Nurses left to pick up the slack – December 2007

Research reveals nurses are left to pick up the slack across a system that has reached a critical point.

This month The Lamp reports on two comprehensive research projects that shine a light on the working conditions of our public health system nurses (see pp 16, 20).

The first is a longitudinal study by the University of Technology, Sydney, based primarily on quantitative data collected from NSW Health administrative systems and directly from wards. It is an ambitious attempt to understand what constitutes nurses’ workload and the skill mix in medical and surgical units across different types of hospitals.

The second is an investigation of NSW Nurses’ Association members’ attitudes, perceptions and experiences of working in the public health system using qualitative research.

These two projects, between them, give us an insightful look at life at the frontline in our public hospitals.

They reveal a complex workplace environment for nurses where there are great pressures and a variation in resources between wards.

Increased patient acuity, the considerable movement of patients on and off wards, the shortage of RNs and shorter lengths of stay by patients have all contributed to an increase in workloads for nurses.

The UTS study concludes that nursing unit managers must be provided with the necessary human resources, including adequate nursing hours and an appropriate skill mix, as well as appropriate data and institutional support.

In our own research, nurses tell us that it is left to them to pick up the slack across a system that has reached a critical point. Nurses are angry they have been put in a position, which is not of their making, where it is difficult for them to provide good nursing care and where they suffer extreme levels of stress.

This is compounded by a perception that their work is misunderstood and undervalued. This perception is validated by the media frenzy that accompanies a system breakdown in one of our public hospitals.

Aggression towards nurses continues to be unacceptable and is now a part of their work environment.

These tough working conditions – long hours, high workloads, extreme stress, high levels of responsibility and relatively modest levels of pay – contribute to a tendency for nurses to neglect their own health.

What came out clearly from our groups was nurses do not believe the system provides them with enough support to do their jobs in an optimum way.

This is the context in which next year’s award covering nurses’ pay and conditions will be negotiated.

Already, the NSW Treasurer Michael Costa, has flagged he will be looking to limit public sector wage increases to 2.5% per year unless there are significant improvements in productivity.

Mr Costa should realise there are no productivity improvements left to squeeze out of nurses. The nursing workforce and the public hospital system they have been propping up are living on the edge now.

NSW Health and the State Government are going to have to think and act beyond their current managerialist mindset if the formidable problems of our public health system are to be solved.

Report after report from such diverse sources as the Productivity Commission and UTS have shown that nurses are the backbone of the health system, that there is a critical shortage of them and that any long-lasting solution involves making their jobs more attractive.

This means better pay, more staff, the right skill mix and an appreciation by management of the realities for nurses at the frontline.

If Mr Costa has trouble getting his head around that, maybe he should get away from his beans and put himself in the shoes of a nurse in an emergency department, or busy medical or surgical unit for a day.

2008 promises to be another challenging and important year for the NSWNA and our members, but I hope many you will take whatever time is available over the festive season to share good tidings and joy with your family and friends. Merry Christmas!