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Nurses more stressed than combat troops

  • 99 Comments

Giving nurses protected time to discuss and reflect on practice can more than halve levels of stress and burnout, according to a clinical psychologist who is leading pioneering research into the area.

Sonya Wallbank, associate professor of child health at South Warwickshire Foundation Trust, told Nursing Times that stress and burnout levels were often higher among nursing staff than serving members of the armed forces.

She has carried out a number of studies into the stress levels of health visitors, midwives and nurses. They form part of her work developing a programme for “restorative clinical supervision”, which is attracting national interest.

She found nursing staff typically have a stress score of 43.35 on the internationally recognised Impact of Event Scale. A score above 44 is categorised as severe and potentially altering the ability of an individual to function.

The nursing score is around 1.5 times higher than the average for soldiers surveyed after a military trauma in a warzone, and more than twice as high as individuals working in emergency services with recent experience of handling human remains.

The scores are based on 1,865 participants working in UK healthcare between 2007 and 2012, 86% of whom were nurses, health visitors or midwives.

Professor Wallbank said she thought nurses had higher stress scores because “their fields of work” did not have the same degree of stress recognition as other stressful occupations.

“Therefore, the support for [nursing] professionals to recognise and process their emotional reactions is limited or defined as an abnormal response,” she told Nursing Times.

The restorative clinical supervision programme involves regular sessions with a supervisor during which a clinician discusses the emotional impact of their work. It is currently being rolled out for health visitors across the Midlands and East region.

Initially the supervisor is a clinical psychologist. But over the course of six sessions, the health professional is taught the techniques and can then provide supervision themselves to up to four colleagues.

After taking part in the programme scores for stress more than halved while scores for burnout, using a different scoring system, also fell significantly.

The use of the programme has so far focused on health visitors in a bid to tackle low morale and retention issues. However, South Warwickshire director of nursing Helen Lancaster is working on a plan to roll it out to all areas of the trust.

Professor Wallbank said interest in the programme was increasing ahead of the expected publication next month of the Mid Staffordshire Foundation Trust public inquiry report.

“There is a lot of interest in whether this could be linked to increasing compassion in nursing and helping staff stay focused on the patient,” she told Nursing Times.

Professor Sue Bailey, president of the Royal College of Pyschiatrists, told Nursing Times it was important that healthcare staff, including nurses, had time to reflect and there was evidence it made them better at their job, reduced absenteeism and attrition, and saved money.

However, she said it was “ironic” that giving staff this time was seen as innovative. “If you go back long enough, before the NHS became so task focused,  this would have been normal practice for health visitors or nurses, although perhaps not in such a structured supportive way,” she said.

“This issue is at the heart of giving good care and will be will be at the heart of the Francis report,” she added.

  • 99 Comments

Readers' comments (99)

  • Nurses don't need 'support'.

    They need decent working conditions, decent wages and decent work/life balances!

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  • Publish a series of articles with similar title in the daily newspapers!

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  • "However, she said it was “ironic” that giving staff this time was seen as innovative. “If you go back long enough, before the NHS became so task focused, this would have been normal practice for health visitors or nurses, although perhaps not in such a structured supportive way,” she said."

    must have been pre-1975 before I trained or else she is dreaming.

    I agree with Mike above. this sounds like more soft skills in coaching and counselling under another name in an attempt to pull the wool over nurses eyes and deviate from the fundamental problems (another sticking plaster initiative) - and a big money spinner which psychologists seem to be extraordinarily good at!


    taking such measures puts the onus on nurses (it is not the problems but how you perceive them and your coping strategies - leading to further and often unhealthy introspection and increased mental health problems where none may have previously been present - self fulfilling-prophesy) without addressing the actual physical problems of the lack of extra hands and adequate management. Not everybody wants this 'touchy-feely' care and even those who do have normally caring and empathetic attitudes towards their patients.

    Help and support should be available only to those who seek it and never imposed. It seems that psychologists and psychiatrists only ever see other people as a mental health problem.

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  • I 'reflect' on my practice, work environment etc. every single day - at home, after a very difficult and short staffed shift. I don't have time at work to sit and 'think', I don't have any management support - I, like the rest of my colleagues, just get on with our jobs the best we can in very difficult circumstances.

    When it all gets too much, I like the rest of my colleagues, have to go off sick. If we don't then we will end up patients ourselves.

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  • Phil Dup

    The only 'Reflection' I undertake is to think how the hell I have just managed to get through another shift from hell with not enough Staff to keep the place safe - wondering whether something I may or may not have done on that shift will come back to bite me and end up with me standing before the NMC as a sacrificial lamb hung out to dry by the Trust Management.

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  • every day I hear staff of all grades saying how they didn't sleep well, were up half the night worrying about work

    every day I hear staff of all grades saying how their day off was dominated by worrying about work, that they didn't do something, they couldn't do something.

    I've had staff ringing the ward in the middle of the night apologising for leaving the ward untidy, or for not having time to do the patients hot drinks round.

    work dominates nurses lives, we worry constantly about our own health, our patients and the very high risk of having a complaint made against us even when we know we haven't done anything wrong.

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  • the only good thing though is that we have a govt that cares for the nhs and its workers eh!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    hunt and his cronies are making the nhs fail on a daily basis so there mates can move in and privatise it, it has been announced that private health companies do not have to pay corporation tax...how convient

    thatcher wanted the nhs scrapped over 30 years ago, these puppets are just doing what she wanted

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  • Anonymous | 15-Jan-2013 12:19 pm

    "hunt and his cronies are making the nhs fail on a daily basis so there mates can move in and privatise it, it has been announced that private health companies do not have to pay corporation tax...how convient

    thatcher wanted the nhs scrapped over 30 years ago, these puppets are just doing what she wanted"

    sounds like there are lots of parrots in the NHS repeating the same things over and over and often without any meaning or understanding behind what has been said.

    Looks like people are afraid of what else Hunt and the government will uncover in the failings of care.

    He has not been in the post long and does not have a magic wand. Give him a chance. As soon as the Lib-Cons came into power to untangle the problems left by the previous government they were heavily criticised before they even had a chance. even nurses starting in new jobs need time to settle in and are not fully functional or able to sort out all their ward's problems. don't forget all are human beings with their strengths and limitations and merit some respect.

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  • Sounds like we (nurses) are all in the same boat! Recently i came home from a 12 rs shift, exhausted, and cried for half hour in front of my husband, who could not console me... Why... Because it was another shift on a busy, female surgical ward ( and every other speciality that comes along), and even though i had given 110% of my time, energy, i still felt guilty when a relative was upset because her relative looked " uncared" for, even though we were looking after and caring for this patient ( medical, patient with dementia), who needed all care on a ward with surgical patients coming back from theatre needing post op care, i've lost count the amount of times i've left the ward an hour after shift finished! I live 23 miles drive the hospital ang got home about 9:20pm after working from 7am, and what are we told by the managers, you must finish 7:30 pm because you will not get time back!! Yes, of course we're just going to go and leave, unfortunately we as nurses care..... And always will about our patients!!!!....

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  • Anonymous | 15-Jan-2013 1:09 pm

    what do you do with a patient with dementia on a busy general ward? they can hardly be left to their own devices. One of ours disappeared at lunch time when we had the most staff on the ward and was eventually located, by staff who had taken to their cars and driven round our village and the neighbouring one a mile away, in a local bar with a bottle of red wine on the table half consumed in front of him! On a day's working visit in an old people's home to see if I would like the job I had a similar situation. This time when I had finished I accompanied my colleague round the village (a different one) and located the old man in a café happily consuming a bottle of red wine. He was aggressive so we had to wait until he had finished it so we could lead him like a very happy lamb back to the home. At least this time the barman knew the dilemma and offered us each a free cappuccino so for once it was worth the unpaid overtime!

    I think many of us have been in similar situations to the one you describe above and also told we must finish on time by our managers yet are responsible and held as such as well as feeling morally bound if work is not finished or if somebody fails to turn up for the next shift.

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