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Professional isolation was highlighted as an issue for the aged residential care sector in Waikato back in 2011.

Lindsay Duncan

The same piece of research also highlighted the age-old issue of recruitment and retention in the sector, plus the difficulties faced by new graduates starting their nursing career in ARC.

Waikato District Health Board felt a responsibility to do something in response, says Lindsay Duncan, who is the practice development nurse coordinator at the DHB’s Nursing and Midwifery Professional Development Unit, which, up until that point, had had little contact with the ARC sector.

Working with Kate Yeo, the DHB’s then still new clinical nurse director for rural, community and older persons (and with the support of the DHB’s clinical nurse specialist in the field, Julie Daltrey), the pair went out to the sector to find out more. The result is a suite of three DHB programmes developed and offered for free to the aged care sector, with 124 nurses from the Bombay Hills to the King Country having now gone through the programmes.

Gerontology turns to foundation skills

The first in the suite of programmes was a clinically focused gerontology workshop series designed for RNs working with older persons in the community and residential aged care, which began in 2013.

Those workshops highlighted the high turnover of ARC staff and the need for a foundation skills training for nurses new to aged care (including migrant nurses and new graduates ineligible or not on a new graduate programme) and the resulting foundation skills programme (five days spread over four months) got underway in 2014.

Leadership programme cross-pollinates

The workshop experience also highlighted the need for a leadership programme to extend and develop the nurses who had actually shown a commitment to the ARC sector, which led to the LARK leadership development programme. Nurses from 44 of the 55 aged care facilities in the region have since taken part in one of the three programmes.

Up until recently, all the programmes have been held in Hamilton, which Yeo says has started some useful ‘cross-pollination’ as it has not only allowed ARC nurses to network and better understand the work of DHB nurses but has also altered the attitude and understanding of DHB nurses about the knowledge and skills of the ARC nurses. 

A change assignment is a major part of the LARK programme that Duncan says was built using a Practice Development approach. She says part of this evidence-based approach is to help people look at themselves and identify their own values and ways of working, so by better understanding the person they are they can also better understand the values and needs of the person they are caring for.

Duncan says after hearing ARC nurses dismiss themselves as “just a rest home nurse” the programmes also aim to impress upon them that their work with the very frail and elderly – who often have complex comorbidities – is a skilled and demanding speciality.

Significant DHB support available

Introducing nurses to the material available through the DHB’s library, which, along with the region’s online nursing procedure service, is accessible from both home and work, supports the ongoing development of the skills part of each of the programmes. Yeo says one spin-off of the free professional development programmes is that that the number of ARC nurses seeking postgraduate study funding through the DHB has jumped from less than a handful 18 months ago to nearly 25 in the latest round.

During the LARK programme the nurses are also exposed to a variety of speakers, including DHB and ARC sector managers; introduced to leadership theory and given the skills to undergo their own change project. They start the project on day one of the programme and present about four months later on day four with their facility manager sitting in for the 15-minute presentation.

To date, 36 nurses have completed LARK and their change projects have covered topics as diverse as infection control, hydration, nutrition, falls reduction, minimising restraint, staff orientation and incident reporting.

Duncan and Yeo say the philosophical basis of the programme – borrowed f   rom the National Gerontology Section’s vision – is the need to have a valued and visible group of nurses working in ARC. The hope is to support the workforce to have a strong identity and not dismiss themselves as they had been previously.

The aim is also, of course, to help stabilise the workforce in a sector with a reputation for lower wages and high turnover. Research into the impact of the programme is being planned but the pair says anecdotally it appears that most programme graduates are staying in the sector, with only a handful coming to the DHB so far.

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