High rates of staff turnover in aged care are having a negative impact on the quality of care delivered to elderly residents, but also on staff morale, as staff are unable to deliver the standard of care they believe residents deserve.

It is well established that the aged care industry has a problem in attracting and keeping staff. The Royal Commission into Aged Care Quality and Safety’s Interim Report stated, “The aged care sector suffers from severe difficulties in recruiting and retaining staff.”

The Aged Care Workforce Taskforce’s report also identified “high employee turnover” as one of the most significant challenges facing the industry.

In this article we take a look at how staff turnover is impacting both residents and staff, and we consider the Australian Medical Association’s recommendation to the royal commission that turnover be reviewed as part of all aged care audit and assessments.

High staff turnover linked to poor health and wellbeing outcomes

Australian Nursing and Midwifery Federation Federal Secretary, Annie Butler, told HelloCare, that high staff turnover is known to have many negative effects on the care of people in aged care. 

High staff turnover negatively affects care and quality of documentation and is linked to worse health and wellbeing outcomes. It leads to reduced satisfaction among residents and patients and poor staff morale. It creates “difficulties in establishing meaningful and supportive person and professional relationships between and among staff, residents, and families,” Ms Butler said.

She said high rates of staff turnover also inhibit the forming of bonds between carers and staff.

“Staff, residents, and their families want to develop trusting and compassionate relationships built on familiarity and shared understandings of preferences and needs regarding care,” Ms Butler said. 

“Reducing staff turnover is an important way of improving the safety and quality in aged care.”

Ms Butler said low wages, poor working conditions, chronic understaffing and workload issues, unreasonable professional and legal responsibilities, a lack of career opportunities, stressful work environments, poor management, and a poor perception of aged care in the community are all factors that contribute to the high rates of staff turnover. 

Continuity of care delivers better outcomes

“Continuity of care is an essential element of quality care delivery,” says Ms Butler. 

“Care being delivered by a known nurse or care worker to a resident has better outcomes for both interpersonal professional relationships and the coordination of care being delivered by the nurse or care worker. High staff turnover of staff prevents continuity of care.”

Consistency of staff is particularly important for those who are living with dementia.

“Staff turnover is especially detrimental to people who are affected by dementia who may be especially distressed by encountering new and unfamiliar staff,” Ms Butler said.

High turnover also impacts staff morale

High rates of staff turnover not only deliver worse outcomes for residents, they also erode staff morale and contribute to staff leaving the sector.

“It leaves nurses and carers, demoralised, overstressed and overwhelmed,” explained Ms Butler. 

“Deteriorating staffing levels and the high turnover of staff are having terrible consequences on the physical and emotional health and professional safety of workers.

“It’s why it’s leading to more and more nurses and carers choosing to walk away from the sector, frustrated at their inability to provide quality care they know elderly residents deserve.”

“Where there is high staff turnover, poor skills mix, and/or low staffing levels, nurses know that there are unable to provide the best care possible,” Ms Butler said.

“Lack of time due to large numbers of residents and low staff numbers, working with new or ever-changing colleagues, and knowing that there simply is not enough time to spend with residents to become familiar with their needs and wishes has a tremendously negative impact on staff morale. 

“Our members have told us that while many staff leave aged care because of this, many more staff stay on despite feeling burned out and stretched to the limit because they feel responsible for the residents they love and care for,” she said.

Should turnover be reviewed during aged care assessments?

The Australian Medical Association’s September 2019 submission to the royal commission recommends staff turnover become part of the audit and assessment process.

They recommend “’The Aged Care Safety and Quality Commission should investigate staff turnover when assessing and auditing aged care providers.”

Ms Butler said the ANMF would like to see the Aged Care Quality and Safety Commission assess staff turnover as a part of every assessment or audit.

“Staff turnover is an important indicator for assessing the culture of the organisation and quality care delivery. This should be assessed along with a number of other quality indicators including resident and staff feedback,” she said. 

“Understanding the extent and nature of staff turnover in aged care is the start of implementing effective solutions and improving the safety and quality of the sector.”

Mandatory reporting of staff turnover means “more informed”

The ANMF would like to see mandatory reporting of staff turnover.

“Mandatory reporting of staff turnover would be a useful, transparent piece of the information for a resident choosing a nursing home and for a nurse or care worker choosing employment,” Ms Butler said.

“Public reporting of these details would enable more informed decision-making for people in aged care, their families, and staff. 

“As there is such strong evidence regarding the impact of staff turnover, it is important that this information is accurately recorded, reported, and acted upon.”

 

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