Towards a Safer Culture

 Supporting our nurses and midwives

The impact of workplace violence and aggression is a global problem confronting all health care workers. Nurses and midwives, at the forefront of health care delivery, are the largest health care group exposed to occupational violence (OV).

In the ACT Government context, OV is defined as any action, incident or behaviour that departs from reasonable conduct in which causes a person to be assaulted, threatened, harmed, or injured during, or as a direct result of their work where the workplace also includes remote, community or home-based sites. It also includes abuse through technology (text, emails, and phone calls).

The fundamental rights of nurses and midwives, to be safe and protected, is a priority for the ACT Government. ACT Health is also committed to improving workplace safety and continued compliance with legislated responsibility to protect workers and others from harm.

Towards a Safer Culture Strategy

In order to address the issue of safety across the nursing and midwifery professions the ACT Government launched its ambitious Nurses and Midwives: Towards a Safer Culture (TASC) Strategy (the Strategy) in December 2018.

This Strategy is led by ACT Health and encompasses Canberra Health Services and Calvary Public Hospital Bruce. Key stakeholder engagement from organisations such as the Australian Nursing and Midwifery Federation (ANMF) has successfully progressed development of the Strategy.

The Strategy outlines a vision of an ACT public health care system where staff, patients and visitors are protected from harm and feel safe at all times. The Strategy makes recommendations for creating a safer and healthier environment for all staff and persons who enter ACT public health workplaces.

The Strategy sought to address the problem on multiple fronts using 22 priority actions with the assumption being these actions would cumulatively work towards the desired impact of reducing incidents of OV, bullying and/or harassment experienced by nurses and midwives in ACT public health workplaces.

The Strategy has made an important contribution to increasing peoples understanding of OV and maintaining focus on the impact of OV on nurses and midwives.  In particular the deliverables from multiple priority actions has raised awareness among staff and in the community, delivered a range of resources and guidelines, and resulted in the implementation of the Safewards Trial in the ACT project.

Interdependent projects

Project activity

In the provision of public healthcare in the ACT, ACT Health, Canberra Health Services, including the University of Canberra Hospital (UCH) and Calvary Public Hospital Bruce are all committed to improving workplace safety. Together we are implementing various initiatives and strategies and addressing continued compliance with our legislated responsibility to protect workers and others from harm.

Informed by the work of the NM TASC Steering Committee and Advisory Group, the Strategy provides a foundation for positive cultural change within ACT health care settings to reduce harm to staff, patients and visitors.

Where are we at?

Timeline infographic

 

The four pillars

The four pillars for the Strategy were based on broad areas for action and implementation. Current and completed work under the Strategy’s four pillars includes:

    Organisational wide actions

    The development of organisation-wide initiatives to review and strengthen governance and workplace risk strategies including identification, minimisation, prevention and reporting of risks with the ultimate goal to promote a workplace culture of respect and staff empowerment.

    Governance

    The TASC Strategy established a formal governance structure to direct development and implementation of the Strategy. The Advisory Group and Steering Committee had representation from relevant ACT public health workplaces and key stakeholders to ensure appropriate leadership and decision making. 

    Nursing and Midwifery Leadership

    Senior leadership across all ACT public health workplaces are committed to the TASC Strategy, noting a requirement to ensure leadership across nursing and midwifery was embedded, from individuals in small teams through to wards, and leaders at the operational level including leadership in senior administrative positions. The challenge would be to ensure modelling of positive leadership was occurring at all levels of leadership within organisations to facilitate a change in workplace culture and perceptions of safety.

    A number of leadership deliverables were identified:

    Senior leadership included: ACT Chief Nursing and Midwifery Officer, Director and Deputy Director-Generals of the ACT Health Directorate and the Minister for Health.

    TASC Strategy evaluation

    ACT Health Directorate requested the Policy Design and Evaluation (PDE) Team, Chief Minister Treasury and Economic Development Directorate (CMTEDD), undertake an evaluation of the TASC Strategy in March 2021. An evaluation approach with process, implementation and impact evaluation components was developed and will soon be released by the ACT Minister for Health.

    Stakeholder engagement

    The TASC Project Team have engaged in a variety of forums to brief and consult with key stakeholders on the priority actions of the TASC Strategy, including:

    • World Cafe
    • ACT Nursing and Midwifery Network Leaders Meeting
    • Culture Review Implementation Group
    • Director General Forum
    • Meetings with the Heads of Health Services
    • Peak Carer and Consumer Bodies
    • Work Health Safety Occupational Violence Community of Practice, CMTEDD
    • ACT Public Advocate and Human Rights Commission
    • Senior Nursing Forum Aged Care, St Andrews Village
    • Health Services
      • New Graduates
      • Wards and Community Health Centres
      • Directors of Nursing and Midwifery Meetings
      • CHS OV Committee

    Events

    • Development, promotion and dissemination of TEN - The Essential Network for Health Professionals
      • The Black Dog Institute TEN – The Essential Network for Health Professionals is funded by the Commonwealth Government Department of Health and has been developed to help healthcare workers find resources and support to manage ‘burnout’ and maintain good mental health.
      • TEN flyer
      • TEN posters

    Conferences

    • ANMF Biannual Conference 2021
    • Australian College of Nursing National Nursing Forum- “Champions of Change
    • Australian College of Mental Health Nurses Conference “Mental Health Nursing in a Climate of Change
      • The TASC Project Team are scheduled to present at the ACMHN 26th International Mental Health Nursing Conference 2021 from Wednesday 4 - Friday 6 May 2022, at the JW Marriott Resort and Spa, Gold Coast. View the draft program guide.
    • 2022 Comcare National Conference- “Creating a Safer workplace together
      • To be held on 7 and 8 June 2022 at the National Convention Centre in Canberra. The TASC Project Team will be presenting “Towards a Safer Culture”. View the program guide.
    • The National Nursing Forum- “Nursing Leadership Unmasked
      • To be held 17-19 August 2022 at the Darwin Convention Centre. The TASC Project Team will be doing an oral presentation and poster presentation.
         

    Other

    The TASC Project Team welcome the opportunity to present and engage with individuals and organisations on aspects of the TASC Strategy and can be contacted at NM.SaferCulture@act.gov.au.

    Occupational violence

    Implement a program of activities to develop and implement initiatives that address the issue of occupational violence in ACT public health workplaces, including the development of standards, guidelines and education and a community, consumer and carer information campaign.

    Challenging Behaviour Guideline for ACT Health Services

    The Guideline provides the framework for ACT public health care workers to manage and respond to challenging behaviours that if not addressed may result in occupational violence.

    Isolated and Remote Worker Guideline

    The Guideline supports ACT public health workplaces to identify, manage, and respond to risk when workers are located in isolated or remote work environments.

    Safewards

    The Safewards model and Interventions is an adaptable program of evidence-based nursing interventions that has been proven to be effective in reducing conflict and the use of containment (restrictive practices). These changes are important strategies for health care workplaces that are looking to reduce the occurrence and impacts of occupational violence (OV). Further, they support a broader culture change where respect, inclusion, and collaboration are embedded across workplaces.

    ACT Health led the trial of the Safewards model and Interventions into ACT Public Health Services from January-June 2021.

    Managers Occupational Violence Incident Response Toolkit

    Managing Occupational Violence (OV) is never easy, but with the correct support and guidance the process can be simplified. Staff look to their Managers for guidance on how best to respond and manage OV that occurs. This toolkit aims to help Managers recognise and respond to an OV incident, report an OV incident, support their teams and their own health and wellbeing, and engage staff in a review of the OV incident.

    Increased OV Visibility across organisation

    The Incorporating WHS into Team Meetings information sheet was developed to assist managers, health and safety representatives (HSRs) or staff members to effectively develop and communicate WHS content for team meetings.

    Staff Rights to a Safe Workplace Factsheet

    Developed to improve staff understanding of their rights to a safe workplace and the help them better identify and report unacceptable behaviours.

    Community Awareness Campaign

    Launched by the Minister for Health, the “Be Kind and Respectful to our Nurses and Midwives” campaign uses a story telling approach to inspire understanding and engage emotions by building  on the community’s appreciation for the valuable work nurses and midwives do and highlighting the impact of unacceptable behaviour on their capacity to provide care.

    Statement of Mutual Expectations

    Designed to be communicated with consumers when they engage with ACT public health workplaces, identifying how consumers and healthcare staff can best work together to reduce incidents of occupational violence.

    Challenging Occupational Behaviours

    Aimed at developing new, or strengthening existing, practices, policies and guidelines that reduce or prevent bullying and/or harassment. Includes a focus improving leadership and developing and implementing workplace civility measuring and management guidelines.

    Achieved with ongoing collaboration with the Culture Review Implementation Branch of the ACT Health Directorate to implement shared recommendations from the Independent Review into the Workplace Culture within ACT Public Health Services and the deliverables of the NM TASC Strategy.

    *The Culture Review Implementation remit is to build positive workplace culture across the ACT public health system. This multiyear program is an evidence-based best-practice design structured to deliver ongoing long-term, positive results.

    Safe Work Practices

    Embed best practice guidelines in the development of safe work practices, to ensure ACT health workplaces embed safe workplace design principles in new builds and redevelopment of workplaces. 

    Nurse/Midwife-to-Patient Ratios

    The Ratio Framework outlines safe work practices (e.g., the way that work is performed including the organisations vision/values, policies, procedures and guidelines which underpin work delivery).

    The Ratio Framework has informed the commitment of the ACT Government to implement mandated minimum Nurse/Midwife-to-Patient Ratios in 2021/22.

    Strengthening Rostering and Leave Allocation

    The Discussion Papers and Review of Schedule 8 collectively present evidence-based guidance and recommendations to strengthen ACT public health services rostering practices and future staffing models in the context of improving nursing and midwifery safety.

    Embedding Safe Workplace Design

    Safe design includes consultation with nurses and midwives in the design phase of new builds and refurbishments as well as incorporation of reduction of occupational violence concerns as a key element in the design phase and adherence to the Australasian Health Facility Guidelines.

    These documents are owned by the Infrastructure and Health Support Services, CHS and  have been strengthened with extensive consultation and input received by the TASC Steering Committee and other key infrastructure stakeholders. These have been shared, with permission, to all ACT health workplaces to create a consistent approach to consultation with end users when commencing any new build or refurbishment.

    If you would like access these documents, please contact NM.SaferCulture@act.gov.au.

    Attachments
    Page last updated on: 22 Jun 2022