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Restructuring and heavy workloads have seen nursing morale fall in the latest NZNO biennial nursing survey but despite this few nurses are indicating signs of burnout.

The New Zealand Nurses Organisation (NZNO) Employment Survey 2017 – called Our Nursing Workforce: Resilience in Adversity – was recently released publically.

The two-yearly survey has been carried out for nearly a decade and for this year for the first time included an exploration of burnout.

“While the survey reveals that nurses show resilience and commitment to their profession in the face of continuing restructuring and resource constraints, there is a tipping point where nurses will just walk away from the profession,” said NZNO chief executive Memo Musa. “Workload, increasing patient acuity, stress and lack of job satisfaction are contributing to staff turnover and to lower morale, and must be better managed.

The survey was sent out to a random sample of NZNO's total membership and 691 nurses responded – a roughly 15 per cent response rate. Researcher Dr Leonie Walker said that was slightly lower than previous years but was a representative sample of the nursing workforce (see details below). 

More than half of respondents were employed by DHBs (the majority of those – 42% - in hospital settings) with the next most common employment setting being general practices (8.2%), aged care providers (7.1%) and NGOs like Plunket or hospices (5.6%).

In the survey report executive summary Walker said the survey findings indicated a steady decline in overall morale, along with specific concerns about staffing levels, workload and pay, and a loss of confidence in health sector leadership.

Nearly a third (32%) of respondents had been affected by significant restructuring in their workplace -  about half had faced reorganisation within their worksite, 24.4% had seen senior nursing leadership positions lost and 23 per cent involved a reduction in the nursing skill mix (i.e. substituting registered nurses (RNs) with enrolled nurses (ENs) or RN/ENs with health care assistants (HCAs).

Changes in nursing morale was also measured using the same or very similar 30 questions – covering attitudes to careers, workload, pay and nursing as a profession – that have been asked since the survey began in 2009.

Walker said the findings reveal that nurses are most positive about the quality of care they deliver and nursing as a career. They were also positive about job security. They were less positive about access to training, career progression, and choice of hours and the extent of bullying. They were least positive about workload and pay, especially in comparison with other professionals.

"Compared to the responses from 2009, 2011, 2013 and 2015, New Zealand nurses’ morale scores with most aspects of nursing as a career have continued to steadily decline across the board," said Walker. "Falls in satisfaction with pay and workload continue, and there has been a slight increase in perceptions of bullying."

But despite lowering morale the burnout survey findings indicated that the nurse respondents showed only a low to moderate risk of burnout – in marked contrast to a recent burnout study of doctors carried out by the Association of Salaried  Medical Specialists (ASMS).  The NZNO survey asked nurses to respond to questions like "I feel emotionally drained from my work" and "I've become more callous towards people since I took this job" and found that nurses scored highly for their sense of personal accomplishment from their work, showed moderate levels of emotional exhaustion but had low scores for "depersonalisation" – one of the three risks signs for burnout.

Walker said the burnout questions had not been specifically validated for use with New Zealand nurses and the results should be treated with some caution. "Nevertheless, it does potentially reveal that despite emotional toll, nurses gain resilience from their sense of job satisfaction related to helping patients."

One positive trend that emerged in the survey was an increase in the number of sample respondents on permanent contracts up from 81 per cent in 2011 to nearly 94 per cent in 2017.  And a subsequent decrease in the numbers on casual contracts (down from 11% in 2011 to 2.6% in 2017) and those on temporary or fixed-term contracts (down from 5.3% to 2.8%).