If you're a nurse that is considering transitioning into a career in aged care, understanding the unique challenges and responsibilities that come with this role is essential. Aged care nursing offers a chance to build deep, meaningful connections with consumers whilst providing compassionate and holistic, person-centered care. However, it also comes with its own set of risks and safety concerns that are crucial to recognize and proactively manage. The most common safety concerns in aged care homes are presented here, along with practical tips to address them effectively to promote and maintain a safe living environment for the elderly, as well as safe workplace for staff.

Workload and Burnout

Nurses in aged care facilities often face heavy workloads, which can lead to burnout. This poses a risk to consumers, as burnout can affect the quality of care delivered. Task prioritization, teamwork, and effective delegation are key to ensuring that all tasks are completed each shift and that the workload is shared. Knowing each staff member’s strengths and skills helps in assigning tasks appropriately for effective completion. Regular check-ins with the team and thorough handovers are essential for smooth operations.

To combat burnout, it’s vital for nurses to take breaks, rest properly, and maintain a healthy work-life balance. Recognizing the signs of burnout and seeking help when needed is a responsibility every nurse should take seriously.

Workplace Safety

Knowing and following the facility’s workplace safety policies is essential for protecting both consumers and staff, ensuring a safe and secure environment to live and work in. All staff must follow safety protocols, including vigilance with potential hazards such as wet floors, improperly stored equipment, and unsafe lifting practices. Reporting faulty equipment immediately and ensuring that it’s marked as out of use and stored safely, where it will not be taken for use by accident, is crucial. Effective communication of such hazards and safety issues during handovers is essential to avoid workplace accidents. Use of proper PPE where necessary, regular training on safety protocols, and staying informed on up-to-date best practice safety guidelines help maintain a safe environment for both consumers and staff.

Physical Accidents

As an RN, preventing physical accidents in aged care facilities is a critical responsibility which requires a proactive approach to consumer safety. Physical accidents, such as falls, often stem from factors like impaired mobility, poor safety awareness, and environmental hazards. To mitigate these risks, it is essential to regularly assess each consumers physical and cognitive status, ensure environments are hazard-free, and promote correct use of mechanical aids. All staff must undertake manual handling training regularly and follow each consumer’s individual manual handling care plan, using mechanical aids where required. This training aids in the prevention of strains, sprains and equipment related injuries in the work place. It is beneficial for permanent staff to assist and supervise new and agency staff with manual handling until they become familiar with consumers' needs and care plans. Printing manual handling care plans and placing them inside consumers’ wardrobes can be a helpful reminder. It is the responsibility of the RN to ensure that these printed plans are accurate and up to date, reflecting any changes made. Ensure that all staff, especially new or temporary ones, are aware of, and familiar with the location of these plans, and any changes made to them.

Risk of Aspiration

Aspiration is a significant risk for individuals in residential aged care, particularly those with dysphagia, underlying health conditions, or compromised immune systems. It can lead to serious and potentially fatal outcomes such as aspiration pneumonia, choking, and death. To mitigate this risk, Registered Nurses (RNs) must conduct thorough assessments, monitor residents closely, and implement effective prevention strategies. This includes proper positioning during and after meals and ensuring that food and drinks are of appropriate texture according to each individual's care plan. Clear communication is required between the RN who writes the care plan, the care staff who assist with meals, and the kitchen staff who prepare them according to the IDDSI framework, is crucial. Additionally, RNs should educate staff about aspiration risks and encourage them to use their observation skills to ensure correct meal texture provision, thereby safeguarding the health and safety of these vulnerable individuals.

Fire Safety and Emergency Procedures

Fire safety and emergency procedures are critical components of ensuring consumer safety in aged care facilities. All staff should be familiar with each facility’s emergency procedures and fire evacuation plan, including the location of emergency exits, assembly points, equipment, and alarms. Regular fire drills and comprehensive training, including each staff members role and responsibility in the event of an emergency, are important for preparedness in case of any emergency, especially for new and agency staff.

Incident Management

Each aged care provider has its own incident plan for different types of incidents, such as new wound, medication, or post-fall incidents. It is vital that all staff familiarize themselves with these procedures and follow each step accurately and effectively to ensure consumer safety and maintain high standards of care at all times. It also ensures that necessary documentation is completed for regulatory compliance and continuous quality improvement.

Falls

Falls in aged care facilities are common due to a number of factors including physical, cognitive, and environmental conditions, as previously stated. Regular risk assessments for each consumer using standardized tools, and proper planning, can help reduce the incidences of falls within the facility. Maintaining a hazard-free environment, adequate lighting, appropriate footwear and supervision are basic yet effective measures.

Educating staff on fall prevention strategies and the use of sensor alarms for those at high risk of falls can further safeguard consumers. Regular quality checks of these alarms ensure that they are functional and ready to alert staff that a consumer may be in danger. The RN should monitor staff competence in the set up and use of sensor alarms if they are manual e.g positioning of a bed sensor, placement of a floor mat sensor. If a consumer is on the move, triggering a constant alarm, check to see if they are looking for something or trying to complete a task, and assist them with their needs, so that they can return safely to their chair or bed.

Medication Errors

Medication errors can have serious and potentially life-threatening consequences. To reduce such risk and safeguard consumers, it is crucial for an RN to always follow the medication rights every time a medication is prepared and administered. Double-check every prescription and avoid rushing during medication rounds. Use of a ‘medication round’ apron alerts staff that the RN needs to focus on the task at hand and consequently should reduce unnecessary interruptions and distractions. Ensure proper communication among the care team. Be aware of drug interactions, polypharmacy, and side effects specific to elderly consumers with complex medical conditions. Maintain accurate, up-to-date, and clear documentation of all medication prescriptions and the administration of them.

Documentation

Documentation is a form of written communication. Effective communication is vital to achieve the best consumer health outcomes. Clear, concise, and detailed documentation of all tasks, assessments, reviews, and post-incident management procedures carried out, is mandatory. It ensures continuity of care and accountability of the RN. It is essential to maintain a clear record of care provided. Without a paper trail of work completed by the RN, there is no evidence or confirmation of the task being carried out. Accurate documentation is necessary for regulatory compliance. For example, should a consumer show signs of acute deterioration, and the RN fails to document their review of the consumer and the actions taken as a result of the evaluation, the next shift may not be aware of the consumer's condition, or attend to the consumer appropriately, resulting in the consumer's condition worsening. This would be considered an omission of care, which falls under the Serious Incident Response Scheme (SIRS) category of neglect. There could potentially be serious consequences for both the consumer's health, and the staff member who did not document their work in a timely manner, if at all.

Serious Incident Response Scheme (SIRS)

A SIRS incident refers to a reportable event under the Serious Incident Response Scheme. It requires aged care providers to report and manage serious incidents that pose significant risk or harm to a consumer, such as abuse or neglect. Understanding and implementing SIRS guidelines is crucial for investigating and managing such incidents, aiding in quality improvement, and preventing such incidents from occurring again.

Absconding and Security

Absconding is the unexplained absence of a consumer from a residential care facility. The risk of absconding in aged care homes is significant. Risk factors include having been recently admitted (within the first month), receiving respite care (short term), being admitted against one's will, and those who have a history of wandering, particularly those living with dementia. Mitigating this risk includes carrying out risk assessments of consumer behaviour, implementing proper monitoring systems such as close supervision, sighting charts where necessary, regular head counts, having a secure entrance and exit, and having alarm systems in place. All facilities should have the main entrance and exit locked at all times and require access codes to open. By implementing these safety measures, consumers can be protected from dangers associated with absconding, such as injury and becoming lost.

Violence and Aggression

Violence and aggression can significantly impact the safety and well-being of both consumers and staff in residential aged care homes. Consumers may exhibit verbal or physically aggressive behaviour for many reasons. Common causes include unmet needs such as pain, depression, hunger, boredom, lack of sleep, constipation, changes to familiar environments, or overstimulation. Those living with cognitive impairment, such as dementia, which results in the inability to express oneself verbally, are more likely to display such behaviours, referred to as 'responsive behaviours'. Staff training in conflict resolution and crisis prevention can help the team manage and de-escalate tense situations and enables staff to respond more effectively. Educating care staff about dementia, dementia-related behaviours, and the possible causes of these behaviours is essential to providing person centered care. Identifying and addressing these underlying issues early on could reduce incidences of agitation and aggression before they escalate. The RN should communicate to staff involved in direct care regarding each consumer's individual behaviour care plan in order to approach each situation appropriately.

Nutrition and Hydration

People living in residential aged care facilities are at greater risk of malnutrition and dehydration due to various factors, including a reduced sense of thirst and hunger, cognitive impairment, physical disabilities, and swallowing disorders. Additionally, inadequate staff assistance and a lack of choice or preference being offered, can exacerbate these risks. Regular assessment and personalized care plans are essential in managing these challenges.

To achieve optimal outcomes for consumer nutritional health, it is crucial to collaborate with a multidisciplinary team, including dietitians and speech and language therapists. Furthermore, ensuring adequate staffing ratios enables staff to provide the necessary assistance during mealtimes, making them more enjoyable rather than pressured or rushed. By doing so, a supportive environment that encourages better nutrition and hydration practices in aged care facilities, can be created.

Infection Control

Rigorous infection control procedures are essential in preventing and stopping the spread of infections and communicable diseases. Those living in residential aged care, the elderly, are at greater risk of negative health outcomes should they acquire an infection or contract a communicable disease. Consumers are reliant on staff practices to prevent such infections. Regular training and diligent monitoring of staff practices ensure adherence to best practice procedures and protocols. An adequate stock of supplies should always be maintained, to avoid breaches in infection control which would put consumers and staff at great risk.

Essential Regulations and Guidelines for Aged Care Professionals

Understanding and adhering to the regulations and guidelines set out for aged care is crucial for ensuring individuals safety and providing quality care. Here are some of the key aspects professionals entering aged care should be aware of:

Familiarity with Policies and Procedures

It is essential that each staff member be well-versed with each facility's specific policies and procedures related to safety and each staff members role. Knowing where these documents are located allows the RN to reference them whenever needed, ensuring compliance and evidence-based best practice at all times.

Mandatory CPD for Aged Care RNs

All Registered Nurses (RNs) must complete a minimum of 20 hours of Continuing Professional Development (CPD) relevant to their field of nursing annually. Employers often require Aged Care RN’s to complete aged care specific CPD modules each year. These CPD modules cover the following topics:

• Aged Care Quality Standards

• Fire Safety in Residential Aged Care

• Bullying, Harassment, and Discrimination in the Workplace

• Open Disclosure and Apology

• Infection Prevention and Control

• Serious Incident Response Scheme (SIRS)

• Work Health and Safety

• Minimising Restrictive Practice in Aged Care

These training modules will be provided by the employer, or can be completed through CPD portals and websites.

Aged Care Act 1997

This is the primary legislation which governs the provision of aged care services in Australia. This legislation sets out the responsibilities of aged care providers regarding the care and rights of consumers. Take time to read this act and understand the responsibilities of the provider you choose to work with. There have been many amendments to the Act since the original was introduced. The newest version is set to replace the original, and come into effect on 1st July 2025, once the new Aged Care Bill has been passed. This Act will introduce significant reforms following recommendations from the Royal Commission into Aged Care Quality and Safety.

Aged Care Quality and Safety Standards

Familiarize yourself with the eight Aged Care Quality and Safety Standards set out by the Aged Care Quality and Safety Commission. These standards can be accessed here: Aged Care Quality Standards. All nursing practice must align with the standards.

National Safety and Quality Health Service (NSQHS)

These standards were originally developed for hospital settings; however, they are relevant to clinical care provided in residential aged care facilities. Find them here: The NSQHS Standards.

Code of Conduct for Aged Care

Understand the national legislation ‘Code of Conduct for Aged Care’ and explore the resources available for workers. This ensures that all actions and behaviours align with professional and ethical guidelines: Code of Conduct for Aged Care Workers.

Work Health and Safety Act (WHS) 2011

This legislation requires employers to provide a safe working environment for staff. RN's are also responsible for ensuring their professional practice does not put themselves, consumers, or colleagues at risk of danger. This Act has also had many amendments overtime.

For the latest, most up to date version of any Act or Legislation, visit the Federal Register of Legislation here: Federal Register of Legislation.

Serious Incident Response Scheme (SIRS)

Gain an in-depth understanding of SIRS, including what is considered a serious incident, and when and how to report a serious incident. Detailed information and guidelines can be found here: Serious Incident Response Scheme (SIRS) and About the Serious Incident Response Scheme (SIRS).

Dementia Care Training

Dementia Australia offers a wealth of free online modules that cover various dementia-related topics. These modules help professionals gain an in-depth understanding of dementia-related behaviours and effective management strategies using a person-centered approach. Explore these resources here: Dementia Australia.

IDDS Framework for Nutrition and Hydration

The International Dysphagia Diet Standardization Initiative (IDDSI) is an internationally standardized framework which outlines different food textures and drink thickness levels (0-7) for people affected by dysphasia. It is imperative to know what each level looks like and how to prepare and test them to prevent choking and aspiration - ensuring consumers' safety, based on each individuals nutrition and hydration care plan. Differentiate between each level and how test them for safe and accurate provision here: IDDSI Framework.

Safety Tips for a nurse who is considering transitioning into Aged Care

Working as a registered nurse (RN) in aged care comes with its own set of challenges and responsibilities. Here are some top tips to help you in this rewarding yet demanding field:

Thorough Orientation

Take time to ask questions during orientation to fully understand the facility's procedures and locations of essential items. The RN should ask themselves what they consider vital, in order to be prepared to work independently, without any assistance from another clinical staff member, as this can be the case dependent on shift time and facility size, in contrast to hospital settings. They should familiarise themselves with the documentation/software systems and their user manual to manage your time more effectively. Understanding the layout of the facility and knowing where to find necessary resources including how to access policies, as well as understanding the routine of the home, will save time and reduce stress during shifts.

Effective Communication

Maintaining clear and thorough verbal and written communication is imperative, especially during handovers, to ensure smooth operations, consumer and staff safety and continuity of care. Effective communication prevents risks to consumer and staff safety resultant of misunderstandings and ensures that all staff members directly involved with consumer care are aware of any changes regarding each consumer’s care plan.

Auditing

Conducting Audits is crucial for compliance with regulatory standards and ensuring safe care through identifying risks, such as incorrect medication storage temperature, low stock supply of vital emergency equipment, nurse-initiated medications, etc. A clear auditing system is required to mitigate the risk of an incident occurring. Auditing guidelines should be clear and precise and should outline the frequency in which they must be carried out, and the role/person responsible for carrying out each audit. It is vital to communicate and address any findings identified, in a timely manner. Reporting of findings should be carried out at hand over and escalated to the correct person. Proactively checking audit checklists at the beginning and end of each shift, mitigates the risk of incomplete audits going unnoticed and thereby pose risk to the provision of safe care. There may be times when a staff member may work a shift that they don't usually do, and so they may not be aware of their duty for auditing on this particular shift and may need to be informed. Initiative and diligence are essential in ensuring the completion of audits and maintaining a safe environment for consumers residing in the home. 

By addressing these common safety issues and implementing the tips provided, aged care homes can enhance the well-being of both residents and staff, ensuring a safe and supportive environment for everyone.