A nurse has told the Royal Commission into Aged Care, there is no excuse for chemically sedating people and it is often done only because of a lack of staff.

Key points: Chemical sedation of elderly people makes things "look clean and tidy", the royal commission heard

Chemical sedation of elderly people makes things "look clean and tidy", the royal commission heard Nurses told the royal commission they had to do unpaid overtime to get things done

Nurses told the royal commission they had to do unpaid overtime to get things done The royal commission also heard relatives were not consulted before residents' medication changed

A panel of three nurses and a diversional therapist gave evidence to the commission on Wednesday, saying their roles were plagued by understaffing and that regularly had to do unpaid overtime.

In answer to a question from counsel assisting Paul Bolster about why chemical restraints were used, registered nurse Elizabeth* said it ultimately came down to not having enough staff.

"It's really confronting and unsavoury to physically restrain people and I can't think of a time where it should be happening at all," she said.

"Rather than give proper care you sedate people so they're not annoying you and it's not acceptable."

"Chemical restraint ... is an anonymous way of doing it because people come in and everyone looks fine, they're all clean and tidy and they're not crying out, but they're not actually getting the care they need."

Maggie Bain, a diversional therapist, said she had seen daily instances of residents being physically restrained.

The nurses spoke of shifts where they were run off their feet and doing unpaid overtime — sometimes on a daily basis.

"I was working in an aged care facility where we'd work half an hour unpaid overtime every day and that was so we could have the handover," Elizabeth said.

"We would be doing up to four hours overtime a day just trying to manage the care for people.

"This is when you're doing one [nurse] to 60 [patients] and you've got people with high needs — so people that are dying for example."

Relatives not consulted about medication

A number of the nurses voiced their support for mandated nurse-to-patient ratios.

"If you've got a person [who's fallen], you're completely taken off the floor with that person," assistant in nursing Susan Walton said.

"So your other 39 [residents] ... you don't know if they're wandering, there's people at risk that you're supposed to check, and you can't get to them physically."

The commission also heard from pharmacist Dr Juanita Westbury from the Wicking Dementia Research and Education Centre.

Dr Westbury said many relatives she had spoken to were not consulted before their loved one was prescribed a psychotropic medication.

"A lot of them said the first time they found out their relative or their mum or their dad was taking these medications was when they received their pharmacy bill," Dr Westbury said.

"Pharmacists who worked in the sector often said they encountered real resistance to reduce the overall use because a lot of the staff were quite concerned behaviours would return or be escalated if the use was reduced."

The commission has heard numerous stories of over-prescribing of psychotropic or anti-anxiety medications in aged care homes.