Creating positive practice environments.

It could be called a "fortunate coincidence" or even "too good to be true", but the evidence is clear--quality workplaces correlate with quality patient care. (1) The reality, of course, is this is no coincidence at all, but simply reflects the fact that nursing is a patient-centred profession.

From this fact it follows that for health systems to be good for patients, health systems must be good for nurses. Some nurses may feel uncomfortable with a seemingly self-serving theorem. But is it self-serving to assert professional authority and to seek to improve workplace conditions, when these aspirations are properly grounded in patient-centredness? Or is it self serving to assert that properly grounded professional authority and legitimate workplace aspirations are a professional responsibility? While some individual nurses may feel too shy to make such an assertion, our international nursing body is not.

Sustaining the health workforce

The International Council of Nurses (ICN) has chosen "Positive Practice Environments: Quality Workplaces = Quality Patient Care" as the theme for International Nurses Day 2007, celebrated on May 12. In launching the theme, ICN president Hiroko Minami declared the goal was "to improve the quality of health services through health care work environments that support performance excellence." She went on to say "this can only be achieved in a workplace that enables and sustains a motivated, well prepared workforce." (2)

NZNO is the New Zealand national nurse association holding ICN membership. Our international participation through ICN not only assists New Zealand nurses to gain an international perspective on nursing, but also informs ICN with the experience and perspective of New Zealand nurses.

The work of the Safe Staffing and Healthy Workplaces Committee of Inquiry (CoI) exemplifies the synergy between the workplace experiences of New Zealand nurses and the international nursing experience. Local experiences and anecdote, together with the international literature, informed the CoI. The CoI also represented a shared commitment by nurses and midwives, whether bringing a district health board employer perspective or an NZNO worker perspective, to produce recommendations that would address safe staffing issues.

Such essential collaboration arose from the determination of ordinary NZNO members to act to improve workplace conditions through their collective action and this, in itself, is a significant demonstration of professional responsibility. NZNO, like ICN, does not hesitate to assert professional authority and to seek to improve workplace conditions.

In choosing to fund the central recommendation of the CoI--the safe staffing unit--the Minister of Health Pete Hodgson has demonstrated the Government understands that quality workplaces equal quality patient care. However, the responsibility for implementation, the responsibility for safe care is ours. The quality patient care that can only be reliably and consistently delivered in quality workplaces is the responsibility of nurses. We know what it entails. We evaluate it when it fails. So the challenge to deliver safe care is ours.

Regardless of job title or organisational responsibility, there are professional tasks for every nurse in this enactment of professional responsibility. Whatever your own role in the delivery of nursing care or in support of nursing, and whatever your practice setting, you have an obligation to identify the tasks arising from your role that will contribute to the creation of positive practice environments. For example;

A registered or enrolled nurse: Ask for and provide support to your peers to enable all patients/clients to receive the care you would choose for those you love and to ensure the trust patients place in you is placed well.

A caregiver: Require an up-to-date plan of care, prepared by a registered nurse, for each of your patients/clients. Support and expect support from each other and from those who direct you.

A nurse educator: Collaborate with practitioners to ensure that education principles inform learning, and practice needs determine learning objectives.

A nurse manager: Involve practitioners in planning and implementation of care delivery systems and support practitioners with the resources and information they need to give good care.

A director of nursing: Exercise the authority required to ensure the nursing service you lead is able to deliver care to the standards to which each nurse in your service is held accountable by the Nursing Council.

A Nursing Council member: Proclaim the responsibility of every nurse to decline an additional patient load in the event a practitioner considers they have reached the limits of their safe professional practice.

Collectively, we must work with our communities and those in need of nursing care to better understand how we should meet their needs. We must support each other to put patients first and to ensure even the most "difficult" patients experience nursing care, as if they were one of our own whanau.

Positive practice environments are not a theoretical ideal; they are the settings where nurses fulfill their professional commitment to society. Positive practice environments are not just nice when you can find them; they are necessary for nursing. The professional responsibility of every nurse is to create a positive practice environment. When we exercise this responsibility we expect society to meet its obligations to us--to ensure nurses have authority matching our responsibilities, and that service infrastructure and support systems enable us to meet our professional responsibilities.

References

(1) A.J. Lankshear, T.A. Sheldon, and A. Maynard. (2005) Nursing Staffing and Healthcare Outcomes: A Systematic Review of the International Research Evidence. Advances in Nursing Science; 28: 2, 163.

(2) International Council of Nurses. (2007) Positive practice environments: Quality workplaces = quality patient care. Information and action tool kit. Geneva: author.

By NZNO chief executive Geoff Annals