Nurses’ wellbeing during the shift

Caring for ourselvesNursing Division –THS North West

Cathy Smith (Project Nurse – Strategic Support & Innovation) Date: 31/1/20

Presentation overview:

• current status of Nursing in the UK

• nursing culture in Australia

• nurses taking breaks in Tasmania

• impact of busy shifts on Nurses’ well being

• opportunities to innovate

Current status of Nursing in the UK:

• acuity and activity

• nursing culture

• facilities and ward environments

RCN strategy (2018) - 3 R’s:

Nursing culture in Australia:

• nursing sisterhood

• female dominated

• selflessness

Nursing in the 21st century:

Nursing is constantly challenged to provide quality nursing care

whilst experiencing churn of patient admissions and discharges,

increasing patient acuity and responding to deterioration

Nursing care:

• comprehensive assessment

• manage risk

• continual observation

• Nursing care with compassion

• remain present if deterioration

Nursing – throughout the shift irrespective of nurses’ planned meal breaks

Nurses taking breaks in Tasmania:

• legislation:

- Industrial –Nurses and Midwives (Tas. State Service) Award 2017

- Enterprise Bargaining Agreements (EBA’s)

- Work Health & Safety Act 2012

• ward activity and patient acuity

• organisational and unit nursing culture and attitudes

Impact of busy shifts - acknowledging issues:

Individual nurses’ responses:

• de-brief - family, peers

• social media

“ NURSING IS PHYSICALLY AND EMOTIONALLY EXHAUSTING (*32,199 views)

https://youtu.be/I3eho8j_77E

“ NURSING BURNOUT” (*27,000 views)

https://youtu.be/YOcDSmQFIno

Impact of busy shifts on health and wellbeing:

• Physical

• Mental

• Psychological

Physical impact:

• physical exhaustion – fatigue related incidents * injury risk

• dehydration – involuntary and voluntary

• chronic bladder conditions – Nurses’ bladder

ref: Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK.

Mental impact:

• fatigue - mental - “fuzzy” or “fog”

• impaired critical thinking, problem solving

• mental exhaustion – slow reaction time - Injury risk

• potential for nursing care errors – incidents e.g. medication errors, care omissions

ref: Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK. p.7

ref: Kelton, D. et al., (2014) Running on empty? The facts about nursing fatigue, NursingCenter, vol. 2, no.2, pp. 45-49

Psychological impact:

• psychological distress

• compassion fatigue

• burnout

ref: Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK

ref: Transitional Support (2019) Burnout vs Compassion Fatigue http://transitionalsupport.com.au/transitional-phase/compassion-fatigue-trauma/ downloaded 26/11/2019

RCN strategy (2018)- 3 R’s:

RCN - 3 R’s - Rest:

• managers lead by example

• communication – team huddles

• monitor ability to take breaks during shift

• staff feedback – review rest areas - facilities

• power naps – long shifts

Guys & St Thomas - HALT campaign

ref: Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK, p.10

RCN - 3 R’s - Rehydrate:

• identify barriers to drinking fluids during a shift

• ensure adequate access to drinking water

• hydration stations

• manager model behaviour

• vigilance – hot weather

• posters – e.g. urine colour charts

ref: Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK.p.11

RCN - 3 R’s - Refuel:

• consult staff accessibility and quality of food

• improve nutritional offerings

• access – clean areas – storage (refrigerators) reheating etc.

ref: Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK .p.12.

Reflection – current issues:

• budgetary restrictions• space• access

Opportunity for improvements:

- explore feedback & data

- staff satisfaction feedback

- SRLS data

- raise awareness & take action

- Pathway to Excellence Program®

- Magnet Program®

Raising awareness:

Suggested acronym – for a local campaign:

M - Make time

Y - You need it

B - Bathroom break

R - Rest up

E - Eat & drink

A - Away from “the floor”

K - Kindness to yourself

We are our nursing culture

Reflect on our:• ward and organisation’s culture• attitudes of our peers• own attitude and behaviours• facilities and environments for breaks

Let’s –

Take this opportunity to lead by example

Adkins, A., (2015) Nursing is Physically and Emotionally Exhausting – published YouTube Dec 19, 2014, https://youtu.be/I3eho8j_77E

Adkins, A., (2017) Nursing Burnout! – published YouTube Jun 17, 2017, https://youtu.be/YOcDSmQFIno

ANCC (2014) Magnet Recognition Program® Manual, American Nurses Credentialing Center (ANCC), USA.

ANCC (2018) 2016 PATHWAY TO EXCELLENCE® Application Mini Manual, American Nurses Credentialing Center (ANCC), USA.

ANMF Australian Nurses & Midwifery Federation Tasmania - http://anmftas.org.au/2014/08/meal-break-entitlement-1_/ downloaded 26/11/19

Dong, D., & Temple, B. (2011) Oppression: a concept analysis and implications for nurses and nursing, Nurs Forum, 46, (3), pp. 169-76.

Ford, S., (2018) RCN launces drive for nurses to take rest, drink and meal breaks, Nursing Times, 14 March 2018, UK. *sourced 15/11/19

Foster, S., (2019) Self-care is a vital part of safe care, British Journal of Nursing vol 28, no. 4., UK

Graystone, R., (2019) Prevent Compassion Fatigue and Burnout With a Magnet Culture, JONA, vol. 49, no. 5, May, USA.

Kelton, D. et al., (2014) Running on empty? The facts about nursing fatigue, NursingCenter, vol. 2, no.2, pp. 45-49. *sourced 26/11/19

Royal College of Nursing (2018) Rest, Rehydrate, Refuel - A resource to improve the working environments for nursing staff, RCN, UK.

Tasmanian Industrial Commission (2017) Nurses and Midwives (Tasmanian State Service) Award, TIC, Tasmania, Aus.

Transitional Support (2019) Burnout vs Compassion Fatigue http://transitionalsupport.com.au/transitional-phase/compassion-fatigue-trauma/downloaded 26/11/2019

*Photos sourced from Bing - online pictures – “This Photo by Unknown Author is licensed under CC BY-NC-ND”