The Enrolled Nurse Decision Aged Care Providers Are Facing

I started my career as an Enrolled Nurse a few decades ago and probably because of this I have been watching and listening intently as my clients, Aged Care Providers, talk about a complex decision that they are facing. Enrolled Nurses – to have or have not.

In 13 days’ time AN-ACC will become the new funding model for aged care and with it comes a case mix approach to government funding. Each resident will be assessed on their care needs to determine their care classification and each of these classifications require a specific number of care minutes. The average care minute requirement is 200 minutes per resident which made up of Registered Nurses, Enrolled Nurses and Care Workers, 40 of these minutes (on average) must be Registered Nurses only.

In this model Enrolled Nurse minutes have no greater value than Care Worker minutes.

And thus our quandary.

Do we really need Enrolled Nurses in aged care?

Or more to the point if they are not going to provide any greater care minute value than Care Workers, can we afford them?

Workforce is the biggest cost for Aged Care Providers. The possibility of reducing this cost by replacing Enrolled Nurses with Care Workers is an option Aged Care Providers are contemplating. ?

There are 3 important factors to be considered when comparing Enrolled Nurses and Care Workers.

1.??????Care Workers are around $4-5 cheaper per hour than Enrolled Nurses. Not an insignificant cost saving.

2.??????Enrolled Nurses are registered with Australian Health Practitioner Regulation Authority (AHPRA) whilst there are no registration or licencing requirement for Care Workers. In the last week I have heard of Care Workers being terminated due to inappropriate conduct, only to be employed by another Provider nearby. And while the overwhelming majority of Care Workers provide great care, this scenario is not an isolated case. Providers cannot go online and, in a few minutes, ensure their Care Workers are registered as they can with Enrolled Nurses. ?Care Worker registration is an idea that has been floating around the sector for years. This may get greater government consideration if they see a reduction in Enrolled Nurse and increased in Care Worker minutes reported in the QFR.

3.??????An Enrolled Nurse holds a Diploma qualification and are required to complete 20 hours of continuing professional development that is directly relevant to their role each year. Often the Enrolled Nurse acts as a Team Leader on the floor at an aged care facility. In comparison, there’s a preference for Care Workers to have completed their Cert III but this is not mandatory. I know from my time working with Aged Care Providers in the education space that ongoing education Care Workers are offered varies significantly.

There are many Providers who have managed the risk of reducing Enrolled Nurse hours in their roster in line with their resident care needs and are delivering a good standard to care. However this care model takes time to develop and refine - and time is not something aged care execs have an abundance of.

The 200 minutes do not become mandatory until October 2023 however they will make up 30% of a facility’s star rating which will be published in December. Additionally, the care minute requirement will increase to an average of 215 minutes, 44 of these being filled by an RN, in October 2024.

Each week I am having dozens of conversations with Aged Care Providers about how we can support their care minute rostering and management. Many of them are concerned they won’t have the staff to meet care minute requirements at all, regardless of the staff designation.

You would have to be living on Mars to not know that the aged care sector needs more staff urgently and a concentrated effort to make the sector more appealing to employees.

There is a case for increased wages before the Fair Work Commission and Aged Care Minister Anika Wells has stated multiple times publicly that the federal government will fully fund the pay rise recommendations. However, this case may not be finalised until the last quarter of this financial year.

The industry will be better funded under AN-ACC if Providers understand it’s nuances and how to achieve optimal performance. But a pandemic and industry wide staff shortages will eat into this extra funding.

In a time of increasing financial pressure for the industry, balancing clinical risk with a bottom line that is black not red is just another tough call Providers are facing.

Please note these views are my own.

About me: I have been part of the aged care sector for 13 years and currently work with the awesome team at?Mirus Australia who are committed to #makingagedcarebetter