30 September 1999
What is Nursing?
The current federal government’s ‘aged care reform’ initiatives have resulted in less funding for aged care and less scrutiny of how funds are spent. Many aged care providers are seeking to cut costs by reducing nursing hours and employing unregulated ‘aged care workers’. They are attempting to justify this by promoting ‘care’ models – the only basis for which seems to be an assumption that all elderly people require is ‘a cup of tea, to be taken for a walk and companionship’.
These ‘care’ models are unresearched and untested and seek to remove nursing from nursing homes. Nursing is practiced within a framework of core values and regulation, which provide protection for the public. ‘Care’ models, which are unresearched and untested ultimately put at risk the relationship and trust that the public has come to expect in relation to their basic health care.
The profession of nursing has been evolving and progressing over many years. Today, the nursing profession is able to achieve a great deal more in the attainment of health and well-being than a century or even a decade ago. Aged care nursing, more formally referred to as gerontological nursing, is the oldest and largest nursing specialty in Australia.
Nursing work revolves around caring for the body, something society deems to be a private matter. Nurses, too, are largely silent about this aspect of their work and as a consequence a large part of the practice of nursing remains invisible and unrecognised by society. It is often undervalued and seen as unproductive. The skills and knowledge associated with care of the body are either taken for granted or ignored.
Core Values of Nursing Practice
Caring
The very existence of nursing is proof of humanity and concern and is an indispensable human service. Unfortunately, the ‘managerialist’ view of caring is ‘if you can’t measure it, you can’t manage it’. Because you can’t measure ‘care’ it is rarely valued by anyone other than those who directly receive it and certainly not by those who control the purse strings!
Holism
Nursing is ultimately about caring for the whole person – basic nursing revolves around the needs of the patient, irrespective of what ails them or what medical treatment they may or may not be receiving. To nurses, the patient is not simply a recipient of a series of treatments such as medicine or wound care. To attend to a specific task without seeing the whole and unique person as the centrepiece of the care is anathema to nursing practice.
Advocacy
The core value of advocacy requires nurses to represent the interests of others and to speak up when witness to actual or potential abuse. Indeed, under nursing regulation, registered and enrolled nurses are required to report any incidences of mistreatment or malpractice. Nurses also advocate collectively through their union, the QNU, on a range of issues affecting our health system. Providing the public with information about issues affecting the care of the aged is an example of this.
Ethics
The need for ethical practice is recognised by nurses and there is a formally established Code of Ethics for nursing that allows for the examination of the professional conduct of nurses and ensures the provision of publicly acceptable care. The Code of Ethics includes values such as respect, the promotion of quality care, confidentiality, accountability and the acknowledgment of the individual as a unique whole. When you consider that nursing work includes the provision of basic intimate care of the body it is easy to understand why it is vital for that care to be provided in an ethical way that is professionally accountable and publicly acceptable.
How Nursing is Regulated
The nursing profession is regulated – in Queensland, by the Queensland Nursing Council (QNC). Two levels of nurses are directly regulated (registered and enrolled nurses) and the performance of nursing work by others is regulated indirectly through rules governing the ‘delegation’ of nursing work. Other regulation also impacts on nursing practice, such as the Health (Drugs and Poisons) Regulation 1996 which sets out rules on the administration of medications.
A registered nurse…
- Has a university level degree
- Is registered and licensed to practice nursing
- Is individually accountable and responsible for the provision of nursing care
- May provide generalist or specialist services
An enrolled nurse…
- Has a diploma level course from TAFE
- Is enrolled and licensed to practice nursing under the supervision of a registered nurse
- Is individually accountable for assigned functions and accountable to the registered nurse for any delegated actions
Responsibilities include:
- Assisting clients with the routine activities of daily living
- Recognising the changing needs of clients
- Performing assigned and delegated functions
(Reference Queensland Nursing Council)
An assistant in nursing…
There is currently no mandatory qualification for Assistants in Nursing, however, the majority of AINs in aged care have or are working towards a Level 3 Aged Care Certificate. AINs perform nursing work as part of the nursing team and under rules of ‘delegation’ are required to perform work in accordance with the Code of Ethics.
Delegation of nursing work…
Registered nurses may only delegate nursing work to a person they deem competent to perform the work. The QNC provides detailed guidance to Registered Nurses on which work they may delegate and to whom. Nursing work that is delegated does not cease to be nursing work and the registered nurse maintains the authority, responsibility and accountability for work which is delegated.
Administering medications…
The administration of medication is governed in Queensland by the Health (Drugs and Poisons) Regulation 1996. Queensland Health have issued guidelines which provide detailed information on achieving compliance with this regulation. Briefly, in Queensland aged care facilities, medication can only be administered by a Registered Nurse or by an Enrolled Nurse who has a ‘medication endorsement’ from the QNC and then only under the supervision of a registered nurse.
Statistics
Only 4% of older people require accommodation within a nursing home (those who are the frailest and sickest)
96% of people aged 75 years and older have one or more disabling chronic illness
48% of nursing home residents are in the 85 year + age group
1 in every 25 residents of nursing homes is aged less than 65 years (nursing homes are increasingly becoming homes for younger disabled people who cannot live in a supported home environment).
There has been an increase in the requirement for medical and nursing interventions, for example dialysis care and complex pain management regimes in nursing homes.
The International Year of the Older Person gives us an opportunity to focus on what’s happening in aged care. Research consistently shows that it is the presence of nurses that leads to improvements in the quality of life for residents in aged care facilities! | 
