result of poor staffing levels, poor skills mix and poor systems for communicating information (handover doesn't exist any more because it costs too much!).

[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 !!