Nursing Conversation Starter written by Teresa Chinn
Nurse shortages are something that are constantly making the headlines so it was no surprise to see the recent BBC article ‘NHS ‘no chance of training enough staff’” The article shared a recent report by Nuffield Trust, Health Foundation and King’s Fund “Closing the gap” and outlined the following points:
- more than 30,000 extra nurses are needed
- on current trends this will rise to nearly 70,000 nurses
- the report warns that the removal of the nursing bursary has had a negative effect and calls for the introduction of a £5,200 annual grant for student nurses
- the report predicts the NHS will need to recruit 5,000 new nurses from abroad every year – three times the figure it is currently recruiting.
What was interesting was what was not mentioned, whilst the shortfall in nurses makes for a good headline, behind the headlines the “Closing the gap” report says much more. One aspect of the report talks about “A good employer’ and addresses such issues as retention, work-life balance and support for staff. Whilst the report eludes to supporting health and wellbeing stating “Understanding the impact of things like lack of work-life balance, bullying, low morale, and low pay will help not only to reduce turnover but also to improve the experience and engagement of all staff” it seems to skirt around the issue that the NHS, despite being focussed on healthcare of its patients, largely seems to forget the health of its staff.
In “other news” “more than 160,000 nurses have quit the NHS since 2010/11 for reasons other than retirement” (ITV News 2019) so isn’t it about time we started to look after the nurses we have AND support them to look after themselves? It seems to be the elephant in the room that 1 in 4 nurses are obese (Kyle et al 2017) which, whilst in line with national obesity figures from Public Health England, remains something that nurses and nursing seems to ignore. Ask any nurse the health risks that obesity brings, and they will be able to cite things like increased risk of heart disease, cancer, type 2 diabetes, lower back injury and reduced quality of life. Kyle et al state the importance of addressing the prevalence of obesity among healthcare professionals for three main reasons.
- obesity increases the likelihood of musculoskeletal disorders and mental health conditions, which are the leading causes of work-related illness and workplace injury for healthcare professionals. As well as being implicated in the onset of chronic diseases, these conditions and their associated sickness absence rates pose a potential problem for the efficacy and sustainability of the healthcare system by potentially reducing the capacity of the healthcare workforce.
- comparing obesity rates in different healthcare professional groups and with the general population will help to identify the possible contribution of adverse workplace factors such as a lack of access to healthy food options, shift working and a possible link between obesity and high demand/low control work to increasing obesity among healthcare professionals
- widespread obesity among the workforce may hamper the efficacy of healthcare professionals’ health promotion efforts. As the largest professional group within healthcare systems both in the UK and internationally, nurses, in particular, have been encouraged to seize ‘teachable moments’ during routine care to educate and encourage patients to make positive changes to their behaviour
Yet obesity in nurses seems to be a taboo subject – a recent #WeNurses Twitter discussion on obesity in nursing came under heavy criticism whilst a similar #WeNurses Twitter discussion on Obesity in patients was widely accepted.
It’s not just the physical health of nurses that needs to be addressed but also the mental health of nurses. Workplace stress and burnout among nurses is well documented, Jennings (2008) states “The nurse’s role has long been regarded as stress-filled based upon the physical labor, human suffering, work hours, staffing, and interpersonal relationships that are central to the work nurses do” This leaves nursing in a Catch 22 situation … the more nurses that leave the more stressful the role becomes and therefore more nurses suffer from stress.
Nurses are in a role where they care for everyone but themselves and this is largely acceptable within nursing culture. How many nurses skip their breaks? How many nurses leave late from their shifts? How many nurses have a chocolate bar instead of lunch? How many nurses don’t have a drink all day? How many nurses don’t go for a wee all day? How many nurses take on an extra shift instead of having a rest day? Furthermore these things are seen as a badge of honour in nursing and it’s, literally, killing nurses and nursing!
Whilst the crisis in nursing numbers is wide and complex and will require multiple approaches to resolve aren’t we missing a trick? Shouldn’t we be cherishing the nurses we have? Shouldn’t we be looking after nurses physical health and mental wellbeing and empowering and enabling them to look after themselves?
Nursing Conversations 
Fed up hearing about retention from NHS England whilst employers still do nothing to achieve this. Although we do have a personal and professional responsibility to stay healthy it helps when employers ensure good working conditions, access to healthy snacks and more importantly facilitate regular breaks. Lack of clinical career progression so nurses either have to step into a management role or come off the ward and become a specialist nurse impacts badly on the wards. In addition the outsourcing of community nursing has caused additional retention issues.
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Retention is about a lot of factors, and good working conditions are key. Employers could make it easier for nurses to eat healthily and exercise. Has anyone seen any good example of this?
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I am not a nurse but I am a nursing historian and I am disappointed to see that lessons have not been learned from the past regarding ensuring good mental, physical, and social health for nurses. I am currently researching a protest in April 1938, which was the first time nurses took to the streets to demand better working conditions for themselves – specifically shorter working hours in the face of a severe nursing shortage, as they were completely burned out and exhausted, physically and mentally. Their message was still strongly tied to the desire to do the best they possibly could for their patients, arguing that the conditions they were working in were so debilitating that patients’ were at risk. Interesting to see how when they were being exploited in the name of ‘vocation’ i.e. nurses will do anything because they are in this line of work as they have a genuine commitment to helping others, that they used this presumed ‘vocation’ and dedication to care in order to win rights for themselves – and rightly so! I’d be interested to know what you think about this and whether or not this resonates today.
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Hi Frances – this sounds like amazing research …. I am particularly interested in what we can learn from history in regard to this .. you comment that “Their message was still strongly tied to the desire to do the best they possibly could for their patients, arguing that the conditions they were working in were so debilitating that patients’ were at risk” is fascinating and gives real insight. I honestly think that there is a strong argument that this is the case today … long hours, lack of access to healthy food and adequate hydration, not days off to exercise or down tools, lack of support for mental and physical well being all have an impact on nurses health … to my mind if our health as nurses if suffering this in turn has an impact on the people we care for. If we just look at hydration alone: Hydration amongst doctors and nurses on call (El-Shakawry 2016 -https://www.ncbi.nlm.nih.gov/pubmed/26216194 ) is a study that looked at the scale and impact of dehydration on doctors and nurses. The study found “Thirty-six percent of participants were dehydrated at the start of the shift and 45% were dehydrated at the end of their shift” and “Single number and five-letter Sternberg short-term memory tests were significantly impaired in dehydrated participants” So my question to you is … will you be publishing your findings and how can we use this to help us with the current predicament?
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Hi Teresa! Thank you for your response – really useful! Thank you also for the link to the hydration statistics! The similarities between past and present conditions are certainly striking. I will (hopefully) publish my research in the not too distant future, and your second question is something which I am constantly grappling with!
The feedback I have had from nurses so far is that they found it reassuring and empowering to know that nurses have been through similar challenges before but were able to enact change – so perhaps this research will serve to encourage a sense of hope and agency for nurses? I would also hope that it would be useful in identifying changes and continuities, ideologically and practically, in the profession in order to understand why older systems and ideals perhaps worked in the past but are no longer sufficient due to different demands and opportunities in our contemporary world – indicating areas where reform needs to happen. I am doubtful that my research will have any direct impact on policy change, e.g. reforms for nursing shortage, due to the circumstances around past and present crises, although similar, are historically specific, but I hope it raises awareness, encourages discussion, and provokes thought amongst nurses, policy makers, and all involved, about ways to tackle current issues to find practical solutions.
Perhaps I will write up a conversation piece for this blog as I would be interested to hear others’ opinions (both inside and outside the profession) on whether or not a historical perspective on challenges and issues is useful, and how we can provide a ‘usable’ history for nurses (or whether it is even possible to make history useful for contemporary purposes!)?
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From my experience you retain staff through post reg education, meaningful conversations between appraisals (not just annually), good clinical supervision & development/ career advise. Really busy areas that have inspiring leaders who care about their staff make a difference & help to retain their employees. It is getting harder amid rising nursing vacancy rates & it is getting to the point when we need to say enough as a professional group.
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From my experience you retain staff through post reg education, meaningful conversations between appraisals (not just annually), good clinical supervision & development/ career advise. Really busy areas that have inspiring leaders who care about their staff make a difference & help to retain their employees. It is getting harder amid rising nursing vacancy rates & it is getting to the point when we need to say enough as a professional group.
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