3 January 2022
Article from January 2022 edition of INPractice
And why we need to ‘bombard’ our politicians about it.
Aged care enrolled nurses are a passionate bunch. Ask one Adelaide EN about the personal rewards associated with working with the elderly and she delivers a powerful, emotion-charged story.
“It’s walking with them as they live their final chapter. It’s listening to their stories, it’s valuing their contribution to where this country is today,’’ Jane says (not her real name).
“It’s recognising where they’ve come from. They’ve lived through wars, depression, meal tickets, clothing tickets, they’ve seen the invention of motor vehicles, television, radio, what they’ve seen in their lifetime is mind blowing.
“We’ll never see that again, that level of invention and grit and hard work and stamina and ability to survive, we’ll never see that again.
“Fourteen or 15-year-old boys signing up to go to war; 14,15-year-old boys today, you can’t get them off the lounge and off their devices to go outside to play with the dog, let alone go to war with another country.
“So, we’ll never see the likes of that again. I have the utmost respect for our elderly people and I just find that incredible. I just love it, I can listen to them talk about their journeys all day long and I wish I had more time in my job to do it, we are so task-oriented it appalls me.
“Aged care workers, they’re expressing frustration that they haven’t got enough people to do what they’re being asked to do, they keep getting told ‘work faster, work smarter’,’’ Jane says.
“They’ve got 60 people to take care of and there’s two of them on night duty or there’s 120 to take care of and there’s three of them on night duty. That’s disgusting, how can you do that? That’s an outrage, and that’s after the Royal Commission.
“For a lot of places nothing’s changing, it’s not going to change anytime soon. People are frustrated as all hell. There is literally nothing changing.’’
Despite the fact the aged care sector has been publicly shamed for its appalling neglect of the elderly, lack of financial transparency continues to blight an industry that, despite $21 billion of Commonwealth money being funnelled into it every year, somehow remains chronically under-staffed and under-resourced.
An aged care site manager, who also chose to remain anonymous, says the staffing shortages and poor skills mix within aged care largely boil down to the aged care system not being funded appropriately
“That’s why I would presume a lot of organisations have changed, removing enrolled nurses and having care staff give medications instead,’’ she said.
“For me personally, that’s a selling point of an organisation, I would not want to be responsible for care workers giving medications.
“If I was looking for job opportunities I would only work for an organisation where they do have enrolled nurses giving medications, not care workers.’’
In a move to make aged care the safe and caring sector it should be, ANMF (SA Branch) CEO/Secretary Adj Associate Professor Elizabeth Dabars said “the ANMF is advocating for not only financial transparency, but for an increase in the levels of all staff and tighter staff ratios, with an average of 4.3 hours (258 minutes) of care per day per resident, with 77 minutes from RNs, 52 minutes from ENs and 129 minutes from personal care workers.
“We want to ensure the skills mix is aligned with the increasingly complex needs of the residents. Evidence shows the skills mix required is RN 30%, EN 20%, and PCW 50%,” said Ms Dabars.
These numbers are aligned with both national and international evidence and whilst the Royal Commission came closer to the evidenced number and skills mix of staff, the Federal Government commitment is still grossly inadequate.
We are also calling for a 25 per cent wage increase for aged care workers, to retain and recruit more people in an industry that is facing an imminent and massive staff shortage crisis.
The ANMF says the Commonwealth urgently needs to make funding available for wage increases to stop the exodus of workers from aged care to better paid jobs at other health care sites, as well as meeting the Royal Commission’s recommendations for extra staffing to ease the burden and stress on existing staff.
“Even if I wanted to put more people on I don’t think we have the capacity to find those people,’’ the site manager says.
“I feel like for the first time in my career I’ve been questioning how much accountability I can manage when there are fundamental things that I can’t change. I can’t recruit people that aren’t there to recruit.’’
“The ANMF is also championing the push to have registered nurses on site 24/7 at all sites, but also recognising that at some sites this is already the case,” said Ms Dabars.
“I do believe in the 24/7 registered nurse push, I give that my full support, once we secure that it’s the launch pad into bigger and better things,’’ enrolled nurse Jane says.
“Off the back of the 24/7 RNs we move on to the next phase which is the enrolled nurse ratio and then the personal care worker ratio.
“It all works together. The difficulty for rural and remote is recruitment and retention. It has to be a rewarding career pathway, you have to attract the right people into the positions.
“People who come into aged care often see it as a stepping stone to other things, they don’t necessarily want to stay. They don’t see it as a speciality nursing occupation. It’s not oncology, it’s not neonatal, it’s not midwifery, it’s not sexy like some of the other specialties, it’s old people.
“We don’t value and respect our elderly like other ethnicities and nationalities do. We’ve lost touch with our elderly. And it takes a particular person to want to engage with our elderly. It’s got to be the right person. You can’t just have some attractive benefits for working in the industry and the wrong person doing it because that’s dangerous.’’
While registered nurses are usually the higher level of worker in the aged care skills mix, the enrolled nurse believes her colleagues are the backbone of the troubled sector.
“It’s been my experience that the enrolled nurses are actually the stable, reliable workforce within aged care,’’ Jane said.
“The registered workforce comes and goes, it’s quite often a segue into other things and the enrolled nurses seem to come into aged care and stay there.
“We enrolled nurses stay put and we’re stable and we last and it’s a long-term population and we develop a very experienced skill set that’s very specialist to the demographic.
“Whereas with the RNs, they’re quite often new graduates or they’ve come out of the acute sector, not necessarily specialist, to aged care. They come and then quite often they go. The ENs just keep kicking along.’’
Jane also believes the role of the enrolled nurse is undervalued, leading to a sometimes demoralised workforce.
“As the registered nurse population expands and contracts, as it always does, the enrolled nurse scope of practice expands and contracts and it can be very frustrating. It can be very confusing, demoralising at times,’’ she says.
“One minute, when you haven’t got a lot of RNs, you’re basically an enrolled nurse-led workforce. All of a sudden there are more RNs and they do these things. You go back to not doing those things.
“The fact the facility cannot recruit and retain registered nurses is not the enrolled nurse’s fault. That’s the manager’s issue.
“There needs to be career pathways for enrolled nurses, there’s provision for career pathways in our awards,’’ Jane says. “They’re not made use of, they’re not advertised, we’re not told of them because they cost money and, of course, organisations don’t want to spend money.
“There’s the ability of enrolled nurses to be upskilled to advanced skill enrolled nurses and be recognised and have a pay increase to be called an advanced skill enrolled nurse and that then captures all those extra skills and credentials that an enrolled nurse may have.
“Why don’t we value the enrolled nurses now and upskill them and give them the appropriate career pathway to do it properly?
“The Royal Commission called for a skilled and trained workforce. Well I know of enrolled nurses who have advanced skills and qualifications and are not recognised or paid accordingly by their workplace,’’ Jane says.
“This is an abuse of the enrolled nurse workforce. Others like myself have completed the Bachelor of Dementia Care program, this is not recognised nor is there a pathway to use it professionally like other members of the MDT get for their additional qualifications. This is an absolutely shameful way to treat your staff.”
Regarding the ANMF’s national Fix Aged Care campaign, Jane urges people to “speak to your local politicians, write letters’’.
“You can go on Facebook all you like and spout off your frustrations, but the MPs aren’t on Facebook looking at your post.
“If you’re not bombarding the politicians with the message about aged care, they’re going to think it’s not an issue anymore, it’s dropped off the agenda.
“And someone will push something else under their nose and that’s where their focus will go.’’
Despite her frustrations with the broken aged care system, Jane says just being able to be walk with the elderly through their final journey is “an absolute gift”.
“Some people love the birth environment and bringing people into the world and that’s a beautiful thing.
“But me for it’s a beautiful sacred moment to be there for them as they leave the world, that’s an absolute honour
“It’s very special.’’