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Editorial
Staying in Nursing
Sustainability of contemporary nursing
Jane Conway
Manager, Organisational Education Learning and Development, Northern Sydney Central Coast Health; Conjoint Senior Lecturer and Consultant, School of Nursing and Midwifery, University of Newcastle, NSW
Margaret McMillan
Professor and Deputy Executive Dean, Faculty of Health, University of Newcastle, Newcastle NSW
Article Text
The third section of this volume focuses on what we have termed 'Staying In' and focuses on retention of nurses and developing nursing careers. Retention of experienced employees is critical to provide an adequate service, develop new nursing career pathways and manage succession planning.
The view of a career as a contract between employer and employee which is based on long term mutual commitment and establishment of a profound relationship within which there are well defined opportunities for hierarchical promotion is increasingly being superseded by a view of a career as series of shorter term interactions between employers and employees based on exchange of services and benefits (Hall & Mirvis 1995). Reasons for this include increased mobility in the workforce, increasing flexibility in patterns of work, flattened organisational structures, and differing expectations among generations of workers (Capelli 1999; Davis & Blass 2007). There has been significant change in both the availability and retention of workers in all industries (Sheehan, Holland & Di Cieri 2006) including nursing and other health professions.
There is a need to examine the extent to which both career development and progression foster fitness for purpose within an environment of changed, and continuously changing, expectations of nurses and nursing (Jasper 2007).
It has been observed that health care services and the quality of patient care are influenced by how a number of factors including administrative systems, work practices and training. Contemporary health systems, and positions and processes within those systems, must be able to accommodate the breadth, range, extent, effect, influence and reach of nursing activities. There has been a marked change within nursing from the 1950s model in which nurses' practices were directed largely within a medically dominated paradigm to contemporary times which have seen significant changes to scope of practice for nurses including an emphasis on a professional rather than industrial agenda as the basis for professional career development (Conway & McMillan 2005; Gould, Berridge & Kelly 2007).
Nursing is now also increasingly governed by nurses. Nursing remains informed by other disciplines but is transmitted and co-created through a range of strategies framed by an increasing consciousness of the uniqueness of the knowledge, skills and attitudes that constitute the practice of nursing. As nursing emerged as a distinct entity readily distinguished from others new career paths and roles have emerged and evolved. Sustainable career development is integral to health workforce development and must be supported and sustained through educational systems and processes, career structures and pathways that are aligned to organisational need yet are sufficiently flexible and responsive to accommodate individual goals, aspirations and circumstances.
Staying in nursing will continue to require a capacity for change and lifelong learning.
Increasingly, literature related to health service delivery and health workforce planning focuses on the need for collaborative inter-professional work practices. It is recognised that there is a need for staff in the current health care industry to be procedurally competent and information fluent; contribute to systems and process review; effectively manage consumer expectations, competing value systems, and tensions in resource allocation; coordinate throughput and care processes; participate in networked organisation and health care teams and focus on consumer needs and outcomes (Conway & McMillan 2005).
A confident, competent nursing workforce that has the ability to provide comprehensive, person centred care and is part of a cohesive, interprofessional health care team is dependent upon the skills and confidence of that workforce. Elwin's paper explores strategies to develop and support those who return to practise nursing after periods of absence and identifies the need to recognise and build upon existing strengths, structure programs to individual needs and provide support in transition.
As Rambur et al (2003: 186) observe:
Classic literature ranging from Maslow and Frankl, to contemporary thinkers such as Csikszentmihalyi voice the importance of 'stretch,' growth, challenge, and meaning in human existence, creativity and contentment. Specific to nursing, organizational commitment, autonomy, and recognition are empirically supported as important to job satisfaction. Moreover, the ability of a job to meet desired career outcomes has been previously identified as a predictor of intention to leave.
The paper by Ferguson et al. explores one of the emergent roles for nurses other than direct care provider, clinical leadership. The authors highlight that nurses, as clinical leaders can influence, create and celebrate exemplary practice through 'stretch' or expansion of their concept of nursing practice.
The emerging central tenet of advanced nursing practice for contemporary nursing is transformational and evidence based leadership. This necessitates not only transforming the physical, regulatory, legislative and industrial environment but having leaders who can influence the beliefs and practices of other nurses. This means valuing learning and innovation, engaging in change management and team development, and welcoming consumer and community participation in decision making.
Nursing has historically been loathe to do this. Ferguson et al note the unique position that nurses are in to shape policy. However, it is our contention that this requires nurses to first challenge and manage themselves and overcome what at times can seem a unitary focus on the registered nurse and hospital based practice. Moreover, it is imperative that as nurses increasingly accept and adopt leadership roles they have well articulated frameworks for guiding role development lest they and others experience confusion amongst what Viitanen et al (2007) have categorised as nurturing mother, administrative nurse, rational producer and expert developer approaches to management and leadership.
Lawless and Moss highlight the need to recognise 'the value of dignity in the worklife of nurses'. They argue that acceptance of dignity in the workplace should go beyond dignity as a basic human right and be viewed as an essential component of staying on in nursing. They highlight that nurses who have a sense of agency that is fostered rather than restricted by the organisation in which they work are more likely to have 'a meaningful work-life and effectively engage with the purpose of their work' and result in a healthy, ethical and productive workforce. They conclude this paper by noting that maintaining individual and independent rights such as dignity are of benefit to all. We would suggest that a reinstatement of the dignity of nursing and nurses, may be a counter to what seems to be increasing cynicism manifested as frustration, contempt, distrust hostility and disillusionment (Andersson 1996) within the nursing workforce.
One aspect of work-life dignity is feeling valued across the age continuum. The paper by Fitzgerald provides an overview of the needs of ageing nurses and outlines a series of recommendation for environmental and human resource practices aimed at making the workplace more physically, emotionally and financially attractive to ageing nurses.
This volume has provided images of the working lives of nurses - the papers in it have discussed the challenges in recruitment and retention across the globe, raised issues about the perception of nursing as a career path, discussed generational differences in the nursing workforce, highlighted the disonnance between the espoused professional values such as support and dignity and the experience of some of those who are in the nursing workforce, identified the challenges in effective management of nurses as human resources, and alerted us to some of the critical elements that will continue to shape the future for nursing as a professional career rather than 'just a job'. Moreover the papers should provide stimulus to reflect on the past, acknowledge the present and vision the future.
References
Andersson L (1996) Employee cynicism: An examination using a contract violation framework. Human Relations 49(11): 1395-1418.
Conway J and McMillan M (2005) Connecting clinical and theoretical knowledge for practice. In Daly J, Speedy S and Jackson D (eds) Contexts of Nursing. Churchill Livingstone, Sydney.
Jasper M (2007) Life at work-modernizing nursing careers, Journal of Nursing Management 15: 1-3.
Gould D, Berridge E and Kelly D.(2007)The National Health Service knowledge and skills framework and its implications for continuing professional development in nursing. Nurse Education Today 26-34.
Hall D and Mirvis P (1995) The new career contract: Developing the whole person at midlife and beyond. Journal of Vocational Behaviour 47(3): 269-89.
Rambur P, Val Palumbo M, McIntosh B and Mongeon J (2003) A Statewide Analysis of RNs' Intention to Leave Their Position, Nursing Outlook 51(4): 182-188.
Sheehan C, Holland P and DeCieri H (2006) Current developments in HRM in Australian organisations, Asia Pacific Journal of Human Resources 44(2): 132-52.
Viitanen E, Wiili-Peltola E, Tampsi-Jarvala and Leto J (2007) First-line nurse managers in university hospitals' captives to their own professional culture? Journal of Nursing Management 15: 114'122.
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