Editorial

Nursing workforce and workplaces: Contemporary concerns and challenges

Debra Jackson
Professor, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney (UTS), Broadway NSW

Carol Haigh
Manchester Metropolitan University, Manchester, United Kingdom

PP: 003 - 005

Article Text

There can be no doubt that a strong, resilient, responsive and effective nursing workforce makes an enormous contribution to positive health outcomes for people. Conversely, a weakened or vulnerable nursing workforce can have negative or deleterious effects on people and their health, and on the ability of health care organisations to provide acceptable services. This is so in hospital care where, for example, long awaited elective procedures can be delayed or even cancelled because of a lack of nurses to care for patients in the post operative, recovery or rehabilitative phases of care. It is also the case in the community setting where nurses are, potentially, able to competently provide a range of essential health services, but staff turnover and a lack of adequately skilled and experienced nurses can also impede the ability of services to meet these community needs.

Nursing has been beset by workforce challenges for much of the recent past, with concern focused on several key issues, such as recruitment and retention of nurses (McMillan & Conway, 2007), the ageing workforce (Fitzgerald, 2007; Jackson, 2008), and workplace issues such as violence (Luck, Jackson, & Usher, 2006; Speedy, 2006) and bullying (Hutchinson, Vickers, Wilkes & Jackson, 2010). Some of these issues are fairly generic in nature. Indeed, many other professional and occupational groups are also facing the challenges of an ageing workforce, and dealing with significant imminent workforce retirement. However, the very nature of nursing means that there are specific characteristics that can complicate these generic workforce concerns for nurses. For example, shiftwork and the physical demands of nursing have been identified in the literature as being particularly problematic for nurses as they age (Gabrielle, Jackson, & Mannix, 2008a, 2008b), and so nurses might therefore be forced to consider retirement earlier than they might if these specific occupational challenges were not present.

Among the specific challenges facing nursing is the pressure of bed usage, such that the art of nursing is in danger of being subsumed by the demands of service delivery. Work carried out in the United Kingdom by Ormandy, Haigh and Solomon (2006) noted that nurse managers in one hospital were required to leave the clinical area three times a day to attend 'bed meetings'-that is, meetings to ascertain bed usage and to identify patients who would be suitable for discharge or transfer to other wards/rehabilitation units. Leaving aside the issue surrounding the need to do this three times a day, the question remains as to the appropriateness of this as the best use of a senior nurse's time. We are sure that other nurses around the globe would recognise this situation, one in which the professional skills of the nurse are sidelined to the demands of a health care bureaucracy.

Indeed, the demands of the health care bureaucracy can be overwhelming. Furthermore, in many locations, the ability to provide efficacious nursing care is negatively affected by continued cuts to funding for hospital services. Like many other workers, nurses are being asked to do more with less, and there are additional challenges presented to the nursing workforce, including increasing global migration (Likupe, 2006; Raghuram, 2007), new superbugs and diseases (see for example: Chen, Chang, Lin & Chen, 2009; Shih et al., 2009), new technologies (Dowding et al., 2009; Garrett & Klein, 2008; Lee, 2008) and new roles (Chaney et al., 2007; Daly & Bryant, 2007). In the context of difficulties presented by workforce challenges, new demands posed by technology and new diseases, and inadequate resources, extended roles continue to develop, scope of practice extends, and nurses work in increasingly diverse and innovative contexts. While these developments are timely and appropriate, and in some cases represent more fitting use of nursing knowledge and skill, they can also present additional workforce challenges.

Part of the problem, we suggest, is that nurses may not be adequately prepared for engaging with the politics of contemporary health care. If the fundamental aspects of humanity, empathy and creativity that underpin nursing are to be protected, we need a workforce that can take its place upon the political stage, and challenge policies and practices that are detrimental to care. Indeed, a strong and resilient nursing workforce requires an adequate supply of nurses who are clinically skilled and politically confident, to effectively engage with decision making. If we want to see optimal standards of care in all situations and settings, we need to ensure that nurses are supported to effectively challenge poor practice, and are able to successfully advocate for individual patients, families, institutions and communities, as well as for their colleagues and the wider profession.

In order to better illuminate difficulties and challenges facing the nursing workforce, it is necessary to turn the spotlight onto nursing workplaces. When considering the idea of focussing on nursing workplaces, the mind boggles, because of course, nurses work everywhere. As well working in hospitals and dedicated community health settings, nurses work in all manner of diverse settings, such as educational institutions, corrections and prison services, child care services, industry, shopping malls, cruise ships, and war zones. However, issues around how nurses work together, communicate with each other and with other health professionals, and how these relationships and associations can shape nurses' working environments and influence the care of clients, patients and families are crucially important in shaping the quality of services delivered. These factors can enhance (or, conversely, detract from) outcomes for patients and families, and the overall patient experience.

Considering some of the challenges nursing faces, it can be easy to fall into a state of despondency and hopelessness about the future of nursing. However, it is vitally important to sustain optimism (Jackson, 2009), to continue to interrogate the issues that affect the nursing workforce, to illuminate that which remains hidden, to engage in dialogue, and to explore innovative ways of addressing the challenges that confront us. This we owe to those that depend on us - our patients and clients, as well as to those who will follow us - the new and future generations of nurses who will likely face problems and challenges even more complex than those we are currently facing.

In preparing this issue of Advances in Contemporary Nursing, we see a number of papers reporting novel innovations and workforce strategies, and the interrogation of some of the thornier, more problematic and largely hidden workforce issues. It is important that these issues be illuminated, because the first step to dealing with a problem situation effectively is to first recognise it, to make it visible, so that the nature and extent of the issue can be understood. Only then can effective explanation and resolution be sought. We are delighted to present this selection of papers. It is our hope that they are the catalyst for reflection, dialogue, further research and inquiry, and most of all, in providing this forum for nurses to share their experiences, ideas, and scholarship, we hope we are contributing to a discourse that will play a part in role enhancement, service development, and improved care of our patients, clients, and communities.

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