Beyond Breaking Point?

1. Beyond Breaking Point? Key Results Rachael McIlroy

2. Beyond Breaking Point? • Online survey of 2,008 members • Followed up with telephone interviews of 22 respondents – cross-section of age, ethnicity, employer, area of practice

3. HSE Management Standards • Key part of research uses HSE Management Standards for work related stress • Define the characteristics, or culture, of an organisation where risks from work related stress are being effectively managed and controlled • Cover six key areas of work design that, if not properly managed, are associated with poor health and well-being, lower productivity and increased sickness absence.

4. HSE Management Standards – 6 areas of work design • Demands – workload, work patterns, work environment • Control – how much say you have in how you work • Support – encouragement, support and resources provided by org, line manager and colleagues • Role – whether you understand role in the org and whether org ensures no conflict in roles • Relationships – positive working to avoid conflict and minimising unacceptable behaviour

5. HSE Management Standards – question examples Demands • I have to work very intensively • Different groups demand things that are hard to combine • I have unrealistic time pressures Control • I have a choice in deciding what I do • I have a choice in deciding how I do my work

6. HSE Management Standards Managerial support • I am given supportive feedback Peer support • If work gets difficult, colleagues will help me Role • I am clear about goals, objectives for my dept • I am clear what is expected of me Change • Staff are always consulted about change

7. HSE Management Standards 1=low wellbeing 5= high wellbeing

8. HSE Management Standards • Demands– urgent action needed Long working hours, unrealistic time pressures and unachievable deadlines • Control– urgent action needed Little control over the way they work and what they do at work

9. HSE Management Standards • Managerial support – good but room for improvement Fairly good relationships with line managers, but problems lie with senior managers • Peer support – clear need for improvement Support from colleagues is essential when dealing with heavy workloads

10. HSE Management Standards • Role –good but room for improvement More confidence about own role than how it fits into wider org objectives • Change – urgent action needed Very negative score on engagement in workplace change

11. Main reasons for high levels of stress • Workload • Staff shortages • Not enough time to do job • Rest breaks • Poor management • Working long hours

12. Presenteeism – over previous 12 months have you gone to work despite feeling should take sick leave?

13. Presenteeism – other results • NHS Staff Survey England 69% of all staff and 73% nurses had attended work in previous 3 months despite not feeling well enough • NHS Staff Survey Wales 70% of all staff attended work in previous 3 months despite not feeling well enough

14. Presenteeism - pressures • Sickness absence policies • Link between sickness absence and reorganisation • Worries about impact on colleagues/patients • Staff shortages and workload • Feelings of guilt – internal or external • Workplace culture

15. Personal experience of bullying and violence Verbal or physical violence • Patients/service users 56% • Relatives of patients/service users 48% • Other members of public 15% • Colleagues 21% • Manager/team leader 15% Workplace bullying • Manager 23% • Colleague 21%

16. Occupational Health • I have access to OH services at work 86% • I feel confident that OH services would be helpful if I contact them 54% • I can access OH services without a referral 61%

17. Occupational health services • Access is better in the NHS, social enterprises, universities than GP practices, independent sector and voluntary sector • But confidence in services is low across all sectors

18. Key Recommendations Kim Sunley Senior Employment Relations Adviser

19. Safe Staffing Levels • RCN actively campaigning on this issue through ‘This in Nursing’ and the work of Safe Staffing Alliance • RCN Guidance • Toolkit for activists

20. Shift Working and Fatigue • Development of a ‘Shift in the Right Direction’ • Employer’s duty to risk assess and introduce safe shift patterns • Importance of rest breaks between and during shifts • CNO announcement of review of 12 hour shifts • Continued input into negotiations on Working Time Directive

21. Workplace Stress Risk Assessments • Legal duty to ensure that work does not make employees ill • Continuous process ‘not a one off’ linked with organisational change and staff survey • HSE need to be active on this and also re-visit benchmarking

22. Presenteeism and sickness absence • Presenteeism must be recognised as a health and wellbeing issue • Implementation of national partnership guidelines on sickness absence • Effective management practices • Appraisals • Supportive approach • Prompt access to treatment • Equalities Act • Annex Z AfC

23. Other key recommendations • Engagement and consultation • Violence and bullying and harassment • Occupational Health Provision • Raising concerns

24. Next Steps • Workshop presentation • UKSRC to further shape recommendations • Campaign – ‘This is Nursing’ and other workstreams/projects • NHS Staff Council • Toolkit for Activists