Nurses and midwives are among society’s most highly valued professionals. But a disturbing national picture is emerging of escalating levels of over-work and burnout. Nurses say their concerns are being ignored by management, amid fear of retribution for speaking out.

Our national survey of 3,000 nurses and midwives found that 32% were actively considering leaving the profession. This comes at a time when the federal government is estimating a workforce shortfall of 85,000 by 2025 and 123,000 by 2030.

Since 2011, we have surveyed Australian nurses every three years on their working conditions, well-being, and organisational and management practices.

Our previous surveys in 2011 and 2013 painted a picture of increasing work demands. But this year, all indicators of work intensification have gone upwards.

Worryingly, 71% felt they often had more work than they could do well (up from 64% in 2013).

Two-thirds (67%) of respondents reported their jobs required them to work very fast, at least several times a day (up from 61% in 2013), while 67% had to work “very hard” several times a day (up from 63% in 2013).

Key factors in this workload included inadequate staff levels, excessive administrative tasks and inappropriate skill mix.

In the face of this, one of the emerging challenges for management will be staff retention. Some 32% of respondents said they were “likely” or “very likely” to leave the nursing/midwifery profession – a significant concern, given the average age of survey respondents was 47.

Whereas a typical organisation might expect a turnover of up to 4% (and estimates in nursing have previously suggested the turnover rate is 3-6%), our study found 25% were very likely to leave the profession in the next 12 months.

So, a strategy around maintaining skilled and experienced staff is essential. Our initial findings indicate that despite improved attempts by management to communicate with staff, nurses and midwives continued to feel excluded from day–to-day decision-making.

More than half (54%) weren’t confident to openly voice their concerns due to fear of retribution. This reflected a general feeling of disconnection between management and nurses and midwives.

Another aspect of organisational concern was the finding that nearly half (45%) of those surveyed believed their organisation had not invested in their further development.

On the positive side, graduate intake for the profession remains good; however, deterioration of working conditions may serve as a deterrent to new graduates if not addressed.

While few would deny nursing is a rewarding career, it can be a particularly stressful profession, and it is vital that those in the profession remain healthy and supported. It is of great concern that highly skilled nurses aged 45 years and above are in the category of lowest hours worked in the profession.

After this third survey, it appears the workforce is coming to a tipping point, with work intensification a key factor. These outcomes are likely to accelerate the departure of highly skilled and dedicated people, who will be expensive to replace.

Such high turnover will affect the quality of health care in an environment characterised by an ageing population and increasing chronic disease.

Issues associated with dissatisfaction at work are all in the control of those managing the system. Targeted interventions are urgently needed to tackle this issue.

Peter Holland, Associate Professor in Human Resource Management and Employee Relations, Monash University and Tse Leng Tham, Higher Degree Research Student, Research Assistant and Teaching Associate, Department of Management, Monash University

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