The saga of Enrolled Nurses and care minute targets

This article was written by Steven Hughes, Aged Care Specialist and Consultant

The Enrolled Nurse (EN) care minute saga is a tale of make-believe and mismanagement worthy of a Netflix series, yet sadly with no dragons.

In Episode 1, The Department of Health and Aged Care made a fateful decision to excluded EN minutes from Registered Nurse (RN) minutes in care minute allocations. This meant EN minutes would be supernumerary to, not supplementary of, RN minutes.

ENs were now competing for work that a PCW could complete 25% cheaper. The EN exodus from aged care began.

Recognising the damage of this decision to the EN workforce, Episode 2 saw The Department include EN care minutes on the My Aged Care website. While this provided transparency for EN care, it did not end the declining demand for ENs.

Episode 3, set amongst the backdrop of the incoming care minute increase, saw further effort to stimulate employment of ENs, by permitting EN minutes to make up 10% of a provider’s RN care minute target.

This decision is troublingly flawed and will not remedy the declining demand for ENs in our industry.

The 10% allocation does not allow for adequate EN coverage. As an example, a 100-bed facility, working to the 44-minute requirement, will staff approximately 10 RN shifts per day.

The 10% EN allocation will allow for just under 1 full-time EN shift per day, leaving providers with no capacity for afternoon EN coverage.

And it is worse for small or low acuity facilities. A 60-bed facility is permitted one 4 hour and 24 minute EN shift per day. Not only is this impractical and difficult to staff, if this EN shift replaced an RN shift, then a 3 hour and 12 minute RN shift would also be needed to maintain full RN care minute compliance.

If this provider instead chose to employ one full time EN, then they would use 17%, not 10%, of their RN target. The Department has not made clear how the additional 7% would be managed.

The 10% allocation unfairly rewards providers who fail to achieve their care minute targets, while penalising those who do.

A 1-star and 5-star facility, with the same AN-ACC care minute requirement, will both be permitted the same EN minute allocation. This is especially vexing as the 5-star facility may have up to 6 additional RN shifts per day.

A welcome plot twist for Episode 3 would be the initiation of dialogue between The Department and industry that acknowledges the following:

Firstly, the decision to use a percentage allocation was a poor one and shows an acute lack of awareness from The Department on how providers manage their rosters.

EN care allocations must be based on full time shift patterns, regardless of a facility size or AN-ACC care minutes, across the full working day.

Secondly, a ratio, not a percentage, is a more sensible method for allocating EN coverage. For example, a 2:1 RN/EN ratio would allow a 100-bed facility a full EN shift across both the AM and PM.

ENs provide an important and cost-effective service to residents and the care team. Let’s pray in Episode 4 the Departmental Lords recognise and respect their valuable contribution.