The Changing Skill Mix and Scope of Practice of Health Care Workers in New South Wales: Implications of Education and Training Reforms for Registered Nurse Practice, Performance and Education

Article excerpt

In Australia, as in much of the rest of the Western world, a number of political, social and technical factors have resulted in a need for the aged care sector and the nursing profession more broadly to modify their skill mix in order to better respond to changes in the needs of older Australians.

In particular, Residential Aged Care Facilities (RACFs) in Australia face a number of significant issues including:

* The need to respond to policy changes emphasising efficiency in RACFs;

* The nature of the needs of residents with increasing acuity;

* The impact of decreasing numbers of Registered Nurses working in the RAC environment;

* The aging of the workforce;

* The changing composition of the residential care team and changing roles within that team.

In contrast to the more 'high tech' trademarks of health care work so often depicted through the media, aged care services are largely hidden from both the public and the professional view (Bellchambers, McMilllan & Conway 2007). Despite this, the aged care industry has had significant influence in prompting a reconsideration of the nursing profession's skill mix requirements in Australia. Specifically, there is now recognition that the aspirations of some for an all Registered (Level 1) Nurse (RN) workforce were, perhaps inevitably, unsustainable. The role of the Enrolled (Level 2) Nurse (EN) has been under considerable scrutiny for the last decade. In particular, A Review of the Current Role of Enrolled Nurses in the Aged Care sector: Future Directions (National Aged Care Forum 2001) illuminated the changing demands within the aged care industry and its associated workforce needs.

Since the 2001 review and a period of extensive consultation, there have been a number of changes in the EN's scope of practice in New South Wales (NSW), perhaps most notably the 2004 amendment to legislation and education that enabled ENs to administer medication. This changed scope of enrolled nurse practice in NSW resulted in Level 2 nurses in NSW being supported through education and legislation to have a scope of practice which their counterparts in other parts of Australia have had for some time. In turn, this has necessitated further examination of the roles, functions and responsibilities of all members of the health care team, reconsider work practices, and establish education and training programs that are consistent with the contemporary health environment across Australia.

Despite the endorsement of ENs, many of the factors that prompted the changed scope of practice for ENs continue to impact upon RAC sector at this time including:

* A decline in numbers of regulated (both enrolled and registered) nurses seeking employment in aged care;

* Case-mix changes;

* Skill-mix deficiencies;

* Changes in the profile and expectations of care recipients;

* Changes in economic and political imperatives of both government and industry.

(Hunter, Conway & McMillan 2007)

In response to this, there will continue to be an expansion of an increasingly certified yet unlicensed workforce in aged care and health service delivery (Conway & Kearin 2007). The recently released Health Training Package offers a nationally recognised framework for health worker training and assessment of competence. It includes a range of qualifications that are reflective of the skills escalation and articulation pathways in health care work. The Training Package provides pathways from high school into health careers for both unregulated and regulated workers. The inclusion of enrolled nursing in this has resulted in a well articulated education pathway from generic and unregulated health worker to Advanced Diploma qualifications in nursing in a range of practice areas such as aged care, diabetes management, acute care, mental health and perioperative care. Given this, it is imperative that the RN workforce to be adequately prepared for a role that has knowledge of standards for direct care but may not necessarily deliver that care. …