Nurses in the aged care workforce
Presentation of data findings
The attractiveness in work for aged people is critical in making nurses consider such positions. Therefore, Table 3.16 shows the arrangement of employments and the hours worked by the various nurse groups between the years 2012 and 2016 for the different employment types. Predominantly, most workers’ residential aged care workers are employed on a permanent part-time basis. The registered nurses working part-time increased in 2016, accounting for 22.4% from 19.3% in 2012. However, there have been subsequent reductions for the workers in permanent part-time and casuals, meaning that there has been a change in an employment arrangement. For the enrolled nurses, workers in the contract/casual category have decreased, which has translated into more enrolled nurses securing permanent part-time and full-time arrangements (Mavromaras et al., 2017). The same percentage of change has been recorded for personal healthcare assistance, allied health, and all occupations, which have decreased from 18.7% in 2012 to 10.1 % in 2016. This data indicates that more registered nurses are being incorporated in either permanent part-time or permanent full time, which gives a positive indication as more nurses are enrolling in this health sector.
Table 3.5
This table shows the age variations for the care workforce conducted between 2003, 2007, 2012 and 2016. Generally, the table indicates that the age of direct care workers is slightly lower than in previous years (Mavromaras et al., 2017). For all direct care employees, those aged 55 years and above rose from 16.9% in 2003 to 27.2% in 2016. However, those 54years and below reduced from 82.1% to 72.7%. This indicates that there has been high retention in the employment sector. However, the data presented in the recent hires section indicates the opposite presenting an observable change in the age structure for the organization. In the recent hires, column 5, there is an increase from 28.9% in 2003 to 46.1% in 2006, showing that those with 34 years and below have increased in number.
Conversely, there has been an increase in the percentage for those aged 55 years and above but with a small margin being 10.9% in 2003 to 12.7% in 2006. Besides, those aged between 35 years and 55 years have decreased from 60.2% to41.2%. Overall, this age distribution indicates that the current workforces that are hired in the care workforce are slightly younger in 2016 in comparison to 2003. However, this variation has been significantly initiated by the recent hires that majorly constitute young professionals.
This figure shows the distribution by gender that constitutes the aged care workforce in 2016. Principally, female professionals dominate the aged care workforce accounting for 87% while men account for the remaining thirteen (Mavromaras et al., 2017). All the occupational groups highlighted in the figure record females as predominant, be it allied health, personal care attendant, Enrolled Nurse or Registered Nurse. The EN occupational group has the least percentage of men, accounting for 8.6%, while the personal care attendant accounts for the highest with 13.8%. These values indicate that female care workers have more acceptability for such a profession and can be used to determine the appropriate gender to consider when there is a need for retention. The PCA, where men have a higher percentage, informs the need to identify whey men prefer this occupational group or the work requirements in each occupational group that is often attributed to a particular gender.
The table provides a combination of factors that contribute to nurses not wanting to work or leaving the aged care sector comparing 2016 and 2019. The Australian Nursing and Midwifery Federation on National aged care survey 2019 report highlighted four main themes presented from the reasons for the two years being under-recognition, lack of respect, undervalue, culture blame, and inability to provide quality care (Australian Nursing and Midwifery Federation, 2019). Workloads presented the most significant reason in both years, accounting for 47.4% and 39.1% in 2016 and 2019, respectively. Due to understaffing, care workers have to overwork while the pay is not commensurate with the work volume. These shortages re dominant in various aged care facilities, making most care workers leave such facilities. Staffing levels are also significant, accounting for 17% in 2016 and 20% in 2019. Staffing translates to workloads as when care workers are understaffed; they will have to deal with workloads. Pay disparity is also crucial, being 14% and 10% in 2016 and 2019, respectively. Workloads make care workers perform an extra duty that is not commensurate with their pay, thus contributing to most care workers wanting to leave the sector.
Workplace culture also remains core to nurse retention, accounting for 4% in 2016 and 2.8% in 2019. The most predominant presented is the culture of blame, translating to zero support from management. The culture of shaming and berating the industry’s work makes it hard for passionate nurses to stay in the profession. The culture of blaming the staff for managerial flaws in the sector was presented as limiting the efforts by care workers to remain in the profession (Australian Nursing and Midwifery Federation, 2019). However, documentation and occupational health issues presented the least causes for nurses leaving. Nonetheless, the high percentage of nurses that constituted higher accounted for 17.2% in 2019, indicating that there is no single cause contributing to leaving with various interconnected details surrounding the aged care system that affect nurses. From the main contributors, it is evident that there is no single cause of nurses wanting to leave, but these factors are interconnected.
Staff concerns
Figure 10 presents three significant themes as being essential for the issues of aged care employees: the safety of staff, inadequacies in staffing, and resident safety. For the safety of staff, there are harassment cases, bullying, abuse of aggression, and violence from the management, employers, and professional strain. On the staffing issue, it not only relates to a lack of numbers but also communication skills, aptitude, and training commensurate with the needs of the sector (Australian Nursing and Midwifery Federation, 2019). Finally, the safety of residents considers a lack of respect and improper care as crucial. The culture undertaken by particular management systems promotes a lack of respect, which translates to poor quality and safe care for residents.
Staffing levels
This data presents how different aged care workers perceive their staffing levels at their facilities for the years 2016 and 2019. The data shows that a majority are not contented with the staffing levels in both years, with the value being higher in 2019 than in 2016. For 2017, those that stated inadequacy in staffing accounted for 79.2%, while 20.80% affirmed that staffing was adequate. The same trajectory is evident in 2019, with 89.1% indicating inadequacy and 10.9% reporting the opposite (Australian Nursing and Midwifery Federation, 2019). This data shows how crucial it is to address the staffing issue in the aged care facilities; this means that the personal care that such nurses administer to residents is poor. The inadequacy remains an issue of concern as the limited staffing levels make it impossible to explore all the healthcare needs of the aged. Besides, the percentages show that the inadequacy issue has risen from 2016 to 2019, meaning that if faster intervention is not considered, the staffing problem will continue for the coming years.
Figure 14: Adequacy of funding in aged care
Figure 14 indicates that lack of staff from all levels of aged care is the major inadequacy that the aged care working environment faces; thus, it is an urgent matter of concern. From the table, lack of staff has translated into three significant flaws missed care, deviation from routine, and unpaid overtime, all of which compromise the quality of healthcare. Missed care means that there are high care needs that are not accounted for, missed care for basic needs, inappropriate accounting for emotional and psychological care, and missed documentation of vital health records. Besides, the deviation from routine is presenting difficulties in responding to call-bell protocols; thus, the inability to respond to calls from high care needs and increased possibilities of unexpected incidents as nurses perform out of their required jurisdiction (Australian Nursing and Midwifery Federation, 2019). On the other hand, unpaid overtime is compromising the morale of the nurses; thus, they are unable to account for the care needs of the aged passionately. These inadequacies are fundamental to deterioration in care provision informing why it is a matter of urgency for the healthcare authorities to solve the staffing problem.
Causes of skill shortage
This table shows the various causes that make requisite skills unavailable for the aged care facilities in the community and residential sectors. The table enlists the unavailability of specialist knowledge, unfavorable location, slow recruitment, limited training, and too high wages for the employer to meet (Isherwood et al., 2018). The availability of training and availability of specialist knowledge are the two principal factors that relate to the development of skill. The two aspects have been on a decline as they account for 55% in 2012 and 31% in 2016, meaning that the care has put more emphasis on developing skills. In the community sector, the unavailability of training remains an impediment accounting for 16% in both the two years, while specialist knowledge’s unavailability decreased from 31% to 21%. Unfavorable location accounted for 34% in 2012 and 27% in 2016 for the residential sector, meaning that the location issue is deteriorating as a concern similar to slow recruitment. However, in the community section, the location remained a cause for skill shortage, being 40% in 2016 from 37% in 2012.
Nonetheless, the recruitment problem remained constant for years. Finally, the high wages for the employers remained the least cause of skill shortage. It has also been on a downward trajectory in residential and community recording 16% to 10% and 15% to12%, respectively (Isherwood et al., 2018). Skill shortage in this sector is the prime issue; thus, high wages have a minimal effect on the unavailability to attract the right skills. Therefore, the evidence presented in the table suggests that concentration in the development of a pool for skill base should be the most vital aspect to consider for addressing skill shortages.
Supporting theories
The data presented has highlighted the different factors for consideration in the retention of experts in the aged care systems. Herzberg two factor theories highlight the motivational and hygiene factors that explain the nature of aged care nursing system. A satisfaction model for aged care needs utilizes this theory to make informed choices on improved care programs. Motivational factors can produce satisfaction in aged care services similar to hygiene factors, which can reduce dissatisfaction. Motivational factors in healthcare workers have an intrinsic implication such that they work to improve job satisfaction. In contrast, the hygiene factors are extrinsic in that they work to reduce the possibility of job dissatisfaction (Alshmemri et al., 2017). In this regard, increasing the staffing levels in facilities will function as a hygienic factor. It will limit discontent while improving the work culture is a motivational factor as it enhances job satisfaction. From figure, 22, some factors contribute to nurses wanting to leave, which are either motivational or hygiene factors. Hygiene factors include salary, working conditions, supervision, policy administration, and interpersonal relationships, which are similar to management practices, workplace culture, expectations of families, and pay disparity in figure 22. However, the motivational factors include achievement, advancement, work itself, recognition, and responsibility, which are similar to staffing levels, workloads, and occupational health issues (Alshmemri et al., 2017). This highlights that accounting for the motivational and hygiene factors presented can be a useful tool in improving the working stature in the aged care
The second theory particular to this issue is the Greenberg and Colquitt theory applicable to organizational justice and translates to the fairness that affects employee performance in an organization. Fair treatment of employees is a critical motivational factor that the aged care factor must explore (Greenberg & Colquitt, 2013). The theory explores the repercussions and impacts that organizations can experience when they do not treat their employees fairly. The employee perception of fairness in the workplace will dictate their ability to perform optimally. It accounts for the different understaffing and unpaid overtime that is pervasive in the aged care sector. From the data, it is evident that the aged care workers are understaffed, meaning that their work is not commensurate with their pay level. Besides, the pay disparity identified as a significant cause for nurses leaving is an organizational justice parameter explored in theory. Therefore, finding a baseline for nurses’ satisfaction requires the incorporation of organization justice parameters in practice.
Implication and recommendation
The data presented in the tables show the different aspects of aged care nursing practice that can be used to explore increase engagement of nurses in aged care. Table 3.16 shows that majority of residential age care is on a permanent part-time basis. This implies employment arrangement dictates nurses’ acceptability to the different employment arrangements for the nurses (Mavromaras et al., 2017). It also implies that forms of employment are attractive if relevant employment arrangement is agreed upon. Therefore, the aged care nursing profession should always ensure that the employment arrangement required by the skilled nurses and provided the relevant personal benefits are agreed upon. Permanent part-time basis attracts most nurses showing that it gives nurses the flexibility to perform other functions, informing them why the management should always allow nurses to choose the arrangement that meets their needs (Health Employees Superannuation Trust Australia, 2018).
Table 3.5 shows that the age of care workers is slightly lower in 2016 than in previous years, implying that the younger workers are increasing in the aging care sector. This is a positive trajectory for the aged care sector because young workers are more amenable to training and upskilling (Mavromaras et al., 2017). Therefore, it is requisite to increase the percentage of young employees to increase aged care support. Figure 3.4 shows the residential age care workforce is predominantly female, implying that female nurses find the aged care system attractive than their male counterparts (Mavromaras et al., 2017). However, it is appropriate to establish a level field to make the aged care profession appealing to both genders.
Figure 22 highlights the major factors that make nurses want to leave the aged care sector, which implies that the causes of nurse dissatisfaction are multifaceted. It implied four significant themes in the sector under-recognition, lack of respect, culture, and undervalue (Australian Nursing and Midwifery Federation, 2019). This implies that not one single factor results in nurses wanting to leave the profession. Therefore, to provide a solution to this challenge, a raft of measures are appropriate, including increased government funding, there is a need for more government funding to improve staffing. Besides, there is a need to set a minimum regulation and training required for the aged care sector staff to improve their skills in handling the contemporary issues affecting the aged. This will address the lack of skill, which is seen as crucial in attaining the best expatriates. There is also a need to value and respect the staff as this will improve the morale and health of staff, improve well-being, and improve the quality of care provided. Finally, there should be a legislated staff number required for a particular healthcare facility to operate. These measures are alternatives to be considered when there is a need to retain nurses in this sector.
Figure 10 highlighted some of the issues that aged nurses face while delivering their duties, implying that aged nurses are vulnerable in their safety concerns, staff numbers, and residents’ safety. Therefore, there is a need to ensure that management practices account for all these safety concerns such that aged care nurses are protected. Figure 13 implies that the current staffing levels in different facilities are insufficient owing to the large number that indicated no (Australian Nursing and Midwifery Federation, 2019). This requires similar recommendations as it stresses that staffing needs a fundamental flaw that the aged care system is facing calling for faster intervention. Figure 14 also highlights some of the effects of staff on the quality of healthcare, implying that the unavailability of enough staff to account for the number of aged care workers can be disastrous to care though routine deviation and lack of care. Therefore, the government must urgently enact the systems that would ensure staffing needs are accounted for in legislation.
The final table on the reasons for skill shortages implies that unavailability of specialist knowledge and limited training availability are the main contributors to skill shortages because they are directly involved in the development of such skills (Isherwood et al., 2018). Therefore, it is required for governments to increase their enrollment of students in medical schools to increase the pool of expertise. Besides, college students should be incubated in aged care facilities to promote obtaining the relevant skills in such fields.
Conclusion
Nurses’ retention requirements in the aged care systems remain a key factor in the promotion of high care and responding to the needs of such people. An understanding of the aged care sector is thus important in determining the best possible alternative to be undertaken to ensure that nurses in this sector receive the relevant care. The study highlighted the employment arrangement in this sector, which is predominantly permanent part-time. Besides, it established that the workforce is younger than the previous year’s having females as the dominant gender. Additionally, the study established the main issues that make nurses want to leave the profession, such as understaffing recommending some of the ways that such governments can employ to reduce these possibilities.
The study also identified the effects of limited staff as well as the major causes of skill shortages. These findings implied that more is required to improve this sector, particularly the understaffing issues that present the most significant bane to the aged care systems to function optimally. Further, the paper explored the Herzberg two factor theories on motivation and hygiene and Greenberg and Colquitt’s theory that focused on organizational justice as important aspects that require consideration for aged care nurses to achieve a conducive working environment. The recommendations provided pointed towards improving both intrinsic and extrinsic factors so that the nurses are accorded an ideal working condition commensurate with their job description. These are the only alternatives that policymakers can utilize to ensure the retention of nurses in the aged care sector.
References
Alshmemri, M., Shahwan-Akl, L., and Maude, P., 2017. Herzberg’s two-factor theory. Life Science Journal, 14(5), pp.12-16.
Australian Nursing and Midwifery Federation (2019). ANMF National Aged Care Survey 2019 – Final Report. Australian Nursing and Midwifery Federation (Federal Office), Melbourne, Victoria
Greenberg, J. and Colquitt, J.A. eds., 2013. Handbook of organizational justice. Psychology Press.
Health Employees Superannuation Trust, Australia, 2018. Reimagining The Aged Care Workforce Of Tomorrow. 1st ed. [ebook] Melbourne, Australia. Available at: <http://file:///C:/Users/hp/AppData/Local/Temp/Hesta%20Aged-care-report%20(1).pdf> [Accessed 7 August 2020].
Isherwood, L., Mavromaras, K., Moskos, M., and Wei, Z., 2018. Attraction, retention, and utilization of the aged care workforce. Working paper prepared for the Aged Care Workforce Strategy Taskforce, 19 April.
Mavromaras, K., Knight, G., Isherwood, L., Crittenden, A., Flavel, J., Karmel, T., Moskos, M., Smith, L., Walton, H. and Wei, Z., 2017. The aged care workforce, 2016. Commonwealth of Australia: Canberra, Australia.