Negative perceptions about working in aged care, fuelled in part by a Royal Commission into Aged Care and associated press coverage, are making the sector less desirable as a career option for nurses.

A literature review in the Journal of Gerontological Nursing highlights this sentiment, revealing that the field does not feature highly on most nurses' career aspirations.

But with a rapidly ageing population and staff shortages across the sector, negative perceptions need to be addressed according to industry experts.

Angela Donato Connolly, a clinical nurse in aged care, began to appreciate gerontological nursing during community visits while working for a nursing agency.

"Many community patients are within the older or elderly population.

"There are a set of stereotypes surrounding the amount of intervention and difference a nurse can make regarding the ‘Western' view of medicine.

"We cannot always ‘fix' the chronic conditions that come with age and people think we ‘do' less to change the trajectory of those conditions.

"It is seen as sad or depressing. This is driven largely by a lack of knowledge and awareness of caring for the aged population."

The perception that working in aged care is somehow an easier option than other areas of nursing is incorrect and unfair, said Ms Connolly.

"Some feel aged care is a slower-paced work environment where a nurse can take it easier before they retire.

"I and many others in the field can assure you that this is not the case.

"Aged care nursing is just as challenging, fast-paced and rewarding as any day in ICU.

"Both fields of nursing deal with bodies doing all the unglamorous, normal bodily functions, but at least in ICU you aren't running as much. You're assigned to one or two beds!

"It takes just as much critical, autonomous thinking to work as an aged care nurse – and some might say a lot more creativity," said Ms Connolly.

Mark Aitkin, a former aged care nurse manager, said several aged care nurses have expressed that they don't feel valued.

"There was a perception from their acute care colleagues that they worked in aged care because they couldn't get a job anywhere else, and their skills were not current or satisfactory.

"Hence, the reason so many residents were transferred from aged care facilities to the emergency department."

If this perception is to change, more value needs to be placed on the importance of nurses in quality aged care facilities, said Mr Aitkin.

"A good start would be mandated minimum numbers of registered and enrolled nurses in residential aged care facilities.

"The federal Aged Care Act 1997 requires aged care providers to have an ‘adequate number' of appropriately skilled staff to meet the care needs of residents.

"Aged care providers interpret this differently.

"There is, therefore, the disparity in relation to the number and type of staff that are employed to meet the care needs of residents."

The problem is also societal, as there is a common misunderstanding surrounding the complexity of aged care.

"Many people don't understand the value of having registered and enrolled nurses in aged care.

"The reality is that this costs more and are consumers willing to pay for this?

"I hope that the Royal Commission into Aged Care makes some recommendations that the sector acts on," said Mr Aitkin.

ANMF's Assistant Federal Secretary Lori-Anne Sharp said the 2019 National Aged Care Survey revealed that the majority of aged care nurses feel undervalued for the work they do.

"Any stigma that exists in the community is founded on the fact that our aged care system is in crisis and currently does not support staff with the sufficient time to deliver the care that the elderly need and deserve," said Ms Sharp.
2019 National Aged Cared Care respondents.

"Why are gerontological nurses paid less than the acute sector given that the skills required to remain in aged care include excellent clinical assessment skills to recognise the deteriorating resident, management of residents, staff and resources.

"It is not recognised that excellent residential aged care nurses have skills that many of their counterparts in the public sector do not, yet there is a perceived attitude among nurses of ‘dumbing down' knowledge and skills to work in aged care," said one respondent.

"I think community culture surrounding aged care services is poor, expectations from families, residents and community clients are quite rightly high, but aged care staff are undervalued in terms of pay parity which reflects on the staffing levels and workplace culture. Staff feel their role is not recognised as important compared to other sectors and other parts of the sector," said another respondent.

"It is seen as a low-level occupation, widely known as being understaffed, underpaid and overworked...It is a special thing to be able to care for people at the end of their lives and their final months, weeks, years... it's a privilege to be a part of this, would be nice if this was acknowledged and appreciated....and staffed appropriately. Our elderly deserves it," explained one respondent.

Nurses in aged care are proud and dedicated to the work they do, but too often aged care facilities are understaffed, and staff are overworked, explained Ms Sharp.

"The elderly are entering nursing homes older, frailer, many with complex health needs, and over fifty per cent have dementia.

"Caring for the elderly is demanding - nurses and carers need the time, support and adequate resources to do their job well.

"It can be difficult work both emotionally and physically and is often low paid.

"It is important that the Government acts now as a matter of urgency to address the low staffing levels that exist in aged care facilities so that our elderly are properly cared for and staff have the time needed to meet individual needs.

"Nurses in emergency departments or paediatrics are much more likely to have safe patient-to-staff ratios.

"You would never hear of only one registered nurse caring for 100 paediatric patients, where this is a common occurrence in residential aged care."

Minimum staffing ratios to provide safer working conditions and delivery of quality care to the elderly is critical to the future of aged care nursing, said Ms Sharp.

"Legislated staffing ratios in aged care will assist in attracting nurses to work in aged care and support staff retention.

"As a society, we must value the elderly and respect those who do the very important work of caring for them.

"There's an urgent need for the Government to legislate minimum safe staffing levels in residential aged care.

"If mandated staff to resident ratios are not introduced, nurses will continue to leave the sector and residents will continue to suffer."