The aged care sector can’t afford to wait for the Royal Commission into Aged Care Quality and Safety to finish before understaffing and substandard care are addressed, two aged care nurses tell The Lamp.

RN Maree Wiseman works in a 96-bed facility that has one registered nurse rostered overnight, and she is worried about the impossible workloads staff in the sector face.

“In the evening we usually have two enrolled nurses, but on night duty we would have one EN and five AINs. You have residents who need three nurses to move them. People who have got dementia need more staff – they don’t want to be rushed.”

Maree talks about nurses constantly running from one resident to another in her facility.

“We have sensor mats for when residents get out of bed, and they are usually high falls risk people. Some of the staff are doing a lot of overtime because there is just not enough staff.”

When Maree heard one witness in the Commission say “that they didn’t think ratios were needed, I was just so annoyed,” she says. “I’ve heard that it is quite common for some places to have no nurses on in a dementia wing at night.”

“We need better ratios – it is just so obvious to all of us that more staff equates to better care. The staff are totally overworked and are at each other’s throats, and it is all because of workloads. The more shifts they do the worse it is. The majority of nurses really do care, but the staff are so exhausted they ring in sick and there is no one to replace them. It is a catch 22.”

In some ways the Royal Commission has been making things harder for staff, as management put more pressure on staff to comply with inspectors, says Maree.

“Since the Royal Commission the government inspectors have been making it harder to pass accreditation. Management then gets tougher on staff.”

Evidence given to Royal Commission is “distressing”

Aged care AIN Christine Spangler works in a 121-bed facility with two floors and one RN per floor. “That is one RN per 60 people with complex needs,” she says.

Christine has seen some improvements in her workplace recently thanks to a new CEO.

“Before that staff were walking out. They can’t handle the exhaustion and the abuse, even from resident families. They are being pushed to the limit.

“When you’ve got five people who need to go to the toilet and you’ve only got two staff who do you prioritise? Do you take a number?”

Christine was distressed when the Royal Commission was told about an aged care resident whose head wound was left so long maggots were found to have infested it.

“It is pretty horrendous that they could let things get that far … that something could be left that long and not even looked at is proof that there are not enough stringent staff levels and people checking up on things.”

What would Maree and Christine like to see the Commission achieve?

“I hope that they recommend minimum nurse-to-resident ratios,” Maree says.

“The Association has a formula – four hours and twenty minutes of hands on direct care per resident in a 24-hour period.”

Christine adds: “Ruby at four in childcare has ratios, but when Ruby enters a nursing home at 80 there are no ratios.”

Better training for aged care workers needed

Christine says the understaffing and a lack of trained staff in homes means that emergency departments and ambulance services are being “blocked up”.

“RNs have skills that mean you’re not going to have that unnecessary trip to the hospital.”

Christine adds that AINs and CSEs should undertake training before they start working in a home.

“I think every aged care worker should do a course in aged care before they go to work in a home. AINs are taught how to take blood pressure and do a urinary analysis on the job. And a CSE can walk in off the street and start work without any skills or training.”

Maree is also worried about unskilled staff increasingly doing nursing work.

Last December, “the NSW govern-ment snuck in an amendment to the Therapeutic Goods Act, so homes don’t need to have a registered nurse to keep supplies of Schedule 8 drugs”.

Since the Commission began “more staff members are joining the Association, so that is a good thing,” Maree says.

“The Royal Commission has given us hope that now is the time for us to be more proactive. We don’t want to sit back. We want things to improve for residents and staff before the end of the Royal Commission.”

“We are hoping the Association is going to ramp up the aged care campaign before the federal election. Now that the NSW election is over we would like more emphasis on ratios in aged care.

“I do feel hopeful. Because people feel so stressed, I think more staff may be prepared to speak up now.”