Staffing levels – is skill-mix the formula for success?
Last month we reflected on how friendly our nursing workforce is and reflected on a degree of bullying in the workplace. This month we look at the discussion around whether mandated staffing levels in aged care as a ratio of care to residents would improve care services?
Rather than numbers of personnel alone, to provide safe and appropriate nursing services, staffing skill-mix (taking into consideration the workforce diversity, layout of buildings and location of resources) is essential to ensuring appropriate effective staffing. These factors are not taken into account or provided for within the industry funding levels which puts additional pressure on those working in aged care services.
While performing statutory (temporary) management roles over past years, adequate numbers of staffing alone hasn’t guaranteed safe and appropriate care. Nursing outcomes for residents have been reliant on a mix of highly skilled staff working in conjunction with newer or less experienced staff. There could be 10 staff on duty but if none of them have had previous experience working in aged care services, these staff are set-up to fail in performance of their duties, and the resident care outcomes are likely at risk.
SNZ HB 8163:2005 – ‘Indicators for safe aged-care and dementia-care for consumers‘ is a national document which includes formulas for staffing levels based on acuity of residents. This document sets the industry guidelines and although not mandated, defines staffing from a best practice perspective. Numbers alone as already mentioned is not sufficient. The 2005 guidelines didn’t take into account the size of the facility in relation to economy of scale and appropriate cover in conjunction with the minimum staffing requirements in the ARRC. Having been implemented in 2005 when resident needs were less complex than they are in 2018, it’s well past time to review how staffing mix is determined and more importantly how the industry will fund it.