Q&A with Jill Dexter: Lessons and views from 50 years in nursing

Jill Dexter, Residential Manager, BaptistCare Carey Gardens

Commencing training in the 1970s, Jill Dexter provides an insightful look at the evolution of the nursing profession and the aged care sector across technology, training and wages. Jill is the residential manager at BaptistCare’s Carey Gardens aged care home in Canberra, managing a team of 60+ staff at the 65-bed facility.

IA: Congratulations Jill on more than 50 years in the nursing profession. In that time, you would have seen a lot of changes, especially with respect to workforce pressures and the impact it is having on aged care. When you started in 1971 what was the workforce situation like in aged care – was there any type of staff shortages?

Jill: The aged care sector has always been short-staffed. There were very few registered nurses, and a lot of the carers were untrained, inexperienced and could not meet the holistic needs of the elderly person.

IA: We write a lot about technology and its role in helping providers and workers to do their jobs better and easier. How much of a role has technology played when it comes to reducing administrative and other tasks that would allow staff to focus more on the care side?

Jill: New technology used in aged care has seen the introduction of an “electronic medical record”, patient management systems, and other software products which assist administrative and clinical staff. Access to programs is by authorisation and password.

Other technologies which directly improve resident care include sensor mats, movement sensors, neck pendants (call for assistance) and other monitors, which have assisted care staff to monitor their residents from a distance.

IA: As you would be well aware there is a wage case currently before the FWC for a 25% pay increase for aged care workers. When you look back at your career in the sector how far out of step do you think wages have fallen behind the general community?

Jill: Aged care workers’ wages have always been behind the general community. Aged care nurses have never been paid at the same rate as their equivalent position in the acute care sector (hospitals). Carers in aged care, in the earlier years, had no formal training and therefore were well underpaid.

Carers are now receiving formal training and extending their training to higher levels, however, there has been no recognition for their professional development and wages remaining low. The carers have achieved their qualification in aged care, continue to work with the most vulnerable people in our community and unfortunately continue to be undervalued, overworked and underpaid.

IA: As the current manager of BaptistCare Carey Gardens in Canberra you would have an interesting view on the role of nurses in aged care. How critical do you think the presence of a full-time nurse is and what type of impact can this have on the everyday?

Jill: Registered nurses are essential in aged care to promote safety and well-being for residents. The RN’s scope of practice enables the high level of clinical assessment, care planning and evaluation of the care to be continuous, thereby reducing the clinical risks to residents.

Registered nurses provide frontline leadership in the delivery of nursing care and in the coordination, delegation and supervision of care being provided. The impact of having a registered nurse, 24 hours a day, will allow continuous review of our residents and timely interventions.

IA: Attracting staff to the aged care profession is one thing while retaining and building teams is arguably more important. What type of approach or tips can you offer other managers looking to improve team function and retention? You’re welcome to share any lessons or examples you’ve seen used in the past that may have been effective.

Jill: Attracting and keeping staff is very difficult. Aged care has been understaffed and underpaid for several years. No leader in government has addressed these issues despite the 20 independent reports over two decades and a Royal Commission two years ago. The issues have not been resolved. If we want more staff in aged care, then we need to increase wages.

At present, I have 17 students. I offer clinical placements at the end of their formal training (Certificate 3 & 1V in Individual Support). We also provide Australian student-based apprenticeship training (school-based traineeship) and provide undergraduate registered nurses opportunities to complete their clinical placements. These students are assessed while completing their clinical placements and some go on to become employees.

IA: What advice would you offer for a young person considering a career that specialises in aged care, including graduate nurses who may consider this path?

Jill: Nursing is one of the most rewarding careers, however, it takes a special type of person to become a nurse. Nurses need special qualities such as compassion, empathy, patience, and a passion for caring for and helping others.

I encourage people who are interested in a nursing career to volunteer or complete a certificate in aged care. This will give them some experience caring for people in the community and those who are ill. This short experience will assist the young person to make their choice.

IA: In your 50 years working in health, how would you compare the current situation of running an aged care facility and all that goes into delivering the services every day, including the headwinds associated with staff, funding and the pandemic?

Jill: Today, the workload is excessive! It is not sustainable, and roles and responsibilities need to be reviewed otherwise more managers will leave the aged care sector due to burnout. The spread of COVID has also put new pressures on our already strained health systems. Managers are constantly navigating the crisis to minimise the impact on care.

The biggest challenge for a manager is the retention and recruitment of staff. We cannot attract sufficient staff as they continue to be underpaid and undervalued.

Another challenge is maintaining a high level of care for our residents. In the past two years, the COVID pandemic has heavily affected residents, staff and families. Our goal is to keep everyone safe from COVID. We need more carers to continue to deliver safe, quality care to our residents.

Maintaining high morale is another challenge – but working as a team, caring for and supporting each other, has developed trust between us all.

The most important message I have to say is that the aged care sector is in crisis! The new government needs to urgently resolve the resourcing issues (poor staffing levels) and increase pay for aged care workers.

IA: Thank you Jill and congratulations once again on such a significant milestone.


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