Removing ENs from aged care would have detrimental effects on safe and high-quality care

What would happen if the number of enrolled nurses, or shifts, were reduced in a nursing home?

According to the ANMF’s National Aged Care Survey 2023, released last October, such a move would create more work for registered nurses, increase workloads for AINs/PCAs/PCWs, and result in serious detrimental effects in the provision of safe and high-quality care. Respondents said getting rid of enrolled nurses would also increase the burden on remaining staff, meaning they have to work extra hours, or shifts, and worryingly, lead to decreased resident safety, such as an increased risk of falls and skin tears, due to the loss of experienced ENs from the floor.

“Dedicated and vastly experienced ENs [are] being replaced by new RN graduates who have little experience and have no intention of staying in aged care,” one EN from South Australia said.

“…decreased knowledge of residents care…EN has been working there for years and a lot of RNs are new or less than a year,” an RN from Queensland shared.

Tellingly, 35% of participants reported being told by a colleague or their employer that there was no funding allocated for ENs as part of recent legislated RN 24/7 and care minute funding requirements. Similarly, over one-third of participants revealed their employer had tried to reclassify EN positions, mostly to lower roles, such as PCWs.

“Aged care providers are not recognising the experience and expertise enrolled nurses bring to aged care and the difference they make to care outcomes,” says Julie Reeves, ANMF’s Strategic Lead – Aged Care.

Julie Reeves, ANMF Strategic Lead – Aged Care

“Enrolled nurses continue to have their shifts reduced, their hours cut and their role title changed to care worker. Enrolled nurse shifts and positions also continue not being replaced. The reported number of care minutes for enrolled nurses is decreasing, reflecting the very real and adverse impact of some providers.”

The results of the survey clearly highlight that staff view the role of ENs in aged care as critically important. Yet, due to ambiguity within recent aged care reforms, challenges persist.

Last October, mandatory care minute targets in residential aged care, stipulating an initial average of 200 minutes of care per resident per day, including 40 minutes of RN time, came into effect. Put simply, the unintended problem created was that the legislation does not specify how the remaining average care minutes should be distributed among ENs and AINs. Despite their vital contribution, it’s subsequently allowed some aged care providers to game the system, demonstrated most visibly in the high-profile Southern Cross Care Tasmania case, with providers attempting to make ENs redundant or reclassifying them into other, often lower positions.

“Many members have alerted the ANMF to a number of concerning practices relating to staffing changes that aged care providers have made within nursing homes that are inconsistent with the intention of the requirement,” Ms Reeves explains.

“The role of enrolled nurses within aged care continues to be negatively affected by the actions of some aged care providers. An ANMF member in Tasmania summed up the experience of many enrolled nurses across the country when she said that she now feels ‘invisible’ to her employer.”

At the ANMF’s 16th Biennial National Conference, held last October, delegates passed a motion calling on the federal government to update the legislation for care minutes to specifically mandate enrolled nurse care minutes as part of the required skill mix to ensure safe staffing and skills mix.

The call to action mirrors results from the ANMF’s Aged Care Survey, with almost all participants believing that the federal government should specify enrolled nurses in the care minute funding allocation.

“It’s not fair for the government to lessen the hours or disregard the work of enrolled nurses…our experience seems disregarded,” an EN from South Australia said.

“This will make it clear to employers and protect ENs from being pressured to have their permanent contracts reduced to <70% of their agreed contracts or being forced to take ungenuine redundance packages,” another EN said.

In 2024, the ANMF will continue to lobby the federal government for legislative change to mandate minimum EN minutes that includes clear specification of the role and its contribution to quality care delivery. It is also recommending that providers be held to account in delivering the care minutes for their facility, including ongoing monitoring and audits, with data from many sources, particularly direct engagement with the worker voice of nurses and PCWs.

“These are not isolated instances of one or two providers,” says Ms Reeves.

“They are common experiences of ANMF members employed across the country.

“The ANMF calls on the Government to urgently commit to implementing a mandated care minute requirement specifically for enrolled nurses. This will ensure ongoing commitment to enrolled nurses and recognise their invaluable contribution to resident care outcomes and improve the staffing and skill mix within facilities. It will directly change provider behaviour in undervaluing enrolled nurses within the sector and engage them to employ enrolled nurses effectively, while also reducing the flow-on pressures of poor staffing practices to residents and other workers.”

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