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24/7 Registered Nursing Care in NSW Aged Care Facilities Bill Defeated


Are you an RN, EN or carer in NSW aged care? Or, are you a Director of Nursing (DON), CEO, or Care Manager? If so, this discussion may be particularly meaningful, frustrating and emotional for you.

Regardless of whether or not you are an aged care registered nurse in New South Wales, you have likely heard reports that Shooters Party MP Phil Donato’s bill to legislate ‘RNs in aged care facilities 24 hours a day’ has been rejected by the NSW state parliament (Rurenga 2017).

‘It passed the Upper House last week but was not supported by the Coalition when it was introduced in the lower house on Thursday’ (Coote & Clift 2017).

This may have left you asking ‘why?’, ‘what is going to happen next?’ and ‘who voted for dough over bros?’.

Consider: without NSW aged care facilities having access to 24/7 registered nursing care, are the residents going to be left with better quality care? Or, are the healthcare organisations going to be the ones left better off, financially?

Let’s have a look at the reports surrounding this issue and try to understand how all of this has come about and what the motivations were behind denying this bill that could likely improve the care of older Australians.

Donato’s Facebook status announcing the bill.

The Guardian News (2017) reported that one Member for Oxley, The Nationals, The Liberals, and the NSW Government ‘voted down’ this bill. Ironically, it was highlighted that the vote ironically comes from the local member of an electorate that consists of around 40% > 60 year-olds.

The NSW Nurses and Midwives’ Association’s General Secretary, Brett Holmes said, ‘the government’s decision was shameful and over time would erode the level of quality care provided to some of the state’s most vulnerable aged care residents’ (2017).

The same article (Guardian News, 2017) expresses that ‘Labor had widespread support for this issue with strong lobbying from the Country Women’s Association, NSW Nurses and Midwives’ Association, NSW Council of Social Services, NSW Australian Ageing Agenda, NSW Rural Doctors, Palliative Care NSW, Palliative Care Australia, and NSW Shooters, Fishers and Farmers.’

So why was the bill voted down?

  • ‘Health Minister Brad Hazzard said some rural nursing homes would face closure if they were forced to have a registered nurse on duty at all times.’
  • Hazzard outlined that he had listened to many nursing home operators
  • They did not want to use a ‘one-size-fits-all’ approach
  • ‘The National’s Member for Barwon, Kevin Humphries, who was an aged care operator at Moree for five years prior to entering Parliament, said the bill demonstrated a poor understanding of providing care in rural areas.’
  • There is a concern over the difficulty of recruiting RNs to work in the aged care facilities

(Coote & Clift 2017)

So, from looking at some of the reports surrounding this bill it is apparent that there are two distinct sides of the argument for and against 24/7 RNs in nursing homes in NSW. That is: the perspective of the organisation/employer, and that of the employees. However, when reading over statements made, it seems that both sides are portraying that they are thinking of the clients.

Reasons made for 24/7 RN care appear to be based on client safety.

Evidently, without access to 24 hour RN care, residents could face potential troubles such as: decreased quality of care; less thorough and timely assessments and interventions; and, fewer available services (because some procedures, e.g. syringe drivers, may be out of the scope of practice of aged care workers other than RNs).

However, the reasons against the bill also indicate that there is a concern that should 24/7 RN care become mandatory, clients may not have access to personal care because there is potential that nursing homes may not be able to continue operating.

As earlier outlined, this was suggested as a result of difficulty in recruiting enough RNs to cover the nursing homes 24/7, and also the obvious financial difficulties arising from paying for 24/7 RN coverage of the nursing homes.

I guess the next concerns that arise from these observations are whether costs of aged care may rise further for residents if 24/7 RN care does become mandatory.

Will there be less access to local nursing homes if the bill passes in the future? And now that the bill has not passed, will people be even more inclined to remain in their own homes for as long as possible?

I wonder if carers will feel empowered or intimidated by the outcome of the bill? And I wonder what the culture will be like in nursing homes throughout NSW, especially considering that there was suggestion, as outlined earlier in this article, that the decision not to vote in the bill was made in consultation with nursing home operators.

Are tensions now expected between executives, nurses, and clients?

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