Poor pay and conditions
and the exodus of nurses from aged care

Summary

·          nurses working in aged care earn, on average around the country, $250 per week less than their colleagues in other sectors making it difficult to attract adequate numbers of nursing staff

·          there has been a steady decline in the number of nurses working in aged care with a 21 per cent decrease between 1995 and 2004 despite the increase in high-level care needs and an overall increase of 23 per cent of residents in aged care facilities

·          rising dependency levels in aged care with the number of residents requiring high-level care rising from about 58% in 1998 to 69% in 2006

·          an inappropriate skill mix resulting in a lack of registered and enrolled nurses

·          at least 46% of registered nurses in residential aged care are over 50 years of age and are approaching retirement – higher than any other area of nursing

NSWNA Survey of Registered and Enrolled Nurses
in Aged Care

Executive Summary

This study explored responses of 1062 aged care nurses to legislation that allows unlicensed workers to administer medications in aged care facilities.  Nurses came from metropolitan, regional, rural and remote areas of New South Wales.

1)    Aged care nursing has an ageing workforce.  Over 50% of nurses in this study were aged 50 years and older.  Only 1.5% of nurses in the survey were less than 30 years of age.

2)    In terms of working conditions, two thirds reported doing regular unpaid overtime, and 81.6% reported an increase in workload over the previous 12 months.  Over 50% reported a decrease in job satisfaction over the previous 12 months.  Only 51.9% reported a definite intention to remain in aged care nursing over the next five years. Of those intending to leave, 90.2% were aged 40 years and older.

3)    Within a particular shift, the higher the number of residents, the higher the number of unlicensed workers.  Between the shifts, however, there were more unlicensed workers available per resident on the morning shifts, with the night shift having the least number of unlicensed workers per resident.  The maximum number of residents on the night shift for whom one nurse was responsible exceeded those for morning and afternoon shifts.

4)    A number of RNs, ENs and EENs were responsible for 100 or more residents each.  On the morning shift, there were 14 (3.1%) nurses who reported that they had responsibility for 100 residents or more; on the afternoon shift there were 9 (2.1%) and on the night shift there were 15 (4.6%).

5)    Caring for residents, teamwork and giving quality care were the three most mentioned contributors to job satisfaction.  The workload, not being able to get the job done in time and inadequate staffing levels were the three main contributors to job dissatisfaction.

6)    Over three quarters of the respondents reported that unlicensed workers would not be competent to administer medication after completion of the medication unit.  A short course was not seen as equivalent to the years of training undergone by registered nurses.  Unlicensed workers being considered as competent to administer medications after a short course was seen as downgrading and insulting to nurses’ experience and professionalism.

7)    Eighty five percent said that unlicensed workers should be regulated if they are to administer medication. Registered nurses were not prepared to accept responsibility for unlicensed workers administering medication, believing the unlicensed worker him/herself should be held accountable or otherwise a nurse in a more senior position.  In addition, nurses felt unsure of the criteria by which they would judge an unlicensed worker competent, particularly in those facilities that had a high turnover of casual staff.

8)    Three quarters would not delegate medication administration to unlicensed workers, even if permitted to do so.  Insufficient training, experience and knowledge as well as (in many instances) limited English, literacy, numeracy and people skills were reasons cited by nurses as to why unlicensed workers should not administer medications.  There was acknowledgement that some unlicensed workers would be competent to administer medication.

9)    Just under three quarters (70.4%) did not support a model of care whereby registered nurses fulfill the role of care facilitator/planner only with all direct care tasks, including medication administration, delegated to unlicensed workers. Many of the nurses insisted that they were already care facilitators, but that this was only made possible through the provision of direct care which was seen as the responsibility of the RN.  Many commented that they became nurses in order to be able to give direct care.

10)The high risk of medication errors was listed as the main consequence of unlicensed workers administering medication. 

11)Participants described a number of conditions under which this model of care could operate.  Unlicensed workers must have extensive training, supervision and ongoing assessment.  A number of participants also mentioned that some medications, and the way the medication was packaged, meant that unlicensed workers would be able to administer.

12)The delegation of medication administration to unlicensed workers was seen by many as a move to remove the RN from aged care altogether, mainly for monetary reasons, although there was acknowledgment that there are insufficient RNs in aged care. A small proportion of nurses tended to see the role of unlicensed workers as a ‘commonsense approach’ to the changing role of nurses in aged care.

13)The aged were seen as deserving, requiring and expecting professional care, which the majority felt they would not receive from unlicensed workers.

14)Nurses identified the excessive workload, the wage disparity between aged care nurses and nurses in the public sector, inadequate staffing levels, and excessive and repetitive paperwork as major issues to be pursued by NSWNA.

Table 3  Staffing ratio in nursing homes: Number of residents and unlicensed care workers whom the registered nurse is responsible for per shift

(Note: These are high care resident numbers only. Respondents who included other resident categories have been excluded.)

Table 3 (continued)  Staffing ratio in nursing homes: Number of residents and unlicensed care workers whom the registered nurse is responsible for per shift

The Howard Government’s

low wage culture in aged care

Current Queensland nurse pay rates

(Average base weekly rates as at September 07)

Aged care RNs, on average,

nearly $200.00 per week behind

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