Improving Quality of Life for Older People in Long-Stay Care ...

Participants from welfare homes reported a particular problem as they perceivedstaffing levels within these facilities to be very low and not reflective of currentresident dependency. They explained that residents’ profiles have changed overtime and these facilities now have large numbers of residents of high or maximumdependency but staffing levels which assume residents to be low dependency.There were difficulties with both the staffing numbers and the number of registerednurses. In contrast, participants who worked in facilities which had previously beendesignated ‘acute’ described their staffing levels as adequate or generous.98In the private sector, staffing was set with residents’ needs and economic viabilityin mind. While the legislation required just one registered nurse on duty per shift,some facilities had increased staffing over and above this level, as recommendedby the Inspectorate. In contrast, other participants suggested that staffing levelsremain an issue within some private nursing facilities. They reported that the issuewas related more to the mix of registered nurses to care assistants rather thannumbers per se and that some facilities did not have an appropriate number ofregistered nurses. The inspectors who attended focus groups highlighted the needfor review of the Health (Nursing Homes) Act, 1990, which currently only requiresone registered nurse to be on duty at any one time. When resident numbers werehigh they found that this level of registered nurse cover was totally inadequate.Coupled with the issue of staffing was the issue of skill mix. All participantsstressed the need for an appropriate skill mix. They argued that there was a need toensure that registered nurses’ expertise was maximised; this could only be done ifnurses were supported by appropriately trained health care assistants and/or careattendants, and nurses embraced change. Some participants reported they did nothave an appropriate mix of staff. For some the problem was a lack of registerednurses but for others it was not enough care assistants.Participants suggested that there should be national policy guidelines in relationto skill mix and the determination of what is an appropriate skill mix. Participantsexplained that an appropriate skill mix also required nurses to delegate some oftheir tasks and duties to others. Participants suggested that it was difficult for somenurses to do this. They believed that some nurses were comfortable with a rolewhich included many non-nursing duties, for example general administrative andclerical work, and did not wish to redefine their role if it meant increasedresponsibility or autonomy.Improving Quality of Life for Older People in Long-Stay Care Settings in Ireland