Your professional judgement is a legitimate measure to determine if the workload on your shift is safe for you and those in your care.
If a workload is unsafe, nurses and midwives must act as soon as possible.
All employers have an obligation to provide you with a safe and healthy workplace. That obligation also extends to the safety of patients and residents.
For members working in Queensland Health, the Business Planning Framework (BPF) is a tool you can use for nursing and midwifery workload management.
Legislated ratios provide the absolute minimum staffing requirements (a safety net), whereas the BPF provides a structured approach for improving that ratio, tailored to your practice area.
It provides nurses and midwives with a process to determine the appropriate staffing and skill mix to meet service requirements – in other words, getting the balance right between supply and demand to ensure you can deliver safe, high quality care.
The BPF applies to all Queensland Health workplaces, including areas where legislated nurse-to-patient ratios do not yet apply.
How do I identify a workload issue?
Exercise your professional judgement. If you are concerned about workloads, ask yourself:
- Do I have the time and/or resources to provide optimal care to one or more of my patients/clients?
- Do I have time to complete my documentation?
- Am I able to take my breaks?
- Am I facing unrealistic performance expectations?
- Do I need to contend with poor workplace design?
- Is there a lack of supplies or other resources?
- Are there missed care issues?
- Do I have time to meet the hygiene needs of people in my care?
- Are residents waiting longer for assistance than usual?
- Am I able to leave my shift on time?
- What is the current nurse-to-patient ratio in my ward/unit/area, and is it safe?
- Do I need additional resources (based on acuity, skill mix, scope of practice, etc.)?
If, in your professional judgement, the workload on your shift is not safe, report it.
How do I report a workload issue?
The NMBA anticipates that nurses and midwives will experience circumstances where the practice environment is not optimal and may impact care.
In that circumstance, the NMBA has the following clause in their Code of Conduct for nurses and midwives:
“Nurses must: document and report concerns if they believe the practice environment is compromising the health and safety of people receiving care.”
In other words, if you believe workloads may compromise care, then you have a mandatory professional obligation to document and report it.
In the first instance, contact your line manager and tell them your concerns and what you require to make the shift safe.
Then write down the manager’s response on the workload reporting form if you have time to do this during your shift. If you don’t, make a note so that you can accurately report it when you do complete a workload reporting form.
- Queensland Health: Complete the QH/QNMU agreed electronic Workload Reporting Form located through QHEPS.
- All other sectors: Download the QNMU workload reporting form from www.qnmu.org.au/workloads and submit it using the steps outlined on the form.
Use the Low Priority Tasks at Step 4 of the workload reporting form to prioritise essential clinical duties (for example, you might stop data entry, not answer phones, not restock, not move or make beds).
Patient/resident safety is the priority and maintaining safe workloads is a professional responsibility for all nurses and midwives and for you as an individual practitioner.
In the public sector, escalating a workload concern is a lawful direction and an award entitlement and therefore an enforceable right.
The public sector award also recognises your professional judgement as a valid tool for determining the staffing level required for patient safety.
In the private sector, aged care sector and elsewhere, raise your concerns initially with your line manager and check your agreement for your workload entitlements.
Ensure you know how to find your agreement and how to look for relevant clauses (QNMU members can access their agreement via the QNMU website here).
Taking action works
Regularly submitting workload forms creates the documented evidence the QNMU requires to escalate a workload issue further (such as to a formal workload grievance).
On the QNMU website, you will also find numerous resources to help you and your colleagues identify and report workload issues in your workplace. Visit www.qnmu.org.au/workloads.
Reflective questions
- When a workload issue arises, what can you do to address it?
- It’s always best when QNMU members work together to escalate an issue. How can you get more of your colleagues to address your workload concerns?
- What are some of the low priority activities in your work area?
Don’t forget to make note of your reflections for your record of CPD at www.qnmu.org.au/CPD