Members’ voice is evidence in EB8

Published: 21 February 2012

Kym Volp, QNU Councillor

The QNU has incorporated the findings of its comprehensive Nurse and Midwifery Unit Manager (N/MUM) Research Report into the current EB8 negotiations.

N/MUMs are frontline professional leaders who are strategically placed to deliver improvements in health outcomes.

The report supports the need to upgrade the career structure of all nurses and midwives, to achieve important supports for N/MUM role work, and to bolster recruitment and retention.

Over 600 Grade 7 nurses and midwives contributed to the research, which produced five key principles and 20 recommendations.

Below we outline those key principles. Full details are available in the report, which is available on the QNU website.

1. Keeping up with changes in the past five years

The QNU N/MUM Research Report catalogues important changes for consideration in EB8 negotiations. These include:

• Clinical governance
• Organisational restructuring
• Operational instabilities
• Workforce planning.

Identification of these changes complements the Nursing and Midwifery Implementation Group (NaMIG) and the priority projects related to recruitment and retention, which previously made recommendations central to the current EB8 negotiations.

These recommendations include:

• Models of nursing and midwifery
• Business Planning Framework
• Work arrangements
• Career and classification structure.

The QNU N/MUM research updates the impact of changes, providing evidence that further informs the NaMIG work across all four projects.

2. N/MUMs are ‘the canary in the mine’

What an N/MUM experiences in their role is a direct reflection of system-wide influences, and affects the work of all nurses and midwives.

N/MUM concerns resonate in the work of all nurses and midwives and related health service teams.

It is important to listen to QH nurse and midwifery managers, and to acknowledge the warnings reported by members across the state.

3. Confirming the value of N/MUM hybrid role work

The hybrid clinical leadership/managerial role of the N/MUM is known to be most effective where the professional values guide the work and are brought to bear on managerial decisions, practices and relationships (Sorensen, Delmar & Pedersen 2011).

Role ambiguity is no longer seen as a problem but rather framed as a strategic advantage for the nurse/midwife as a frontline leader. The problem occurs when role ambiguity is confused with role overload.

The core QNU professional values of nursing and midwifery that complement the role of the N/MUM as frontline service leader, are (Volp 2006):

• caring (nursing/midwifery as indispensable, complex, knowledgeable, human caring)
• professionalism (self-regulation, established/legislated authority and accountability)
• holism (nurses and midwives keeping the system human)
• advocacy (nurses and midwives keeping the system safe, including ethical safety).

It is this professional grounding that is evident in the ongoing efforts of N/MUMs to keep solutions patient-centred. Such expert knowledge needs appropriate acknowledgement and valuing in the context of an N/MUM’s managerial practice.

These professional values apply to all nurses and midwives, and in particular to senior nurses and midwives who exercise ethically-mature leadership.

The values are the framework around which the QNU can articulate the defining qualities, unique contribution, and distinct purpose of nursing and midwifery in evidence-based claims in enterprise bargaining across all sectors.

Understanding and maximising the potential of nursing and midwifery in EB8 negotiations depends entirely on apprehending and acknowledging the value of this professional identity and what it means to us as practitioners, to the communities we serve, and to the organisations for whom we work.

Currently, the role of senior clinical nurse and midwife leaders is seriously limited by lack of appropriate resources.

4. Making the connection: service sustainability

In the key employment areas of medical, surgical, intensive care and midwifery units, clinical leadership work has been compressed into the N/MUM role.

This has negatively affected the recruitment and retention of senior clinical nurses, has limited the potential of the N/MUM for innovation and clinical governance work at the point-of-care, and most significantly has resulted in high levels of N/MUM role dissatisfaction and related recruitment.

Stability in this leadership group is critical for its impact on the nursing and midwifery workforce, and for its direct links to negative outcomes for patients, staff, and the organization and for recruitment and retention failure.

Service sustainability relies in large part on workforce stability. By way of example, and reinforced in the findings of the most recent QNU N/MUM Research are the ‘trio’ of instabilities—case-mix instability (higher patient acuity, and churn in acute hospital nursing and midwifery), workforce instability, management instability (Chiarella & Roydhouse 2011)—and underbounded systems (Chiarella & McInnes 2010).

5. Making it work: nursing and midwifery governance

The key findings of the research can be traced directly to the weakening of the structure and day-to-day operation of nursing and midwifery governance in Queensland Health.

Governance must be the first consideration in implementing the recommendations of the four NaMIG priority projects. This is the most fundamental and strategic issue NaMIG must address to reach agreement on what can be achieved.

Professional and clinical practice matters are one, and can only work where authority structures align nursing and midwifery as clinically-based professions within an appropriately governed and authorised reporting and communication structure.

Separating professional from clinical operational decisions and practices has led to enormous dissatisfaction and has diluted the role for senior clinicians.

This impacts staff at a unit level. They share concerns of isolation, frustration and disempowerment (Duffield et al 2007).

An agreed way forward

An agreed way forward is required to rebuild confidence and trust through a more valued engagement of professional nurses and midwives to meet both the unprecedented complexity of service growth, and the challenges of service sustainability.

It is vital that we take full opportunity of the research contained in the QNU Nursing and Midwifery Unit Manager Research Report to achieve the best possible system outcomes in this current round of enterprise bargaining negotiations.