Academic journal article Australian Health Review

Experiences of Nursing in Older Care Facilities in New Zealand

Academic journal article Australian Health Review

Experiences of Nursing in Older Care Facilities in New Zealand

Article excerpt

What is known about the topic? The lack of registered nurses generally and the more critical shortage in residential care is well known.

What does this paper add? This paper explains the impact on the current and future viability and the quality of registered nurse services in an area of service where acuity continues to rise and the demand for nursing services is increasing.

What are the implications for practitioners? Nurses in older care settings often express a sense of isolation and note limited career development despite their passion for serving the frail older person. The establishment of nurse practitioner (gerontology) roles offers the potential for improved quality of clinical care for residents and clinical champions for development of nursing services.

As with other Western nations, New Zealand has an ageing population, which is expected to have a large impact on the country's health and welfare sectors, the availability and development of its workforce and future economic prosperity. The demands of older populations will be heightened as the increasing numbers of people exposed to hypertension, less physical exercise and altered diets are realised.1 This will have a huge impact on the nature and use of the health sector and on workforce capacity.

One segment of the nursing labour market already under pressure is that of nurses who provide the care of older people in residential settings. This paper explores the experience of working in this type of environment and the issues these nurses face.

Background

The older person in NZ

As the public health system becomes overwhelmed by the increasing acuity and chronicity of patients, so too does the need to transfer unwell older adults into the residential care setting. In 2006, 42 500 older New Zealanders received residential care subsidies,2 with around 850-900 such facilities spread throughout the country.3 Full-time care is only deemed appropriate for those whom needs assessors consider require 'high' to 'very high' support. Residential care facilities provide 24-hour care, 7 days a week, and residents are either subsidised or private. Residents have to be assessed as requiring 24-hour care to be admitted. A fully subsidised resident receives approximately NZ$88 dollars a day. Private geriatric hospitals are usually part of residential care facilities and provide hospital-level care to residents who are sick and dying.

The nursing workforce

In 2004, the New Zealand Institute of Economic Research (NZIER)4 quantified the demand for health services against the predicted supply of health workforce personnel. They calculated that by 2021, depending on the scenario, the excess of labour demand over supply was projected to be equivalent to between 28 and 42% of the 2001 workforce.

A nursing workforce survey commissioned by the Ministry of Health5 revealed a workforce with fragile capacity, characterised by an older age range in community and residential settings. There were also widespread reports of significant barriers in access to education and professional development, and minimal evidence that new graduates were able to find supported positions in residential care settings. The evidence demonstrated that the sector was not well positioned to support and sustain the demands of core policy without significant investment and development.

The Nursing Council of NZ (NCNZ), through routine data collections, reported that 8.9% of the registered nursing workforce was employed within the field of older care. The majority were NZ European, with an average age of 51 years (NCNZ data provided for 2007). Sixty-four nurses were reported as being in the 70-80 years age range and over 600 (14.5%) were older than 60 years. A survey of 919 residential care facilities in NZ6 found alarming turnover rates, with approximately half of the staff having moved during the previous 2 years. These authors also noted that 46% of the nursing staff within their surveyed facilities were between 46 and 60 years of age. …

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