Academic journal article Australian Health Review

Living on the Edge: Issues That Undermine the Capacity of Residential Aged Care Providers to Support Student Nurses on Clinical Placement

Academic journal article Australian Health Review

Living on the Edge: Issues That Undermine the Capacity of Residential Aged Care Providers to Support Student Nurses on Clinical Placement

Article excerpt

Abstract

This paper reports in part on the Building Connections in Aged Care Project about developing quality clinical placements for undergraduate nursing students in residential aged care in Tasmania, Australia. Informed by an action research approach, and using multi-methods data collection, the three-stage project explored issues impacting on students' experiences of placement, implemented strategies to address identified issues, and tested the sustainability of achievements gained. This research highlights the vulnerability of residential aged care facilities to changing conditions and shows how problematic circumstances related to staffing and workloads can readily undermine their capacity to provide supportive teaching and learning environments for students.

Aust Health Rev 2007: 31(3): 368-378

THE AGEING OF Australia's population1 presents challenges to aged care providers. Residential aged care facilities (RACFs) will provide care for increasing numbers of frail elderly people - since the late 1990s there is evidence which suggests that people are entering residential aged care older and with greater levels of dependency.2 This changing profile highlights the importance of attracting appropriately trained staff to provide required care.

The number of registered nurses (RNs) employed in aged care has been steadily decreasing since 1997,3 and with shortages of nurses willing to work in RACFs4 there is cause for concern. Increasing levels of casualisation and part-time employment mean that RNs now constitute just over 20% of the workforce,4 and consequently, their role in providing "direct care" to residents has declined. Meanwhile, the proportion of care provided by personal care assistants (PCAs) has increased significantly.5

The disproportionate increase in the number of PCAs in RACFs has led to increased supervisory responsibilities for RNs, while inappropriate skill mix reportedly has a negative impact on RNs' work satisfaction and their recruitment and retention into the sector.6 It is not surprising then that aged care nurses are reportedly less satisfied than other aged care workers.4 Evidence of unsupportive work environments, stress associated with staff shortages and high workloads, combined with increased resident dependency, further adds to dilemmas around staffing in aged care.5 Such are the circumstances that student nurses find themselves in when undertaking clinical placements in RACFs.

A positive experience while on clinical placement is recognised as an important factor in facilitating students' recruitment.7"9 While it is strongly agreed that RACFs are appropriate sites for student nurse placement,10'11 with potential to provide useful learning opportunities,10·12"14 there has been little critical assessment of the impact on students of staffing and organisational problems associated with aged care practice. Similarly, while it is known that the capacity of aged care providers to support learners has a significant impact on students' placement experience,8 there has been limited investigation into barriers inhibiting RACFs from providing quality clinical placements.

Research in acute care hospitals has shown preceptors can help students make links between theory and practice and increase students' learning.15·16 Students have identified hospital staff shortages and the absence of key staff as especially problematic.17 The consequence of not having a regular preceptor is students lacking direction in their learning and feeling that they are a "burden" to other staff.17 Staffing and resource availability issues impact on the capacity of aged care nurses to provide a positive educational experience to student nurses on clinical placement in RACFs. This issue was identified in the Tasmanian research Building connections in aged care, which explored developing quality clinical placements in aged care with the intent to positively influence students' attitudes to working in the sector following graduation (http:// www. …

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