This month, I joined nurses and midwives in Belfast for the Northern Ireland Chief Nurse's annual conference. The conference coincided with the launch of Strengthening Our Core. A regional framework for health and social care staff health and wellbeing in the workplace (Department of Health, 2024). Both the conference and the framework acknowledged the context in which health and social care staff are operating, and the recognition of the importance of staff health and wellbeing to achieving high-quality care. The framework recognises the many factors that influence the health and wellbeing of staff, both within and external to the workplace, and considers:
Of course, a key enabler to the delivery of these factors is leadership – which caused me to reflect on the evidence base that I drew upon to share as part of my presentation at the conference.
This started with what I see as the core of workplace wellbeing, which is to enable professionalism. The Nursing and Midwifery Council (NMC) document Enabling Professionalism (2018a) sets out what professionalism looks like in everyday practice through application of the Code. (NMC, 2018b). This work was led by the four chief nursing and midwifery officers from across the UK and was, in my view, ahead of its time. It recognised that, whatever the practice setting, the environments in which nurses and midwives work are pivotal in supporting professional practice and behaviours, and details the factors that require consideration to achieve this. Wider evidence includes conclusions that professional behaviours are primary determinants of positive patient experience (Adams et al, 2024), whereas:
‘Unprofessional behaviours are any interpersonal behaviour by staff that causes distress or harm to patients or other staff in the health care workplace.’
In addition, professional behaviours may play a vital role in safety culture (Maben et al, 2023).
I was drawn to the work of Dr Chris Turner, as well as the theory around ‘Civility Saves Lives’ and the evidence base for the impact on individuals who are victims of incivility (https://www.civilitysaveslives.com). The online Civility Saves Lives resources are incredibly helpful to understanding the evidence base that describes how incivility has been shown to reduce team functioning, clinical decision making and patient outcomes.
Person-centredness is at the heart of holistic care. However, when the care environment is not functioning and providing a safe environment, this has several consequences for patients, with evidence concluding that:
One of the sources to which I often signpost colleagues is the work of Amy Edmondson, who has developed a framework for understanding the concept of ‘psychological safety in the workplace’. In summary, this is:
‘The belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes, and that the team is safe for interpersonal risk taking.’
‘Incivility has been shown to reduce team functioning, clinical decision making and patient outcomes’
I think that it is important to balance reflections and learning from when things go well. So I conclude with the summary of the research of my colleague Sam Donohue (2022), whose study found that the experience of professional enjoyment of nursing was strongly associated with ‘being a nurse’ and ‘making a difference’, from feeling valued to the value of the professional voice of nursing being heard. Furthermore, that professional enjoyment can be enhanced or diminished by others: by workplace culture, leadership, civility and recognition of contribution.