Delivery of training programs supported managers and new graduate nurses improving workplace culture and reduced staff turnover

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This research received a ‘High’ rating for impact in the Australian Research Council’s Engagement and Impact Assessment 2018-2019 National Report

Overview of Impact

Over the past 16 years there has been a nursing shortage in the Australian health system and this trend is expected to continue. Workforce retention is a key factor in overcoming this problem. Southern Cross University worked with a global health care provider to improve nurse retention by introducing programs to develop unit managers and support newly-graduated nurses into the provider’s Australian hospitals. Staff retention improved dramatically.

Workers compensation claims due to work-related stress are costly for employees and employers. Health workers who provide front-line, emotional labour are at high risk of work-related stress. The emotional resilience training developed by Southern Cross University in response to these challenges was effective in improving safety practices in a social welfare organisation.

  • Professional employees
  • First-response employees
  • Administrative employees
  • Other emotional labour
  • Organisations
  • Australia as a whole

By 2002 Australia was facing an acute nursing shortage attributable to population health trends. Despite Australian Government interventions, long-term projections for nursing shortages had not reversed by 2011 when Health Workforce 2025 – Doctors, Nurses and Midwives was released by Health Workforce Australia. This report projected a shortfall of 109,000 nurses by 2025, noting that improving workforce retention could reduce this expected shortage by 77%. The Commonwealth Department of Health’s Australia’s Future Health Workforce – Nurses (2014) highlighted retention of early career nurses as a key issue.

Ramsay Health Care (Ramsay) is among the top five private health providers in the world. By 2016 its 60,000 staff cared for three million patients in 238 facilities across six countries. Professor Yvonne Brunetto worked with Ramsay on two projects to improve nurse retention. She brought the fresh lens of Homan’s Social Exchange Theory (SET) to bear on Ramsay’s practices (2007-09). Her survey of nurses in Queensland, New South Wales and Victoria found only slight satisfaction with supervisor–subordinate relationships which, in turn, impacted morale and commitment.

Working closely with Ramsay’s Global Director People and Culture, Professor Brunetto demonstrated how front-line managers were the key to nurse satisfaction and staff retention. In response, Ramsay Training Institute rolled out an innovative Manager Development Program in 2009. The pilot was so effective that the Program became compulsory for all supervisors. Ramsay also developed Gradplus, a structured program to improve retention of newly-graduated nurses. It was highly successful. For example, in 2010 Ramsay’s new-employee retention (1st year of employment) was 56% while Gradplus participants had a retention rate of 94%. Professor Brunetto’s research also prompted Ramsay to take the successful 2010 Tomorrow Starts Today roadshow across Australia to 500 team managers. Ramsay’s Chief Executive Officer participated, speaking passionately about the importance of effective leadership at a unit level for workforce sustainability.

From 2010-12 Professor Brunetto undertook a second project with Ramsay. Her survey of nurses in four Australian States showed that good supervisor-subordinate relationships, high perceived organisational support and satisfaction with teamwork resulted in employee well-being, engagement and subsequent organisational commitment and staff retention.

Professor Brunetto continued to work with Ramsay on successful strategies to enhance nurses’ well-being and lower employee turnover. Programs were introduced to tackle work harassment and bullying and, in 2011, Ramsay launched the highly-effective Onboardplus to increase retention of all new employees. Staff turnover reduced from 16% to 9% from 2011 to 2014). Ramsay’s 2014 staff survey showed improvements in overall satisfaction and, in 2012, Ramsay won an Australian Human Resources Institute Award.

Professor Brunetto’s 2013-15 research with Ramsay was framed by SET and Luthan’s Psychological Capital (PsyCap) construct which explains individual motivation as flowing from hope, resilience, optimism and efficacy. A staff survey showed that positive supervisor-subordinate relationships enhanced nurses’ PsyCap, which led to improved in-role safety performance. The Professor’s project provided novel information to support Ramsay’s safety program; demonstrating that enhancing supervisor-subordinate relationships and training to build nurses’ PsyCap were highly-effective approaches.

Professor Brunetto’s three projects with Ramsay Health Care delivered social benefits to nurses and to the organisation itself, in the form of economic benefit due to the significantly lowered staff turnover (Research by Duffield et al. (see refs) identified a US$48,790 average cost for each nurse who voluntarily left the 11 NSW, WA and ACT hospitals surveyed in 2014.) . Australia as a whole also benefitted through positive workplace cultures and safer hospitals.

Work-related mental disorders are a major concern in Australian workplaces (Safe Work Australia’s Work-related Mental Disorders Profile 2015). Between 2009 and 2013, an average of $432 million/year was paid out in workers’ compensation claims attributed to work-related stress. Most at risk occupations were those with high personal interaction performed in difficult and challenging circumstances (i.e. front-line, high emotional labour). Health and welfare support workers are a high-risk occupation with five times more claims than the average of all occupations.

From 2015-16 Professor Brunetto provided advice to Wesley Mission Qld (Wesley) on enhancing well-being, autonomy and lowering work-related stress. Using Social Exchange Theory (SET) and Psychological Capital (PsyCap) (which can buffer negative consequences of occupational stress), she surveyed staff and delivered tailored emotional resilience training for aged care workers, drug and alcohol officers, nurses, managers, physiotherapists, occupational therapists and disability carers. Data gathered pre- and post-training showed significant improvement in PsyCap, emotional intelligence and safety practices. This training upskilled Wesley’s employees and proved a cost-effective way to reduce safety breaches and workers’ compensation claims. The Professor’s work provided social and economic benefit to Wesley and Australia as a whole.

In 2012 Professor Brunetto worked with TriHealth Inc (TriHealth) Cincinnati. Her staff survey led to employment of a training coordinator and integration of her findings on engagement, well-being and organisational commitment into training programs. TriHealth has been ranked nationally among the 100 Best Companies (Working Mother 2011-15), Best Employers for Workers Over 50 (AARP 2014) and 150 great places to work in healthcare (Becker's Healthcare 2015/16). TriHealth was also ranked as the best non-profit employer in the USA (National Association for Female Executives 2014) and in the top five Medium Size Health System employers (Truven Health Analytics 2016).

Professor Brunetto’s research delivered social benefits to health workers, organisations and Australia. She proposed research-informed solutions to improve work practices, staff satisfaction, nurse retention and in-role safety. She also delivered economic benefits to health organisations and Australia by improving health workforce retention and lowering workers’ compensation claims.

World-first benchmarking of nurses: Australian public versus private; Public versus private in Australia and the United Kingdom (UK); Private in Australia and the United States (US); Public and private in Australia and Italy: 

  • 2007-09 Australian private/public - Impact of supervisor-subordinate relationships on commitment - 900 Ramsay Health Care (Ramsay) private hospitals (Queensland, New South Wales and Victoria) and 164 Queensland public hospitals (Brunetto, Farr-Wharton, Shacklock, Bartram, Leggat, Stanton, Casimir and Teo)
  • 2010-2012 Public/private in Australia/UK – supervisor relationships, teamwork, role ambiguity, discretionary power – 1,064 from 2 public/6 private (Ramsay) hospitals (Queensland, New South Wales, Victoria and Western Australia); 725 from 3 public/15 private hospitals UK (Brunetto, Farr-Wharton, Shacklock and Robson)
  • 2012 Private in Australia/US - impact of workplace relationships on engagement, wellbeing, commitment, turnover - 510 from 5 Ramsay hospitals Australia and 718 from 2 US hospitals (Brunetto, Shacklock, Farr-Wharton, Shriberg, Newman, Dienger and Xerri)
  • 2010-15 Public/private in Australia/Italy – work harassment – 510 from 5 Ramsay hospitals and 250 from 5 public hospitals in Australia and 535 from 4 public and 292 from 2 private hospitals in Italy (Brunetto, Xerri, Farr-Wharton, Shacklock, Trinchero and Borgonovi)
  • 2013-15 Managerial Support, psychological capital, intention to quit - 242 from 6 Ramsay hospitals (New South Wales/Queensland) (Brunetto, Rodwell, Farr-Wharton, Shacklock and Demir)