New blood for aged care

1 July 2013

Aged care has one of the fastest ageing workforces. Getting new blood into the workforce is an obvious need and a pilot underway of providing extra support for new graduates entering residential aged care is one step being taken. FIONA CASSIE finds out more.

At just 22 years of age and fresh from nursing school, Whitney McIntyre says working in residential aged care is not without it challenges.

“The challenge for me is probably – especially for someone of my age – is being the senior person for a shift where you have to delegate and direct staff who have been here a lot longer … and also maybe a few years older,” says McIntyre.

But the rewards are also there for the new graduate from Nelson, who started job hunting in July last year in the lead-up to her graduation and was eventually successful in February when offered a job in Timaru as one of 16 graduates taking part in the Aged Residential Care Nursing Entry to Practice (ARC NETP) pilot.

Jane O’Malley, (left) the Ministry of Health’s Chief Nurse, says the idea for the pilot, which offers increased funding and support for new graduates in aged care beyond the normal NETP scheme, arose from a workshop with aged care nurse leaders.

The main focus of the $320,000 ARC NETP demonstration project, being overseen by Health Workforce New Zealand, is ensuring extra supernumerary support to the novice nurses during the orientation period.

O’Malley says unlike a new graduate starting work in a hospital ward, with up to six other nurses working with them, a new grad in residential aged care nurse can find themselves working in relative isolation.

The pilot aims to bolster the support offered to new nurses entering the sector to not only attract more but also retain more in one of the fastest ageing workforces.

Nursing Council statistics for 2011 show that while 41 per cent of the active nursing workforce is aged over 50, it is 56 per cent in the continuing/aged care sector. While about 12 per cent of all active nurses are aged over 60, it is nearly double that figure (22 per cent) in the aged care sector – so the need is definitely there.

Small DHB signs up two trainees

Whitney McIntyre (left) is one of two graduates signed up in South Canterbury to the ARC NETP pilot.

Paula Finnigan, the NETP coordinator for South Canterbury District Health Board, says the small board has good established relationships with its aged care providers and was already in its fourth year of offering new graduate placements in residential aged care when the additional pilot places became available.

Taking up one of those places was Whitney’s employer, Strathallan Lifecare Village – a large Timaru retirement village with a 29-bed rest home, 20 bed dementia unit, and 27-bed hospital – which has been offering NETP places since 2010.

Up to this year, it had only taken on new graduates in its hospital wing and already had a NETP nurse in the hospital for 2013 when an extra ARC NETP place became available.

Debbie McMaster, registered nurse and Strathallan’s general manager, says the extra funding for supernumerary support enabled them for the first time to bring a NETP nurse into the rest home environment.

“Our management team consists of registered nurses but to have a RN on the floor in the rest home for that many hours a week, we wouldn’t be able to do that. So to have a programme where we can have her being mentored by a care manager is a big advantage, really.”

McIntyre is also getting exposure to Strathallan’s dementia unit and the plan is to rotate her into the hospital wing later in the year.

The NETP new graduates have never been rostered on to night shifts at Strathallan, and following their orientation period with their preceptor, they begin on morning shifts, so there is a care manager RN also on deck and they are not left on their own.

McIntyre was not new to the aged care sector, having worked part-time as a health care assistant in residential aged care while she studied. She says she has always really enjoyed working with the elderly but hadn’t sought a new graduate job in the sector until the opportunity was opened up with the ARC NETP pilot.

“It’s been really hard for nursing students to get jobs, but ARC NETP has opened up a lot more opportunities for students for jobs which is really good.”

Out-of-towners drawn to jobs

Finnigan says South Canterbury is in the novel situation this year that it started out with more NETP placements in the community than in the secondary sector, with initially five in aged care (one North Island graduate has since withdrawn for personal reasons), one in the local hospice, and one in general practice.

With no nursing school in Timaru (though it does have an affiliated cohort with Otago Polytechnic) the majority of its NETP graduates are always from out-of-town, and nearly all of its aged care graduate placements, apart from Nelsonian Whitney, were from the North Island.

Finnigan says from her perspective her role remains the same and she is there to support all of her 12 NETP graduates and provide the same support to all four aged care graduates, whether on the pilot or not.

She says most of the aged care graduates are young and vulnerable, having left their support networks behind to shift to Timaru, and she sees her role as not only looking at how they are integrating into their work environment but also the wider community as well.

The graduates working in aged care attend the same NETP study days and are encouraged to keep in touch outside of work and study time. Having two graduates employed at Strathallan also means they can be a great support to each other.

“It can be quite lonely and isolated working in an environment where the age of the people working is probably above the average age – which is probably pretty high, anyway.”

She tries to see graduates once every two weeks and encourages phone, text, and email contact between visits if they have any concerns. “They are very good at doing that.”

Calls come about collegial relationships, direction, and delegation issues, which Finnigan says is a common issue for new graduates, and sometimes personal issues that are impacting on their work.

Long-term career choice?

McIntyre says shifting to a new town where she had no family or friends was initially difficult, but she says her workplace has been very supportive, she has now joined a hockey team, and has regular catch-ups with other new graduate nurses in Timaru – including her fellow NETP graduate at Strathallan.

Being familiar with aged care meant she came into the job knowing what would be expected of her, and ten weeks into the job, her biggest challenge was directing and delegating experienced care staff quite a bit older than herself.

But she says everyone is really supportive, including the health care assistants and the rewards include being respected as a nurse and having the chance to experience the challenge of being the senior person on staff.

It is early days yet but does she see herself staying in aged care? “It’s definitely something I will be looking at but I’m also looking at doing a lot of things throughout my career.”

McMaster sees the ARC NETP pilot as a good chance to have young nurses exposed to aged care. The ideal, of course, would be for them to stay in the sector.

She says while Strathallan’s first NETP graduate is still with them, their second left at the end of the programme to work in the public hospital, and the third returned to Christchurch to work in a private hospital.

“So the success rate is one in three staying in aged care, but you can’t not have a NETP nurse

for that reason, either,” says McMaster. “You have to offer new graduates a chance to develop their practice, and hopefully, it will help them throughout their practice to have had that exposure to residential aged care and the issues facing the elderly and their families – whether they stay in aged care or come back to aged care – at least they know what aged care is about.”

How to build lagging new grad interest in aged residential care

New graduates, despite entering a tight job market for first jobs, are still on the whole reluctant to seek out work in the residential aged care sector.

Only four per cent of the 1232 new graduates applying for jobs late last year via the new Nursing ACE (Advance Choice of Employment) clearing house put down aged residential care as one of their choices, and only a tiny seven of those 49 new nurses put it down as their first choice.

It appears to be residential care rather than working with older people that’s putting off new graduates, as triple that number (152) chose the older person’s health setting of ‘assessment, treatment & rehabilitation’ as a preferred job option.

Likewise, when it came to registering interest in the Voluntary Bonding scheme’s aged care option (which included DHB older person’s health services) around 20 per cent of new graduates were ready to sign up.

So what are the barriers to new graduates wanting to work in residential aged care?

NZNO: safe staffing and support are key

David Wait, aged care industrial advisor for the New Zealand Nurses Organisation, says NZNO is concerned that the low numbers of new grads nominating aged care will not replace the number of nurses retiring. “The gap will only grow with expected demand for more aged care over the next few years.”

He says when you look at new graduate wages (see table below), most of the large aged care employer pay rates are higher or fairly close to the DHB rates (but when other conditions like penal rates and shift leave are taken into account, the pay advantage is reduced or lost).

If pay at the new graduate level is not the barrier, what is?

Wait thinks the root cause is inadequate government funding for the sector that places financial pressure on providers that impacts on not just penal rates and the like but also professional development opportunities and staffing levels.

”Staffing levels often place nurses in situations where they have to ration care and subsequently place themselves and their practicing certificates at risk.”

The situation is generally better and safer for those working for ‘not for profit’ providers, says Wait. Another factor impacting on the appeal of aged care for new graduates is they can find themselves in situations where they are the only RN on duty and are responsible for the work of the unregulated care staff.

He says NZNO wants to see appropriate government funding for the sector that would allow the recommendations from the Human Rights Commission report Caring Counts to be implemented.

Wait adds, “from a professional development perspective, if aged care employers want to attract new graduates they need to provide opportunities for them to grow and develop. These opportunities are generally lacking at the moment.”

Chief Nurse: support the keen and willing

Chief Nurse Jane O’Malley acknowledges the sector is not without difficulties and that few new graduates seek to work in the sector.

She says that makes it important to concentrate on giving good support to the graduates who do show a preference for working in the sector, in the hope they may wish to pursue a long-term career in aged care.

That support should include having access to a good new graduate programme, being exposed to a model of care that encourages best practice, receiving good support for their career progression, and access to postgraduate education funding so they can further their skills and knowledge.

“So I think my strategy is more focusing on not what we don’t have or can’t do but actually on what we can do with the willing,” says O’Malley. “Then you create pockets of excellence that people want to come and work in. I think that’s another way of going.” She points to regions like Canterbury, Waitemata, and Horowhenua, which are working on local solutions that are leading to really good outcomes for staff and patients.

O’Malley says the same workshop that lead to the ARC NETP pilot also discussed ways of highlighting good models of care leading to improving patient outcomes and staff retention and satisfaction. The resulting short videos, showcasing innovative and integrated care models involving residential aged care and DHB services, are due out later this year.

“We’re hoping that we will also be able to use these videos in undergraduate education to give students insight into the potential for a career in aged care,” says O’Malley.

 RN base salaries*

New Grad

Step 5**

 NZNO/District Health Board MECA

$47,528

$63,336

 NZNO/Primary Health Board MECA

$45,760

$61,152

 Best religious/welfare group ARC

$52,382

$64,480

 Radius

$48,942

52,873#

*NB Based on figures supplied by NZNO and a conventional 40-hour week without penal rates.
**NZNO says DHB new graduates automatically progress a pay step each year to step five but in aged care nurses can get ‘stuck’ at step one or two of the pay scale. 
#Radius pay scale only has three steps.

Aged Residential Care Nursing Entry to Practice (ARC NETP) pilot

  • Provides 16 extra NETP places in residential care.
  • There are four places in the Auckland region, three in Wellington region, two each in Waikato, Nelson-Marlborough, South Canterbury, and Southern District Health board regions, and one in the Hawke’s Bay.
  • Each ‘enhanced’ ARC NETP trainee contract is worth $20,000 – the lead DHB gets the standard NETP funding and the extra funding goes to the ARC facility, which receives $12,800 per trainee.
  • The extra funding allows for an extended minimum six week orientation period during which trainees are rostered on with an RN who takes overall responsibility for their shared case load.
  • The trainee nurse is not allowed to be the only RN in a facility for the first six months of the programme. A clinical preceptor is to be available to the trainee throughout the programme, including weekends and late shifts.
  • Trainees to access the existing DHB NETP education programmes and receive 12 backfilled days off to attend NETP support days.
  • Only ARC facilities that have more than 50 beds and are certified for hospital-level care are eligible for the scheme.