This is in memory of "Mary". I am sorry I could not do much to help you. You and your family put your trust into this aged care facility. You were failed.

Introduction:  I would like to introduce you to an experienced Registered Nurse's (RN) account of working in a fully accredited and licensed Australian nursing home. With over twenty years of experience in nursing, including Emergency Departments of Australian hospitals, medical and surgical nursing, the RN also had qualifications in Training and as an Assessor.

The RN unfortunately, must remain anonymous until public and industry opinion takes a more charitable turn towards "feedback" and whistle-blowers. Let's call the RN "Peter". All real names and details have been changed to protect the author, whose name has been withheld and forgotten. This article illustrates one of the reasons why many good staff leave aged care. Names and some details have been changed to protect the author.

A good start...

So I’ve got the job. A Div 1 nurse for three nights a week, in a local Nursing Home. I was looking forward to a part time role of three nights a week at a local nursing home and importantly, looking forward to getting to know the residents and staff, instead of just dealing with a constant stream of emergencies within a hospital setting.

The facility was for 40 nursing/transitional care (where I was to work) and 80 plus other wing of the facility which were individual units. I however, was in charge overnight for approximately 120 plus patients and 3 other staff. I was to work with a PCA my end and the other 2 PCA’s were working the other. I didn’t fully appreciate when I got the post just how busy it was to be.

After a month into the job I informed the Nursing Manager of the facility that I also have my Training and Assessor Qualification, and was more than happy to help out if needed in training as I liked education. I was in fact being very diplomatic and that I really thought the current staff needed some training on how do deal with people in aged care! They replied "Oh really I didn’t know you had that qualification". I explained that it was in my Resume. Their reply to this was "Oh sorry, I never got time to read it.... even though you were their only applicant..." They sort of laughed and went on their way. How can this be? I was very offended by this that someone in this authority actually responded in this way. Little did I know, this was only the beginning of my nightmare.

After a few weeks, I was beginning to understand how Aged Care 'worked'

I am truly shocked how these places are run. One particular night the out of hours GP came at 1am to visit a patient. I was not aware that there was a problem. The GP looked familiar and as we chatted it was evident that we once worked together. The GP was an Emergency Doctor.

The GP told me that they were only coming here to write up a drug chart. I told the GP that in my opinion it wasn’t necessary for a doctor to come out at 1am just to write up a chart. The GP smiled when filling out the 'slip' to get paid. The GP then said:

"Ah …this is the biggest scam going - I get paid a shit load for doing very little... we are more than happy to come at night as it means more money for us ..."

The GP asked me to sign his slip to say that they had seen the patient. I declined as I explained that I have already written in the notes that the patient is fast asleep. However in reality I was not happy at all to sign the slip for something that clearly has not happened. The GP's smile was gone by now and they told me that they had never ever, had a problem with any nurse before and that slips are always signed.

This was to become a very common practice. Things that could have easily be done during the day for very minor things were often done out of hours. Why can’t there just be a list done and get the GP to come in when there are a few things that need doing? This will never make sense to me. Of course if there is an emergency then by all means call in the GP, although in reality all they do is to call an ambulance for the slightest thing. And so this merry go-round continues.

"Never mind about that … do you want gravy with that?"

I arrived at work a little early so I could help out with a few things. I was helping out with the last few drugs that needed to be given. We had a new patient in transitional care. She was very tearful and upset about leaving her house and her dog. She could no longer cope being home alone and a placement was needed. I was just about to walk over to her when one of the PCA's came over to see what the matter was.

I glanced over when the new patient said through her sobs and tears "I feel so depressed and sad I don’t know how I am going to cope ..." I saw the PCA sit on the bed next to her. I was pleased that we could offer some comfort. Instead - the PCA was on a mission to get the menus done for the next day!

The PCA's response to this new resident was: "never mind about that ... do you want gravy with that?"

I was glued to the spot and just could not believe my ears. As soon as the tick on the 'gravy' was done, off the PCA went to the next resident.

I gave a reassuring hug to the new lady, made her a cup of tea and explained that I will try and arrange for her to see the dog or if I can bring it in to see her. By this time it was a few minutes after 9pm and the late nurse was getting annoyed that handover was a minute or so late.

"I hope you sleep well tonight …" (the staff, that is…)

On a very busy night I had one of the "bank" staff working with me. He had been there for years and worked an average 2 nights a week. He worked for the same company but in a different facility. In my 20 years of nursing I have come across some lazy staff. But ‘’Dave’’ was by far the laziest. The routine was to do the first "round" at 11pm then 3 hourly. With hourly checks in-between.

After the 1st round, "Dave" made up his bed in the corner of the lounge and set himself down for the night. As this was my first night working with him I was just interested how he worked. After a few things that I had to do I pulled up my chair about 1am in the corridor so I could see easily if any patients were wandering. Dave by now was snoring loudly.

At approx 2am I woke up Dave to ask him to give me a hand and that it was time for the 2nd round. He looked confused. "But we don’t do a second round" I explained to him that I do and he will give me a hand.

Every patient that we went to "Dave" would say "Let them sleep... we don’t do this". I am all for letting the residents sleep. But when it comes to pressure area care this becomes first.

I couldn’t help but think this is obviously what he is used to. If the Div 1 nurse in charge does not take charge then this is what happens. He was not at all happy with me when I told him to move his chair in the corridor so he could see and hear the residents. I asked him not to sleep. This, after all, was a waking night shift.

Another bank nurse that I worked with "Steve" was equally lazy, except I could not even wake him! I was later told it was due to the medication that he was taking for a medical condition. Now I am all for people having jobs etc when they are unwell, etc, but when it impacts on the care of the patients then I have a problem. After discussing this with the nurse in charge she explained to me that he has been like that for years and that it is just accepted.

"Tell us about it …"

After one particular busy and stressful night, I decided to put it in writing on the 'Tell Us About It' form that is on show in the entrance of the facility. The same used by staff, residents and family members for any concerns they may have about almost anything.

On the form I wrote about a lady with dementia that I found hard to deal with overnight as we just could not manage her wandering behaviour. She was continually going in and out of other peoples rooms frightening them overnight. With only two of us on duty dealing with the other things that we had to do, and me having to go over the other side constantly to assist if it was dangerous.

We just needed someone extra until she settled for the night. I explained that the lady was a challenge and that it did not seem fair that there were 10 members of staff that I handed over to in for the morning shift and that there was a much higher ratio of staff to residents during the day, and that at night there was only two members of staff? I put this form in the Facility Managers letterbox outside their office. As I was leaving, I saw her unlock the box and read my form. I heard her say out loud "Not interested.. not bothered" (I was in direct earshot!). She then promptly ripped it up and put it in the cleaners bin as she walked past. I am not lying or exaggerating about this. It is the truth.

This was the time when I realised that I had made a grave mistake by taking this post. I had to get out. I later find out that she had got the job without having a nursing qualification. I don’t want to come across as being disrespectful, but the first thing a Manager should do in this case, was to make an appointment to see me to explore my concerns. This is what good managers do! You could even be forgiven for not being a nurse if the management skills were up to speed!

Please, can we have some help!

A resident "Mary" had dementia but after a recent urine infection he dementia was becoming worse. She was wondering around all the time and was a falls risk. Again, I asked the manager if we could have some help as Mary was a falls risk and that I really believed that something was going to happen if we could not manage her wandering at night. This fell on deaf ears.

I wrote another Tell Us About It form requesting for additional staff. In her care plan it stated that she was to be monitored carefully especially at night and if needed on a one to one. (this always looks good on paper for the relatives!). I photocopied the care plan and attached it to the form. I never heard anything. A few days later she had a fall at night hitting her head. She had a Subarachnoid Hemorrhage from the fall and died 24 hours later. No questions were ever asked. I was hoping the coroner would be involved but it was not to be. And the family are none the wiser. As far as they are concerned she received excellent care. Little do they know ....

Time to go

I told the nursing manager of the facility what had happened with the 'Tell Us About It' form. She said to me that this does not surprise her in the least and that she would not expect anything less from her. So that makes everything ok then? I just couldn't understand this. I handed in my notice. I felt that something had to be done. I spoke to a friend of mine who is a Director of Nursing in a huge hospital. I explained my dilemma. Shall I just leave and be done with it or shall I go to the Manager Director in the city to talk about the concerns that I have. After exploring some options I decided to go and see the MD.

I made an appointment and met the MD and the State Director of Nursing (which I didn’t even know existed let alone met). I went through quite a few things that I had concerns about showing him photocopies of all of my documentations and tell us about it forms etc. I explained that I was not here to cause trouble but to really bring to his attention of what was happening in their facilities. I was worried that if I stayed employed at this facility much longer my registration would be in jeopardy. The Director of Nursing was frantically taking down notes throughout the whole of the meeting.

I said we needed an extra member of staff at night. The GM told me that the company could not afford it.

I then gave the GM a printout of the accounts for the last financial year showing how many millions that the company made through their national chain of care facilities, health care insurance policies and hostels.

The GM was unresponsive and just glared at me.

When I had finished with my list of concerns and events that had happened, the MD asked me if I had ever had any trouble at work in any other establishments before. I said no. He asked me if I had been in conflicts with managers/workplace relations before. I said no. He then politely said that perhaps I was not experienced enough to work in aged care and that perhaps it is a good thing that I was leaving.

I drove home in a daze. Here was I really trying to do my best when the MD was trying to turn the tables and that everything was my fault. It you have someone at the top like this then why the hell would you bother? It just cascades down to every employee that money is all that matters. 'Care' is just a secondary thing..

I am no saint. I am just a nurse that wants to do the very best I can do for my patients. I have never worked in such an organisation that just does not care. And yet all the glossy brochures and happy smiles that the company portrays it is just disgusting. So what can I do? I can do nothing. I am powerless to help these poor venerable people. I am working in a very busy hospital again and enjoy every minute. I would like to think that I can make a difference to someone’s hospital experience and make them feel better.

I hope and pray that I, or a member of my family ever has to go into a nursing home in Australia.

My plan is to try and build up a small home one day so that I can run it myself. Train the staff how I want them to be trained. And last but not least, show them how to care. I sometimes feel ashamed to be called a nurse. Maybe it is time to get out all together and do something different like buy a small cafe. Who knows.