Researchers behind the Choice, Voice and Control report talk to The Lamp about their findings.
From your research, what snapshot of the wellbeing of our nursing and midwifery workforce did you get?
Prof Rae Cooper AO: This is a workforce under significant pressure and exhibiting multiple signs of difficulty, disenchantment and distress. NSW’s public sector nurses and midwives are stressed, depleted, frequently at risk of quitting or burning out, and feeling underappreciated and unseen. Worryingly, two out of every three regularly think about leaving the profession.
What do you see as the barriers to more family-friendly workplaces for nurses and midwives?
A/Prof Josh Healy: Our research highlights “good flex” – essentially, flexibility that benefits workers as well as employers – as a cornerstone of workforce sustainability in nursing and midwifery. At present, however, nurses and midwives in the NSW public sector get much less of this “good flex” than they want. And the types of flex that they want, but cannot currently access, are often uncomplicated. At least half of them would like more opportunities and choice to swap shifts, change their work start or finish times, and take paid time off for appointments.
Yet, while these “good flex” varieties are easy to name, they are harder to implement in practice for many NSW public hospitals. Our report identifies four main barriers that prevent good flex from being more widely available: local work context; a lack of consistent managerial support for flexibility; the complex nature of rostering itself; and chronic understaffing.
Experiences of flexibility differ markedly. Even where the work setting is conducive to flexibility, this is not necessarily facilitated by managers. Some of our research participants spoke of managers who impede workers’ attempts to achieve good flex. Even for well-intentioned managers, rostering is a difficult task. It too is an essential, but underappreciated, skill; and it too requires flexibility. Finally, these challenges are compounded by the pervasive realities of understaffing and stretched budgets in the public system.
What are the factors that facilitate a more sustainable workplace for nurses and midwives?
Prof Rae Cooper AO: A sustainable workplace provides what we describe as “good flex”: predictability, support and genuine choice. This is different from “bad flex”, where flexibility primarily meets the employer’s needs and workers are expected to absorb unpredictable hours or changes to their working time. Flexibility is only good when it works for both workers and employers.
Nurses and midwives need flexibility and better control over rosters and shifts, more manageable workloads, work that lets them have a life, and increased support from senior managers for job design that works for people. Employers can support this by establishing and expanding flexibility initiatives in partnership with staff, recognising and resourcing rostering as a specialist skill, and building support for good flex across teams, managers and senior leadership.
What are the consequences for our public health system if there is no structural change in the way nurses and midwives work is organised?
A/Prof Josh Healy: Changes in work organisation and job design are imperative to ensure that our public health system can continue to meet the growing health needs of the people of NSW.
The system’s sustainability is at risk, at a time of rising service demand. Without changes in work design and organisation that enable more sustainable workforce management, the problems revealed in our report will persist or get worse. Our public hospitals will continue to struggle to hold onto their nursing and midwifery staff – including the most experienced of these staff, who are essential to quality care.
How central is improved staffing to solving the problem?
Prof Rae Cooper AO: Improved staffing is central, but it cannot be separated from how the work is designed. More staff would help to manage workload pressures, prevent burnout and create the conditions in which access to flexibility expands. But understaffing can’t be effectively resolved while the jobs themselves continue to drive skilled nurses and midwives away.
What are the benefits for employers and health organisations from improved flexibility and control for nurses and midwives in their jobs?
A/Prof Josh Healy: Work design is critical to organisational success and workforce sustainability. Good flex benefits both workers and health organisations. Nurses and midwives experience better wellbeing and job satisfaction, along with reduced fatigue and less risk of burnout. Employers benefit from being better able to attract and retain skilled staff, which eases understaffing issues, and helps to build sustainable institutional knowledge and capability.
The benefits flow through to efficiencies and productivity gains via lower staff turnover and replacement costs and higher staff engagement.
What weight would you give to the gendered undervaluation of nurses and midwives’ skills and labour to the existing problems in the system?
Prof Rae Cooper AO: It deserves significant weight. Nursing and midwifery are predominantly female, frontline workforces, and their work and skills are often undervalued. This is reflected in understaffing, workload pressures and limited attention to job design that accounts for workers’ lives and caring responsibilities outside work.
The recent wage increase from the NSW Industrial Relations Commission helps to rectify the historical undervaluation, but it doesn’t address all the issues that affect job quality for nurses and midwives. The public health system cannot continue to rely on the commitment of its staff, while expecting them to sacrifice their own wellbeing. Designing jobs that work for a predominantly female workforce is essential if we want to attract and retain skilled staff. We must ensure that the people who save our lives are not sacrificing their own lives to do it.