Culture change needed for a person-centred approach in nursing

The nursing profession has featured consistently in media coverage over the last several years. In the early stages of COVID-19, nurses were applauded by the public and hailed as heroes for their efforts.

As the media focus on the pandemic has shifted, the nursing profession has been depicted in stories about poor pay and conditions, staff shortages and nurses who are burnt out.

This media rhetoric has done a disservice to a profession that is being seen as now less attractive as a career option.

As a result, we have seen a decline in applications to nursing programs worldwide and many Australian nursing programs are struggling to fill all their places.

Multiple state governments have turned their attention to nursing recruitment to remedy this problem. In August 2022 the Victorian government made nursing education free by providing scholarships of up to $16,500 for domestic students. Added to this, in April 2023 the NSW government announced university fee subsidies of up to $12,000 for nursing students.

Nursing is facing many global challenges and focusing on international recruitment strategies alone is not the answer. What’s needed is a multi-pronged approach to addressing this problem. We can’t ignore that while media coverage can be negative, many of the individual cases and challenges they highlight are indeed legitimate. The evidence clearly shows the need for person-centred organisational cultures and the effect this has on nursing retention.

A 2022 study showed that the work environment is the most important factor in influencing nurses’ decisions to stay in their current role. Top of the factors that impacted on that decision was ‘having trusted colleagues’ but was closely connected with the meaningfulness of the work, a sense of safety and feeling valued by the organisation.

Registered nurses provide care, and they do so from a person-centred perspective. In return, nurses should have their personhood  equally valued to that of the patient.

Striving for a workplace culture that considers person-centred care is the difference between registered nurses ‘doing practice’ to nurses being ‘engaged with practice’.

We know that the outcome from the implementation of these organisational and practice constructs is that of a ‘Healthful Culture’. A healthful culture is one in which decision-making is shared, staff relationships are collaborative, leadership is facilitative, innovative practices are supported and it is the ultimate outcome for teams working to develop a workplace that is person-centred. Ultimately a healthful culture leads to the flourishing of all persons.

The impact of a highly educated and experienced registered nursing workforce on patient outcomes is well known. However, the lived experiences of nurses working at the height of the pandemic, as well as the media narrative of nursing conditions has led to a dilution of the registered nursing workforce and replacement with a variety of ‘nursing assistant’ roles.

Nurses around the world are battling to have their unique nursing knowledge, skills and expertise recognised, adequately remunerated and supported.

Throughout the pandemic there have been calls for healthcare workers to be paid more. Currently, the average salary for a registered nurse in Australia is approximately $73,000 per year. This can vary depending on experience, qualifications, location and level of seniority.

In the May 2023 Budget, the Australian Federal Government has pledged to increase the award rates for enrolled, assistant and registered nurses working in aged care settings, which will see them earn between $7,000-$10,000 more per year. While this goes some way to addressing nurse retention in these settings, we need to see such a commitment to nursing as a whole.  However, financial incentives are not enough in themselves and more needs to be done to change the workplace cultures of our healthcare settings.

The role of nurses in our community requires real culture change. Now is the time for all nursing leaders to join forces and develop integrated strategies for advancing the implementation of the evidence that clearly shows the impact of registered nursing on patient outcomes and the impact of organisational culture on nursing retention.

Adopting a person-centred focus enables us to consider the wellbeing of all persons and ensure that we are proactively developing workplace cultures that are respectful of everyone and ensures they thrive in a healthful culture.

There is no hierarchy of privilege when it comes to respecting persons, and any workforce strategy that does so is at serious risk of compromising its goal of having knowledgeable, expert and person-centred teams who have as their central focus, the delivery of evidence-informed person-centred care.

This article was written by Professor Brendan McCormack, Head of School and Dean, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health.