A recent RCNA conference identified development issues for nurses in Australia. Here, researchers Kasia Bail and Louise Schreuders reflect on these workforce challenges and the need for nurses to get better at telling their professional story.
Nursing is an increasingly complex field in which identifying and keeping abreast of the shifts influenced by research, collaborations, critical reflection and organisational as well as government interests can be crucial.
Perhaps one of the biggest shifts underway now is how we understand and manage a multigenerational workforce. Questions such as how to embrace Generation Y; the mobility and casualisation of the workforce; the push to embrace generalist rather than specialist nursing; arranging collaborative and mutually beneficial training strategies for health professionals, and workforce leadership might all come under this umbrella.
At the conference there was discussion about retaining older nurses past retirement, or attracting more undergraduates, yet we still need to address the issues of those leaving the workforce after less than five years of experience. Eminent researchers have described nurses with around five years experience as making an important transition from competent to proficient.
On top of this, current research shows the average job for a Gen Y worker lasts only 13 months. Generation Y university graduates have increased expectations of their workplace compared to previous generations, and expect to be able to apply their skills and knowledge and be respected for their unique contributions – perhaps the ongoing assessments and focus on policy and competency for new grads in their first 12 months contributes to the mismatch of expectations and practice?
Research in 2009 found that the ‘superficial statements of value’ – such as the quality of the toilet paper and coffee provided to employees – made the difference to staff feeling appreciated and valued; the little things are big things. This value and respect for individual contribution, and how that value is felt by staff, goes beyond just Generation Y.
Additionally, a significant proportion of nurses work casually or part time, some have second jobs, and some hospital wards average a 50 per cent turnover of staff. Consequently, we can assume that a large proportion of nurses are already functioning as generalists as they move between specialities and locations. It is well understood that patient outcomes might be optimised when they are cared for by nurses with a specialisation in their area of health. However the detrimental effects of churn as patients are moved on average three times within a hospital stay (an average of which is six days) to reach specialised nurses requires careful consideration Nursing, and nurses, need to consider where their skills are best applied to achieve the best patient outcomes.
Compelling stories are important to understanding our world, to tell others our stories, to be heard. If our stories are constantly about poor pay, poor recruitment and poor retention, are we fulfilling our own prophecies and creating a viscous circle? Perhaps Victorian Acting Chief Nurse advisor, Katy Fielding said it best at this conference; “Nurses need to stop asking to have a voice, and start learning how to use the ones they have”. What story do we want to tell, and who do we want to hear it? Do we each have the skills to tell our stories, and in ways that economists, politicians, public servants, hospital administrators, nursing managers can hear them? There are two important ingredients, language and data.
The need for greater understanding of the nursing workforce needs to be addressed. One of the reasons mentioned is that we do not have much information about the nursing workforce and this is because nurses are not willing share it. Having ‘friended’ quite a few Gen Y nurses, their facebook pages tell a different story. If we offer rationales for this information, put in place appropriate protections of privacy, and essentially, offer distribution of the findings with the participants, we believe many nurses would be willing to share information that can be used to help the profession as a whole and to contribute to improved patient outcomes.
One of the strategies we can move forward with is to get better at telling our story about nursing. By this we do not mean little anecdotes about rewarding experiences or difficult patients. Every time you speak to someone about nursing related issues you are painting a picture of the nursing profession. Two suggestions we can do at an individual level to get better at telling the nursing story came from presentations at the conference. Katy Fielding’s advice was to know what you want when you go to a meeting, be prepared, and declare from which position you are acting (which hat you are wearing). This will be part of the story of nurses as capable, confident and collaborative health professionals, as well as being sensitive and solution focused. Professor Di Twigg encouraged nurses to have their ‘lift conversation’ down pat. Always have in mind your short synopsis of current topical nursing issues, use any opportunity to engage others in the nursing story.
As a broader profession we can get better at collecting standardised data for research analysis. Part of the strategy for getting better at sharing the nursing story is having evidence of the impact of nursing care on patient, nurse and system outcomes. This would require significant cooperation between nursing stakeholders, not an unworthy strategy in itself. There is limited baseline staffing data from which to establish whether workforce retention and attraction strategies even work: we need to be willing to take ownership of the responsibility to collect such data.
As nurse researchers we will continue to focus on patient outcomes as measurements of nursing success. We cannot separate nurse staffing from patient outcomes: however it is hard to know what is working, or not working, if we don’t have a good picture of the nature of the nursing practice environment in those places. It’s like collecting vital signs. If we don’t have a systemic, shared process of collecting, documenting and communicating vital signs of our patients, then the effectiveness of collecting them is undermined. We need data to tell when they’re deteriorating, in order to communicate to other team members about what is going wrong, and what we might do to address the changes.
We are both early in our careers and we have much to learn and discover, but we have a passion for nursing and are proud to be nurses. As PhD students we have already encountered the challenges of accessing nursing workforce and appropriate patient outcomes data phrased by one researcher as ‘measuring shadows’. Now is the time to respond to these challenges and contribute to the future of the nursing profession. Use of data to advocate for patient health isn’t a new concept in nursing. Florence Nightingale invented the rose graphs to display data demonstrating the harm that was being done to soldiers after they got to hospital, more dying from infection and malnutrition than from their wounds. Flo may not have been a specialist, bedside clinical leader but she offered a level of analysis, leadership and role modeling for academic, political and managerial domains of nursing. We urge nurses of all generations to see the value in nursing workforce data, and find ways to use that data, or other sources of information, to tell stories about nursing that others need to hear.
Kasia Bail is Assistant Professor, Discipline of Nursing, University of Canberra and a PhD Candidate with the Dementia Collaborative Research Centre.
Louise Schreuders is the recipient of the second Olive Anstey scholarship, and has taken up her studies at Centre for Nursing Research, Innovations and Quality – Sir Charles Gairdner Hospital and the University of Western Australia. n
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