industry & reform
Virtual care
Could ‘ virtual nurses ’ be the key to aged care staffing shortages ?
By Micah DJ Peters
Former Health Department Chief Martin Bowles has reportedly proposed “ virtual nurses ” could help address the shortage of nurses in aged care .
This might involve remote , possibly artificial intelligence-assisted , virtual care , rather than physical nurse presence , to assist nursing homes to meet new legislative requirements to have a registered nurse present 24 / 7 .
There are clear opportunities for technological innovations to improve the care , health , and wellbeing of older people . However , substitution of face-toface nursing and human interaction with remote care is not the answer .
This seriously risks perpetuating the status quo where many older people suffer from isolation , neglect and lack of human engagement .
Eroding requirements to properly staff nursing homes with registered nurses could make it even harder to attract and keep staff .
“ Robot nurses ” already exist in some contexts , helping to move patients , take vital signs ( such as blood pressure ), carry medicines and laundry , and even engage with patients .
However , “ virtual nursing ” likely refers to more familiar technology where a real nurse provides a limited range of care via telehealth ( by phone and / or video ).
While some might appreciate when robots can assist with certain tasks , much of what nurses do cannot and should not be performed remotely ( or by robots ). Indeed , older people , their loved ones , and staff are calling out for more physically present staff and more time to care and interact , not virtual interfaces and remote consultations .
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The benefits of technology in health care are unquestionable and many innovations have improved care for older people . Artificial intelligence shows promise in helping prevent and detect falls , and socially assistive robots such as PARO ( a baby harp seal ), have been shown to reduce stress , anxiety and antipsychotic use in people with dementia .
Technology should not , however , be introduced at the expense of care quality or supporting and sustaining a suitably sized and skilled aged care workforce . We still need to adequately staff nursing homes to provide safe , dignified care .
The Royal Commission into Aged Care Quality and Safety heard a vast quantity of evidence regarding insufficient staffing , particularly of nurses who have the education and skills to deliver high quality clinical and personal care .
This expertise is why nurses cannot be replaced with remote care , and why the Commission recommended 24 / 7 registered nurse presence ; this has now been legislated .
More than half of Australian aged care residents live in nursing homes with unacceptably low levels of staffing and around 20 % do not have a registered nurse onsite overnight .
Insufficient staffing results in workers not having time to interact with residents meaningfully and compassionately and also contributes to avoidable hospitalisations , worse quality care and outcomes , and poor working conditions for staff .
As social beings , human interaction is fundamental to health , wellbeing , and best practice care . This is particularly true for older people in nursing homes who are less able to engage with others
“ Remote care is not the answer .
and is especially vital for those living with mobility challenges and dementia .
Partly due to nurse low staffing levels , loneliness , isolation and mental ill health are widespread in aged care and have become more common due to pandemic related restrictions on visitors and staff .
Care experiences are shaped by human interaction and contact ; the touch of a hand , a smile , eye contact , and being able to take the time to genuinely listen .
These actions are central to how nurses and other staff build effective and meaningful relationships with residents . Seeking to replace human contact with virtual interfaces seems both inconsistent with the Royal Commission ’ s findings and possibly cruel . Personal interactions also help staff , as the Royal Commission highlighted . Knowing those they care for helps care staff to understand how someone would like to be cared for and what is important to them . It helps staff to care – and to care in a way that reinforces that person ’ s sense of self and maintains their dignity . This type of person-centred care takes time .
Rather than circumventing reforms to ensure more nurses provide face-toface care in nursing homes , we need to address the range of challenges contributing to widespread and tenacious workforce shortages .
There are clear challenges for growing and retaining a sufficiently sized and skilled aged care workforce . However , government reforms , such as better pay , mandated care time , and greater accountability and transparency regarding the use of funds all work together to make aged care a feasible and attractive sector to work in .
This is one where staff are supported to provide the high quality and safe aged care all Australians deserve and where older people receive best practice , human care . ■
Dr Micah DJ Peters is a senior lecturer in the University of Adelaide School of Nursing and director of the Australian Nursing and Midwifery Federation ’ s ( ANMF ) national policy research unit .
This article was originally published in The Conversation .