Greater flexibility with rosters and improved staffing by addressing the structural constraints are fundamental to the resilience of the health workforce, says a new report.

NSW nurses and midwives want more flexibility in their rosters to improve wellbeing, retention and longevity in their careers, says a new report.

The report – titled Choice, Voice and Control – outlines what NSW nurses and midwives want from their shift and roster patterns. It outlines the barriers and enablers that exist between them and their aspirations; and the consequences and risks when nurses and midwives do not properly have the choice, control and flexibility they want and need.

The report was based on an overview of existing research, a survey of more than 2,000 nurses and midwives, 15 focus groups, and in-depth interviews.

The researchers – led by Professor Rae Cooper AO from the Australian Centre for Gender Equality and Inclusion – describe “a cycle of poor job quality” with three interacting elements: endemic understaffing, overwhelming workloads and a lack of flexibility in rosters.

Nurses and midwives told the researchers they wanted more say over their hours and “to feel that their voices are being listened to”.

“You would think that (with) the volume of nurses that there are in any ward or any hospital, if we all were able to put forward our preferences and then be heard … things would balance out pretty much,” a Clinical Nurse/Midwifery Specialist said.

When analysing workplace flexibility, the researchers distinguished between what they call “bad flex” – employer-driven practices designed for operational efficiency and delivery – and “good flex”, which consists of working arrangements that offer employees predictability, support and a say in their working hours.

An aspiration to be away from work more often

Overall, participants revealed that nursing and midwifery is not only unfriendly to workers with families, but to anyone who wants to have a life outside of work.

Many nurses and midwives reported experiencing clashes between work and life, with over half of the survey respondents (54 per cent) disagreeing that they ‘have an adequate balance between their work and personal/family life’.

One RN pointed out the consequences of inadequate breaks after relentless shifts.

“You’re creating fatigue. You’re not allowing for family time. You’re not allowing for me time. I’ve actually said to my manager, do you want to come around and do my washing and cook a week’s worth of meals? Because, you know, (with) this roster, I haven’t got time.”

A Clinical Nurse/Midwifery Specialist warned that unless nursing and midwifery become family-friendly, there was a high risk of losing more staff.

“I always think you will retain nurses if you make it accessible to people who have kids and have to work these unsocial hours,” she said.

Good flex constrained by structural issues

Nurses and midwives said they wanted support from their managers, including greater fairness and equity in rostering; clearer communication with employees; and a more sincere desire to understand employees’ needs and wants in relation to workloads, rosters and hours, the report says.

Managers highlighted “chronically busy, overwhelming and stressful workloads” as a structural barrier to good flex. These overwhelming workloads were seen as a consequence of insufficient staffing. “Time pressure and exhaustion push staff away from nursing and midwifery and, when experienced staff cannot easily be replaced, overwhelming workloads intensify, perpetuating the cycle,” the report says.

Many participants spoke positively about managers that had endeavoured to make rostering ‘work’ for their teams. Solidarity from co-workers and supportive teams were also seen as a “significant enabler of good flex”.

In the survey, 81 per cent agreed they can ask co-workers for help, and 72 per cent agreed they can rely on their co-workers when things get tough.

It starts with understaffing

The report concludes that while the “poor job quality cycle” has several elements, the cycle starts with understaffing: “This cycle is entrenched at the structural level by the chronic understaffing of nurses and midwives throughout the state… time pressure, overwork and poor work-life balance lead in combination to fatigue and emotional exhaustion, which drive worn-out nurses and midwives out of their jobs.”

NSWNMA General Secretary Michael Whaites said the report reflected what members had told the Association about their overwhelming pressures. “The report reveals significant and worrying implications for the sustainability of the health sector and the perceived quality of the care that nurses and midwives can provide to patients.

“Helping nurses and midwives gain greater control over their hours and shifts would help to stem poor workforce retention and make nursing and midwifery more sustainable professions as the workforce demands greater flexibility,” he said.

Stronger rights needed around rosters

The researchers propose working arrangements “that provide clear benefits to employees by offering predictability, support, and genuine scope for voice, choice and control – while also meeting organisational needs” which they call “a good flex”.

These improved working arrangements would include:

• strengthening working-time rights,
• embedding employee-centred rostering,
• enhancing managerial capability and
• transparency, and enabling genuine employee voice.

What nurses and midwives want

NSW nurses and midwives have five major aspirations for their working time:

1. Greater flexibility and control over theirrosters, shifts andhours of work
2. More manageable workloads and improved staffing
3. Increased support from managers
4. Work that accommodates life outside of work
5. Better wages to support retention and ease workloads