8 December 2020
Article from October 2020 edition of INPractice
The noble professions of nursing and midwifery appear to be in a perilous state.
According to the Nursing and Midwifery Workforce Climate Survey 2019 - Full Report, half of all survey respondents - SA nurses and midwives - were planning to leave their position within the next five years, comparable to the last report in 2017.
The report found increased high levels of emotional exhaustion and risk of burnout, and alarmingly the online survey was conducted last October, months before COVID-19 hit our shores and dramatically changed the health care working environment.
One of the report co-authors, Professor Marion Eckert, acknowledges "things may have potentially got worse since then" as nurses and midwives dealt with a range of emotions - “ fear of COVID exposure, fear of exposing their family and friends, uncertainty, confusion over PPE, loss of shifts and employment in some cases and the not knowing when - or indeed if - the pandemic nightmare will ever end or if the change has become the new normal.
Considering the increasing demand for health care, exacerbated by the ageing nature of our population, attracting the next generation into nursing and midwifery is the huge challenge facing the professions.
“The sector is at a critical turning point and it is now vital to consider individual, unit, and system-level strategies that will improve the practice environment, reduce emotional exhaustion, and reinforce engagement among nurses and midwives,’’ the report notes.
If there is a positive in all this it’s that the pandemic has thrust a giant, high-intensity spotlight on health care workers and just how immense their role is in the social fabric, “the glue in the system’’, to quote Prof Eckert, director of the Rosemary Bryant AO Research Centre, which conducted the survey on behalf of the ANMF (SA Branch). The Rosemary Bryant AO Research Centre is an organisation dedicated to strengthening the nursing and midwifery professions through the development of evidence-based health care.
“We’ve seen now with 2020 and COVID-19 more than ever people are realising nurses and midwives are the critical element to global health security,’’ Prof Eckert says.
“The critical nature of our workforce means we will continue to make sure the community is safe. You take that on as a mantra but you also see that it’s an incredibly rewarding opportunity to make a difference to the health and lives of people.’’
The report identified that the nursing and midwifery workforce climate in South Australia remains negatively impacted by organisational change in 2019. Over 1,700 nurses and midwives accessed the online survey last October, with 1046 (67%) completing it in full.
“Although many respondents expressed high regard for their colleagues and believed the quality of care to be improving, there were concerns about low levels of staffing, challenging working conditions, high workloads and non-clinical duties, poor wellbeing and safety among staff, as well as unsupportive management and leadership,’’ the report states.
“Moreover, South Australian nurses and midwives were found to be overextended by the practice environment and work conditions, as indicated by high levels of emotional exhaustion over a two-year period, and there remains a risk of burnout.”
The report found the survey results “suggest that the South Australian nursing and midwifery workforce is emotionally exhausted to a high degree, feeling detached to a moderate degree, and experiencing personal accomplishment to a moderate degree.
Although emotional exhaustion and depersonalisation significantly increased from 2017 to 2019, the overall profile remained the same. “This profile suggests the workforce is ‘overextended’, which is more positive than a complete burnout profile.’’
Overall, South Australian nurses’ and midwives’ perceptions of quality of care appeared more favourable in 2019 compared to 2017. There was also an increase in respondents who indicated that they would recommend their service to their family members in 2019 from 2017.
On the other hand, respondents were concerned about professional development for staff, as well as unsupportive management and leadership negatively influencing the delivery of high-quality care.
The report highlighted several avenues for improving the practice environment and reducing the risk of burnout among nurses and midwives, including:
- Reviewing and adjusting nursing and midwifery staffing levels and workload, with the overall aim of reducing emotional exhaustion and promoting safe, high-quality care.
- Providing education and training to managers and senior staff to promote high-quality clinical leadership, support of staff, staff scheduling, and communication.
- Developing and implementing strategies aimed at building stronger relationships between management and senior leaders with nurses and midwives
- Developing and implementing strategies aimed at facilitating nurse representation and participation in hospital affairs, and creating professional development opportunities for staff
- Consider introducing a mentoring and peer support program (e.g., buddy system) for all levels of nursing, in which nurses and midwives are vigilant for signs and symptoms of burnout in their colleagues
- With consideration to the significant increase in emotional exhaustion and depersonalisation from 2017 to 2019, continued monitoring of the wellbeing and working conditions of the nursing and midwifery workforce within South Australia is recommended
“It becomes even a greater challenge when we know there are such high levels of emotional exhaustion in the health workforce … how do you inspire the next generation to take on the profession?,’’ Prof Eckert says.
“There’s a lot of good things that happen, like the personal accomplishment of looking after patients.
“I do think the future direction to attract nurses and midwives into the profession is to talk about the very nature and essence of the profession, being that human science and how rewarding it can be to work with people of many different walks of life,’’ she says.
“You have very unique experiences when you support people when they’re at their lowest ebb.
“Or (on the flipside) having a baby, and the joy of working with women during their pregnancy is an experience you get to share with women in a very personal way.
“It’s a very rewarding profession to be involved in and that’s something you can’t get from other professions and I think that’s what makes nursing and midwifery incredibly exciting and special,’’ Prof Eckert says.
“Is the fact that you have these very unique connections, not just with the patients or consumers but the camaraderie and team morale with the other nursing and/or midwifery professionals you work with.’’
Read the full report at: unisa.edu.au/research/rbrc/
Click here to read the October 2020 edition of INPractice