Mental health problems among nurses are increasing. What can we do to help?
The mental health crisis among nurses is the unseen epidemic sweeping the NHS. We explore what could help.
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The Covid-19 pandemic left devastation in its wake. With 22 million cases and 177,000 deaths in the UK alone, everybody has encountered the disease that will have a lasting impact on us for decades to come. The NHS and healthcare providers around the UK became the country's heroes, with the public flocking to the streets in their millions to cheer on our frontline workers.
However, it quickly became apparent that applause wasn't enough to keep them going. Hospitals operated at more than full capacity, equipment like ventilators and PPE were running out, and nurses saw first-hand the destructive effects of the virus. Unfortunately, after all this, nurses face an epidemic amongst themselves in the form of a severe mental health crisis.
In a Nursing Times survey in 2020, 33% of nurses said their mental health was "bad" or "very bad", increasing to 44% in 2021. And 84% said they felt more stressed or anxious than before the pandemic. More nurses report mental health problems due to the pressures and stresses of their occupations, making nursing the 6th most stressful job in the UK. In addition, a worrying 30% of nurses reported experiences indicative of probable post-traumatic stress disorder.
The Importance Of Nurses:
At the inception of the NHS in 1948, nurses were not regarded as integral members of the healthcare team, despite their many responsibilities, skills and work ethic. However, after many years of fighting for more recognition, nurses today command much more respect and autonomy within their fields, gaining a more collaborative partnership with doctors and other healthcare staff.
Nurses spend an incredible 83% more time with patients than physicians, at just 13%. Nurses know that time spent with patients is fundamental to uncover any health issues that patients may not offer up otherwise, get to know patients' needs for their care and explain treatment plans put in place by doctors, creating a relationship with patients and putting them at ease.
As well as this, nurses are patients' greatest advocates. They spend more time with the patient than any other healthcare practitioner, get to know them as a person and can recommend the right course of care to doctors. Patient advocacy takes many forms, including monitoring a treatment plan and raising issues with the doctor, talking to a patient's family and uncovering a detail that can be relayed to doctors and coordinating a patient's care with other providers and giving them the right information.
Nurses monitor patients' health more than doctors do, regularly observing a patient's health metrics, relaying this information, and flagging any anomalies in treatment. Not only this, but nurses also have an overwhelming amount of administration work to do, including audit completion, incident reporting, action assurance and performance management, admitting and discharging patients, running wards and teams and reporting back to senior staff members.
Nurses are critical in the running of healthcare practices across the world. Without them, we will see a detrimental impact on patient care when we need healthcare providers the most. The mental health crisis they face is unsettling news that inspired the Nursing Times campaign 'Are you Okay?' to investigate practices that can help ease the problem.
So, we must investigate the contributing factors weighing them down to free them from the constraints of mental health burdens and improve their way of working, which will lead to a stronger, more stable NHS.
As part of any workforce, we expect to experience some stress levels at work. However, the toll that the following factors have on NHS staff is far beyond the typical workplace.
To better understand what they face, we must look at the contributing factors that strain the workday. So, what contributing factors need tackling to reduce the strain on nurses?
The pandemic has had detrimental effects on the mental health of nurses, with an 8% increase in mental health problems like stress and anxiety since 2017. The history of pandemics on mental health reflects the same results, with nurses and midwives experiencing more psychological trauma than other professional groups. Almost 30% of NHS staff who contributed to an online survey highlighted problems that concur with a PTSD diagnosis.
Work-related factors such as being redeployed to areas outside their field with little training or inadequate infection control training were associated with adverse effects. The pandemic shed a spotlight on cracks in the NHS that were not fully visible until now. The overwhelming number of patients admitted highlighted the lack of PPE, funding, staffing and proper digital systems problem like nothing before.
Also, the pandemic's vast number of patient deaths took its toll, with nurses aiding patients' families to say their goodbyes over technology or being the only ones with them when they passed. The isolation that quarantine imposed on them, with some staff having to stay in Covid-safe hotels instead of returning to their families at night, added to the strain.
The increasing number of patients coming through hospital doors during the pandemic has significantly impacted the workload of NHS staff. As a result, not only were patients sick with Covid, but staff were too, leaving those behind to pick up the slack.
The increasing number of patients leads to more administrative work, such as admittance and discharge paperwork, audits, incidents recording and risk analysis, reporting, and so on. With less staff to work on these, the workload to staff ratio increases in favour of the workload!
Increased workload leads to increased stress, with staff taking sick time, leading to a vicious cycle of understaffing and overworking. The lack of funding for extra nurses provides additional pressure, with few more people coming in to ease the load.
In addition, the 22m Covid cases meant that the 1m regular annual users of the NHS either avoided seeking treatment to prevent extra pressure on the service or had delayed consultations. These patients are now flocking to the NHS, already frustrated about the extensive wait times. The backlog of patients is a priority for the NHS, with nurses being encouraged to increase their hours or even come out of retirement.
Despite the Government's efforts with increased minimum salary for nurses and the advertising of available vacancies, there aren't as many applicants as there are positions, leaving hospitals still understaffed.
On top of this, nurses must often battle outdated, unsuitable systems that work against them and are incredibly complex and time-consuming, leaving limited resources stretched thin and nurses having to extend their workday beyond their safe shift to accommodate the workload. This leads to a cycle of burnt-out, exhausted healthcare staff with little time to recover between shifts, which is detrimental to their mental health.
Frustrated, abusive patients
NHS staff sometimes face a tidal wave of abuse from frustrated patients. In response, six medical bodies put together a strong statement, urging government ministers to help with the backlog of patients with more funding and staffing.
One senior member of staff told The Guardian, "As we come out of the pandemic, there is a notable change in the political rhetoric away from thanking and supporting the NHS to demanding that it now delivers on the recovery of services. There is a danger that this translates into blaming the individual staff members on the frontline."
The statement urged the Government and the media "to be honest and transparent with the public about the pressures facing health and care services […] This means making it clear that the problems are systematic and the blaming and abusing of individual staff members is never acceptable."
Without the proper tools, equipment and staff, extra pressure is mounting on those working in healthcare, wreaking havoc on their mental health. So, what can be done to help ease the mental health crisis?
What Can Be Done To Help?
Now that we understand more about the different factors impacting nurses' mental health, we can look towards solutions. Nurses are crucial to the NHS and other healthcare services, so returning the care they give to others is also crucial. Their importance needs to be recognised and supported.
Change the rhetoric
As we have seen, there has been a significant change in political rhetoric surrounding the expectations of what the NHS can deliver. Once heralded as the heroes of the pandemic and the country's backbone during its most challenging time in healthcare, descriptive language has changed to demanding and blame.
Politicians must return to that language of support and understanding to reframe how we all see healthcare services. Instead of demanding that the NHS achieves outlandish deliverables within an unrealistic timeframe, we must be honest and transparent about the challenges they are facing.
This way, we can tackle the real issues head-on, including underfunding, understaffing, and an increasing workload, to improve the mental health of nurses.
Ease the workload
We know that the current amount of work that nurses must complete in a day is often beyond the scope of what they can do. Not only is the backlog of increasingly frustrated patients adding to the pressure, but administrative tasks must also be completed, taking time away from patients but imperative to the safe day-to-day running of a hospital.
Audits, incidents, risk assessments, actions, policies must be recorded, reported or adhered to, often whilst battling incredibly ineffective, outdated, not fit for purpose IT, or worse, paper systems that require collation of data from multiple sources. Some Trusts use decades-old software or opt for Excel, Word documents or even paper to manage their patient safety, compliance, action tracking, assurance and reporting.
Combined, these practices are ultimately time-wasting, leaving nurses with less time to tend to patients or forcing them to extend their workday well beyond what is considered a safe shift to accommodate all the work.
Trusts must update digital systems to a robust, reliable framework that fully integrates with each moving part so staff can compare audits against actions and assurance quickly and in real-time. In addition, they must quickly be able to identify trends in incidents and risks for learning purposes and prevention, as well as collate and track actions against CQC, NICE Guidelines and policy to assure everything is in alignment with the Trust's compliance, assurance and broader improvement outcomes.
Data capture forms can be intelligent, quick, and easy to use, saving minutes at each capture stage, totalling 2 - 4 full-time clinical staff members time each year, depending on Trust size. In addition, triangulation capabilities that eliminate the need for endless searching for relevant data and a new LFPSE (Learn from Patient Safety Events) certified incident reporting system, can put the right digital tool in their hands to identify critical areas that require improvement, ensuring that resources are spent in the most impactful areas.
These features are all cost effectively available with technology from InPhase. Adopting such system will enable improvement towards the goals set by NHS England in the post-Covid recovery plan and free up the nurses' time by simplifying the processes involved in the workload. With extra time from these simplified processes, nurses can be more focused on helping ease the backlog of patients at NHS doors.
Provide proper mental health support
Recently publications include a series discussing 'reflective practice' to help ease the mental health worries of nurses. This theorises that time for reflection after a demanding workday can help lighten the load. Reflection takes many forms, such as private journaling, chatting to colleagues who have a similar experience or seeking professional guidance to help process the complex emotions that arise as part of the healthcare profession.
A group reflection firm named Schwartz Rounds found that attendees fared better mentally than non-attendees, with a 13% decrease in poor psychological states, compared to a 3% fall in non-attendees. These groups are purely reflection-based, with topics such as 'when things go wrong' focusing on the emotional impact instead of purely problem-solving.
Some attendees have questioned the necessity of 'unearthing' sad feelings whilst others cannot spare the hour to go. The vast workload must be simplified and decreased so staff have the time available to take care of themselves. This will lead to better staff performance and a decrease in mental health problems.
Proper mental health support is vital for nurses in the NHS. Clinical supervision may be necessary to aid this practice, with certain people available to provide psychological support for staff when needed.
Ultimately, it's vital to look at what would help ease the mental health crisis among nurses to end the vicious cycle of work and mental strain.
Nurses are facing an epidemic of mental health problems throughout the profession. The factors impeding their mental health include overworking, understaffing, criticism from politicians, media and the public, lack of support and outdated tools that complicate simple processes and pressures to recover from the pandemic in unrealistic time frames.
To help ease the administrative strain placed on the shoulders of nurses, we must provide updated digital systems that simplify and streamline the processes. The Oversight suite from InPhase helps save time and effort by reducing the time it takes to capture data, help learn from incidents to lower the re-occurrence and triangulating data to other apps to allow for immediate real-time and complete visibility and oversight of quality and safety performance across the Trust. This will help ensure that limited, valuable resources are spent in the most impactful areas, and nurses can see the direct result of their actions, giving motivation, support and assurance.
A change in rhetoric is required, describing the real situations that nurses face daily, including the verbal and sometimes physical abuse from increasingly frustrated patients. Nurses must return to their status during the pandemic: as public servants and heroes that the public depends on. We must consider their perspective, and their struggles reframed to what they are: a lack of support and unrealistic expectations.
Proper mental health support must be in place to aid nurses through this crisis and give them the tools they need to continue. Reflective practice encourages nurses to identify and reflect on difficult emotions related to the workday, talk to colleagues who share these experiences to lighten the load and get one-on-one support where needed. The workload must be reduced first to allow for the extra time required for this support.
Something that we can do, crucial to the issue of tackling nurses' immense workload is implement time-saving updated digital systems that are designed with the users in mind, like the Oversight suite from InPhase, Trusts can save administrative time for nurses to spend instead on tackling the patient backlog, manage improvements in the Covid-19 recovery plan and allow for extra time to tend to their mental health.
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About the Author
As our Chief Executive and Founder, Robert has been the visionary leading InPhase to be one of the UK's leading providers of business management, governance and assurance solutions, and helping organisations align their actions and goals more easily and efficiently with InPhase's suite of integrated apps.