Southern Cross University (SCU) Business School


The Challenge 

For the past 16 years the Australian health system has suffered a shortage of nurses. One 2011 report, Health Workforce 2025 – Doctors, Nurses and Midwives, projected a shortfall of 109,000 nurses by 2025. Workforce retention is a key factor in overcoming this problem. Also, nurses and frontline staff in other professions are at higher risk of work-related stress disorders.

Research Impact summary

  • The research influenced the design of Gradplus, a Ramsay Healthcare initiative that saw first-year nurse retention rates soar from 56% to 94%
  • Based on other research-informed programs, staff turnover for all Ramsay Healthcare employees declined from 16% to 9%
  • Wesley Mission Queensland instituted training programs based on the research. The programs resulted in significant health and wellbeing improvements for frontline staff
  • TriHealth Incorporated, an American healthcare provider, used the research to establish training programs that resulted in the company receiving multiple awards and nation-wide recognition for its employment practices.

Putting Theory into Successful Practice

Professor Yvonne Brunetto of Southern Cross University has been successfully put theroy into practice in many real-world situations. The work has been framed by Luthan’s Psychological Capital (PsyCap) concept and the social exchange theory of behaviour. Research by PsyCap explains individual motivation in terms of hope, resilience, optimism and efficacy. Social exchange theory proposes that in a social exchange, the purpose is to maximise benefits and minimise costs.

Ramsay Heathcare, one of the world’s largest providers of health services, consulted with Brunetto and used her research as the basis for three separate endeavours, two of which sought to achieve better nurse retention rates.

Tackling Issues That Lower Staff Moral

By 2016 Ramsay Healthcare’s 60,000 staff cared for three million patients in 238 facilities across six countries. Research surveys discovered a pattern of unproductive supervisor–subordinate relationships that resulted in lower morale and weaker job commitment.

Working closely with Ramsay’s Global Director People and Culture, Brunetto demonstrated that front-line managers were key to nurse satisfaction and staff retention rates. In response, Ramsay Training Institute rolled out an innovative manager development program that proved to be so effective it became compulsory for all supervisors.

Dramatic Improvement in Retention Rates 

The company also developed the above-mentioned Gradplus, a structured program that dramatically improved nurse retention rates.  The research also prompted Ramsay to take its successful 2010 Tomorrow Starts Today roadshow across Australia to 500 team managers. The roadshow highlighted the importance of effective frontline leadership for workforce sustainability.

As part of a second Ramsay project Brunetto conducted a survey of nurses in Queensland, New South Wales, Victoria and Western Australia. It showed that good supervisor-subordinate relationships, effective organisational support and positive teamwork resulted in higher levels of employee wellbeing, engagement, job commitment and staff retention.

Addressing Workplace Harassment and Wellbeing

The research contributed to a third project designed to address workplace harassment and bullying and so enhance nurses’ wellbeing and lower employee turnover. Titled Onboardplus, the Ramsay program was introduced in 2011. It resulted in better retention rates for all Ramsay staff, lower staff turnover and improvements in reported levels of overall job satisfaction. In 2012 Ramsay Healthcare won a corresponding Australian Human Resources Institute Award.

Research about the correlation between the supervisor-subordinate relationships and nurses’ reported levels of psychological capital (an individual’s positive psychological state of development[1]) showed that positive supervisor-subordinate relationships enhanced nurses’ PsyCap, which led to improved in-role safety performance.

Aiming to Reduce Work-Related Stress

The research has also been applied farther afield. Between 2009 and 2013 an average of $432 million per year was paid out in workers’ compensation claims attributed to work-related stress. The most at-risk occupations were those that involved intensive personal interaction in challenging (frontline) circumstances. For example, health and welfare support workers make five times more compensation claims than the average across all occupations.

Extending Much Further Afield

During 2015-16 Wesley Mission Queensland sought Brunetto’s help to reduce stress and improve wellbeing for its frontline workers. Following formal staff surveys, Brunetto designed and delivered tailored emotional resilience training for various Wesley staff—aged care workers, drug and alcohol officers, nurses, managers, physiotherapists, occupational therapists and disability carers. Data gathered pre- and post-training showed significant improvement in reported levels of PsyCap, emotional intelligence and safety practices.

In 2012 TriHealth Inc., a United States healthcare provider, consulted with Brunetto who initiated a staff survey that led to the development of training programs based on her engagement, well-being and organisational commitment research. Subsequently, TriHealth was ranked nationally among the 100 Best Companies,[2] it was voted to be one of the Best Employers for Workers Over 50,[3] and as one of 150 great places to work in healthcare. [4]  The company was also ranked as the best non-profit employer in the USA.[5]


[1] Fred Luthans, et al., 2007

[2] Working Mother 2011-15

[3] AARP 2014

[4] Becker’s Healthcare 2015/16

[5] National Association for Female Executives 2014

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