The courage of compassion: Supporting nurses and midwives to deliver high-quality care (Kings Fund, October 2020)

Summary

The COVID-19 pandemic has put the UK health and care workforce under unprecedented pressure. The workforce had been struggling to cope even before the pandemic took hold. Staff stress, absenteeism, turnover and intentions to quit had reached alarmingly high levels in 2019, with large numbers of nurse and midwife vacancies across the health and care system. 

The impact of the pandemic on the nursing and midwifery workforce has been unprecedented and will be felt for a long time to come. The crisis has also laid bare and exacerbated longstanding problems faced by nurses and midwives, including inequalities, inadequate working conditions and chronic excessive work pressures. The health and wellbeing of nurses and midwives are essential to the quality of care they can provide for people and communities, affecting their compassion, professionalism and effectiveness. 

This review, from the Kings Fund, investigated how to transform nurses’ and midwives’ workplaces so that they can thrive and flourish and are better able to provide the compassionate, high-quality care that they wish to offer. 

Nurse and midwives have three core work needs that must be met to ensure wellbeing and motivation at work, and to minimise workplace stress: autonomy, belonging and contribution. This report sets out eight key recommendations designed to meet these three core work needs. These recommendations focus on: authority, empowerment and influence; justice and fairness; work conditions and working schedules; teamworking; culture and leadership; workload; management and supervision; and learning, education and development.

Content

The recommendations set out in the report are addressed to all leaders who influence the workplace experience of nursing and midwifery staff

Recommendations 

Key recommendation 1: Authority, empowerment and influence 
Introduce mechanisms for nursing and midwifery staff to shape the cultures and processes of their organisations and influence decisions about how care is structured and delivered.  

Key recommendation 2: Justice and fairness 
Nurture and sustain just, fair and psychologically safe cultures and ensure equity, proactive and positive approaches to diversity and universal inclusion. 

Key recommendation 3: Work conditions and working schedules   
Introduce minimum standards for facilities and working conditions for nursing and midwifery staff in all health and care organisations.  

Key recommendation 4: Teamworking  
Develop and support effective multidisciplinary teamworking for all nursing and midwifery staff across health and care services.  

Key recommendation 5: Culture and leadership  
Ensure health and care environments have compassionate leadership and nurturing cultures that enable both care and staff support to be high-quality, continually improving and compassionate.   

Key recommendation 6: Workload  
Tackle chronic excessive work demands in nursing and midwifery, which exceed the capacity of nurses and midwives to sustainably lead and deliver safe, high-quality care and which damage their health and wellbeing.   

Key recommendation 7: Management and supervision  
Ensure all nursing and midwifery staff have the effective support, professional reflection, mentorship and supervision needed to thrive in their roles.  

Key recommendation 8: Learning, education and development
Ensure the right systems, frameworks and processes are in place for nurses’ and midwives’ learning, education and development throughout their careers. These must also promote fair and equitable outcomes.