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Nurses more stressed than combat troops

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.

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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  • Phil Dup | 15-Jan-2013 11:43 am

    sounds like you need to go out whilst riding high. there is little use in being a martyr.

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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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  • Anon 1:40
    I'm not sure what you thought i meant, the medical, confused patients get exactly the same care as every other patient. its just that patients needs are different and we as busy nurses with mixed specialities havent always got the time to spend giving as much care as they deserve, this shift there was myself caring for 8 patients with a 2nd year student..Hope you didnt think i meant they are not given the care they should, they are, but this nurse always feel saddened by lack of time and hands!....

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  • Anonymous | 15-Jan-2013 2:27 pm

    Anon 1:40

    sorry, it was rhetorical question which i answer partially in my comment below. I know only too well what is like to try and care for a confused patient alone on a ward with the needs, sometimes urgent, of all the other patients as well as the feelings after a shift and often all night long when one has not been able to give all the care one would have wished. an acute and chronic general medical ward with all its different demands is not so much different from a surgical ward as far as workload goes.

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  • sorry about my grammar in the comment above. it was my second attempt after the first disappeared. I have discovered this sometimes happens when two people try and post at the same time.

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  • michael stone

    Anonymous | 15-Jan-2013 1:09 pm

    This isn't quite about burnout - it is more about the 'theme of the moment', this 'care' thing.

    In the interests of PATIENTS, will nurses please not fall for the 'line' that the problem to be addressed is 'the lack of a caring culture/attitude in some nurses' - will nursing please combine behind:

    1) the patient/relative perception that there is sometimes an 'uncaring culture' must be correct, because so many comment on it, and are upset by it;

    2) WHY IS 1) EXTANT ?

    It seems clear, that a (probably the) major contributor is NOT 'the wrong attitude by nurses' but is actually 'there are not enough nurses on shift'.

    If you allow them to, the 'bean counters' will persuade the ill-informed, that this problem can be solved by changing the attitudes of nurses (this 'caremakers' thing), instead of by making sure that there are enough nurses to 'do some caring' {and that nursing feedback is paid attention to } - this is obvious, but like so many other obvious things, is likely to be 'spun' !

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  • michael stone

    PS Lost my thread in there - my post was drawing attention to the 1:09 post, and its relevance, but I wasn't addressing my comment to its author in particular.

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  • DH Agent - as if ! | 15-Jan-2013 3:24 pm

    this article is about nurses for once, and for nurses and their well-being as well as their susceptibility to stress and its effects which can lead to burnout, if their working conditions are not properly managed and inadequate! If they are unable to do their job properly for these reasons it impacts upon the quality of care given to patients as has been said so often before . Now we need a discussion on how to address this which most seem to agree requires enough staff, an appropriate skill mix and effective management.

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  • tinkerbell

    i think a soldier might disagree who returns with PTSD, less limbs & with only a charity to offer them counselling.

    Yes nurses need support too.

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  • can't be easy for the French troops to be dropped in the extreme heat from their snow-covered country in Mali and to be fully functional in such a short time either.

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  • i know i am going to get creamed for this but ladies,and gentleman i am going to say it anyway and for all to see...here goes...umhummm...nursing has evolved into a very technical field, we give iv medications, start iv cardiac gtts, give meds, drop ng's, educate, prevent medical errors, advocate for our patients, we identify abnormal ekgs, shock people...etc, etc..as we all know. we have evolved into medical professionals and expected to be able to have the knowledge and judgement to act as such. but then we are asked to identify, and intervene in emergencies, then go to the kitchen and fix everyone a snack and mop the floor. nursing is not the same of 1922, the practice has advance and with that advance we have taken on more responsibility, skills and knowledge, and yet we are also responsible for being the maid. we have to go one way or the other. take the "service excellence" off our back or less demanding from the technical standpoint. we cardioverting someone in a room with a md, another room calls out for water and it wasn't brought fast enough...they had to wait ...well omg....it is hard for me to be in the middle of an emergency and someone call out for something such as a pop, and they demand to see the NURSE RIGHT NOW! it is hard for me to pull off like i care they want a pop. RIGHT NOW!! we are held accountable for the cardioversion, but also held accountable to not bringing the pop to someone fast enough....we can't do both. we are sooo anxious because we are being held accountable for both. we cannot afford to make a medical mistake and miss something...we cannot have anyone wait for anything ever.. if they hired people to do the 'customer service" end, such as pca's and let nurses do the technical and medical aspects, think of how much happier we all would be. and those we wouldn't be seeing those service issues people are complaining about. it is hard for me to be in that situation...i have a patient i am trying to get ready to go to the icu and i have a family member upset because she wants me to fluff mom's pillows and pour some water, and she wants it now...well i could get fired for postponing transfer , and allowing a bad situation to get worse or i could get fired for not reaching "service excellence" if they want people to feel as though they are in a hotel, hire more pca's to be able to accommidate that. Take it out of my job description. when assessing nursing service excellence, assess things like prevention of wound infection, education received, not was water pitcher always full. why is it so hard for us to admit or say that we have evolved. i know people are going to say "bad nurse" but honestly think on it. do md's get reprimmanded because they didn't bring their patient a sandwich quickly enough? Its not that i don't wipe butts or that i don't do all these service things , i am just so stressed out about it because fooling around with all this other stuff i am terrified i am going to miss something medically. and visa versa i am trying to intervene with a patient before they code and am pulled on the carpet because someone had to wait for ice chips.

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