Related issues

Yvonne Brunetto talks to Amie Larter about the importance of establishing positive dynamics amongst co-workers.

The quality of nurses’ workplace relationships is a key factor in predicting staff turnover, a leading academic says.

“Workplace relationships affect how engaged nurses are on the job, they affect the perception of wellbeing in the job, they affect how committed nurses are to a hospital,” Southern Cross University professor Yvonne Brunetto says. “And all of these factors affect whether a nurse is prepared to stay in nursing.”

Brunetto has travelled the world researching nurse management and the impact of workplace relationships on nursing outcomes. Last year, she was the lead researcher in a study examining the nursing workforce in seven countries, looking at the triggers that cause turnover in the profession.

She spoke to Nursing Review about why it’s important for Australian employers and managers to place an emphasis on effective workplace relationships.

NR: From your research, are the workplace relationships in Australia worse/better than in other countries?

YB: I think there are differences within the public and private system, both within our country and other countries – certainly in the UK.

If I understand correctly, there is a stronger focus in the private sector to ensure that NUMs have training in management – not just clinical training but nurse management training.

People just need to understand the importance of workplace relationships and that [improving them] doesn’t cost anything. All it means is you have to eliminate autocratic management styles, listen and be empowering of the other person and their skills.

What are common triggers for negative workplace relationships?

Senior management that is far too focused on financial short-term imperatives that totally neglect the importance of building an effective culture based on good workplace relationships and incorporating appropriate respect for safety culture.

These are the things that make the difference in the long-term but they are also the things first neglected and we know senior management is under the thumb because [resources are not unlimited], particularly in public hospitals. But they are still making choices that probably are not looking at the long term.

Also, nurses are constantly asked to do more, and I now have benchmarks that show our nurses probably have higher caseloads than our UK and US [peers]. This isn’t sustainable in the long term, because what happens when nurses are working harder and harder? Their wellbeing is compromised.

When you have compromised wellbeing then, my research shows, engagement falls. That means nurses don’t have the level of energy and vigour they could have in the workplace. They are just doing the stuff they have to do. They probably can’t even get to helping their colleagues because their energy is taken trying to do their workload. Over time they just stop wanting to be nurses.

We have two times when nurses are likely to leave – within the first five years and then after the age of 45. We have got an ageing workforce so that situation is not sustainable.

How will this affect patient outcomes?

Nurses are part of a caring team for patients. When they are stressed because their workloads are too high and they don’t have the support of colleagues to help them out, this is when the potential for adverse events is greatest.

So we need to be thinking about the cost, particularly in public hospitals, where only X number of nurses can be employed and consequently there is so much expected of them. They might be expected to do more work, sometimes taking extra shifts they don’t even want. It’s putting a lot of pressure on nurses. How can that be the best thing for patients?

There are processes in place for an absolutely dire emergency but that is not sustainable. We need nurses, who get the support they require in wards so they can be effective and so they are in fact sustainable in their job but also sustainable in terms of looking after patients.

Moving to a place where the relationships are going to be more effective, what else needs to be addressed?

If a NUM has to deliver X amount of hospital beds for a certain number of patients with zero adverse events, why not make that NUM responsible for effective workplace relationships in the ward? This should be combined with clear evidence of sharing of information, resources and support as needed.

Additionally, the NUM has to lead by example. When there are a lot of patients, it shouldn’t just be colleagues jumping in to help; it should be the NUM. The best cases of workplace relationships – with the highest engagement of nurses and lower turnover – come when a NUM can also turn around and help when needed.

That said, this does require that the NUM not be overloaded as well. And unfortunately I see a lot of overloading of NUMs.

You can easily improve the performance indicators of NUMs, but there has to be a more sustainable way of looking at funding healthcare management such that, within financial parameters, important factors such as workplace relationships are promoted and modelled from the highest to the lowest – within any hospital.

What future research do you plan on doing?

I am looking at the impact of workplace relationships on safety culture. And I am not talking about a safety climate, that’s different. I am talking about everyday practices of nurses and how they operate under increased workloads, high pressure and high acuity of patients.

There is also the gen Y versus the baby boomer issue. The average age of a nurse is well over 45 now in Australia and it’s pretty similar in the UK – but we are the worst in terms of that situation.

That means that when a new nurse who has just finished university walks into a ward, a lot of the nurses there are going to be, from a young nurse’s perspective, old. They may be over 40 or 45.

It’s tough breaking in and making friends with people your own age … It is a hell of a lot harder if you don’t share similar experiences and problems.

It really is up to the NUM to help new nurses feel like they are part of the group. Include them, respect their clinical information; and there also should be an exchange of information. Because often the baby boomers have a lot of experience, but the clinical nurses have some of the new knowledge and getting these groups to respect one another is a big issue.

Another thing we are researching at the moment is bullying. The incidence of bullying is very high in the public and private sectors.

Do you have an idea for a story?
Email [email protected]