Editorial

Abstract

Over the last several decades the contemporary nursing workforce has been under siege. Many challenges to the viability and ongoing development of the profession abound including: an ageing workforce and the loss of collective wisdom as boomer nurses retire; multiple generations with sometimes conflicting needs and wants compete for primacy of attention in the workplace as healthcare costs rise exponentially and budgets are ever more tightly constrained.Back in the late 1990s early 2000s nursing globally was struck by a crisis of recruitment and retention of registered nurses; febrile commentary as to how best to deal with the immediate reality and its consequences for the future was rife. As I noted then: 'a number of reports ... have now well established the presence of a pervasive malaise affecting those who work in the healthcare system ... one commentator in the US has been moved to suggest that many healthcare professionals are currently working in a 'toxic work environment' (Puetz in Walker, 1997). Bullying, harassment (physical, emotional and sexual) were endemic in healthcare culture (Ball, 1996; Duffy, 1995; Madison, 1997) the health system itself, perversely, was sick.Unhappily, a couple of decades before, in the early 1980s, a similar crisis had been manifest, particularly in the USA. Of note during this epoch of angst and turmoil was a sense that the healthcare system was not 'caring for the carers' as burnout, high stress and turnover rose to unprecedented levels. The idea of workforce resilience and sustainability were clearly not on the agenda and as I recall, this period saw the first wave of mass migration of nurses around the world to plug the workforce deficiencies. (Indeed I was one such nurse who went to work in the USA with some colleagues mostly in the spirit of a grand adventure rather than a more altruistic motivation!) Research at the time, into why some hospitals and healthcare systems seemed able to recruit and retain nurses, however, suggested that certain features marked these hospitals as fundamentally different from their peers who struggled to do so. This was, for those not familiar with the literature, the so-called 'magnet hospital research'. The characteristics of these 41 'reputational' Magnet hospitals included: the head nurse being a member of the highest decision-making body of the hospital; decisions regarding staffing and care of patients were made at the unit level by staffnurses; nurses and doctors communicated well and; the organisation was relatively flat with few levels of hierarchy (Hannigan & Patrick, 2009). Importantly, these characteristics imply notions of resilience and sustainability in that such hospitals obviously valued their nurses by including them in hospital affairs which in turn made the staffmore likely to stay.THE IMPORTANCE OF THE PRACTICE ENVIRONMENTSince this early research, considerable work has been done over the last 30 years in an attempt to pin down exactly what features of the healthcare practice environment are necessary for building a resilient, indeed high performing and sustainable workforce, particularly so for nursing. Of note is the work of Linda Aiken and colleagues. In an international study of the importance of work environments on hospital outcomes in nine countries the percentage of nurses reporting negative outcomes and poor quality of care by quality of work environment demonstrated that 'countries with better work environments tend, in most cases, to have smaller percentages of nurses reporting negative outcomes (high nurse burnout, job dissatisfaction, not confident patients are prepared for discharge, quality of care rated fair or poor) than hospitals with mixed work environments, that in turn have smaller percentages of nurses reporting negative outcomes than hospitals with 'poor work' environments' (Aiken, Luzinski, & Reid Ponte, 2011, p. 362). Similarly, Aiken et al. (2002, p. 5) in an earlier cross-national study including the USA, Canada, England and Scotland with a sample of 10,319 nurses working on medical/ surgical units in 303 hospitals, noted two key features of good work environments: adequate nurse staffing and organisational support for nursing. …