I have written previously about my organisation's participation in the nationally led Shared Governance Collective Leadership Programme (NHS England and NHS Improvement, 2020). Organisations progress to applying to join the global Pathway to Excellence® accreditation. The global programme is a ‘nursing excellence’ framework, aiming to create a positive practice environment for nursing staff that improves nurse satisfaction and retention and focuses on key standards: leadership, shared decision-making, quality, safety, wellbeing and professional development.
So much is written in relation to the current issues affecting our profession and how the current practice environment feels. The 2019 Royal College of Nursing (RCN) employment survey (RCN, 2019) found that 44% of nurses and midwives indicated that they had been unwell as a result of work-related stress in the previous 12 months, the highest percentage reporting this in the past 5 years. More than half reported attending work in the past 3 months despite not feeling well enough to perform their duties.
The NHS England website includes a ‘Nursing and Midwifery COVID-19 Catalogue of Change’ (NHS England, 2020). This recognises that the COVID-19 pandemic has put the UK health and care workforce under unprecedented pressure. It acknowledges that the workforce had been struggling to cope even before the pandemic took hold. Staff stress, absenteeism, turnover and intentions to quit had reached alarmingly high levels in 2019, with large numbers of nurse and midwife vacancies.
It also recognises the opportunities that shared professional decision-making offers as a vehicle to help drive transformational change, which, when underpinned by evidence-based policy, provides a strong collective voice for nursing and midwifery.
NHS England's Catalogue of Change showcases a range of case studies from nurses and midwives in England, sharing experiences, innovations and solutions that illustrate the beneficial changes they have made during the pandemic and the ongoing restoration work.
West et al (2020), on behalf of The King's Fund, undertook an extensive review to investigate the opportunities to transform nurses' and midwives' workplaces to enable them to thrive and flourish, which in turn would enable the delivery of high-quality compassionate care. The report states that nurses and midwives have three core work needs that must be met to ensure wellbeing and motivation at work, and to minimise stress:
The report makes eight recommendations designed to meet these needs, focusing on:
These recommendations are, in my opinion, an excellent framework for us to review our respective local positions; they are highly practical and are addressed to all leaders who influence the workplace experience of nurses and midwives. The call to action includes a call to regulators, improvement bodies and all partners in health and social care to support organisations to effectively implement each and every recommendation, not just those that seem most expedient or attractive.
This is not a ‘fluffy’ policy document, it raises issues that are difficult to admit to, often difficult to fully understand and complex to deal with. It states:
‘It is critical that organisations also tackle the underlying causes of stress, ill health and poor wellbeing—such as chronic excessive workload, bullying, inadequate supervision, discrimination and poor teamworking—rather than focusing solely on their consequences.’
The report urges organisations to ensure that they meet the needs of their workforce by providing wellbeing support and ensuring that those charged with caring for patients themselves get treatment for ill health.
Frameworks such as Pathway to Excellence® and the eight recommendations within The King's Fund report require leaders to work towards transforming the working lives of nurses and midwives, and thereby the quality and sustainability of the care they provide. This requires that we implement an integrated, coherent and comprehensive strategic approach and, as nurse leaders, we are likely to be held to account to ensure our delivery plans make improvements where required.