March 21, 2019

Competency-based training for nurses leads to better care for the aged

Nursing competencies framework can address problems highlighted by Aged Care Royal Commission

A study of competency-based training for registered nurses in aged care has found the program produced nurses who were more confident and skilled in the specialist work of caring for older people.

The program provided an evidence-based pathway where nurses worked with mentors to develop specialist knowledge and skills, which lead to improved quality of care for older people.

The Gerontological Nursing Competencies (GNCs) framework was developed by researchers at the University of Wollongong (UOW), led by Professor Victoria Traynor from the School of Nursing and the Illawarra Health and Medical Research Institute, in partnership with aged care providers to address the lack of specialist knowledge that leaves nursing positions unfilled and limits the professional development opportunities for nurses.

It comes as the first rounds of hearings get underway in the Royal Commission into Aged Care Quality and Safety.

“Implementing the gerontological nursing competencies is a structured and transparent approach which organisations can use to achieve the Royal Commission goal of Australia becoming known for world-class aged care services,” Professor Traynor said.

By 2030, more than 20 per cent of the population will be aged over 65 years and the Royal Commission’s terms of reference call for submissions that offer insights into how aged care can be delivered to meet the growing numbers of older people with complex needs in a sustainable and person-centred way.

Professor Traynor said that while the number of support staff in aged care had increased rapidly in recent years, the number of registered nurses remained static.

“At the same time, the health problems that older people now face, both in the community and in nursing homes, are greater than in the past,” she said.

“A competency framework says if you’re working in aged care as a registered nurse you should be competent in these areas. It would give the public reassurance that the aged-care industry is going to deliver services of a similar high standard.”

The competencies were developed through a two-year research project involving input from university researchers and consultation with more than 400 nurses working in clinical care, education, management and research.

The final GNCs framework included 11 core competencies and 33 domains of practice that covered the everyday activities and responsibilities of registered nurses working with older people.

“This framework gives aged care providers guidance on how to structure the delivery of best practice care and inform the education programs they offer staff,” Professor Traynor said.

“Using this framework will contribute to the delivery of high-quality person-centred care by enabling staff to know what aspects of aged care are the most valuable and the standards they are expected to reach in their individual practice.

“Aged care providers can adopt this framework in their ‘usual business’ because the evidence-based workbook developed by UOW can be used by leaders in their organisations to guide nurses through the five step process of becoming accredited gerontological nurses.”

An evaluation of the framework was run for 12 months to late 2018 and involved registered nurses and mentors from across NSW and the ACT.

Alex Blanch, Assistant Manager at provider HammondCare, participated in the trial as a mentor and a mentee.

“The competencies recognise the interaction of tasks in aged care nursing, particularly those social components that are so important such as working with the family and transition in care. Even in its most clinical components, the competencies recognise that everything should be viewed through the lens of caring for people,” he said.

Mr Blanch said the competencies provided a clear path for nurses in aged care to progress, from beginner to expert, and in addition to creating better skilled and more confident nurses they helped with job satisfaction – a key issue given the need for more workers in the sector.

“Nursing has so many time constraints and competing interests that you’re often get pulled away from career development because you’re worried about the here and now, about helping the people in your care,” Mr Blanch said.

“An important lesson from the pilot program was to quarantine the time for setting goals. The relationship with your mentor is critical. You learn that it’s okay to have weaknesses and it’s okay to take time to develop skills in those areas.

“So many nurses want to be better at their job and this shows them how to get there, which has a big impact on job satisfaction and ultimately the quality of care we provide.”