Mar 29, 2019

Unregulated staff make up 70% of aged care workforce

Australia’s professional association for nurses is calling for better training and regulation of unlicensed healthcare workers.

In a recently released white paper, the Australian College of Nursing has revealed that the number of unregulated workers in Australia’s healthcare system is growing at an exponential rate, having the potential to diminish the quality and safety of our healthcare services.

In the aged care sector, 70 per cent of the workforce is made up of unlicensed health care workers, the report says, while the number of registered nurses has fallen from 21 per cent in 2003 to less than 15 per cent.

What is an unregulated healthcare worker?

An ‘unregulated’ or ‘unlicensed’ healthcare worker is someone who supports the delivery of nursing care by helping people with personal care and activities of daily living. Their role can cover aspects of traditional nursing, but can also include supporting health professionals in operating theatres, outpatient clinics, and other acute care units.

The terminology for unregulated healthcare workers can be confusing because they work across a wide range of healthcare settings, performing a wide range of roles.

There is currently no national code of conduct or consistent national qualification requirement for unregulated healthcare workers in Australia.

Decline in proportion of nurses in aged care a “serious concern”

The white paper says that in the aged care sector, nurses are commonly now only employed for “legislative requirements”, with unregulated healthcare workers performing most of the “traditional care” elements of the work formerly performed by nurses.

The decline in the proportion of nurses working in aged care is a “serious concern”, the white paper says, noting the increasing number of people entering residential aged care facilities with higher care needs and unregulated healthcare workers having limited and varied training.

More investment in regulated workforce a key theme of Royal Commission

Australian College of Nursing CEO, Adjunct Professor Kylie Ward FACN, said in a statement that a “recurring theme” of the Royal Commission into Aged Care has been “the need to invest in our registered and regulated clinical workforce to ensure care is overseen by skilled professionals.”

The Royal Commission has heard that more than 50 per cent of Australia’s aged care workers have no dementia training, despite the majority of aged care residents living with the condition.

Demands of aging population a “Tsunami bearing down on us”

“The aged care and chronic illness tsunami is bearing down on us,” Adjunct Professor Ward said.

“We urgently need to work together to ensure our health workforce can match future demands and expectations before it is too late.”

Consistent training, supervision and job titles needed

The white paper calls for unlicensed health care workers to obtain a minimum qualification before working in the primary, acute or residential aged care healthcare, and for this workforce to be regulated.

“This is a valued group of healthcare workers and our health system could not operate without them.

“However, their responsibilities, level of supervision, and even their job title differs across the country,” ACN Workforce Sustainability Policy Chapter Chair, Professor Lee Boyd MACN, said.

“We are seeking unregulated healthcare worker regulation, and nationally consistent nomenclature, scope of practice, minimum educational requirements and ongoing professional development.”

Two key recommendations: regulation and training

The ACN’s white paper makes two key recommendations:

  1. Unregulated healthcare workers must be regulated. Nationally consistent nomenclature/titles, code of conduct, professional standards and scope of practice must be developed and implemented.
  1. The unregulated healthcare workers must be regulated to achieve nationally consistent, minimum educational and ongoing professional development requirements.

These recommendations align with those made by the Aged Care Workforce Strategy Taskforce, led by Professor John Pollaers.

Paul Gilbert, Assistant Secretary, Australian Nursing and Midwifery Federation Victorian Branch, told HelloCare, “The ANMF strongly supports the regulation of anyone performing nursing work, and has provided evidence to this effect in numerous inquiries and submissions, including to the Productivity Commission.”

When aged care staff are unregulated, he said, “It is possible for any person who isn’t registered to move from one employer to another despite being found to be unsuitable.”

You can read the ACN’s ‘Regulation of the Unregulated Health Care Workforce’ white paper here.


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  1. The value contributed by these so-called unregistered Workers is immeasurable. I absolutely agree that they should be recognised for their skills and contributions to the care of our loved ones and to say they are not is a denial of reality. What they don’t need is for the union movement to further dictate what they can and can’t do. “Nursing work” is an extremely broad term as it is applied by the unions but is it already defined under industrial legislation and regulations. Although there is no doubt that clinical care is required in aged care it is by no means the predominant requirement. Strict regimes of care the way that the union movement wants to see is a complete anathema to any principle of customer first ethos. Customers should not only maintain rights but have them increased – not dictated or limited by industrial agendas. If that’s where the Royal Commission ends up they will have failed customers completely and the Australian community.


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