Jun 11, 2021

Should there always be a nurse on duty and present in nursing homes?

When an older person moves into aged care, they are usually doing so because they need around-the-clock care they can’t receive at home.

But the move can be traumatic. The person must leave their home and community, and adjust to new people and surroundings. They also have to accept they have lost a degree of their autonomy and independence.

The comfort to older people of making this life-altering move is that they will be expertly and knowledgeably cared for.

But what happens when the aged care facility doesn’t have the appropriate staff on duty; can this care be delivered to the standard we expect?

Inadequate staffing is a problem we hear about all too often in aged care. Our readers tell us about it. We read about it in the media. And it has been mentioned multiple times at the royal commission hearings.

One of the most pressing aspects of inadequate staffing is that not enough registered nurses are employed in aged care facilities – sometimes, there are no RNs on site at all.

We spoke to three experts about what the shortage of nurses in our aged care facilities means for the quality of care we are delivering for older Australians.

24% of aged care facilities don’t have a nurse on site 24/7

According to a recent survey by Dr Sarah Russell, principal researcher, Aged Care Matters, 24% of aged care homes do not have a registered nurse on site 24/7.

Dr Russell said having a nurse available on site can prevent situations from escalating.

“When PCAs observe changes in a resident’s behaviour or health, they are trained to report these changes to a registered nurse.

“But with no registered nurse on site, elderly residents – particularly those who are uncommunicative – do not receive timely treatment when their condition changes,” she said.

“In some cases, this [absence] is a form of neglect,” she said.

“Not on-call, not at the end of a phone, or with responsibility for three or four facilities”

ANMF federal secretary, Annie Butler, agreed. She told HelloCare there should always be a registered nurse on duty in residential aged care.

“And that means on site. Not on-call, not at the end of a phone or with responsibility for three or four facilities, but on site 24 hours a day.”

“And, depending on the number of residents and their care needs, there should be more than just one RN on duty,” she said.

Almost 70% of respondents to a 2016 ANMF survey said the ratio of registered nurses to other staff was inadequate.

The average resident receives only eight minutes of care a day from a registered nurse, according to a survey commissioned by the commonwealth government.

Operators “making do” with staff and skill mixes

Paul Gilbert, Australian Nursing and Midwifery Federation (Vic), also told HelloCare that more than one nurse should be on duty at all times.

“The current situation is having to ‘make do’ with the staff numbers and skill mix the approved provider determines, with little if any guidance from legislation,” Mr Gilbert said.

“The exception to this is Victorian public sector nursing homes who have legislated minimum nurse to resident ratios,” he said.

“It is now increasingly common for there to be shifts with no registered nurse, as a deliberate cost-saving strategy,” Mr Gilbert said.

Nurses have irreplaceable role in aged care

Registered nurses are educated and qualified to perform a range of duties.

Registered nurses assess the residents on admission and subsequently develop nursing care plans for each resident.

They are responsible for ensuring the nursing care plan matches the assessed needs of the resident. They are responsible for the management of medication administration, pain management, continence management and wound care. They delegate nursing care to other staff.

“RNs know when to act and crucially, when not to act, for example, when not to give a medication,” Ms Butler said.

“They also know how and when to intervene to avoid complications and deterioration,” she said.

Our elderly deserve “so much better”

Ms Butler said not having enough registered nurses available results in “missed care, unreasonable workloads and expectations for care workers, avoidable transfers to hospital and unnecessary suffering for residents.

“Without adequate nursing and care staff, a resident’s care needs are not adequately recognised or acted upon, care is missed or inappropriate, or residents are unnecessarily transferred out into emergency departments,” Mr Gilbert said.

“So many problems in residential aged care could be avoided by guaranteeing safe staffing levels of both qualified nurses and well-trained care workers,” Ms Butler said.

“For the sake of our elderly, who deserve so much better, it has to happen.”

Please note: The image used to illustrate this article does not reflect actual people or events. Image: iStock.

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  1. Residents of aged care homes usually have multiple comorbidities and are often very frail. Their condition can deteriorate quickly. RNs are essential in RAC homes 24/7. They should be the only ones to decide, using their professional clinical decion making expertise, if medical review should occur immediately or can wait until a GP comes on site. They often do this on their own, without an opportunity to discuss the decision with another RN or health professional. This is a huge responsibility. RNs working in hospitals have other health professionals available all the time. The disparity between RN wages (hospital vs aged care) is apalling. Aged care is a specialty in it’s own right with subspecialties such as dementia and mental health. It is a complex clinical environment to work in with minimal resources and every day is different. Therefore, you get the opportunity to continuously use generalist & specialist nursing skills all the time. When there are minimal RNs rostered on duty, RNs can only ever be reactive rather than pre-emptive.

  2. It would be interesting to review the retention data of RNs working in RACF. I am an RN who worked in Aged Care for 15 years and left the industry 3 years ago due to the risks both personal and professional associated with 24/7 on call and the risks to residents actual and potential from not having an RN on site 24/7.

  3. This is true. But even when there is one they should speak and understand English. Not like one I had when I was vomiting up very dark liquid, which I knew was blood, said, “do you think you should go to the hospital?

  4. There is no incentive to work as a Registered Nurse in aged care. The pay is poor and the ratios are terrible. Nurses do want to give person centred care but that is only to those who become ill or have a complex wound. Other residents miss out, which is no fault of staff.

  5. Long story short!

    It upsets me when I see my 90 year old mum’s needs not being met. My children and I go have to Doutta Galla age care Avondale Heights every single day for feeding, as my mum takes a long time swallowing her food and apparently they don’t have the time to feed her. Weeks ago a doctor who saw my mum did not diagnose her correctly, he said she had a heat rash rather than diagnosing her with scabies. This caused her so much discomfort for weeks, he also prescribed her with a wrong oral medication that made her ill. The list goes on and on and on. I’ve repeatedly addressed many other issues and concerns we have but there is always an unreasonable excuse, passing on the buck to someone else eg. why they didn’t. why they can’t, and making silly lying excuses etc. Not sure what to do anymore. All my mums pension plus bond has gone into the Age Care and we feel short changed. This is so upsetting for me and my family. Could someone please intervene?

  6. I understand in 2022 this is now a common theme to not have RGNs on duty or just one for a entire home. Yet the legislation says it is illegal to operate a home without a nurse on duty 24/7. Why is the care regulators not intervening, in fact allowing this practice to go on without repercussions to the home in fact allowing multiple nursing home owners to use one nurse on call to all there homes. Condoning this practice undermines the safety and the nursing care of elderly patients. Hardly any wonder nurses are leaving the profession. Managing a entire building 60+ patients and on call to another home. NMC must also be condoning this practice a nurse employed in one building is not allowed to leave the building until another RGN relives her of her legal duty. The whole system is in complete shambles. This is by design there is no need for this to be happening, it appears to be deliberate. Nurses under paid and replaceable and the elderly are not considered valuable this appears to be the money hungry private home owners and governments moral compass.


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