Aged Care Nursing in the New Normal

The Aged Care sector provides speciality services which require experienced, highly skilled nurses and as New Zealand is currently known to have a high rate of internationally qualified nurses making up their workforce, the continued closing of the borders due to COVID-19 is of great concern.

Aged Plus talked to Gillian Robinson (RN, BN), Aged Care Nursing Consultant and Director of Healthcare Compliance Solutions Ltd, provider of Aged Care and Retirement Village software and quality systems about how the industry should react to the ongoing effects of this novel coronavirus and prepare for the possibility of future pandemics.

“Current literature and my own observations working with aged care services throughout New Zealand, indicate the level of the nursing workforce will not be sufficient to meet the pending need of aged care services in particular,” commented Robinson.

“New Zealand health services have had an awareness of a pending shortage of nurses and the need to plan ahead for many years but there has continued to be an under-investment in NZ nursing programmes.”

The projected numbers of nurses due to retire in the next 10 years, as reported in the recently published International Council of Nurses (ICN) ‘State of the Worlds Nursing Workforce’ report, is going to leave a much greater shortfall than that which is evident already. New Zealand is reported as a country which is not self-sufficient in training and retraining sufficient nurses to meet the complex clinical needs of those residing in aged care services.

“There needs to be a far greater investment in nursing education programmes in general but also those which recognise aged care services as an increasing speciality area of nursing."

New Zealand is reported by the ICN to have 26 per cent of its nursing workforce made up of internationally qualified nurses. With the borders closed, if there is limited ability for New Zealand trained nurses currently overseas to return home to work here, to help ease the pending nursing crisis. Current border rules do allow for IQNS and CAPs nurses to come into New Zealand as they are classed as essential workers. The reality is of course quite different since returning New Zealand citizens and residents have priority.

“There has been a recognised migration of nursing staff from underfunded aged care to work in District health board services which have not had the same restrictions on funding,” noted Robinson.

“This has contributed to a nursing workforce shortage in the aged care sector. The ‘Fair Pay’ campaign launched by the New Zealand Aged Care Association (NZACA) is a response to the difference in pay-rates which is contributing to the migration of nurses away from aged care.”

Robinson also noted that recently COVID-19 managed isolation quarantine facilities have been offering higher than usual rates to acquire the services of nurses. This is further increasing the nursing crisis in aged care facilities. It is also not consistent with directing resources to the most vulnerable members of society in relation to the potential for series adverse outcomes from contracting COVID-19.

With the coronavirus being a serious threat to the elderly and having a devastating impact on the mortality of residents in aged care facilities, there need to be some clear first steps in bringing sector standards into line so that there is a commonality in care.

Robinson explained that the Health and Disability Services Standards which include the infection prevention and control standards are under review in New Zealand currently. It was expected they would be available by the end of 2020, however, due to the impact of COVID-19 the completion of this piece of review work is now expected by the middle of 2021.

“As has been evident in the aged care service clusters both in New Zealand and in Australia at the time of writing this article, it is very clear from the special nature of aged care services, the development of any Standards should be led, in my opinion, by nurse leaders from aged care services,” expressed Robinson.

“The concept of aged care leading the development of protocols for implementation in aged care should be applied, as they know the particulars of the sector more than anyone from other services such as acute services. I have seen first-hand that it does not go well for aged care services when those without expertise in this area of care dictate policies, standards or protocols.

“It would not be appropriate for aged care nurses to design protocols by way of standards for acute services and it’s equally not appropriate from my observation for acute service personnel to be writing standards intended for implementation in aged care services. Only then can the outcome be appropriate and consistent rather than having regional recommendations by a range of different agencies all offering what they perceive to be the best advice.”

Countries which have traditionally been the supplier of Aotearoa’s internationally qualified nurses are going to need a greater number of them staying within their own borders, they therefore may not be available to New Zealand.

“I would like to see more collaboration between government and the NZACA as the primary-aged care representative organisation, to ascertain the needs of the sector and correspondingly commit to greater urgent investment in nursing education programmes,” Robinson suggested.

“This would be with the view to have New Zealand far closer to self-sufficiency in the supply of their own home-grown nursing workforce.”

Robinson also has practical advice for how Personal Protective Equipment (PPE) should be handled within the aged care sector. PPE in the case of an outbreak gets used very quickly and so it could be suggested that a minimum of a 2 week supply PPE would be a good start. This would need reviewing daily as soon as an outbreak was identified to determine the rate of usage to plan-ahead.

After the closing of borders with a lot of PPE coming from overseas, New Zealand now appears to have greatly depleted stocks. The amount of PPE needed depends on the type of precautions being implemented, the possible extent of infection and needs to take into consideration the size of the aged care service, for example, the bed numbers.

“I would suggest as part of induction and orientation processes, all staff undergo education and achieve competency in the use of PPE. They will also need to understand the different types of precautions which may be implemented,” said Robinson.

“These differ depending on the infection which is causing a risk of transmission and spread of infection. Review of competencies should occur at least annually and be included in all nursing education programmes.”

The world has changed and therefore how we care for the elderly in care facilities must also change. Hopefully, with greater communication between the government and those on the frontline of the aged care sector, the industry will be better prepared for our future in the new normal.

The views offered in this article are those of Gillian Robinson, Registered Nurse, Bachelor of Nursing, Lead Auditor and Director of Healthcare Compliance Solutions Ltd (provider of Aged Care and Retirement Village software and quality systems); Author of ‘Excellence in residential care: a guide for managers and nurses’ (2003).