Nurse and midwife navigator resilience, well-being, burnout, and turnover intent: A multi-methods study.

PURPOSE: To explore levels of Navigator resilience, well-being, burnout, and turnover intent. DESIGN: A longitudinal, multi-methods study concurrently collected quantitative and qualitative data over three years. METHODS: A survey and Action Learning Groups. FINDINGS: No statistically significant change in resilience, well-being, burnout, or turnover intent. Supports, self-care and leaving the position, were used to maintain well-being. CONCLUSIONS: While quantitative measures did not change, qualitative data demonstrated how adaptive coping mechanisms maintain well-being. Recommendations for nurses working in Navigator, or similar community/public health roles include work-based programs targeting support, good leadership, governance systems including their impact on turnover intent. CLINICAL EVIDENCE: Job turnover intent can be used as a mechanism to monitor resilience and well-being.

Yarning as an Interview Method for Non-Indigenous Clinicians and Health Researchers.

In this article, we discuss the origins, epistemology, and forms of Yarning as derived from the literature, and its use in research and clinical contexts. Drawing on three Yarns, the article addresses the extent to which non-Indigenous researchers and clinicians rightfully use and adapt this information-gathering method, or alternatively, may engage in yet another form of what can be described as post-colonialist behavior. Furthermore, we argue that while non-Indigenous researchers can use Yarning as an interview technique, this does not necessarily mean they engage in Indigenous methodologies. As we note, respectfully interviewing Aboriginal and Torres Strait Islander peoples can be a challenge for non-Indigenous researchers. The difficulties go beyond differences in language to reveal radically different expectations about how relationships shape information giving. Yarning as a method for addressing cross-cultural clinical and research differences goes some way to ameliorating these barriers, but also highlights the post-colonial tensions.

A qualitative exploration of a mindful resiliency program for community healthcare providers.

Despite the important contribution of nongovernmental organizations (NGOs) to the community healthcare sector, the building and maintenance of occupational resilience in community health workers has received little attention. However, it is recognized that employees in this sector are exposed to significant stressors from the high demand work environment which negatively impacts on their well-being. Therefore, this research examined the acceptability, feasibility, and sustainability of a mindful resiliency program by employing a qualitative analysis of participant subjective experience of the program in this cohort. This was the first study to be conducted with senior managers and frontline healthcare providers in the nongovernmental organizations community sector. A 1-month post-delivery qualitative review of the program identified four major themes: applicability, changes to participant's skills, social support, and coping with COVID-19. A major finding was the ability of the participants to immediately recognize their stress levels and then manage them. Additionally, lessons from the program were shown to be usefully applied with colleagues and clients within the work environment, and with family members.

Exploring the nurse navigator role: A thematic analysis.

BACKGROUND: Patients with complex chronic conditions experience fragmentation of care, unnecessary hospitalization and reduced quality of life, with an increased incidence of poor health outcomes. AIM(S): The aim of this paper was to explore how nurse navigators manage client care. This was achieved through an examination of narratives provided by the nurse navigator that evaluated their scope of practice. METHOD(S): All nurse navigators employed by Queensland Health were invited to participate in a study evaluating the effectiveness of the service. Eighty-four self-reported vignettes were thematically analysed to understand the work from the nurses' perspectives. RESULTS: Two themes emerged from the vignettes. Theme 1, the layers of complexity, is comprised of three sub-themes: the complex patient, the complex system and patient outcomes. Theme 2, professional attributes, has two sub-themes: person-centred care and clinical excellence. CONCLUSION: Navigators innovatively integrate services and address the fragmented nature of the health system. They apply expert clinical and social skills, through consistent and robust communication, to meet the needs of those with multiple chronic conditions. IMPLICATIONS FOR NURSING MANAGEMENT: Results provide insight into the new role, illuminating the work they achieve, despite system complexities.

Pilot study of the effectiveness of a Mindful Self-Care and Resiliency program for rural doctors in Australia.

OBJECTIVE: Rural doctors are difficult to recruit and retain. Burnout and stress in the medical workforce fluctuates according to location. Overall, doctors have an elevated risk of depression and suicide compared to the general population and other professionals. Higher levels of occupational stress also effect patient care, levels of work satisfaction and relationships with others. This study evaluated the effectiveness, acceptability, feasibility and sustainability of the Mindful Self-Care and Resiliency Program. DESIGN: This was a sequential mixed-method study involving the collection of both quantitative and qualitative data. SETTING: The study was conducted in Emerald, Queensland. PARTICIPANTS: Thirteen doctors took part in the program with seven providing pre and post survey responses. Qualitative data were collected via semi-structured telephone interviews with an additional four rural doctors. Intervention The Mindful Self-Care and Resiliency program consisted of a 4-hour face-to-face session and three 1-hour video-conference follow up sessions. Main outcome measures Burnout, negative affect, well-being and psychological strain were assessed using self-report measures before and after taking part in the program. Results The majority (six out of seven) of the doctors showed reductions in burnout, psychological strain and negative affect following participation in the program. The qualitative data indicated that all doctors gained new skills: self-awareness, reflection and self-care. They also reported improved interaction with colleagues and patients, to whom they passed on their new learning. Conclusion This preliminary investigation of the effectiveness and feasibility of Mindful Self-Care and Resiliency for rural doctors indicates that the program has promise in improving the emotional well-being of this occupational group. Although this study captured approximately one-third of the Emerald workforce, further research with a larger sample is required to confirm these findings.

A comparison of nurse shift workers' and non-shift workers' psychological functioning and resilience.

AIMS: To investigate the impact of shift work on the psychological functioning and resilience of nurses by comparing nurses who work shifts and nurses who work regular hours. DESIGN: A comparative descriptive design using an online self-report questionnaire. METHOD: Data were collected from employed Registered and Enrolled Nurses (N = 1,369) who were members of the Queensland Nurses and Midwives Union (QNMU) in 2013. The survey included standardized measures of resilience, depression, anxiety, compassion satisfaction, compassion fatigue, and intention to leave the profession. RESULTS: Generalized Linear Mixed Model analysis revealed shift workers had significantly lower levels of compassion satisfaction. However, there were no significant differences between the groups on resilience, depression, anxiety, stress, compassion fatigue or intention to leave nursing. CONCLUSION: The findings suggest that shift work is not associated with worse psychological functioning or lower resilience in nurses. However, this study requires replication using a longitudinal design to confirm these findings.

The evaluation of nurse navigators in chronic and complex care.

AIM: With increasing age and chronicity in populations, the need to reduce the costs of care while enhancing quality and hospital avoidance, is important. Nurse-led co-ordination is one such model of care that supports this approach. The aim of this research was to assess the impact that newly appointed Navigators have on service provision; social and economic impact; nurses' professional quality of life and compassion fatigue; and analysis of the change that has occurred to models of care and service delivery. DESIGN: A concurrent mixed-method approach was selected to address the research aims. METHODS: The research project was funded in July 2018 and will conclude in December 2020. Several cohorts will be studied including; patients assigned to a navigator, patients not assigned to a navigator, family members of patients assigned a navigator; and a sample sized estimated at 140 navigators. DISCUSSION: This study provides a comprehensive international longitudinal and mixed method framework for evaluating the impact of nurse navigators on quality of care outcomes for patients with chronic conditions. IMPACT-WHAT PROBLEM WILL THE STUDY ADDRESS?: Even with specialty focused co-ordinated care, patients get lost in the system, increasing the incidence of non-compliance and exacerbation of condition. Navigators work with patients across service boundaries allowing for care that is patient responsive, and permitting variables in clinical, social and practical elements of care to be addressed in a timely manner. This novel nurse-led approach, supports hospital avoidance and patient self-management, while encouraging expansion and opportunity for the nursing and midwifery workforce.

The Effect of Media Campaigns, Patient Characteristics, and Presenting Symptoms on Prehospital Delay in Myocardial Infarction Patients: A Prospective Cohort Study.

BACKGROUND: Delays in reperfusion therapy for myocardial infarction (MI) are associated with increased mortality and morbidity, and most of this delay is due to delay in patients initiating contact with emergency services. This study assesses the impact of the Australian National Heart Foundation media campaign and identifies patient characteristics and presenting symptoms that may contribute to delay. METHODS: This prospective cohort study identified patients with a diagnosis of MI admitted to a single tertiary metropolitan hospital in Perth, Western Australia from July 2013 to January 2014. Patients were interviewed and responses were categorised to determine their reasons for delaying treatment and the impact of mass media campaigns. Delay times were analysed using multivariable linear regression models for the Whole Cohort (all patients admitted to the tertiary hospital, including patients from rural and peripheral hospitals) and the Direct Admission Cohort (patients admitted directly to the tertiary hospital). RESULTS: Of 376 patients, 255 patients provided consent, and symptom onset-time was available for 175 patients. While almost two thirds of the cohort was aware of media campaigns, awareness was not associated with decreased prehospital delay. Median delay was 3.9hours for the Whole Cohort and 3.5hours for the Direct Admission Cohort. Delay was associated with being widowed, symptom onset on a weekday compared with weekend, past medical history of MI and coronary artery bypass graft, private compared with ambulance transport to hospital, and lack of symptoms of sweating and weakness. In addition, for the Direct Admission Cohort, age and income were also associated with delay. CONCLUSIONS: This study did not find an association between awareness of media campaigns and delay. This study identified important characteristics and presenting symptoms that are associated with delay, and possibly relevant to future media campaigns.

Perceptions of nursing workloads and contributing factors, and their impact on implicit care rationing: A Queensland, Australia study.

AIMS: To explore nurses' perceptions of factors affecting workloads and their impact on patient care. BACKGROUND: Fiscal restraints and unpredictable patient illness trajectories challenge the provision of care. Cost containment affects the number of staff employed and the skill-mix for care provision. While organisations may acknowledge explicit rationing of care, implicit rationing takes place at the point of service as nurses are forced to make decisions about what care they can provide. METHOD: A self-report cross sectional study was conducted using an on-line survey with 2,397 nurses in Queensland, Australia. RESULTS: Twenty to forty per cent reported being unable to provide care in the time available; having insufficient staff; and an inadequate skill-mix. The respondents reported workload and skill-mix issues leading to implicit care rationing. Over 60% believed that the processes to address workload issues were inadequate. CONCLUSIONS: Institutional influences on staffing levels and skill-mix are resulting in implicit care rationing. IMPLICATIONS FOR NURSE MANAGERS: Adequate staffing should be based on patient acuity and the skill-mix required for safe care. Managers should be more assertive about adequate clinical workloads, involve staff in decision-making, and adopt a systematic planning approach. Failure to do so results in implicit care rationing impacting on patient safety.

A re-examination of the individual differences approach that explains occupational resilience and psychological adjustment among nurses.

AIMS: This study re-examines the validity of a model of occupational resilience for use by nursing managers, which focused on an individual differences approach that explained buffering factors against negative outcomes such as burnout for nurses. BACKGROUND: The International Collaboration of Workforce Resilience model (Rees et al., 2015, Frontiers in Psychology, 6, 73) provided initial evidence of its value as a parsimonious model of resilience, and resilience antecedents and outcomes (e.g., burnout). Whether this model's adequacy was largely sample dependent, or a valid explanation of occupational resilience, has been subsequently un-examined in the literature to date. To address this question, we re-examined the model with a larger and an entirely new sample of student nurses. METHODS: A sample of nursing students (n = 708, AgeM ( SD ) = 26.4 (7.7) years), with data examined via a rigorous latent factor structural equation model. RESULTS: The model upheld many of its relationship predictions following further testing. CONCLUSIONS: The model was able to explain the individual differences, antecedents, and burnout-related outcomes, of resilience within a nursing context. IMPLICATIONS FOR NURSING MANAGEMENT: The results highlight the importance of skills training to develop mindfulness and self-efficacy among nurses as a means of fostering resilience and positive psychological adjustment.

Sustainability of the Australian radiation oncology workforce: A survey of radiation therapists and radiation oncology medical physicists.

This study aimed to determine and compare Radiation Therapists' (RTs') and Radiation Oncology Medical Physicists' (ROMPs') perspectives about their profession and workplace, satisfaction with career progression opportunities, and leaving the current workplace. RTs and ROMPs who were currently or had previously worked in Australia were invited to complete an online survey. Univariate and multivariate methods were used for analysis. Participants were 342 RTs and 112 ROMPs with estimated response rates of 14% and 26% respectively. Both professions rated workload poorly and identified the need for improvement in: communication between professions' members, support for junior staff/new graduates, staff morale, on-site training and multidisciplinary communication. RTs, more than ROMPs, perceived their profession was recognised and respected, but RTs were less likely to be satisfied with career progression/advancement, job promotion prospects and opportunities to specialise. At least 20% of RTs and ROMPs were thinking about leaving their workplace and 13% of RTs and 8% of ROMPs were thinking about leaving their profession. Different factors contributed to workforce satisfaction and retention within each profession. Staff satisfaction and career progression are critical to retain RTs and ROMPs. Further research is required to explore strategies to address workplace dissatisfaction, recruitment and retention.

The Effects of Occupational Violence on the Well-being and Resilience of Nurses.

OBJECTIVE: This article reports findings from a 2016 survey exploring the working life of nurses/midwives in Queensland, Australia. Responses related to occupational violence (OV) are reported. BACKGROUND: OV is linked to high rates of burnout. It is imperative to continue efforts to understand how to avoid burnout and build nurse/midwives' resilience. METHODS: A total of 2397 nurse/midwives working in Queensland responded to the survey and were asked to answer 8 questions related to OV. RESULTS: In the last 3 months, 53% of nurses/midwives had experienced OV. Those respondents had significantly higher rates of burnout and lower resilience and rated the practice environment lower than their counterparts who had not experienced violence. CONCLUSIONS: The experience of OV significantly impacts nurse resilience and levels of burnout. To retain nurses, attention must be given to reduce OV and support nurses who have experienced it.

Aboriginal parent support: A partnership approach.

AIMS AND OBJECTIVES: This study was positioned within a larger action research study relating to a peer-led Aboriginal home visiting parent support program in an urban Western Australian setting. The aims for this study component were to identify program elements, exploring participants' perceptions of the program's suitability, feasibility, acceptability and effectiveness to inform program model recommendations and add to the body of knowledge on effective Aboriginal peer-led program models. BACKGROUND: The ability of Aboriginal parents to develop positive family environments is crucial, with parent support needing to be reflexive to local needs and sociocultural influences. Culturally appropriate service provision needs meaningful and acceptable strategies. DESIGN: This study was situated within a critical paradigm supporting Participatory Action Research methodology, using Action Learning Sets as the participant engagement and data collection setting. METHODS: Within ten Action Learning Sets, focus group interviews were carried out with Aboriginal peer support workers, a non-Aboriginal parent support worker, an Aboriginal program coordinator, an Aboriginal education support officer and non-Aboriginal program managers (n = 8), and individual interviews with parents (n = 2) and community agencies (n = 4). Data were analysed using thematic analysis. RESULTS: Five themes were derived from peer support worker and community agency cohorts: peer support worker home visiting skills; responding to impacts of social determinants of health; client support and engagement; interagency collaboration; and issues addressing program sustainability. Parent responses augmented these themes. CONCLUSIONS: Participants identified five key elements relating to peer-led home visiting support for Aboriginal parents. These are uniquely placed to inform ongoing program development as there is little additional evidence in wider national and international contexts. RELEVANCE TO CLINICAL PRACTICE: Engagement with communities and peer support workers to develop culturally relevant partnerships with Aboriginal families is integral to contemporary child health practice. Ongoing nurse support is needed for peer support worker role development. Indigenous Australian peoples are people who identify as Aboriginal or Torres Strait Islander. Respectfully, throughout this paper, they will be described as Aboriginal.

What is the impact of shift work on the psychological functioning and resilience of nurses? An integrative review.

AIM: To synthesize existing research to determine if nurses who work shifts have poorer psychological functioning and resilience than nurses who do not work shifts. BACKGROUND: Research exploring the impact of shift work on the psychological functioning and resilience of nurses is limited compared with research investigating the impact of shifts on physical outcomes. DESIGN: Integrative literature review. DATA SOURCES: Relevant databases were searched from January 1995-August 2016 using the combination of keywords: nurse, shift work; rotating roster; night shift; resilient; hardiness; coping; well-being; burnout; mental health; occupational stress; compassion fatigue; compassion satisfaction; stress; anxiety; depression. REVIEW METHODS: Two authors independently performed the integrative review processes proposed by Whittemore and Knafl and a quality assessment using the mixed-methods appraisal tool by Pluye et al. RESULTS: A total of 37 articles were included in the review (32 quantitative, 4 qualitative and 1 mixed-methods). Approximately half of the studies directly compared nurse shift workers with non-shift workers. Findings were grouped according to the following main outcomes: (1) general psychological well-being/quality of life; (2) Job satisfaction/burnout; (3) Depression, anxiety and stress; and (4) Resilience/coping. We did not find definitive evidence that shift work is associated with poorer psychological functioning in nurses. Overall, the findings suggest that the impact of shift work on nurse psychological functioning is dependent on several contextual and individual factors. CONCLUSION: More studies are required which directly compare the psychological outcomes and resilience of nurse shift workers with non-shift workers.

Myocardial infarction, patient decision delay and help-seeking behaviour: a thematic analysis.

AIMS AND OBJECTIVES: To explore patient decision delay, the symptom experience and factors that motivated the patient experiencing myocardial infarction to go to the emergency department. BACKGROUND: Reperfusion for myocardial infarction is more effective if performed as soon as possible after the onset of symptoms. Multiple studies show that prehospital delay is long and can average several hours. DESIGN: A qualitative descriptive design using semi-structured interviews. METHODS: All consecutive myocardial infarction patients who between July 2013-January 2014 at a single-centre metropolitan tertiary hospital in Western Australia were included. Patient responses to an open-ended question were recorded and transcribed verbatim. Data were analysed using Braun & Clarke (Qual Res Psychol, 3, 2006, 77-101) thematic analysis method. RESULTS: Of the 367 eligible, 255 provided consent. Three themes emerged from the qualitative analyses: (1) onset and response to symptoms, and this included three subthemes: context of the event, diversity of symptom interpretation and response to symptoms; (2) help-seeking behaviour, and this included the patient seeking help from various lay and professional sources; and (3) help-seeking outcomes, which include calling the emergency ambulance, going to emergency department, seeing a general practitioner, seeing a general practitioner who advised them to go home. CONCLUSION: The context of the event, their symptomatology and the layperson who was the first point of contact influenced the decision for the patient to go to the emergency department. Many patients used private transport or contacted their general practitioner. New knowledge from this study emphasises the importance of the layperson understanding the appropriate response is to seek prompt care through immediate emergency transport by ambulance to emergency department. RELEVANCE TO CLINICAL PRACTICE: This study highlights the need to educate both the patient and the wider public, not only to seek prompt care but to also to call the emergency ambulance to arrange transport to the emergency department.

Factors influencing workplace violence risk among correctional health workers: insights from an Australian survey.

Little is known about the environmental and organisational determinants of workplace violence in correctional health settings. This paper describes the views of health professionals working in these settings on the factors influencing workplace violence risk. All employees of a large correctional health service in New South Wales, Australia, were invited to complete an online survey. The survey included an open-ended question seeking the views of participants about the factors influencing workplace violence in correctional health settings. Responses to this question were analysed using qualitative thematic analysis. Participants identified several factors that they felt reduced the risk of violence in their workplace, including: appropriate workplace health and safety policies and procedures; professionalism among health staff; the presence of prison guards and the quality of security provided; and physical barriers within clinics. Conversely, participants perceived workplace violence risk to be increased by: low health staff-to-patient and correctional officer-to-patient ratios; high workloads; insufficient or underperforming security staff; and poor management of violence, especially horizontal violence. The views of these participants should inform efforts to prevent workplace violence among correctional health professionals.

The emerging role of the urban-based aboriginal peer support worker:A Western Australian study.

Purpose: To explore the self-perceived role of the Aboriginal peer support worker working with familieswith young children. This study was a component of a larger participatory action research study under-taken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility andeffectiveness of an Aboriginal peer-led home visiting program. Methods: Focus group interviews were carried out with peer support workers using unstructured andsemi-structured interviews within Action Learning Sets. Data were analysed using thematic analysis.Results: The overarching theme on the self-perceived role of the Aboriginal peer support worker wasGiving Parent Support, with subsidiary themes relating to development and ongoing sustainability of thesupport. Discussion: The peer support workers viewed their role as providing parent support through enablingstrategies which developed client acceptance and trust, delivered culturally relevant support, advocatedfor families, developed therapeutic engagement and communication strategies, and created safe homevisiting practices. They recognised the importance of linking families with community support such ascommunity child health nurses which was important for improving long term physical and psychosocialhealth outcomes for children. Conclusion: Aboriginal Peer Support Workers identified their emerging integral role in the developmentof this unique culturally acceptable home visitingsupport for Aboriginal parents. Innovative approachestowards client engagement demonstrated their value in developing creative ways of working in part-nership with families, community support services and child health nurses across a range of challengingpsychosocial environments.

Protocol for a randomised controlled trial of an outreach support program for family carers of older people discharged from hospital.

BACKGROUND: Presentations to hospital of older people receiving family care at home incur substantial costs for patients, families, and the health care system, yet there can be positive carer outcomes when systematically assessing/addressing their support needs, and reductions in older people's returns to hospital attributed to appropriate discharge planning. This study will trial the Further Enabling Care at Home program, a 2-week telephone outreach initiative for family carers of older people returning home from hospital. Hypotheses are that the program will (a) better prepare families to sustain their caregiving role and (b) reduce patients' re-presentations/readmissions to hospital, and/or their length of stay; also that reduced health system costs attributable to the program will outweigh costs of its implementation. METHODS/DESIGN: In this randomised controlled trial, family carers of older patients aged 70+ discharged from a Medical Assessment Unit in a Western Australian tertiary hospital, plus the patients themselves, will be recruited at discharge (N = 180 dyads). Carers will be randomly assigned (block allocation, assessors blinded) to receive usual care (control) or the new program (intervention). The primary outcome is the carer's self-reported preparedness for caregiving (Preparedness for Caregiving Scale administered within 4 days of discharge, 2-3 weeks post-discharge, 6 weeks post-discharge). To detect a clinically meaningful change of two points with 80 % power, 126 carers need to complete the study. Patients' returns to hospital and subsequent length of stay will be ascertained for a minimum of 3 months after the index admission. Regression analyses will be used to determine differences in carer and patient outcomes over time associated with the group (intervention or control). Data will be analysed using an Intention to Treat approach. A qualitative exploration will examine patients' and their family carers' experiences of the new program (interviews) and explore the hospital staff's perceptions (focus groups). Process evaluation will identify barriers to, and facilitators of, program implementation. A comprehensive economic evaluation will determine cost consequences. DISCUSSION: This study investigates a novel approach to identifying and addressing family carers' needs following discharge from hospital of the older person receiving care. If successful, the program has potential to be incorporated into routine post-discharge support. TRIAL REGISTRATION: Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 .

Work and personal well-being of nurses in Queensland: Does rurality make a difference?

OBJECTIVE: This study aims to ascertain if differences exist in the perception of the professional practice environment and personal well-being of nurses across different geographical areas in Queensland. DESIGN: This paper was performed on a prospective, self-report cross-sectional on-line survey. SETTING: The study was conducted among the nurses employed in public and private health care settings: acute hospitals, community health and aged care in Queensland, Australia. PARTICIPANTS: Participants of this study were 1608 registered and enrolled nurses and assistants in nursing, current members of the Queensland Nurses Union in 2013 and who provided a workplace postcode. One thousand eight of these participants worked in major cities, while 382 in rural locations and 238 in remote areas. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Scores of well-being as determined by the following scales: the Depression, Anxiety and Stress Scale, the Professional Quality of Life Scale version 5, the Connor-Davidson Resilience Scale and of the Professional Practice Environment using the Practice Environment Scale - Nursing Work Index Revised. RESULTS: Nurses employed in major cities perceived 'nursing foundations for quality care' more favourably than those from other settings. Remote area nurses had lower levels of secondary traumatic stress than nurses in major cities and rural areas. There was no difference between nurses across their geographical locations for stress, anxiety, depression, compassion satisfaction, burnout, resilience and the four other measures of the Practice Environment Scale. CONCLUSIONS: The study findings provide new data suggesting that, with the exception of secondary traumatic stress, the personal well-being of nurses does not differ across geographical settings. Similarly, with the exception of the subscale of 'nursing foundations for quality care' there was no difference in perceptions of the professional practice environment. As secondary traumatic stress is associated with burnout, this finding needs to be investigated further.

Nursing and the nursing workplace in Queensland, 2001-2010: what the nurses think.

The purpose of the study was to inform policy for reform in nursing. A survey mailed to members of the Queensland Nurses' Union four times between 2001 and 2010 elicited views on their employment and working conditions, professional development and career opportunities. Results across years and sectors of nursing consistently showed dissatisfaction in many aspects of employment, particularly by nurses working in aged care. However, views on staffing numbers, skill mix, workload, work stress, pay and staff morale all showed significant improvements over the decade. For example in 2001, 48.8% of nurses believed that their pay was poor, whereas in 2010, this had reduced to 35.2%. Furthermore, there was a significant rise throughout the decade in the opinion of the value of nursing as a good career. In light of the need to address nurse workforce shortages, the trends are encouraging; however, more improvements are required in order to support recruitment and retention.