1. Beyond Breaking Point? Key Results Rachael McIlroy

2. Beyond Breaking Point? u Online survey of 2,008 members u Followed up with telephone interviews of 22 respondents – cross-section of age, ethnicity, employer, area of practice

3. HSE Management Standards u Key part of research uses HSE Management Standards for work related stress u Define the characteristics, or culture, of an organisation where risks from work related stress are being effectively managed and controlled u Cover six key areas of work design that, if not properly managed, are associated with poor health and well-being, lower productivity and increased sickness absence.

4. HSE Management Standards – 6 areas of work design u Demands – workload, work patterns, work environment u Control – how much say you have in how you work u Support – encouragement, support and resources provided by org, line manager and colleagues u Role – whether you understand role in the org and whether org ensures no conflict in roles u Relationships – positive working to avoid conflict and minimising unacceptable behaviour

5. HSE Management Standards – question examples Demands u I have to work very intensively u Different groups demand things that are hard to combine u I have unrealistic time pressures Control u I have a choice in deciding what I do u I have a choice in deciding how I do my work

6. HSE Management Standards Managerial support u I am given supportive feedback Peer support u If work gets difficult, colleagues will help me Role u I am clear about goals, objectives for my dept u I am clear what is expected of me Change u Staff are always consulted about change

7. HSE Management Standards 1=low wellbeing 5= high wellbeing

8. HSE Management Standards u Demands – urgent action needed Long working hours, unrealistic time pressures and unachievable deadlines u Control – urgent action needed Little control over the way they work and what they do at work

9. HSE Management Standards u Managerial support – good but room for improvement Fairly good relationships with line managers, but problems lie with senior managers u Peer support – clear need for improvement Support from colleagues is essential when dealing with heavy workloads

10. HSE Management Standards u Role – good but room for improvement More confidence about own role than how it fits into wider org objectives u Change – urgent action needed Very negative score on engagement in workplace change

11. Main reasons for high levels of stress u Workload u Staff shortages u Not enough time to do job u Rest breaks u Poor management u Working long hours

12. Presenteeism – over previous 12 months have you gone to work despite feeling should take sick leave?

13. Presenteeism – other results u NHS Staff Survey England 69% of all staff and 73% nurses had attended work in previous 3 months despite not feeling well enough u NHS Staff Survey Wales 70% of all staff attended work in previous 3 months despite not feeling well enough

14. Presenteeism - pressures u Sickness absence policies u Link between sickness absence and reorganisation u Worries about impact on colleagues/patients u Staff shortages and workload u Feelings of guilt – internal or external u Workplace culture

15. Personal experience of bullying and violence Verbal or physical violence u Patients/service users 56% u Relatives of patients/service users 48% u Other members of public 15% u Colleagues 21% u Manager/team leader 15% Workplace bullying u Manager 23% u Colleague 21%

16. Occupational Health u I have access to OH services at work 86% u I feel confident that OH services would be helpful if I contact them 54% u I can access OH services without a referral 61%

17. Occupational health services u Access is better in the NHS, social enterprises, universities than GP practices, independent sector and voluntary sector u But confidence in services is low across all sectors

18. Key Recommendations Kim Sunley Senior Employment Relations Adviser

19. Safe Staffing Levels u RCN actively campaigning on this issue through ‘This in Nursing’ and the work of Safe Staffing Alliance u RCN Guidance u Toolkit for activists

20. Shift Working and Fatigue u Development of a ‘Shift in the Right Direction’ –Employer’s duty to risk assess and introduce safe shift patterns –Importance of rest breaks between and during shifts u CNO announcement of review of 12 hour shifts u Continued input into negotiations on Working Time Directive

21. Workplace Stress Risk Assessments  Legal duty to ensure that work does not make employees ill  Continuous process ‘not a one off’ linked with organisational change and staff survey  HSE need to be active on this and also re-visit benchmarking

22. Presenteeism and sickness absence u Presenteeism must be recognised as a health and wellbeing issue u Implementation of national partnership guidelines on sickness absence u Effective management practices –Appraisals –Supportive approach –Prompt access to treatment –Equalities Act –Annex Z AfC

23. Other key recommendations u Engagement and consultation u Violence and bullying and harassment u Occupational Health Provision u Raising concerns

24. Next Steps u Workshop presentation u UKSRC to further shape recommendations u Campaign – ‘This is Nursing’ and other workstreams/projects u NHS Staff Council u Toolkit for Activists