CHAPTER SIXTEEN Leadership to enhance quality of work life
INTRODUCTION
Quality of work life is a concept that is gaining currency in the international nursing literature. In the context of a worldwide crisis in nursing workforce supply, the concept is increasingly becoming the subject of intense discussion and analysis as health service managers endeavour to find a solution to this rapidly deteriorating situation. There are many definitions but the most comprehensive refers to an array of concerns that include ‘adequate and fair compensation, safe and healthy working conditions, opportunities for continued growth and security and for the use and development of human capacities, social integration into the workplace, the social relevance of work and the rest of one’s life’ (Attridge & Callahan 1990).
increasingly used to refer to work itself—the culture of the organization, corporate culture, the cultural image an organization presents to its clients, the culture of a work team, the learning culture of an organization. Culture is now used to describe human bonds, the shared goals and aspirations that drive people at work—the things that make people want to work (Cope & Kalantzis 1997, p.2).
The qualities and attributes of the leader are critical determinants of the organisation’s culture and how employees perceive it. In this context, the culture of the organisation will be reflected in the work environment, which has physical and psychosocial dimensions, manifested in the employee’s sense of belonging, job satisfaction, commitment to the organisation and productivity (Lowe & Schellenberg 2001).
There are many interacting factors at an individual, organisational and systems-wide level that can impact on work-life quality for nurses. This chapter discusses these factors as, first, the physical aspects of the work environment (workload issues, control in the workplace, occupational health and safety and staff management practices); and second, the psychosocial aspects of work (trust, commitment, collegial relationships, job satisfaction, personal growth and development). There is a growing body of evidence suggesting that the quality of the work environment is a critical factor in influencing nurses’ decisions to either work casually, work reduced hours or to leave the profession altogether (Duffield & O’Brien-Pallas, 2003). Rapid changes to the health care environment over the past decade or more have created a work environment for nurses that is characterised by excessive workloads, feelings of disempowerment and not being valued as professionals (Department of Education Science and Training [DEST] 2002; Duffield & O’Brien-Pallas, 2003).
Organisational restructuring and downsizing in response to financial constraints have also been part of the past decade of change where nurses’ work-life concerns, the quality of their work-life experience and their career aspirations have often been overlooked (Duffield & O’Brien-Pallas 2002). In addition, there has been a dramatic increase in the casualisation of the workforce, changing the nature of employee–employer relationships. While in most industries casualisation has been employer driven, this is not so in nursing, where much of it is employee driven. It may be a manifestation of a work life that is no longer meeting nurses’ needs personally or professionally (Creegan et al., 2003; Duffield & O’Brien-Pallas 2002; Fagin 2001).
THE CHANGING WORKFORCE PROFILE
Changing attitudes in society, where individuals are now seeking more balance between work and lifestyle, is a driving force for change in employment patterns, and as a consequence, the profile of the nursing workforce has changed considerably. During the past decade there has been a shift away from standard full-time employment to non-standard forms such as part-time, temporary, casual and contractbased employment (Mangan & Williams 1999). Campbell and Burgess (1997) estimate that 25 per cent of all employed persons in Australia work on a casual basis. Compared to other OECD countries, Australia has one of the highest levels of non-standard employment, and the growth in casual employment has doubled over the past decade. Nurses also follow this employment pattern. For the period 1994–97 the proportion of nurses working part-time increased from 48.6 per cent to 51.8 per cent, resulting in a fall in the average weekly hours worked from 32.5 to 31.8 hours, while the national average number of hours worked weekly by agency nurses (excluding NSW) was 25.6 hours (Australian Institute of Health and Welfare [AIHW] 1999). Correspondingly, there is an increasing nurse vacancy rate and an increasing utilisation of hospital pool and agency nurses to enable service demands to be met (DEST 2002).
Casualisation of the nursing workforce has had a considerable impact on nurse managers, who are faced with a larger population of nursing staff (by head count) to manage. The transient nature of the employment contract in many instances adds to the complexity of maintaining a work environment that meets the needs of the total staff complement. Compounding this emerging difficulty are other changes to the nursing workforce profile. The workforce is ageing and nurses are potentially retiring faster than they can be replaced (AIHW 1999; Buchan 1999; O’Brien-Pallas et al. 1998). The high recognition given to Australian nurses, their educational preparation and experience (DEST 2001) means that many are being offered positions outside nursing (Duffield & Franks 2002). Nurses are becoming better qualified, with many clinicians and nurse managers now holding higher degrees (Duffield & O’Brien-Pallas 2002; DEST 2001; Duffield & Franks 2001; Pelletier et al. 1999). There are also indications that more nurses will be required, with the introduction of new roles relating to specialty practice and clinical case coordination. These specialty roles are likely to be more flexible in terms of work hours and conditions, which may act as an additional incentive for nurses to leave the more restrictive hospital environment where the imperative for care 24 hours a day, seven days a week will remain constant.
Intergenerational differences in attitude to work and lifestyle has also been identified as a potential source of work-life conflict. Baby Boomers (born 1946–64) in management are grappling with the population of Generation Xers (born 1961–81), who value flexibility and work-life balance and see themselves as individual contributors rather than team members (O’Bannon 2001). This author also states that they tend not to have aspirations for lifelong employment with a single company. Green (2000) describes the Net generation, who were born between 1977 and 1997, as people who have grown up on technology, and with that knowledge and experience they are provided with an understanding of its potential to change the environment in which they work. The life experiences of the Net generation have provided them with an inquisitive spirit and willingness to think independently (Green 2000). The challenge for the Boomers in management will be to reconcile the different work-life views and expectations of each generation to successfully retain nurses in the health service.
FACTORS INFLUENCING WORK-LIFE QUALITY
Effective leadership
Effective leadership is pivotal to the creation of a work environment that allows nurses, the largest employee group in the health service, to grow and expand their individual capacities. Leadership in contemporary times is not the sole province of the top echelons of management. Contemporary organisations require leadership at all levels of the organisation, with an understanding that the essential element of success is in being able to access the intelligence, commitment and caring of staff (Mintzberg 2002). Organisational loyalty comes from employees who feel a sense of belonging and connectedness (Arbuthnot 2002).
Occupational health and safety factors
Safe working conditions includes work practices, systems of work, the physical and psychological work environment, and the education and training of staff in hazard prevention. It is widely accepted that employers have a responsibility to identify, assess and control all workplace risks, including workplace aggression and violence instigated by patients or clients towards staff, as well as staff to staff aggression. In many instances, the rights and responsibilities of insurers, employers and employees with respect to workers’ compensation and injury management are specified in accompanying legislation and supporting government regulation. A compensatable injury must be work-related and it can be either physical or psychological (NSW Occupational Health & Safety Act 2000).
It could be argued that in the past, prevention of physical injury in the workplace was the main emphasis for most organisations. However, in more recent times the potential for psychosocial injury has gained momentum and specific policies and procedures are being developed to manage the increasing incidence of verbal and other forms of intimidating behaviour. Unsafe work environments, characterised by safety issues such as bullying and harassment, impact negatively on staff retention (Duffield & O’Brien-Pallas 2002; O’Brien-Pallas & Baumann 2000). This form of occupational hazard is gaining widespread importance, to the extent that in some places legislation covers ‘at risk’ occupational groups such as doctors, nurses and police to provide specific penalties for the perpetrators who injure them in the course of their work.
Leading to promote effective employee–employer relations
These authors examined the impact of trust, commitment, influence and communication on the quality of the employment relationship and found a healthy and supportive environment to be a critical factor (Lowe & Schellenberg 2001). A healthy and supportive environment includes a spirit of collegiality, interesting work, a safe and healthy workplace, reasonable work demands and an environment that supports staff to achieve a balance between their work and personal lives. Having sufficient resources to do the job, including training, equipment and information, is the second most important factor. High levels of job satisfaction are also linked to skill development and use, high workplace morale and lower levels of absenteeism (Lowe & Schellenberg 2001).
Shapiro (1998) argues that universal markers of job satisfaction for nursing are difficult to identify due to nurses having different priorities at different stages of their lives. For example, nurses in the early stages of their career want recognition and flexible rostering, whereas nurses in the mid- to later career stages want autonomy, opportunities for career pathways and financial rewards associated with childcare needs (Shapiro 1998). Job satisfaction reflects not only the overall quality of the individual’s working life but has also been linked to a range of positive outcomes for employers, such as increased productivity (Lowe & Schellenberg 2001).
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