Dr Miriam Stanyon is a Research Fellow on the Achieving Quality and Effectiveness for Dementia Using Crisis Teams (AQUEDUCT) research programme at the University of Nottingham. She also worked, until very recently, for a number of years as a care assistant in care homes. Here she talks about work to establish agreed competencies for Registered Nurses working in care homes.
It is no secret that care home nurses get a bad press. If you type ‘care home’ into the BBC news website, the result is a series of stories about neglect and elder abuse, care homes put in special measures by the CQC or having to close due to lack of funding. Among nurses themselves, care home nursing has a lower status than working in the NHS. It has traditionally been seen as a job to do when you’re close to retirement or can’t get a job in a hospital. I remember speaking to a colleague after she had attended some CPD training (which she had to self-fund and attend in her own time) and she expressed how she felt embarrassed to ‘only work in a care home’.
Care home nursing is, in fact, a highly skilled role requiring an in depth knowledge of the medical conditions commonly associated with age such as dementia, stroke, diabetes, and Parkinson’s disease, the management of complex multiple morbidities and frailty and being able to do this whilst maintaining a person- and relationship-centred focus that recognises the care home as the residents home as well as a place of care. They have to be able to apply their acute health knowledge in a social care setting. They have to use their initiative, communicate with and coordinate other healthcare professionals and establish relationships with resident’s family members. Often they are the sole qualified member of staff on a shift with care assistants and have to use managerial and leadership expertise, as well as sort out the broken chairlift and the man from BT coming to fit an extra phone line.
They also have the opportunity to make long term relationships with those they care for, often becoming deeply involved in resident’s lives. When I asked colleagues why they work in a care home, rather than a ward, they stated that they love getting to know the people they care for and seeing them through many years, often caring for them at the point of their death. This can be both upsetting and incredibly rewarding.
Despite this the vacancy rate for care home nurses in the UK remains very high, much higher, as a ratio, than shortages in the NHS. Literature and anecdotal evidence suggests this is due to low pay rates, lower status and a lack of career trajectory.
It has been suggested that one step towards improving status would be recognising, formalising and accrediting the core competencies required to be a care home nurse – providing much needed structure to the role, as well as recognition and status. We recently conducted a modified Delphi study designed to do precisely this. We drew upon the expertise of staff in the care home sector as well as a series of stakeholders who interface with the care home sector. We agreed 22 core competencies. A further 10 advanced competencies came close to achieving agreement and we plan to revisit these as part of future work to explore what a curriculum for Registered Nurses in Care Homes might look like.
It is crucial to raise the status of care home nursing and to develop it into a speciality of its own. We hope that the Delphi study recently published in Age and Ageing is the first step on this journey.
The ultimate aim is to help build care home nursing into a sought after form of work for registered nurses. A future where there is competition for care home nursing jobs, fair reward for their work, and where newly qualified nurses say “I want to have a career in care home nursing” should not be beyond ambition. To achieve this will be to the benefit of nurses in the sector and to the residents they serve.
Interested in care home medicine? Join us at the BGS Autumn Meeting in London where this topic will be a key focus!