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Aged Care and Disability News

Ratios in Aged Care

30 Nov 16:00 by Dr Katrina Radford

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Recently there has been increased discussion on the need for set ratios within aged care. This debate is not new, and has been ongoing for the past 15+ years. More recently, a focus group study on the impacts of inadequate staffing mix by Gaffney (2017), revealed that while people entering aged care require more complex care, the staffing mix and ratio is reducing. This has led to unsafe practices as the number of registered nurses are decreasing, yet the amount of administrative tasks demands on registered nurses is rising, resulting in less time to provide quality care to clients (Gaffney, 2017).  This is important to address because research has consistently found that insufficient staffing has led to 1) lower levels of patient satisfaction with care; 2) an increase in clinical complications such as urinary tract infections, pneumonia, upper gastrointestinal bleeding, and shock; and 3) higher rates of “failure to rescue” (Eley, et al. 2007; ICHRN, 2009, 2010; Hall & Buch, 2009; Needleman, Buerhaus, Mattke, Steward & Zelevinsky, 2002; Sellgreen, Ekvell & Tomson, 2007; Teng, Hsiao, Chou, 2010).

 

As clients become more complex, the decision to alter the mix of workforce to decrease registered nurses and increase unregulated workers such as Personal Care Workers, may in fact result in some dire consequences. Yet the Productivity Commission (2011) report reported no changes in resident-staff ratios despite the increasing care requirements of clients. This suggests a need for organisations to review their risk tolerance levels, when they make these decisions in order to ensure the safety of clients is maintained. This is particularly the case as the demands of clients increase with their complex health challenges.  

 

One of the factors influencing decisions seems to be staff shortages. In particular, the insufficient qualified skilled worker shortages were noted as a reason some organisations are choosing to change the skill mix on shifts to cope with demand (Hodgkin, Warburton, Savy, Moore, 2017). However, this has also resulted in a decrease in job satisfaction, increase in the amount of stress leave and burnout experienced by staff and decreases in their intentions to stay because the stress left behind on the remaining workforce. This is further exasperated within the rural aged care sector, which already reported shortages in the workplace (Hodgkin, Warburton, Savy, Moore, 2017).  Consequently organisations need to ensure attractive packages are produced to entice workers to the rural areas as well as ensure that professional development opportunities are available to keep current staff and fill future gaps.

 

In conclusion, while the formal introduction of ratios in aged care seem unlikely to be mandated anytime soon. Organisations need to consider the risks vs reward ratio they are willing to take to ensure the safety of clients particularly as funding tightens and public scrutiny around aged care increases. 

 

References

Eley, R., Buikstra, E., Plank, A., Hegney, D., & Parker, V. (2007). Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004. Journal of Nursing Management, 15, 285–293.

Gaffney, Ann. Surveys pinpoint aged care staffing flaws [online]. Lamp, The, Vol. 74, No. 1, Feb 2017: 12-13. Availability:<http://search.informit.com.au/documentSummary;dn=705610432802373;res=IELAPA> ISSN: 0047-3936. [cited 30 Nov 17].

Hall, L. M., & Buch, E. (2009). Skill mix decision making for nursing. Retrieved 5/8/2011 at: http://www.ichrn.com/publications/policyresearch/Skill_Mix_EN_web.pdf

Hodgkin, S., Warburton, J., Savy, P., & Moore, M. (2017). Workforce crisis in residential aged care: insights from rural, older workers. Australian Journal of Public Administration, 76(1), 93-105.

International Centre for Human Resources in Nursing (ICHRN) (2009). Skill mix decision making in nursing. Retrieved 4-6-11 at: http://www.ichrn.com/publications/policyresearch/Skill_Mix_EN_web.pdf

International Centre for Human Resources in Nursing (ICHRN) (2010). The impact of turnover and the benefit of stability in the nursing workforce. Retrieved 4-6-11 at: http://www.ichrn.com/publications/policyresearch/Turnover_EN.pdf

Needleman, J., Buerhaus, P., Mattke, S., Steward, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346, 1715–1722.

Productivity Commission 2011. Caring for older Australians, Report No. 53, Final Inquiry Report, Canberra.

Sellgreen, S., Ekvell, G., & Tomson, G. (2007). Nursing staff turnover: does leadership matter? Leadershipin Health Services, 20, 169–183

Teng, C, Hsiao, F., & Chou, T. (2010). Nurse perceived time pressure and patient perceived quality of care. Journal of Nursing Management, 17, 275–284.