Two days of the The Royal Commission into Aged Care Quality and Safety have now been completed, with 13 witnesses called to the stand.

Registered nurse Prudence Dear was among the witnesses to speak on Monday and she told the commissioners she had worked in a nurse adviser role at Pioneer House in Mudgee since March 2019.

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The aged care facility was subject to sanctions earlier this year with lawyers also asked to present a case study to the royal commission on Monday.

Ms Dear said in her time at the facility she witnessed gaps in the rosters that "weren't able to be filled or weren't filled".

"It seemed that there were insufficient staff to be able to fill those shifts," she told commissioners.

She said staff at Pioneer House were also "experiencing some burnout".

"When they're short staffed, they would go home feeling very frustrated, because of their inability to provide the care required," she said.

"And as we move towards, or, ideally, have already moved towards a person-centred approach to care, the first thing that tends to happen as a generalisation is that people go back to task focus and task, because that's the best way of being able to get through their work. And so the person-centred care is not able to be achieved.

READ MORE: See the full witness list for the Mudgee royal commission hearing

"They also are not always able to complete the requirements that are needed on a day-to-day basis of providing care for the residents."

Ms Dear told the commissioners that there was a reactive style of management at Pioneer House and staff had no confidence in management and decision-making in the facility.

She said there was a "AIN [assistant in nursing] dominated culture" rather than staff with higher qualifications.

"Everyone was trying to do their role, but, because of the stress that everybody was under and the increase in the roster not being filled, it was very reactive," Ms Dear said.

She also expressed concerns with complex medication rounds that took staff a significant amount of time and said patient weight management procedures had not been completed in "a number of months" when she started her role at Pioneer House.

Ms Dear said there was insufficient support from management towards staff who deal with residents with behavioural and psychological symptoms of dementia. There was also limited placement options for residents with extreme behaviours.

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"When you're short-staffed and when there's challenging behaviours that need to be addressed or incidents that need to be followed through on and managed, so the systems fall apart. The processes fall apart and you're in a reactive phase of trying to manage those rather than looking at things proactively and so therefore it implodes as such," she said.

The final day of the Mudgee hearing will take place on Wednesday, November 6. The public are welcome to attend or watch the live webcast.

The royal commission will continue to accept submissions until April 30, 2020.

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