Why Nurses Really Get The Blues

Low morale is harmful to nurses’ health and puts patients at risk. A university study asks what really causes nurses to feel down.

Nurses with low morale are more likely to have accidents and make mistakes, become ill and take sick leave, and express a desire to find employment in other organisations.

These are among the findings of a study of factors affecting nurse morale conducted by an Australian team led by Dr Gary Day, a lecturer at Queensland University of Technology’s School of Public Health.

Results of the study were published in the November 2006 edition of the Australian Health Review.

Low morale is a major contributor to high staff turnover’ a 2002 study by Best Practice Australia found that 42% of 6800 Australian nurses surveyed expressed a desire to leave their organisations.

Results such as this led Dr Day and colleagues to examine Australian and international literature on factors causing poor morale among nurses.

Their report distinguishes between intrinsic or personal factors that nurses have some control over, and extrinsic or structural factors which are largely out of the control of the individual nurse or group they work in.

Dealing with intrinsic factors, the report identifies workplace relationships between nurses as one of the most important factors influencing nursing morale.

Relationships with doctors are also important. The report notes that ‘when supportive professional relationships with medical staff were present nurses reported that their work was more meaningful and satisfying, their professional knowledge and skills were utilised, and they thought less often of quitting.

Also, ‘absenteeism and turnover were significantly reduced as a result of a strong sense of community and work-group relationships fostered by the nurse manager.’

Dr Day refers to one study which found that the two factors that dominated nurses’ understanding of morale within their workplace were

(i) the perceived ability to deliver good patient care and (ii) good collegiate relationships with co-workers.

Opportunities to move up a career ladder also strongly influence morale.

Dr Day cites UK studies which found that nurses attributed poor morale to -lack of support for education and training and frustration about the limited opportunity for promotion.

Positive morale was linked strongly to the nurse’s position and level of education. One study highlighted that as a nurse rose higher in the organisational hierarchy, so did the level of morale.

High on the list of extrinsic factors affecting morale are staffing and workloads issues.

One study argued that nurses who worked in units where there was a poor work climate and low staffing were generally twice as likely as nurses on well staffed and better organised units to report risk factors, needlestick injuries and near misses, Dr Day notes.

A three-year study of nurses showed ‘there was an increasing tension between workload pressures and the desire to give holistic patient care. These tensions had a negative impact on morale.’

Current clinical practice fosters low morale where cost efficiency is paramount and patients are processed through the hospital system like a production line in order for a hospital to make a surplus. A friction has developed due to the dichotomy of nurses being both caregivers and financial stewards.

Perceptions of minimising costs and compromising care are heightened by the drive to redesign workforce models that promote substituting cheaper workers or increasing nurses’ patient loads.

Looking at hospital organisational structures, Dr Day points to research showing a number of hospitals that are considered ‘market leaders’ because of low turnover and high staff morale.

These so-called -magnet hospitals build high nurse morale through fostering nurse fulfilment, self-esteem and employee stability, Dr Day reports.

As public hospitals have little ability to increase wages and incentives, efforts have been concentrated on improving the work environment, he says.

Magnet hospitals are able to retain and attract well qualified nurses through the adoption of ‘participatory supportive management styles, decentralised organisational structures, adequate staffing, flexible working schedules, professional autonomy and responsibility, emphasis on teaching and education, and career advancementopportunities.’

It is clear that low morale is costly to organisations and is a key source of poor patient outcomes and care, Dr Day says.

Organisations need to be aware that a range of practical strategies can be employed to increase staff morale and in the process improve patient care and outcomes, Dr Day concludes.

Education Key To Happy Nurses

Better internal training and higher assertiveness is the key to keeping nurses happy and helps avoid high staff turnovers, according to a recent study by the Japan Academy of Nursing Science.

Researchers found 20.5% of Japanese nurses experienced burnout in the first year on the job and 8.5% go on to quit within a year as a result.   The issues of burnout and high turnover of first-time nurses has largely been a taboo matter but publication of the study in the Japan Journal of Nursing Science is bringing the issue to the forefront.

The study aims to show the relationship between first year burnouts at university hospitals and levels of assertiveness, indicating the serious need for assertiveness training to prepare nurses for the stresses of their job.

Dr Eiko Suzuki, who led the research, highlights the need for nurses to be equipped with skills to manage their role and duties in order to avoid this growing problem. It is imperative that novice nurses have the ways to prevent the burnout by themselves. This study reiterates the importance of assertiveness training for novice nurses at university hospitals – giving them the necessary skills to cope with the incidence of burnout and a serious burnout especially during their first year of working life.

An interesting finding from the research also indicates that novice nurses with an unusually high level of assertiveness are also likely to burnout, suggesting the need for very tailored and cautious training for new nurses.

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