Care minute exclusion of Enrolled Nurses could hurt workforce sustainability

Mandatory care minute requirements for residential aged care have come into effect as of October 1 with the Federal Government calling it a boost for care levels. However, there are those who still want to see further refinement and adjustment to the mandates to better protect staff job security and continuity of care.

Minimum care time standards were recommended by the Royal Commission into Aged Care Quality and Safety, a move many within the sector have supported, including Fronditha Care CEO Faye Spiteri. 

Ms Spiteri has held the position of CEO at the not-for-profit organisation since 2021, and she acknowledged the aged care sector has experienced a considerable amount of disruption, change and transformation necessary for the lifting of standards. 

In order to deliver quality holistic care, Ms Spiteri has seen her organisation attract an additional 200 staff members since 2021, including many with bilingual skills in Greek to cater to a diverse community care client base. They also have roughly 80 RNs on board, a result achieved through strategic and tactical recruitment to meet compliance and care needs.

But when paired with the challenges of the COVID-19 pandemic, mandates and compliance requirements have been a heavy ask even for the most strategic organisations already under pressure to fill workforce gaps. 

“If you overlay recent changes, requirements and mandates with the COVID-19 pandemic it has been a very unusual time to focus on business as usual and then on reform. If all things were equal I think providers would have had a different response to the care minute requirements but losing [members of the] workforce has created double the challenge,” Ms Spiteri told hello leaders. 

“But it is a challenge we were happy to take on. We have had 24/7 Registered Nursing and other structures in place to ensure that we provide excellence in clinical care and other aspects of caring for our elders and residents in our facilities, including their cultural and spiritual care and general health and well-being.”

Labelled as an “important milestone” by the Minister for Aged Care, Anika Wells, the mandated care minute requirements are simple enough on the surface; every residential aged care facility will have a case-mix adjusted number of average care minutes to deliver per resident per day, which will contribute to a sector average of 200 care minutes per resident per day (including 40 minutes of Registered Nurse care).

However, there are no specific requirements for the amount of care that has to be provided by Enrolled Nurses, Assistants in Nursing or Personal Care Workers, resulting in some nurses losing jobs or being moved to new positions. As a result, the depth and diversity of the aged care workforce could continue to be put at risk, rather than be strengthened, if providers are working to just meet mandated requirements.

It’s why Ms Spiteri appreciated the introduction of the mandated care minutes as an ambitious approach to lifting standards, albeit one that did not recognise the holistic approach to aged care. 

“We looked at our existing workforce and identified how it could be bolstered without letting current staff go. When you look at it deeply, my view was that removing staff would undermine the capability already built because you have that connection, the commitment, the people who have been trained in the Fronditha Care way,” she explained.

“You can appreciate the logic of the RN care minute mandate but care on the ground is delivered in a much more holistic way. It’s not like an RN will be on their own doing care planning. They work collectively in a team with the ENs, PCWs, clinical care coordinators, deputy managers and managers.”

Currently, the Government does run the risk of further splintering its workforce if it does not recognise the clinical care provided by ENs in equal measure with RNs. There have already been mixed reactions to not including non-direct care staff in its interim 15% pay rise funding, while not investing in nurses of all skill levels could see workforce sustainability take a further turn over the coming months and years. 

With mandatory care minutes in place, Ms Spiteri said the 40 minutes of clinical care included in the 200-minute total should include ENs as formally recognising their contribution would improve job security and highlight career pathways.

“We believe that EN contribution needs to be recognised formally because it’s currently a limitation and it’s having an adverse effect. It is an overcorrection. In principle, the aim of the 40 minutes requirement is very important but not including ENs in the 40 minutes is counterproductive to investing in staff and their career paths,” Ms Spiteri said.

“It’s about appreciating the career path and trajectory for someone who decides to go into nursing. There is an investment they make in terms of their commitment and dedication while we work hard to build on the capability and capacity of our ENs through training and investment so they can transition to becoming RNs. If this part of the workforce isn’t included in the care minutes and we can’t afford to keep them, who is next in line if your RNs move on?”