It’s much more than a numbers game

BY DAN PRENTICE, QNMU PROFESSIONAL RESEARCH OFFICER

Across the world, nurses and midwives are taking to the streets to protest about a range of issues that affect both their work and private lives. Burnout, exhaustion, not enough staff, nurses and midwives leaving their profession, wages that aren’t keeping pace with the cost of living, and unsympathetic governments and employers are common complaints.

A recent ANMF National COVID-19 Survey Report has indicated that about 21% of nurses expressed a likely intention to leave their current job over the next 12 months. Worse still, 13% indicate they plan to leave direct care roles entirely (ANMF, 2022).

Concerns about nurse and midwife shortages are not new. Even before the COVID-19 pandemic, Health Workforce Australia had projected a shortage of up to 123,000 nurses in Australia by 2030, with the resulting impact this shortfall would have on the health system (Mannix, 2021).

Undoubtedly, the COVID-19 pandemic has exacerbated and complicated this picture. So, how did we get to this parlous state and what can be done about it?

While many of the issues currently being experienced were present prior to the pandemic, this worldwide event has magnified them considerably.

While previously, there was a lot of papering over the cracks, new initiatives and promises of change that kept the health system functioning, it’s now time for a fundamental rethink as we simply can’t just go back to the way it was before COVID-19 emerged.

Workplaces that support nurses, midwives and carers are an essential part of any change.

In 2022, a multinational study on the effects of COVID-19 on the nursing workforce, identified ‘doing meaningful work’ as the most significant factor influencing nurses to stay in their current role.

This finding held true for Australian nurses as well. Other important satisfiers included good health, positive interactions, caring and trusting teammates, engaged by work, work-life balance, safe work environment, manageable workloads and a sense of belonging (Berlin &

Essick et al., 2022). In other words, nurses were describing a positive practice environment (PPE).

The International Council of Nurses (ICN) describes positive practice environments as “… characterised by professional recognition, education, reflection, support structures, adequate resourcing, sound management practices and occupational health and safety” (ICN, 2021).

Importantly, these findings highlight that positive practice environments have many influencing factors, and all must be addressed to create workplaces where nurses and midwives can do meaningful work

An important part of creating positive practice workplaces has been the introduction of nurse to patient or resident ratios in significant portions of the public hospital system and in Queensland Health nursing homes.

As part of the Queensland State Government election commitments, work is ongoing to expand ratios into practice areas such as maternity, emergency departments, operating theatres and prisons.

What research has established, is the impact that ratios have on meeting the positive practice environment requirement of manageable workloads.

As a consequence, better staffing and manageable workloads as a result of ratios, led to safer care and better patient outcomes such as reduced mortality, decreased length of stay, lower rates of iatrogenically acquired infections, fewer readmissions, higher patient satisfaction, as well as significant cost savings, and helps to reduce nurse burnout (McHugh et al., 2021; McHugh et al., 2020).

However, while ratios are a core element of delivering effective and safe nursing and midwifery care, improving the wider work environment of nurses and midwives is fundamental to improving hospital safety and quality more generally (Olds et al., 2017).

In aged care too, better nurse work environments are associated with improvements in resident safety and reduced levels of nursing burnout and dissatisfaction (White et al., 2020).

These findings are critically important given the aged care reform process underway in Australia following the damning findings of the Royal Commission into Aged Care Quality and Safety Report published in 2020 along with 148 recommendations for aged care reform.

There are a number of key elements that together, create and sustain positive work environments where nurses and midwives can do meaningful work.

These elements are outlined in the QNMU Positive Practice Environment Standards for Nursing and Midwifery (2020) which provide a holistic view of positive workplaces (QNMU, 2020).

These evidence-based standards encompass the six work environment characteristics that drive the achievement of supportive workplaces that accomplish excellence. These areas are:

■ safe staffing levels

■ physical, psychological and cultural safety

■ autonomous and collaborative practice

■ shared governance and decisionmaking

■ research and innovation

■ transformational leadership.

However, simply developing and publishing these standards is not enough to ensure their adoption across the health and aged care sectors in Queensland. Building on the success of the QNMUs Ratios Save Lives and Money campaign, the positive practice environment has been integrated into the Nurses and Midwives (Queensland Health and Department of Education) Certified Agreement (EB11) 2022

While this is a starting point with much work to be done, it reflects a broad recognition that positive practice environments for nurses, midwives and carers are the only way to meaningfully respond to the many health system issues being experienced by members in these COVID-19 pandemic times.

Ultimately, the positive practice environment focus agreed to by Queensland Health will flow to the private health and aged care sectors with the QNMU taking every opportunity to see these standards embedded across the board.