27
ALAMY
King ’ s Fund recommendations to improve nurse working conditions in social care
Authority , empowerment and influence
1 Introduce mechanisms for social care nursing staff to shape the cultures and processes of their organisations and influence decisions about how care is structured and delivered
Justice and fairness
2 Nurture and sustain just , fair and psychologically safe cultures and ensure equitable , proactive and positive approaches to diversity and inclusion
Work conditions and working schedules
3 Introduce minimum standards for facilities and working conditions in all organisations
4 Teamworking Develop and support effective multidisciplinary teamworking
Culture and leadership
5 Ensure health and care environments have compassionate leadership and nurturing cultures that give staff high-quality and compassionate support that is continually improving
6 Workload
Tackle chronic excessive work demands that nurses cannot meet sustainably and safely , and which damage their health and wellbeing
Management and supervision
7 Ensure all social care nursing staff have the support , professional reflection , mentorship and supervision they need to thrive in their roles
Learning , education and development
8 Ensure the right systems , frameworks and processes are in place for social care nurses ’ education and development throughout their careers . These systems must promote fair and equitable outcomes
Committee on workforce burnout and resilience , stating that ‘ the issues are the same in social care as in the NHS and people are dealing with similarly complex cases ’.
In 2019 , the annual staff survey in the NHS was already showing very high levels of stress among nurses and midwives . Some 44 % in 2019 reported being unwell as a result of work stress in the previous year . Essentially this was because work demands were exceeding nurses ’ resources . Chronic excessive workload was a key factor and was the number one predictor of staff stress and influenced nurses ’ decisions to quit the profession . It manifested in emotional exhaustion , cynicism and detachment ( difficulty in relating to clients as people ), and distressing feelings of lack of accomplishment .
The Royal College of Nursing ( RCN ) employment survey 2019 also showed nurses were already facing excessive levels of work pressure across all sectors . Nearly two-thirds of those working in independent-sector care homes felt they were under too much pressure at work .
Covid-19 may have added to this pressure – in another RCN survey , conducted in 2020 , four in 10 respondents said staffing levels had worsened during the pandemic , and this was particularly problematic in the independent and social care sectors .
It is too early to tell what the long-term consequences of the pandemic will be on staff mental health and wellbeing or the impact on rates of sickness absence , though sickness absence during the pandemic has inevitably been high . In 2019 / 20 the average number of sickness days in social care
Nurses and midwives must have voice and influence in the design and delivery of care was 4.7 , which equates to approximately 6.72 million days lost to sickness over the 12-month period .
What should be done ? The King ’ s Fund report for the RCN Foundation , The Courage Of Compassion : Supporting Nurses And Midwives To Deliver High-Quality Care , makes eight key recommendations to improve working conditions and support the wellbeing of nurses in all sectors , though some elements will need to be adapted specifically for nursing in social care . They focus on developing good work environments by changing the factors that affect wellbeing and effectiveness , rather than focusing on ways to help people cope with negative working environments or providing treatment when they become unwell . Efforts must be focused on changing the factors that cause stress rather than only dealing with symptoms .
Across the country , these recommendations are already being implemented . We call on all health and social care leaders to adopt them in every care organisation . Some may seem basic or obvious , but they are not embedded , widely or universally . In such cases , it is even more pressing to seek to understand why , and what can be done to ensure they are .
High-quality , compassionate social care can only be delivered if social care staff receive high-quality , compassionate support . Organisations with cultures of compassion promote fairness and foster individual , team and organisational wellbeing . Everyone working in care can help by developing their own teamwork skills , whatever their role , which leads to better support for all team members .
Our report ’ s framework on the core needs of nurses and midwives can be used to help explore local workplace issues and generate ideas for improvements .
Autonomy is probably the most important of the core needs that must be met in the workplace , so that nurses and midwives have voice and influence in the design and delivery of care . People need to feel their organisations are just and equitable places , free from all forms of discrimination . In our report we gave focus to the experiences of people from minority ethnic groups working in health and care , because of the scale of the issue , the heightened awareness resulting from the tragic and disproportionate effect of Covid-19 and the global Black Lives Matter movement which demands urgent action to address structural and institutional racism .
Interviewees in our research stressed the need for leaders and managers at all levels to ensure that equity , diversity and inclusion are the responsibility of everyone . This means helping people to develop their awareness of the impact and prevalence of racism and discrimination in the health and care system . Critically , it also requires nurse leaders and managers to help facilitate discussions in teams and organisations about how racism works , supporting people to embrace antiracist practice through inclusive behaviours in their everyday work . This will require a consistent leadership commitment to help improve workplace cultures . And it is imperative for the working lives of care staff and vital to help support retention .
As the pandemic has shown , the social care sector relies on the dedication of skilled and caring individuals . Social care funding reforms are long overdue but when these eventually materialise , they must be accompanied by a comprehensive , funded workforce plan . This should include improving pay , conditions and training . We also must do more to promote working in the sector . Such a plan is needed to meet the growing social care needs in our communities and to protect the staff who make the difference , which is felt by people across the country every day .
Suzie Bailey is director of leadership and organisational development , Michael West is visiting fellow and Ethan Williams is a researcher , all at The King ’ s Fund think-tank and health charity
Winter 2021 nursinginpractice . com