There is a nursing workforce shortage in NZ that is expected to worsen. New nurses need to be supported by their training provider and their workplace so that they enjoy their work and remain in the profession. Using the Social Embeddedness of Thriving at Work model, this research stream will work with first year nurses completing the Nurse Entry to Practice Programme (NETP) and 3rd and 4th year nurses post-NETP, to identify elements of their training and their organisations that have supported them to thrive as nurses, and then develop recommendations for training organisations and workplaces to promote new nurses thriving at work. This will be a research programme that will work with DHBs and nurses to co-create educational and management approaches that are effective in helping nurses to thrive at work.
Rationale for the Research
The ageing population and a growing prevalence of multimorbidity are placing increasing strain on a limited and insufficient nursing workforce. Compounding this issue is an ageing nursing workforce, with 48 percent of nurses in New Zealand aged over 48 (Ministry of Health, 2014) with evidence that there is a steady decline in the number of nurses over 50 (Nursing Council of New Zealand., 2011). In New Zealand between 2006 and 2011, one-quarter of Registered Nurses aged 50-plus left the workforce (North, N., Leung, W., & Lee, 2014). Attracting, recruiting and particularly retaining a younger generation of nurses is an urgent consideration for nurse managers internationally, as there are significant differences in the career aspirations and expectations between different generation cohorts (Hoare, 2016), so leaders within contemporary health organisations need to apply insights and develop strategies to address different generations’ needs (Stanley, 2010).
This anticipated growing nursing shortage, which is worldwide, needs to be addressed (Nursing Council of New Zealand., 2011). Answers should focus on reducing burnout and enhancing the engagement of Registered Nurses (RNs) to improve retention. NZ research has identified that: a) Higher engagement, i.e. a committed nursing workforce that is fully engaged in its work and settings that empower nurses to provide the care they are educated to provide (Cho, Spence Laschinger, & Wong, 2006), results in lower intention to leave the organization and profession; b) Burnout has significant effects on intentions to leave through lower engagement; and c) Greater workload and greater work-life interference result in higher burnout and are the strongest predictors of intentions to leave. Greater emotional demands (challenges) and greater self-efficacy also have strong effects in lowering intentions to leave through higher engagement (Moloney, W., Boxall, P., Parsons, M., Cheung, G., 2017).
To assist nurses to cope with the demands of the job, one approach would be to concentrate on developing resilient nurses (Hodges et al., 2005), Student nurses describe resilience as having the determination to succeed, rather than retreating in the face of challenges (Carroll, 2011). Within the educational context, evidence suggests resilience can be improved through provision of relevant and practical protective factors, such as an educational setting that is caring and learner-centred, has positive and high expectations and provides a positive learning environment (Rapp, 1989, Gu and Day, 2007. Little is known, however, about evidence-based processes that promote the development and enhancement of resilience of nursing students and nurse educators (Reyes et al., 2015).
The suggestion that teaching resilience is enough must be seen as insufficient because it does nothing to engage nurses in changing the work environment they are becoming resilient in (Salmond & Echevarria, 2017). Resilience must be seen as just one aspect of a wider programme for the development of a vibrant nursing workforce. The socially embedded model of thriving at work (Spreitzer et al., 2005) has been identified as an effective framework because, while it includes resilience, it also aims to create an environment in which nurses are energised and thriving so that their intention to leave either the professional or organisation is reduced. At a recent Universitas 21 meeting in Melbourne, Australia, the Heads of Schools of Nursing group was presented the Thriving at work model as a potential framework to explore across the international network. This model was well received and the eight universities present all committed to exploring the model further in regard to the development of the theory within nursing education. The UoA is well placed to lead this research as it is committed to providing the best learning environment for the future nursing workforce. There is already content throughout the current BN curriculum for undergraduate nurse training that focuses on self-care and well-being.
Emerging research evidence across multiple industries suggests that thriving at work is critically important for creating sustainable organizational performance (Walumbwa, Muchiri, Misati, Wu, & Meiliani, 2018). Thriving is shown to have a positive relationship with positive health at the level of the individual. Collective thriving at work positively relates to people’s emotional engagement to work, which in turn relates positively to overall unit performance. The characteristics of both the workplace context and the individual play significant roles in facilitating thriving at work. Paying attention to thriving at work is an important means by which managers and their organisations can improve both employee health and unit performance
Thriving is a crucial mechanism for increasing job performance, while also mitigating burnout and improving health. Thriving individuals are growing, developing, and energised rather than stagnating or feeling depleted. Thriving is indicated by the joint experience of 1) Vitality, the sense that one is energised and feels alive at work; that one has a zest for work, and 2) Learning, growing through new knowledge and skills. The conceptual model underpinning this research takes a socially embedded approach (See Figure 1), because learning takes place through the social interactions that bind us together with others, both inside and outside the organisations in which we work. Vitality and learning are deeply rooted in social systems. Learning occurs in the doing of work, the talking about work, and observing others doing their work.
Figure 1. (Spreitzer & Cameron, 2012)
This research stream will develop a long-term co-design research pathway involving DHBs and nursing education providers, answering the question: What is the best way to prepare nurses for and support nurses in their roles in the nursing workforce so that they flourish in their roles? The School of Nursing delivers a NETP programme for general nurses and a New Entry to Specialist Practice (NESP) programme for mental health nurses in their first year of practice. These programmes provide a cohort of nurses who come from different undergraduate nursing schools and are now working in different organisations. This research stream will work using a co-design approach with DHBs (initially Waikato, CMDHB and Auckland) to explore and develop new ways of managing the nursing workforce.