A passion for gerontology: valuing all the members of the staffing team is the secret to running a successful aged-care facility, says Lonsdale nurse manager Dorothy Moore.

Dorothy Moore, the new nurse manager at Lonsdale Hospital and Rest Home in Levin, is passionate about gerontology and committed to running a facility where residents feel safe and happy, and staff gain some real job satisfaction.

Moore joined Lonsdale when the new owners New Zealand Lifecare took over 15 months ago. Prior to that, she held management roles at Levin's Te Whanau Elderly Care Centre and the Levin War Veterans' Home. Her real interest in gerontology was sparked during the 12 years she spent nursing at Horowhenua Hospital--in the dementia unit, continuing care and rehabilitation wards. She is also a committee member of NZNO's National Gerontology Section.

"Gerontology is still seen as the Cinderella of the nursing profession, but it is in fact a specialist, primary health care area that is not always well understood and needs a lot more promoting. Our residents at Lonsdale have multi-diagnoses. They are here because they can no longer continue living independently in the community, even with help. By the time they come here, they are frail and quite dependent."

Moore values the close involvement Lonsdale, its residents and staff have with the wider community. Most of the residents have lived in Foxton or the surrounding areas for many years, as have many of the staff members, including herself.

"When I arrive each morning, the first thing I do is to speak to all the residents, once they are up and dressed, and to the staff on duty. I Like to be out and about the place, building up the homely atmosphere and making sure the residents are comfortable and reasonably happy with their daily lives. I run an open door policy that applies to everyone--staff, residents and their families. Although keeping the budget balanced is importance and maintaining our contracts and standards, first and foremost comes the welfare of the residents--their physical, emotional and spiritual well-being." Even though Lonsdale and New Zealand Lifecare's other rest-home facility Riverside at Foxton Beach (jointly managed with Lonsdale) are the only rest-homes in Foxton, maintaining occupancy is still a challenge, Moore says. This year, the Lonsdale site will be upgraded, which will see hospital patients having their own rooms and a general modernisation of facilities. "Once the renovations are completed, I would like to see Lonsdale reach full capacity. We can take 54 people here, with another 20 rest-home residents at Riverside. Full capacity would also enable me to employ more staff."

Moore believes Lonsdale is quite well staffed, even though not all staff might agree. The facility has registered nurses (RNs) rostered on 24 hours a day, seven days a week, with a full complement at present. Two to three RNs are rostered during the week, including a clinical co-ordinator, with one RN at the weekends and Moore herself on call. "We are delighted that one of our RNs has come to us from MidCentral District Health Board's (DHB) first-year-of-practice primary health care programme for new graduate nurses. It is great to see gerontology nursing being recognised as a primary health speciality. When I first came here, it was a challenge to recruit RNs. Now we have a waiting list of people wanting to work here. When there's a change of owner, it takes quite a while to rebuild trust and credibility.

"Having legal and safe rostering is very important to me, as well as ensuring staff are satisfied with their work in other ways, like getting annual Leave when they want it. Our RNs are mostly involved with assessment, documentation and liaising with other health professionals. We have a GP on site during the week, but not after hours, so it's up to the nurses to assess when a doctor or ambulance needs to be called. We don't have a physiotherapist or pharmacist on site, but we can call them when we need to. We share the care of our patients and residents with other specialists, like the visiting hospice nurse or diabetes nurse specialist. "Our RN rates are competitive with the DHB rates, but we don't pay the same penal rates as the DHB. We also employ some excellent caregivers. I would Love to be able to pay them more, for they are our main workforce and we rely on them heavily. But in the end, it's the market that governs these things, like everything else. The annual collective agreement negotiations is the opportunity for them to seek increased wages. I support NZNO's Fair Share for Aged Care Campaign and am pleased to see the efforts being made to make the public aware of working conditions in the aged-care sector." While not being able to pay her caregivers more, Moore believes other incentives like quality in-service education and the WellCare national certificate course, which are paid for by New Zealand Lifecare, provide some compensation. She would like to think most staff have job satisfaction and appreciate the safe rostering she achieves. However, she admits some caregivers are not that interested in ongoing education. "We encourage all staff, nurses and caregivers to do some form of education and professional development. Most of our in-service education is offered in work time and covers such things as pressure area care, continence, back care for staff and residents' rights. It's great that two of our caregivers have now gone on to do their nurse training."

Having all staff working as a team and respecting each others' roles within that team is the key to residents receiving the best care possible, says Moore.