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‘Brain Drain’, Aged Care Nurses leaving for greener pastures

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Lauren Todorovic
‘Brain Drain’, Aged Care Nurses leaving for greener pastures


Why are we some of our most talented and passionate nurses leaving the aged care sector?

The aged care industry, like other areas of the healthcare system reliant on health professionals, are facing major challenges in sustaining a healthy workforce to meet the rapidly rising demand in Australia’s ageing population. This is amongst a backdrop of many of the more acutely ill ageing population living in nursing homes now requiring more intensive levels of care such as post-operative care, palliative care and dementia with challenging behaviours.

To set the scene, there are some 358,497 practicing registered nurses and midwives in Australia (2015) [Nurse & Midwife Registrant Data]. Importantly, however the last available national statistics on the aged care sector (Australian Government Department of Health and Ageing 2012, see table below) highlight a trend to increasing personal care attendants (PCA) and a slower growth, certainly not enough to keep up with the industry growth and demand for beds, of registered nurses (RN).

During the global financial crisis the number of nurses leaving the workforce declined, however it is expected to rise in the next few years as nurses explore greener pastures and consider new careers. The number of nurses and personal carers that leave the workforce is one third higher than for the health care and social assistance industry and slightly higher than for the economy in general. The Productivity Commission was of the view ‘that the sector overall has a high turnover rate, with around one in four personal carers having spent less than a year with their current employer’. High staff turnover isn’t only an expensive exercise for aged care providers, but also unsettling for residents in their care. The impact is often a reduction in the quality of care provided.

So why is staff turnover in aged care is so high? Over the years I have witnessed many skilled, passionate and dedicated senior and junior nurses, and personal carers, vacate the workforce. Either returning to the acute, exploring other areas of the healthcare industry, or simply wanting to leave the industry for good. While the reasons aged care workers may choose to leave the industry are multifactorial, in most cases it’s not because they no longer want to care for the elderly but for more emotive reasons that I will discuss in more detail shortly.

What is it about working in aged care that is compelling this mass exodus, or ‘brain drain’ so to speak from the sector, and how can we encourage and promote the positive aspects of working in aged care to young graduates, or experienced nurses alike? After all caring for the elderly and providing the very best care to them can be one of the most rewarding parts of the job where individuals can feel satisfaction in making a difference in the lives of others. A report published by The Department of Health elegantly summarises from my experience why aged care workers, in particular nurses are leaving the profession, some include:

  • Professional burnout, work related stress, and lack of management action to address these issues;
  • Decreased job satisfaction due to lack of autonomy;
  • Inadequate remuneration and industrial relations issues;
  • Trying work conditions;
  • Increasing workloads;
  • Lack of opportunities for career progression, including lack of opportunities to participate in continuing professional development;
  • Lack of professional and skill development opportunities.
  • To begin with let’s discuss in a little more detail about some of the main areas.

Nurses leaving the profession- but why?

Inadequate remuneration and industrial relations issues

A recent report indicating sector profits are increasing substantially for some aged care providers, showing 40 per cent up on last year, whilst the hours of care delivered to older people are reducing, down 7 per cent. In particular from trained nurses, and other costs per resident.

A 2012 report released by The Department of Health & Ageing, Aged Care Workforce, showed the disparity in average weekly earnings between aged care and acute care nurses is a $114 per week nationally, in favour of the acute care nurses. With the greatest disparity in the Northern Territory at $295 per week, it’s no wonder they struggle to attract nurses to the outback. Remuneration is symbolic of more than an employee's pay packet, it’s symbolic of an employer's recognition for their team's hard work, appreciations and motivation, as well as their sense of ‘worth’. To be paid a low salary in combination with feeling unappreciated by the employers, quickly leads to an unmotivated workforce, not wanting to do more than the bare minimum and if they stay in their role, not emotionally connected or providing quality care. In more and more cases, this is leading to the staff seeking opportunity to ultimately exit the industry.

Having low paid, low skilled workers delivering care to people with chronic and complex conditions, severe dementia and behavioural disorders in many cases puts quality of care of these particularly vulnerable people at risk and will the problem only projected to get worse.

Often it’s not the actual day-to-day work that hastens nurses leaving a career in aged care, nor is it remuneration alone, with nurses aware of the salary before entering the profession in the first place. However when you couple working conditions, lack of professional development and leadership among the other areas mentioned, at some point, it gets the better of the individual that had expected more.


Lack of professional and skill development opportunities

Leadership education for nurses, or the lack thereof is also suggested as a reason for turnover with good clinical nurses at some point promoted into leadership roles without the qualification, skills or mentorship to undertake this important role of not only motivating and inspiring a team, but also ensuring the delivery of quality care to residents. Without seeing the need for development, or simply failing to invest in nursing care expertise in the first place, has a multitude of economic and social impacts too. Nursing as a profession is one of the largest health professions, working in most areas that healthcare is delivered. No other health professional group offers the same capacity and reach for health care delivery as nurses.


Trying work conditions

Difficult working conditions including insufficient time to complete the necessary requirements for each resident being supported by a nurse in the facility to ensure they are provided with quality care, too often gets the better of nurses with a particularly high personal standard. Job satisfaction, quite understandably among nurses is closely related to having adequate opportunities to provide quality care and team collaboration. If nurses are unable to maintain care standards and continue to be excellent clinicians, as their workloads increase along with their scope of practice, preventing them from providing humane and holistic care, then it’s no wonder good nurses reach a tipping point and leave. Competent and skilled nurses play a critical role in ensuring a high standard of clinical care and leadership are delivered. They are a critical link with other members of a resident's multidisciplinary team often responsible for observing health issues in a resident earlier than a doctor may have opportunity to see a concerning symptom. They are part of the ecosystem of care and support that the health system cannot operate without and relies on for efficiency in early identification, and prevention. Without nurses the workforce and sadly our elderly under their care suffer as a result.


Professional burnout, work related stress

It is common for nurses to work long hours, in some cases unpaid overtime or working without breaks, just to ensure the basic standards of care are delivered. Work related stress, can stem from the sheer workload and significant responsibility of overseeing the care of residents’ needs. Coupled with managing the high standards and expectations of residents, or the questions and demands of their concerned families and guardians (and rightly so I must add). This can be a challenging aspect of the job, especially when some nursing and personal carer staff have not received adequate interpersonal training to do this; to listen to the family, understand and acknowledge their concerns and provide reasonable and transparent information, and expectation management, fairly and sensitivity for the situation the loved one of the family may be facing. This is made even harder when at times as a nurse, you may in fact completely agree with the family that is raising a particular concern or complaining however, how does one explain to them that as a nurse operating in today’s environment with today’s pressured time conditions and limited support staffing resources, that nurses simply do not have the bandwidth to complete some requested or missed tasks as trivial or important as they maybe; or a nurse simply can’t guarantee staff will think to action a family’s request or a resident’s requirement every day with the level of care delivery being so person dependent. None of these scenarios being a reasonable outcome under the lens of quality of care.


Lack of management action to address these issues

Lack of management action and the behaviour of some managers was identified in the report by The Department of Health & Ageing as a highly significant factor impacting on employee turnover in the nursing profession. Nursing leaders themselves confirmed that within the overall culture in healthcare services, work conditions across Australia need to improve and organisations need to evolve their standard practices by developing supportive and strong leadership to drive collaborative and supportive action sustainably amongst the workforce against the backdrop of staff turnover. This is necessary for organisations to enhance contemporary clinical practices as well as improve the environment overall staff job satisfaction and working conditions.

In the absence of effective leadership, employee satisfaction can be affected, along with trust in management, the culture of the organisation, the individual’s commitment to do more than the basic requirements, and individual and team effectiveness in general. Leadership is central to mobilising individuals and teams towards a common goal, creating a positive working environment that is successful in attracting and retaining a high standard of nursing staff, as well as achieving outstanding health outcomes. Given the issues faced by the sector, the leadership in the nursing sector and those responsible for it have a large burden and challenge ahead of them indeed.


Conclusion

There remain a number of areas of the aged care workforce and systemic issues in the sector that need to be addressed at both an industry level and within individual organisations to put a halt to the ‘brain drain’ effect that sees many skilled and passionate nurses leaving the industry. ‘Brain Drain’ is a term often used to reflect the loss of talent and experience from Australia to overseas markets but in this case it is the loss of competency, experience and qualification form a sector, the aged care nursing sector, and the issue is only getting worse.

Major issues around workplace environment and the culture embedded in practices for some individual nursing homes and organisations alike are a direct result of the lack of management and leadership skills present, along with levels of remuneration and workloads for aged care workers. Whilst some of the areas talked about around job dissatisfaction are intrinsic to the nature of the work, some others may easily be addressed, mitigated and improved by the actions of management. Strategies will need to include creating a culture of supporting one another, showing staff they are appreciated for what can be an often thankless job, developing and investing in the training of skilled clinical staff to take the next step as a leader in management, leadership to not only support the workforce but continue the focus on improving and ensuring excellence in the delivery of care to residents. The ability to perform one’s job well often directly results in a more cohesive and satisfied workforce, and critically, helps ensure the quality of care for patients, residents and loved one’s in their care.


Have your say, share your experiences of working in aged care. From rewarding moments to challenging situations. How have you overcome these and what advice would you give other aged care professionals to continue working in this area?

Join the conversation

39 Comments:
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Comments

In my case I was an RN in aged Care and was replaced by EN's, I chose not to accept what I was offered and left the profession altogether after being in the one Nursing home for 20 years.!!! Was not happy.
I was in exactly the same position!! Same place of employment for 20 years and replaced by new EN's I also chose not to accept what was offered and left the profession altogether. as well. I realized how burnt out I was after I had retired. It is a very demanding job and definitely no appreciation by heirachy for the extra hours you put in for no pay. I always put my staff and residents first but money runs everything!!!
so true
Have worked in aged care for 30 plus years as Manager / DON. Had some really nasty experiences with some proprietors / GM's. I felt completely undervalued and disrespected. At 63yo, I can no longer do management, just too exhausting and frustrating having to be told by senior personnel in Admin who tell you how todo your job, with no basis, other than to save money! All responsibility and no rights!
I left a Nurse Unit Manager Position to have my two children and apart from the odd casual shift never went back after 2005. For pretty much all the points mentioned. After 15 years in Aged Care I could no longer practice in what I called a safe, professional manner. I watched Care Assistants do their Cert 4 and become Enrolled Nurses, work in the same facility and truly believe all that a Registered Nurse did was the drug rounds. Hence that's all they did when they were employed to run a Ward/Unit. As the overseeing RN I was not prepared to be accountable for their work. Don't get me wrong, some of the best Nurses I have worked with have been EN's. But a new EN has to have more experience than the same Aged Care Facility that they worked in as an Assistant. I gave up my Registration in 2010 and have never looked back. However I have been extremely fortunate to have a partner who has supported my dreams. Otherwise I would be still be there and no doubt turn into one of the bitter old RN's I used to see when I first started ou Nursing in 1989.
Very well stated.
Totally agree. This was my experience also have just retired at 64yrs after 40 odd years as an RN. I worry about the current education of EEN's who do 18months at TAFFE come back to the aged care system and RN are accountable. No thank you.
Very well presented I'm sure you have the support from so many who experience the same & feel exactly like you I know I am one of them
Very well presented I'm sure you have the support from so many who experience the same & feel exactly like you I know I am one of them
My mum has Alzheimer . She has been in a home now for 8 years. Over that period of time I have seen the best most dedicated nurses brought to their knees with long hours little or no appreciation from higher up the chain, who seem intent on working their staffs guts out to total burn out, rather than having enough staff qualified to perform the jobs expected of them. These nursing homes are not cheap. I see staff being brought in from agencies, some of which have no idea of how to care for these dear old people. This situation is so unfair on both the staff and the patients
My mum has Alzheimer . She has been in a home now for 8 years. Over that period of time I have seen the best most dedicated nurses brought to their knees with long hours little or no appreciation from higher up the chain, who seem intent on working their staffs guts out to total burn out, rather than having enough staff qualified to perform the jobs expected of them. These nursing homes are not cheap. I see staff being brought in from agencies, some of which have no idea of how to care for these dear old people. This situation is so unfair on both the staff and the patients
I am a little miffed that your wonderful article mentions Registered Nurses, but not Enrolled. I am an EN working in the Aged Care Sector and I agree with most of what you are saying. I personally have 34 residents I care for, but there is very little time to do any one on one care. This is left to the carers who advise when the residents are having issues which I have not picked up on during my medication rounds. Things like skin tears or skin breakdown. Then I spend some one on one time with them, which takes away from the time I have to do my wounds and documentation. All of which take time. And I am guilty of not having breaks some days because I just cannot get through everything which crops up and the paperwork which goes with it in the time allowed. Something has to give and I would rather it be my break than allowing a resident to have to wait 15 minutes for a n examination of an area whilst they are in a sling. This may be the best time to view this. But love my "oldies". They are awesome. I would like to see management do an entire shift themselves to reacquaint themselves with the issues we face each day. I do believe they are so very much out of touch of what they are asking their staff.
So true ! The EN team leaders I work with work up to an hour unpaid overtime a day . Their dedication is awesome !
Because where I come from staff are told they are replaceable
Because where I come from staff are told they are replaceable
Dear Ms Todorovic I agree with all that you say, however, I can't but feel that you should have also mentioned the patently obvious and long standing failings in the operation of the Aged Care Accreditation Standards/Outcomes, the wording of which is so vague as to be almost meaningless from the perspective of achieving effective transparency, scrutiny and accountability of the sector, the Aged Care Funding Instrument (ACFI), which is similarly poorly worded and, in fact, perversely promotes resident dependency and ignores the need for every reasonable effort to be made to maintain, where possible, or to improve the mental and physical well being of residents, and the truly unchallenged capacity of the peak bodies to influence the formulation of public policy via representations to senior parliamentarians and bureaucrats. In the absence of political will at the highest level, I fear that the combination of the factors referred to above will sadly mean that working in a nursing home shall continue to be an unrewarding and stressful occupation for nurses and PCA's alike and that the general standard of resident care will decline as the sector becomes increasingly dominated by very large, for-profit providers who not unexpectedly see aged care as an industry rather than as a vocation. The peak bodies do not, of course, seek greater clarity in the Accreditation Standards/Outcomes nor an Aged Care Funding Model that addresses the inevitable conflicts of interest in the operation of nursing homes, as this would dramatically strengthen calls for the adoption of mandated ratios for nurses and PCA's, which I enthusiastically support but which the peak bodies will steadfastly oppose. My Change.org petition in regard to the almost ubiquitous lack of focus upon the retention of residents' mobility, which I deliberately directed to the Prime Minister, illustrates the moral bankruptcy that characterises much of the sector and the disgraceful care that we provide to residents. Kind regards BOYD FRASER
Worked Aged care for the Last 29 years, over worked ,bad managers ,PCWs telling u what to do. Quality of care is dropping with this. I am an EN .Short of staff is a regular thing. You have to stay and do documentation
Worked Aged care for the Last 29 years, over worked ,bad managers ,PCWs telling u what to do. Quality of care is dropping with this. I am an EN .Short of staff is a regular thing. You have to stay and do documentation
Personal care workers have a staff ratio of 7.5 take 1 hour plus for serving breakfast that we have toiled residence in the same uniform..we serve teas coffee make toast wait on tables deliver meals in the same uniform take 1 hour out for serving linches again in the same uniform. Take 1/2 lunch break and a ten minute coffee break. What does that leave. It leaves 15 minutes per resident to shower dress make bed tidy room and chat to the person assess report are they unwell etc etc.
I also work in the industry.It's an utter disgrace.Fed up with greedy people profiting from vulnerable people.I'm exiting the industry.
All of what has been stated is true. THERE MUST BE MORE STAFF ACROSS THE BOARD ALLOCATED TO CARE FOR OUR BEAUTIFUL FAMILIES. The Church based or not-for-profit organisations also fall under this category also.
It's all true.
I have been working in the nursing home Sector in Perth for the last 7 years I have noted a great decline due to the economic situation & permanent qualified positions being limited & financial cut backs many nursing homes are employing cheaper labour , I have witnessed increasing bullying going on within facilities it is so common now it is accepted as no one wants to speak up in fear of loosing their jobs and sadly the employers know this and can literally over work their staff and treat them badly . The RNS hit the worst with horrific work loads they possibly can not handle the increase of the pressure of work logs ecase , no breaks & continual negativity and lack of support from management , staff moral is at a all time low , staff turnover is high & nurses are literally burning out the impact on residents and their care is great and the level and standards are dropping , even the unions are limited in what they can do in the end most nurses just end up leaving .... And it's usually the most hardworking & skilled ones I fear for the future for the aged here in Perth & for the nurses it is so wrong I wish the people who own these nursing home companies wete made accountable instead of lining their own pockets all they care about is making money residents & the staff mean nothing .....
Shame.Shame .Shame.
I have worked as an ain for many years and have been mentally affect physically affected by the gruelling hours with no consistancy in the rosters being put on days nights afternoons with no proper breaks between the shift changes working shortshifts and still expected to complete the duties that 4 or even 5 staff usually do with on two staff Excessive workplace bullying non existant pay rises and management that treat the staff like second class citizens with comments like do you know how many people ive had looking for work in other word were not appreciated because were expendable its refered to as zombie work because this is how staff end up 6 yrs straight i was put on christmas morning shift 7 yrs of missing my sons christmass what apreciation did i get when rxpecting a proposed pay raise from that particular company a cheap jar of chocolate coated peanut and christmas card that states the commitee has denied the payrise that staff had nogotiated and waited since june that year for why are people leaving you do the math
we have lost the legal requirement to have a registered nurse on site 24/7
Have worked mainly in Aged Care, since becoming an Enrolled Nurse over 40 years ago. Have seen changes,some good, some not so. We desperately need specific Dementia care units, especially in Rural areas. Mainstream Residents are not tolerant with behaviours of Dementia Residents. Staff don't have the time to complete all that is expected in a shift. The paperwork is beyond belief. I loved my job, but have no regrets about retiring. It's a business now, the almighty dollar speaks!
We have been looking at this problem for many years. And the answer is the same. Nothing will be done so don't get excited!
I agree with all the above comments having worked in Aged care as an RN for 15 years. Aged Care is all about profit. Dedicated staff cannot possibly keep up with the workload and many end up saying it's just too much and leaving. There is no job satisfaction. In my case, due to reduced staff numbers and while looking after 50 people, my feet became very sore over a period of 10 days. The bone in the ball of my foot snapped while I was at work. Many complications developed because the insurance company would not approve treatment and I have not been able to work ever since. That was 6 years ago.
I have a grandaughter who Graduated and is a EEn ,she has been trying to get work for the past 4mths ,after applying for so many job's and getting told she has to have at least 1 years experience,she is starting to feel really down and stressed as no job no money and bill's stacking up ,lot's of tear's..I know that aged care need's nurses and I can tell u she has tried every where ,I really feel for her ..I worked aged care for 20 yrs ,just can not understand why Hospitals or aged care do not pick her up ,she has wonderful cv,so please some one give her a job...Thank you !!!!
Talk about profit making....no increase of work load (same number of resident beds), but two new managers (clinical and care) positions have been created because of office politics. However, the cleaners and laundry have less time to work on weekends( saving money!) because I guess residents soil sheets and clothes less and make less of a mess BECUSE ITS A WEEKEEND?
Choosing this field of their interest..
I agree with your post. I have worked in aged care for 30 odd years. If it wasn't for the fact that I love my elderly clients, I would quit. I know my job inside out. I go out of my way to be kind, compassionate and non judgemental. I often have clients I form a bond with, which is what keeps me going. Our pay is ridiculously low, I would get more making coffee, yet at times the life of my client is in my hands. I hate being micro managed, and now told that we should not be getting too close to our clients. Our hugs are sometimes the only physical touch they get. So are our visits. I have seen things in the community that are horrendous. Yet nothing gets done. Reporting elder abuse is a joke. But I keep going, because I hope that the hour or two I am with them, gives them comfort, a laugh or just so they know someone actually cares. I am not interested in going back to residential care, as my friends tell me its all about the dollar, not enough staff to even get a coffee break, no appreciation and total micro managing. The client's pay very good money for this non service. Shame on these disgraceful companies.
I loved working in a clinical position but was so undermined by managers with less experience that I have taken a clinical advisor position. Miss working with residents but not prepared to be unprofessional to meet the needs of a manager who has less experience
I have worked at same facility for 13 yrs. I work in memory support. We have 28 residents in our unit. I start at 7am with one other pca and an EN who is not allowed (suppose) to work on the floor. 2 other pcas start at 0800 till 1300. I shower for one hour, hoping to get done atleast 4 residents in this time. We then serve breakfast and cook 3 loaves of toast while assiting residents making tea and coffee. Continuing with adls until 1030hrs which we then serve and assist morning tea. Adls and toileting until 1200 hrs. We then dish up meals which come in a bain maree also assisting with feeding. 1230 hrs lunch for 30 mins. Continue with toileting,linen run, rubbish run, paper work while attending to numerous behaviours. I do take a huge amount of pride in my work in which i love doing. But i know our residents aren't receiving the care the deserve. I come home feeling so guilty as i know im not able to do my job properly due to the ridiculous work load. It doesnt matter how many complaints and requests for extra staff are made, it falls on deaf ears. Under no circumstances would i ever put my mother in an aged care facility
I like many have decided not to continue my nursing. Like many I worked in Aged Care for most of my nursing career. I was EEN working in wings of 30- 40 residents. Worked countless unpaid hours. Worked shifts where RN in charge was straight out of university . This was alarming as they were unsure about many things. When handing in my resignation I was told by GM that they didn't care how many staff left as staff are only numbers and replaceable. It was hard to work in the conditions they expected. Eg shortage of staff, equipment, medical supplies. The hierarchy were also bullies and bullying seemly was promoted and never address in the workplace. I too have moved into another career and am much happier.
Well when u try to do the right thing by a resident and the inexperienced EEN and RN that weekend can't understand leaving a person returned from hospital with no food, no water and no medication for a whole weekend and you speak up that it wrong, you get sacked because you are a trouble maker and the Clinical Nurse and assistant Integrated Service Manager create false documentation after the weekend to cover their arses when the government come asking questions... is it any wonder care standards have dropped? The industry needs a huge shake up. ACFI documents are routinely made up and self assessed. One client hadn't had a bowel movement recorded in 18 days yet was ACFI listed as requiring staff to help toileting. It was all faked for funding. This goes on regularly. There is no way a single cater can look after 14 residents to the level they are funded at. You do not have the time to shower 3 of them, dress a few more and wheelchair the others to breakfast. Residents often inadequately "wash" without supervision even when they are listed as full assist. It's wrong and staff need to start speaking up. These non-profits are making huge Surpluses all the whole they are crying poor to staff.
Very true article, well put together. My wife is an EN and it is normal for her to work through her breaks and UNPAID 30-60 minutes after her designated time so that she can finish her tasks. When she politely asked if consideration could be given to paying her for this time, her time management skills were questioned and she was reminded that there were plenty of nurses out there looking for jobs. Senior Management publicly extol the care, compassion and dedication of their staff, yet their actions show they are solely interested in $$$. In most cases nursing and care staff on the floor are bullied and harassed into accepting the fact that they must finish their allocated tasks within their (often reduced) normal working hours or work extra hours unpaid to complete them (and should they make a mistake whilst rushing , they are hauled 'over the coals' and disciplined). Last year my wife 'gave' her employers over $3000 in unpaid hours. When it comes to the ratio of remuneration for responsibility, nurses must be very near (if not at) the bottom of the list.
Very true I work now as a agency EEN and we get 6 hours a shift in aged care to do 8 hours of work but in acute care I get 7.5 hours and all gets done on time time management isn't the problem it's row faster because of $$$ wouldn't work only aged care on a bet

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