Nurses not monoliths are the backbone healthcare system

A recent report by global management consultants McKinsey & Company on why nurses want to leave contains valuable lessons for New Zealand. It’s not all about money

New Zealand politicians continue to prevaricate on nursing needs and concentrate on creating government-controlled health monoliths.

“They pay little more than lip service to the actions they need to undertake to keep our nurses at home, safe and happy in their vital tasks,” says Industrial Safety News publisher Mike Bishara.

Once cynically charged expressions are looking less and less like harbingers of doom and more and more like accurate assessments of the future, he says.

“Blessed are the young, for they shall inherit the national debt, a ravaged planet and a failed health system.

“A start in working on a solution to the last item is not rocket science – we need to upgrade our nurses’ skill base, attract them here and keep them here. Few would question that they are the key for decades to come to ensure the effective implementation of patient care plus medical and technological advances.

“We need to send a strong wake up call to our moribund immigration department to ditch its elitist immigration policies and get nurses to choose New Zealand in the face of intense global pressure for their services. This can’t wait for another ‘ministerial consultation’ with unnamed sources,” says Bishara.

The McKinsey survey found that, while compensation and a view of total monetary rewards are important for those who plan to stay in their jobs, they also cited reasons that go beyond salary.

Factors such as feeling engaged by work, doing meaningful work, and maintaining good health were the top drivers in surveyed nurses’ decisions to stay in the profession.

The survey asked frontline nurses if they want to stay in their current role. Between 28 and 38 percent indicated they were likely to leave their current role in direct patient care in the next year.

The lesson for New Zealand lies in the survey findings which found “a striking degree of consistency around how nurses feel in their roles today, despite the different healthcare systems and delivery networks in each of the six countries” they surveyed.

“Sorry, no easy escape route there for politicians about different needs for different countries,” says Bishara. “The survey covered countries with diverse economies and cultures -- Brazil, Singapore , Japan, UK, France and the US.

One thing is becoming clear, the survey found. A substantial population of nurses are expressing a desire to leave direct patient care which means a growing risk of nursing shortages around the world.

McKinsey estimates, for example, that in the United States there may be a shortage of between 200,000 to 450,000 nurses (10 to 20 percent) by 2025.

“This would seem a cost-effective opportunity for New Zealand to offer jaded and weary nurses a chance to refresh themselves and their careers by immigrating to New Zealand,” says Bishara.

The report says that by learning and sharing promising paths forward across nations, stakeholders could support their clinical workforce and look to solve what has become a consequential global problem.

Positive leadership initiatives—such as directors rounding once a week to show support—have been correlated in studies with higher retention, reduced medical errors and administrative efficiency.

The report outlines steps employers could consider in an effort to provide nurses with better support.

Nurses cited lack of recognition and being overworked and understaffed as contributing factors in their decision to leave direct patient care.

Surveyed nurses said they were drawn to opportunities where they could have a break from the stress and challenges of direct patient care.

The reasons for leaving vary. In some countries, more than half of respondents said their decision to leave was not directly related to the Covid pandemic.

While the percentage of nurses leaving may have grown in countries such as the United States, currently about half of all nurses in surveyed countries said their likelihood to leave or stay was the same or unchanged since the COVID-19 pandemic began.

Doing meaningful work is a top reason to stay, nurse respondents say.

Across geographies, respondents said the most important factors keeping them in their direct-patient-care roles included doing meaningful work, a positive and engaging work environment and feeling healthy and safe.

“All things New Zealand can offer at little direct cost with a change of attitude and direction and a lot less bureaucracy. It’s an obvious direction which allows us to compete with the big money offered by some countries,” says Bishara.

Japan was the only country with respondents including compensation among their top three factors.

Feeling valued by a manager and efforts to create positive working environments were ranked with high importance in the report.

In the United Kingdom, for example, 63 percent of respondents said “positive interactions” were important and 49 percent said feeling “valued by manager” was important. Respondents cited recognition and more work breaks as helpful for well-being

For example, US and UK respondents were more likely to list open lines of communication as an effective well-being support initiative, while France and Brazil respondents were more likely to say monitoring signs of nurse distress

was effective

Many respondents prioritise the ability to set their hours. Respondents in most countries highlighted the ability to take time off and to work specific hours or days of the week as important.

The ability to work remotely was listed as more of a priority by respondents in the UK and Brazil than their cohorts.

Respondents in France, the UK, and the US cited the ability to work three shifts per week while keeping full-time status as a priority.

Many surveyed nurses indicated uncertainty around whether they had enough advanced clinical skills. Across all countries, nurse respondents reported being less confident about their advanced clinical skills.

Japanese respondents also listed less confidence in having enough technical skills and higher analytical skills, such as interpreting new data and analysis.

If companies make a concerted effort to better understand why employees are leaving and take meaningful action to retain them, the Great Attrition could become the Great Attraction, the report says.

No matter the country, examining what is important to nurses and why they leave could help organisations adjust.

Healthcare stakeholders in all countries may consider strategies to recognise the contributions of nurses, embed more breaks, create positive interactions, and build caring teams, all with the goal of boosting well-being in the workforce. In the long term, these efforts could improve retention.

Health systems may find that positive environments reflecting nurses’ priorities may attract new workers or lure back those who have left direct patient care over the past two years.

In the long run, investment in nurses could offer stability and support top-quality care for patients, the reports says.

Nurses who responded that they were unlikely to leave their current role may be motivated by a variety of factors, such as financial considerations, plans to retire, or plans to further their education, but more research is necessary to determine the specific factor, the report notes.

The survey report was prepared by McKinsey staffers Gretchen Berlin, RN, a senior partner in McKinsey’s Washington DC office, where Faith Lyons is a consultant; Connor Essick is a consultant in the Bay Area office, where Meredith Lapointe is a partner. Catherine Wilkosz and Grace Li contributed to this article. Mike Bishara is the publisher of Media Solutions’ three titles AsiaPacific Infrastructure, Property&Build and Industrial Safety News.