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Registered nurses in aged-care struggle to deliver quality care as patients' needs get more complex, GP services decrease and education options remain limited, a recently-studied research paper found.

Published in Australian Health Review, the research led by Massey University clinical nursing chair Jenny Carryer and MidCentral District Health Board primary health nursing director Chiquita Hansen suggests that gerontological nurse practitioners could help improve the quality of residential care.

The research looked at residential aged-care nurses in one district health board region and specifically focused on their experiences of caring for people with one or more of the three chronic illnesses (diabetes, cardiac and respiratory conditions).

Nearly 100 questionnaires were sent out to registered nurses on the DHB’s database, but only 28 responded, prompting the researchers to organise a series of focus groups, which drew in a further 26 nurses. The researchers reported how hard it had been to get the often-marginalised aged-care nurses involved and noted the irony that the “nurses whose voices most need to be heard are the hardest to reach”.

The nurses taking part had an average age of 50, which reflected the national average for this workforce. “In the focus groups, nurses spoke with concern and passion about the obvious ageing of themselves and their colleagues and the difficulty of attracting younger graduates.” Minimal RN staffing levels meant few if any opportunities to provide supervision and support of a new graduate.

Nurses in the focus groups talked about a lack of career progression and frustration in not being able to provide the quality of care that residents needed. One nurse said: “It is only my huge concern and affection for the residents that keeps me coming back.” Another nurse noted it took at least two hours in the morning to distribute all the breakfast medications.

A recurring theme of focus group discussion was admiration for the tireless and poorly paid work of many caregivers, but there was also concern about those who were clearly unsuited for such work. Another theme that arose was lack of timely intervention by busy GPs, resulting in exacerbated suffering of residents and preventable hospital admissions.

Just over a quarter of surveyed nurses had a bachelor degree and about the same number had been involved in some further tertiary education in the past two years. Barriers identified to hindering further study were work/life balance, the cost of courses and clinical release time. When asked whether they would like further education relating to caring for people with the three chronic illnesses, there was an “overwhelmingly positive” response.

Almost all of the surveyed nurses said they cared for people with the three conditions and the biggest barriers to providing good care were seen to be non-compliance by residents with treatment regimes, followed by lack of nursing or caregiver knowledge and the poor health status of the elderly residents.