The Hon.

Robert Brown MLC

Parliament of New South Wales
Legislative Council
Shooters and Fishers Party

MEDIA RELEASE
2 May 2016

Upper House United on Keeping

Registered Nurses in Nursing Homes
NSW Shooters, Fishers and Farmers MLC Robert Brown hit back at the NSW Government's
response to the inquiry by General Purpose Standing Committee No. 3 into Registered Nurses in
New South Wales Nursing Homes.
The Minister for Health, Jillian Skinner, announced that the NSW Government won't be keeping the
30 year legislated requirement for nursing homes to have at least one registered nurse on staff at all
times. This was put into jeopardy by a 2013 Federal law change to the definition of a "nursing home"
in the Aged Care Act 1997 (Cwth)- the definition used in New South Wales legislation.
"This response by the Government fails the pub test," Mr Brown said.
"If you ask anybody in the community whether they believe that registered nurses should remain in
nursing homes the overwhelming response is 'yes'.
"It's surprising that in their response the NSW Government is deferring this fundamental issue to their
Federal counterparts on the eve or a Federal election.
"Since the Nursing Homes Act 1988 New South Wales nursing homes have been required to have at
least one registered nurse on staff at all times, 24 hours a day. The only reason I can see for a
change is to increase profits for private operators, and that argument is just not good enough!
"My understanding is that Opposition and Crossbench are united in favour of keeping registered
nurses in nursing homes. It's not often that you see The Greens, the Shooters Fishers and Farmers
Party, the Animal Justice Party, Labor and the Christian Democratic Party stand shoulder to shoulder
on a single issue.
Mr Brown said that registered nurses have a skill set and focus on the essentials of care framework
that's vital for health care settings, especially aged care.
"Registered nurses are required for their higher level of skills and focus on improving patient
outcomes, through the Government's own Essentials of Care framework.
"Without a registered nurse on duty to administer Schedule 8 medications, pain relief stronger than a
Panadol can 't be given.
"A registered nurse has the clinical expertise to know when to and when not administer medications,
such as not giving blood pressure medications when somebody already has low blood pressure.
Parliament House

Phone: 02 9230 3059 Fax: 02 9230 2613

Macquarie St SYDNEY NSW 2000

email: robert. brown@ parliament.nsw.gov.au

''Their high level of training also allows them to respond to critical incidents to prevent unnecessary
hospital admissions- an important attribute when 'trolley block' plagues many hospital emergency
departments."
Mr Brown added that he feared what impact this change could have.
"I fear what this change to nursing home practices could mean for our elderly. This affects us all.
Nobody will be spared from the impact of this change- whether it's our loved ones or even
ourselves, we all deserve quality nursing home care."
"The Shooters, Fishers and Farmers Party will not stand idly by while older people are taken for
granted."
MEDIA CONTACT:

Robert Brown MLC

(02) 9230 3059

Key Points on Keeping Registered Nurses in Nursing Homes

One Registered Nurse on Staff At All Times

The requirement to keep at least one registered nurse on staff at all times is in s104 of the
Public Health Act 2010 (NSW).
o This requirement has existed since the Public Health Act 1991 (NSW) and earlier in
the Nursing Homes Act 1998 (NSW)

Why We Need Registered Nurses

o

Under the Poisons Act and TGA Act anybody needing pain relief greater than a
paracetamol (i.e. codeine, oxycodone, opiate-based drugs, etc.) requires at least one
registered nurse because the drugs are classed as Schedule 8 drugs (i.e. drugs of
addiction).
Medication scheduling, storage and administration in aged care has the same
standards as hospitals. There are whispers of these changing, but it brings
into question why lesser standards should be allowed in aged care (these are
in place to prevent medication errors, and to prevent theft of drugs.
Registered nurses also:

know when to and when not to administer drugs (e.g. withholding blood
pressure medications when a patients blood pressure is too low),
can admit patients back from hospital (a nursing home resident and
former doctor was evicted from hospital last year because there wasnt a
registered nurse available over a weekend to readmit her apparently the
patient died a week or so later at St Vincents Hospital after leaving Prince of
Wales and being refused at her nursing home due to inadequate staffing to
care for her), and
can respond to critical incidents, preventing unnecessary hospital
admissions (reducing existing bed-block issues and taking the pressure off
the public health system).
The Governments idea is just to have employees with a minimum of
a first aid certificate on site, responding to an incident with the bare
minimum of interventions (i.e. CPR if they arrest) and call an
ambulance.

Arguments in Favour of Not Employing Registered Nurses

Pay rates are lower (NB hospital pay rates quoted here, but nursing homes often pay less,
though ratios between roles is the same).
o Base rate for a first year Registered Nurse in a public hospital is between
$57,943.60 and $81,369.60 without penalty rates.
o Base rate for an Enrolled Nurse is between $52,234.00 and $56,747.60 without
penalty rates.
o Base rate for an Assistant in Nursing is between $41,641.60 and $45,687.20
without penalty rates.

Assistants in Nursing are easier to employ, and theres more of them looking for work
o Very little training is required for an AIN at best a Certificate III course is required,
but unlike Registered Nurses and Enrolled Nurses, AINs are not registered and have
no professional standards governing minimum requirements.
For the record, training for each level of nurse is as follows:
Registered Nurse 3 years, Bachelor Degree
Enrolled Nurse 1 year, TAFE Diploma
Assistant in Nursing 1 month Certificate III TAFE Course

Most AINs are students studying to become RNs, so theres a lot of people
looking for work. Many are also migrants, etc. from overseas working in the
industry as a stepping-stone to something else.

Nursing Home Definition Changed Federally

The definition of a nursing home in the Act defaulted to the Aged Care Act 1997 (Cwth).

The federal Aged care Act was changed in 2013, coming into force at the start of the
2014/2015 financial year to streamline funding arrangements for residents and transitions
between low care and high care facilities. One flow-on consequence was to change the
definition of a nursing home. The term in the new Aged Care (Living Longer Living Better)
Act no longer used the word nursing home so s104 in the NSW Public Health Act became
nullified by default.

The three largest private nursing home providers floated on the ASX just soon after the law
change and are recording high profits as a result.

NSW Health Minister Jillian Skinner grandfathered the status quo provisions for keeping at
least 1 Registered Nurse on staff at all times to nursing homes that had been operating before
1 July 2014, but it means that all other nursing homes that established after that date
were exempt from the standard. Thats why Uniting Care and other providers made
submissions to the GPSC 3 inquiry saying it would affect their profits because many places
started building new nursing homes to take advantage of the loophole.
o That regulation, the Public Health regulation 2012 (NSW) is due to be reviewed on 1
September 2017.