The Australian nursing sector is precariously placed in meeting future demand. In its latest report, the Department of Health and Aged Care estimated Australia is presently facing a shortage of 5918 registered nurses to meet 2024-2025 aged care staffing requirements.
This is driven by the Albanese government’s mandatory minutes law which requires aged care providers to staff homes with an average of 200 minutes of personal care and 40 minutes of registered nurse care per resident per day. This mandate increases to 215 care minutes and 44 RN minutes on 1 October 2024.
The mandate was introduced despite known aged care staffing shortages, which has resulted in several negative outcomes for the sector:
- many providers have immediately fallen into non-compliance with mandated staffing targets.
- registered nurses have become a scarce but essential resource creating a labour market bubble.
- providers have become highly reliant on agency registered nurses who do not build organisation skills or culture, and enrolled nurses are losing employment opportunities in aged care due to the emphasis on registered nursing hours.
In the most recent Quarterly Financial Snapshot into Aged Care, it was found that agency labour constituted 13.8% of all RN costs and 9.5% of all RN hours, an increase on the prior quarter. Despite this agency RN labour, providers averaged only 38 minutes per resident per day. At the same time enrolled nurse resourcing declined slightly from 15 minutes in earlier periods to 14 minutes. Due to the focus on mandatory RN staffing, enrolled nurse employment is being reduced by providers to afford elevated market rates for RNs.
The Aged Care Quality and Safety Commission reported for the Quarter ending September 2023 that the standards with the highest non-compliance are 3 (personal and clinical care), 7 (human resources) and 8 (organisational governance).
Compliance with these standards requires a skilled and stable registered nursing workforce, which casual agency nurses are unable to contribute to.
During the mandatory minutes transitional period I opened a discussion with my EN workforce encouraging them to consider attaining their RN qualification and supporting them with funding for university fees, however this pathway is not attractive to mature age workers given their obvious need to maintain an income during their studies.
ENs considering a registered nursing degree are required to undertake 640 hours of unpaid placements throughout the 2-year full-time course (which in reality would be studied over 4 years part-time).
I submit there are four policies that are worth considering to address Australia’s registered nursing shortage:
- Enhanced recognition of prior learning for ENs. I find that experienced ENs have
enormous knowledge in the aged care clinical setting and are often teaching
graduate RNs on how clinical care and governance is conducted. There should be
scope for experienced ENs to have their competency tested in RN units before being
required to undertake the study. - Fast-tracked RN study. A recent FoxNews article
https://www.foxnews.com/health/combat-nursing-shortage-universities-create-
accelerated-12-month-training-programs-win-win
discussed new opportunities in some American universities to obtain a nursing
degree with 1 year of study, completing only 8 courses as a postgraduate. - Government payment for practical placements. As opportunities for ENs in aged
care diminish, the government should consider re-deploying the EN workforce into
registered nursing. 640 hours of unpaid practical placement means ENs are
sacrificing over $20,000 in paid work to achieve their qualification.
Ref: https://www.abc.net.au/news/2024-03-02/university-accord-unpaid-student-poverty-
placements/103511408
The Commonwealth Government could consider funding these practical placements
in exchange for an agreed period of Australian residency and nursing employment. - Adjustment to the RN mandatory minutes formula. The present requirement for
providers to staff an average of 40 minutes per resident per day, does not
acknowledge the complimentary skill set of ENs. It creates an unnecessary bubble in
the RN labour market. ENs are trained to perform many of the same skills as RNs in
an aged care home i.e. medications, wound management, resident observation and
record keeping, and assistant nurse oversight. It makes sense to define the 40 minutes
as EN/RN minutes, and provide a reduced minimum requirement of registered
nursing minutes provided the balance is comprised of enrolled nurses.
Unless immediate action is taken to reduce the shortfall of registered nurses in Australia and review the mandatory minutes staffing legislation, aged care will – for the foreseeable future – be reliant on expensive agency RNs to comply with arbitrary government rules instead of building a long-term skilled aged care workforce, which enrolled nurses could play an enhanced role in.
