The community has been successful in demanding reform for care delivery to the older population and the frail and vulnerable in our society. The government has moved through the reform process and the new CDC platforms of service funding and delivery are in place and rocking the boats of many in the sector. The role of the registered nurse in aged care and community services has missed the call again. More often than not, I am seeing a service provider employing: a person to be a CASE Manager, a person to be a Care Coordinator, and on the outset an RN for clinical issues and advice. Did you realise that a nurse can be all of these roles (and more).
Aged care and Home /Community organisations need to identify and adapt to the changes needed to recruit and retain the most valuable professional member of the business (the RN) as a holistic key person in client case management. The first thing that needs addressing is that nurses are still being used as a commodity or plug and play to workforce issues, and not as the professional partner in care. With the current funding and consumer directed care model, placing the RN or nurse as a specialised care service that requires more out of the package or perhaps an out of pocket expense, we see more consumers seeking better services or negating cheaper care. This affects clinical governance and in turn quality of life.
The Role of the RN in Gerontic, Home and Community care has shifted dramatically over the last decade. The skills needed by an RN in home and community care are diverse as they are complex for meeting the operational needs of supervising the multidisciplinary healthcare team that is delivering the service. A modern nurse is ‘NOT JUST A NURSE’. Nurses are great transformational leaders, they prove this in their therapeutic relationships and practice standards. Nurses make the perfect fit to be the all inclusive CASE Manager/Care Coordinator/Clinical Advisor, holding expert skills in observation, communication, leadership and management as well as holding professional registration which comes with holistic and professional focus on service to clients and organisations. The skills and knowledge to meet contemporary practice begin for the RN in the following areas:
Regardless of the numerous environmental, cultural and subcultural (workplace/operational) issues that sit around care planning, it is and still remains a fundamental value in the nursing process, and one that requires some critical thinking and clinical leadership in regards to effective management. Nurses have deep ethical and professional concerns when it comes to applying and implementing the outcomes of our focused work, particularly when we realise that it could all be in vain as the true value is not being recognised or respected. Nevertheless, I would advise all nurses to build some emotional intelligence when reflecting on your practice and ask yourself some critical questions.
- Assessment for transition into a care home or packaged care in the community
- Clinical assessment in complex health care and chronic disease management
- Re-ablement and wellness goal setting and support planning
- Dementia specific transitions and care goals
- Behavior management
- Palliative care approaches and process
- Pain management plans
- End of life Care planning issues
- The dying process and care
- Grief and loss counselling
- Case management and clinical reviews
For delegation to staff alone it can also include:
- Duty of care and responsibilities
- Quality documentation and communication (including training)
- Performance management ( including mentoring)
- Bullying and harassment management
- Abuse and neglect training & monitoring
- Conflict management issues.
On top of these skills comes professional practice, funding, resources, autonomy and accountability when issues go pear shaped ( and they do). Add to this the compliance for CDC and residential care and we are looking at a very important team leader. This is one place that the contemporary practice of nursing is being underutilized.
Attracting a good quality nurse professional is a Key Performance Indicator for any aged and community care business. Why is it that we have left the important decision making in regards to care needs and services to the people that have limited multi disciplinary skills and require another person for support? Perhaps it is the perceived costs of having and RN to come into the home to ‘do’ a job or task. Perhaps it is nurses themselves that do not value their own scope of practice to become expert CASE Managers, or perhaps the voice is not loud enough in regards to nurse lead care management. Either or, it is time for a revolution in aged care and community nursing, and one that should be led by our most senior nurses and professional advocates. As the number of elderly in the population increases so too does the demand for quality nursing care that enables choice and quality of life in a palliative approach. Why it is that general consensus is that we can leave the care of aged, frail and disabled consumers in the hands of the non-regulated , non-professional workers without quality clinical leadership.
If you are a nurse and you have a passion in the aged and community care then my advice is to build your skills to meet the KPI of CASE Management and go after these challenging yet rewarding roles. If you are a CEO or executive manager reading this than my advice is to reflect and review the positions, roles and KPI of what it is you are aiming to achieve. Investigate and look at the role of the RN CASE Manager, one that can hold a client base of 60 plus. Recruit and retain one of the most valuable and professional multi skilled people in the game (the RN) there are many out there looking for the right role in the right organisation for the right pay parity. You don’t have to teach them much, because that’s included in their own CPD. Design the role, pick a motivated leader and build better care teams, give the clients what they truly want and deserve. I know there is much to servicing the community in the CDC, NDIS, MH and CHSP. Just remember, ‘A Nurse is NOT just a Nurse’. Unless that is the role you build for them.