A recent spate of damning headlines about patients starving in hospital has made nutrition a key priority for the government and NHS trusts.
But, while there may have been a push to offer better food to patients, there has been little focus on ensuring that good-quality food is always available for nurses.
And nurses themselves are all too often guilty of focusing on their patients’ needs while neglecting their own.
Julian Topping, NHS Employers’ head of health, agrees the issue of providing healthy food for staff has fallen off the NHS agenda.
‘It was an issue that we covered a huge amount up until five to six years ago but I think the mistake we made was that we thought people were taking notice and trusts were offering healthy food,’ he explains. ‘There was a really big push between 1992 and 2002 but it’s taken more of a back seat to issues like stress and musculoskeletal injuries.’
A recent government-commissioned report, Tackling Obesities: Future Choices, estimates that, by 2050, 60% of men and 50% of women will be clinically obese.
This is worrying – and no one knows better than nurses that being overweight or obese is associated with numerous long-term conditions including type 2 diabetes, hypertension, stroke and cancer.
Furthermore, being obese can increase nurses’ susceptibility to other problems, says Mr Topping. ‘The biggest problem for nurses who are obese or overweight is when they come to do lifting and handling because they are more at risk of injury,’ he explains.
Good nutrition is not just about maintaining a healthy weight and preventing ill health. Numerous studies have shown that good nutrition and hydration are also important for mental performance.
Debbie Dzik-Jurasz, RCN nutrition adviser and lead on the organisation’s Nutrition Now campaign, explains: ‘You need to have appropriate nutrition to enable you to feel able to do the job. Similarly, with hydration, there’s a lot of evidence to show that concentration levels drop if you’re not adequately hydrated.’
According to Water UK, motor coordination can show a decline even at very low levels of dehydration (less than 1% loss of body weight). As dehydration increases to 2%, functions such as short-term and long-term memory, motor coordination, reaction times and perceptive discrimination decrease significantly.
Some people argue that nurses have an additional responsibility because they are role models for the wider public.
‘It’s imperative for nurses to be healthy long term,’ says Helen Frostick, clinical manager and nurse adviser at Eurodiets UK, a company that provides nutritional advice targeted at nurses.
‘Nurses are advocates for a healthy lifestyle and are at the forefront of health promotion. We should also be healthy so that we can care for our patients to the
best of our abilities.’
Armed with these facts, why do nurses still find it difficult to ensure they are properly fed and hydrated?
One of the problems faced particularly by nurses working in acute care is a lack of access to good food – especially when they are doing shift work and nights.
‘There’s a real problem with the lack of access to facilities and good-quality food,’ says Kim Sunley, RCN senior employment relations adviser. ‘During the night, the canteen is shut in many places and the only things that are available are vending machines.’
She adds that numerous studies have shown a link between shift working and obesity and related diseases such as coronary heart disease.
‘Night shifts are particularly bad for keeping diets regular,’ agrees Ms Frostick. ‘Appetite is affected on the shift and we feel hungry at unusual times. We then have to adjust back to a day routine when they are finished. Again, when we are very tired, we often pick foods which are quick and easy – and they often tend to be foods high in sugar, saturated fat and salt.’
But even ensuring nurses have access to good food during the daytime can be a challenge. ‘The feedback we’ve had is that the quality of food really does vary from place to place,’ says Ms Dzik-Jurasz.
This has not been helped by the advent of large commercial chains taking up residence in a number of NHS trusts.
Gail Adams, Unison’s head of nursing, says: ‘One thing I’d really like to see is the removal of Burger King and McDonald’s from our NHS trusts. We would always
want to see a return to in-house catering – provided that catering is suitable and accessible, of course.’
Furthermore, because of a government report, published in September 2007, which suggests nurses should not be seen in uniform outside the hospital, many are now being discouraged from finding healthy food options off-site during breaks.
‘Trusts are changing policies in relation to staff uniforms,’ Ms Sunley explains. ‘Even though the recent Department of Health report admitted there was no evidence to link it to infection control issues, it did highlight issues about patient and public perception. So a lot of trusts will now say that nurses can’t go out in uniform. That can also be a challenge for community nurses who need to grab a sandwich while they’re on the run.’
Finding somewhere to eat can also be difficult as many staff canteens in trusts have been closed or merged with the public restaurants – and this can deter staff from sitting down for a nutritious meal. ‘Not many places have private areas any more,’ points out Ms Sunley. ‘You wouldn’t’ expect to see staff from Sainsbury’s eating in the Sainsbury’s restaurant.’
The biggest obstacle nurses face when it comes to ensuring good nutrition is inevitably a lack of time. ‘The main challenge is that nurses work irregular hours,’ explains Ms Frostick. ‘Meals are often rushed and sometimes missed altogether. It is certainly easier just to grab something when we are busy – unfortunately we usually grab the wrong things to fill up with.’
What’s more, staffing pressures mean that nurses often skip their breaks altogether.
‘The RCN Working Well report in 2006 noted a reduction in the proportion of nurses saying they had breaks,’ says Ms Sunley. ‘It was down from 84% in 2000 to 76% in 2005, and I would hazard a guess that it has dropped even lower since then.
She points out that the working time regulations say that employees are entitled to a 20-minute break every six hours.
However, nurses put their patients before themselves – so, on wards that are short-staffed or during a busy shift, nurses will pass up that break so they can spend more time caring for patients.
‘It’s a problem because poor nutrition can mean you’re more prone to fatigue and making mistakes,’ notes Ms Sunley. ‘But sometimes it’s difficult on an emergency ward to say: “I’m going off on my break”, when colleagues are really stressed and have too much work. It all links into the bigger issue around staff levels.’
Time and workload pressures may also mean nurses do not always eat healthily when they do have the opportunity. ‘There’s that mentality that we are not sure when we will have time to have another break, so we try to fill up as much as we can and as quickly,’ says Ms Frostick.
Nurses should take charge of their own health, says Jan Sinclair, matron in surgery at Stockport NHS Foundation Trust. ‘Staff have got to take responsibility for themselves,’ she says.
‘I sometimes think people want things handed to them on a plate. But staff health is so important. If you are healthy yourself and you promote being healthy, then people will see you as a good role model.’
Ms Frostick suggests nurses can take a number of measures to ensure they are eating more healthily (see box, above). Trusts can also help nurses, by providing better access to nutrition.
Guidance produced by NHS Employers last year suggests a range of measures, which include allowing employees time off to attend weight loss clinics and ensuring better food provision for shift workers who may find it difficult to access healthy food out of hours (see box, p17).
However, Mr Topping admits that weight can be a very sensitive issue with employees. ‘If employers make it their job to consider whether you’re leading a healthy lifestyle, then they are open to the risk of being accused of interfering in something that’s not their concern,’ he says.
Such feelings were in evidence when last month, as part of its £300m healthy eating strategy, the government announced it would be piloting health and well-being schemes in NHS trusts facing the biggest health issues (NT News, 29 January, p2).
The schemes, which are being developed with the support of nurse unions, will see nurses and other NHS staff offered confidential health checks, alongside personalised advice on healthy lifestyles.
The trusts will receive anonymised data on staff health which they can use to target action to improve health and well-being.
While some nurses support the idea, others are less than enthusiastic.
Rosie Purves, a paediatric staff nurse at Southampton University Hospitals NHS Trust, voices the views of many when she says: ‘Many people I know will just see this as an interference. I’m not sure it’s your employer’s business – people will see it as the government just taking another
jab at nurses.’
However, the NHS Employers’ guidance reveals that, when a nurse or other member of staff becomes obese, it can become the employer’s business.
‘Where employees are underperforming as a result of their weight and there is no medical reason for their condition, the employer can invoke the organisation’s capability procedure,’ it says. The document notes that such matters should be handled very sensitively and that the individual concerned must be offered support and help. However, it concludes: ‘Employees should be offered a reasonable period of time to demonstrate that they are losing weight. If they fail to do this it may ultimately be possible to dismiss the employee.’
Mr Topping says that cases such as these are unusual in the UK. ‘I know of individual instances where it has been an issue but it’s not currently a huge problem for the NHS. But we
keep hearing that people are getting bigger and bigger, so I think if we’re not careful we’re going to have a problem
on our hands.’
He believes the answer lies in getting both employers and employees on side. ‘You’ve got to win hearts and minds,’ he says. ‘It’s a bit like the problem faced by Jamie’s School Dinners – there’s no point in employers providing lots of healthy food if everyone still buys chips.
‘I don’t claim to be any different to anyone else; sometimes choosing the salad when you can smell the chips can be quite difficult. But we do need to make it as easy as possible for people to make the right decision.’
What nurse employers can do to help staff
What you can do to help yourself