ILPC 2027

The impact of neo-liberal policies on the welfare state in advanced capitalist economies has made the labour process in public hospitals subject to work intensification. The pursuit of productivity increases in healthcare is unrelenting. For example, the reductions in hospital bed numbers, along with increasing rates of patient turnover associated with reduced lengths of hospitals stays, have led to work intensification for nurses, in the absence of adjustments to nursing staff numbers and skill mixes. Performance targets and lean management have also intensified the rate of patient flows though hospitals, yet tensions remain between faster and better quality of care.  The relationship between nursing staff levels and the quality of patient care is well established in the nursing literature, and this relationship has helped nurses’ collective bargaining to try to control nurse work intensification through establishing regulated nurse: patient ratio, uniquely in some Australian states and in California.

This longitudinal case study of a tertiary metropolitan hospital in Australia found that nurses greatly appreciated the reduction to work intensity associated with the initial introduction of nurse: patient rations in one Australian state. However, in follow-up interviews five years later (2012-2014) nurses report increasing levels of work stress and work intensification, associated with faster rates of patient turnover. Patient turnover is partly associated with increased workloads related to the complexity of patient admission and discharge processes. It is also associated with higher levels of acuity of the patients in hospital, since low acuity patient are now discharged very quickly.  This points to a limitation of nurse patient ratios in addressing key aspects nurse work intensity (and potentially to patient care) associated with demands to increase productivity.

Based upon the qualitative interviews with nurses and managers across five hospital units, hospital employee data, and a survey of nurses in the hospital, our research demonstrates that most nurses are coping with these increasing levels of work stress and pressure by working part-time, generally 0.8 FTE. The hospital data reveal a significant jump in the number of nurses working part-time over the past five years, with most nurses now doing so. The most common reason given by nurses for working part-time was work stress and pressure. This represents a shift from a collective approach to work intensification, towards an individualised, internalised coping mechanism. It has material implications for the gender wage gap, wage justice and for nurses’ superannuation saving to the extent that this becomes a long-term way of coping. It also has implications for the collective identity of nurses in relation to neoliberal efforts to increase the productivity of the nursing workforce.