This news story was first published in print and online by Australian Doctor on the 24th May 2016.
The NSW Government has been criticised for abandoning rules that require registered nurses to staff high-need residential aged care centres around the clock.
Here, NSW Health Minister Jillian Skinner responds to claims that the move will put some of the most complex patients in the health system at risk.
Australian Doctor: Last year, a NSW Parliamentary inquiry said 24-hour, high-quality care was essential for this very frail and complex patient group. Are you worried that quality will fall without guarantees that RNs are staffing facilities?
Jillian Skinner: No I’m not, because no other state or territory has an equivalent regulatory requirement for RNs. And there’s no evidence that there is a drop in standards or outcomes for those residents.
One of the things we had to consider was the potential impact on smaller facilities where they’d have to close because they could not afford to undertake this regime.
This is so particularly for facilities in country areas where there’s not a high acuity, but they’d have to put an RN on duty when they are not necessarily needed.
But without these rural facilities, in some cases you’d have residents separated from their families and social networks by hundreds of kilometres.
AD: How do you ensure aged care operators don’t simply cut staff to save money and thereby compromise patient care?
JS: The regulation of aged care is the Commonwealth’s responsibility. Under the Quality of Care Principles and Aged Care Funding Instrument, the level of nursing experience is tailored to meet the needs of the person, and certain complex care needs must be managed by a registered nurse.
AD: GPs working in aged care say they will be less inclined to prescribe “as needed” pain or sedative medications because they can’t be sure there’s an RN to administer them.
JS: If you can demonstrate to me where in any other state this has been a problem, fine, but we’ve not found one.
NSW Health has been conducting a consultation process to update the Poisons and Therapeutic Goods Regulation, which regulates medication management in aged care facilities.
It is proposed that while not requiring an RN on hand 24/7, nurses will need to ensure the facility complies with the safe and appropriate use of medicines.
AD: Without RNs, surely you would have more ambulance call-outs and patients taken into EDs?
JS: There is evidence to show that having a registered nurse on duty 24/7 does not actually decrease the rate of hospitalisation for residents.
An unexpected accident can happen anywhere, and an enrolled nurse would respond in the same way as a registered nurse and seek medical assessment.
Programs such as Geriatric Rapid Acute Care Evaluation in Hornsby have worked. The emergency department there has formed a relationship with 70 or 80 nursing homes now where they provide backup and advice.
In Sutherland, the Geriatric Flying Squad has prevented 370 hospital presentations each year.
AD: For patients with high rates of dementia, are RNs not necessary to pass on important clinical information to GPs or emergency services?
JS: Enrolled nurses are able and qualified to provide an adequate clinical handover where a registered nurse is not present.
NSW Health has strategies in place to share hospital discharge summaries with both GPs and MyHealth Record.