Penelope Marshall: Trailblazing aged care voice on Nursing and Midwifery Board

Penelope Marshall has become the first-ever aged care representative of the Nursing and Midwifery Board of Australia (NMBA). 

With over 25 years in healthcare, Ms Marshall worked the majority as the national manager of patient safety and clinical risk for Ramsay Health Care, Australia's largest operator of private hospitals.

In June 2022, she took the helm of clinical governance, risk, and innovation manager at Victoria's leading private aged care provider BlueCross Aged Care.

"People need guardrails and guidance," Ms Marshall said.

"It's the organisation's and the government's responsibility to help set them up for success.

"It's an indictment on society that we haven't done that for aged care very well."

Join Aged Care Insite's conversation with Ms Marshall on how to build a health and aged care workforce that is 'appreciated for its true worth' and has reached its full potential.

What aspects of your career prepared you for the role?

I started as a ward nurse, a theatre nurse, and a midwife. 

I've always wanted to make things better for people and believe that health is fundamental for a good quality of life. 

During Covid, I was the national manager of patient safety and clinical risk for Ramsay Health Care, Australia's largest operator of private hospitals in Australia.

We were asked on a few occasions to assist, particularly in Victoria, with aged care facilities struggling with infection control and the care of people, among other things.

When I went there, I deployed teams, and I was sometimes shocked to find that they didn't have the same structures, processes and supports we have in hospitals. 

So, after the peak of the pandemic, I felt saddened about that.

I'm going to get older, and I have an aging parent. 

I felt a little guilty that I had all this knowledge in my mind and experience in improving and establishing processes for people but wasn't using it for aged care.

In crises, you have to rely on structures and processes to get through - you can't have chaos in aged care or healthcare. 

So, I felt obligated to try to improve things and help people in aged care.

Many staff members and really good people in aged care are trying to do their best, but they could use a system that would support them and help them better.

They have the best intentions but still need robust processes, systems, and frameworks to work with. 

People need guardrails and guidance. 

I don't think anyone in aged care would ever mean to harm people, but it's the organisation's and the government's responsibility to help set them up for success. 

It's an indictment on society that we haven't done that for aged care very well. 

What do you believe are the strongest skills you'll bring to the board?

I am very process-driven, structured and methodical in decision-making.

There is much to be done in all healthcare environments, and there always will be. 

However, when assessing risks and considering actions, it's important not to engage in activities that won't make a difference. 

We can all be tempted to do things simply because they're comfortable. 

But in aged care, I believe we should focus on addressing significant issues and keeping things straightforward. 

We shouldn't overcomplicate matters for the frontline workers.

I also believe in empowering people. 

Much of aged care and healthcare comes down to equipping and investing in individuals and highlighting their strengths. 

It also involves listening attentively because frontline workers often possess the knowledge and ideas to improve things. 

Unfortunately, care staff, who may not have formal qualifications, are sometimes not heard, despite having valuable insights into what residents or clients need and ideas on simplifying processes for themselves and others. 

So, listening is crucial. 

However, it's also essential to adhere to fundamental principles and not overcomplicate matters, keeping the focus on promoting health and wellbeing.

Because it can be easy to become too top-heavy in decision-making.

What major issues in aged care do you hope to address?

Many providers lack robust systems and technology in aged care. 

The sector is still in its early stages of generating data for informed decision-making. 

So, before delving into various initiatives without measuring their impact or analysing the root causes, it's important to assess the main problems and contributory factors that can be targeted for effective solutions.

The Aged Care Commission and the Royal Commission have played a vital role in bringing about a necessary reset in aged care. 

However, the pace of change can be overwhelming. 

It may be better to focus on a few significant areas and address them well. 

For instance, let's prioritise fall prevention, nutrition, and other fundamental aspects that can make a tangible difference rather than getting too caught up in numerous minor issues. 

Teaching people how to measure outcomes, produce reports, and make data-driven decisions is essential rather than relying solely on anecdotal accounts. 

Making decisions based on statistical evidence is crucial for sound scientific practice. 

Another vital aspect is valuing the individuals who deliver care. 

Recognising their contributions, playing to their strengths, and creating a sense of worth will benefit everyone involved. 

I hope to elevate the community's appreciation for the invaluable work in aged care. 

Unfortunately, there is sometimes a stigma associated with working in aged care, which should not be the case. 

The work is truly incredible and meaningful. 

We all hope to receive quality care in our later stages of life, so there's a moral obligation to influence perceptions and show respect and value for those who provide care.

You said you also wanted to allow more nurse practitioners (NR) to prescribe in aged care. Could you elaborate?

I've always believed that healthcare practitioners are a valuable and limited resource, and we must utilise and maximise their skills to the fullest extent. 

While doctors, such as GPs, in healthcare facilities are essential for medical oversight, certain tasks could be appropriately delegated to qualified NRs.

For example, if a patient has been on antihypertensive medication for the past ten years and only requires a prescription renewal, why couldn't an NR handle that? 

NR also have limitations in their scope of practice to ensure appropriate care is provided. 

However, they could assess individuals and provide care without the need to transfer patients to hospitals, as many people in aged care facilities prefer not to go to hospitals. 

If NRs could conduct telehealth assessments, it would relieve a significant burden on the healthcare system and allow individuals to remain in their familiar and safe environment. 

Taking cognitively impaired individuals, placing them in an ambulance, and subjecting them to a chaotic emergency department setting is not always the kindest or healthiest approach. 

NRs have much to offer in aged care settings. 

We are aware that primary care, including GPs, is under considerable strain in our country, and by optimising their skills for their essential tasks, we can easily integrate more NRs into aged care.

My main focus is to ensure that the work in aged care is acknowledged and appreciated for its true worth and to provide the necessary support for staff to reach their fullest potential. 

I want to contribute to building a workforce equipped to meet the evolving demands of care delivery in the future.

That's what truly matters to me. 

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