The perils of working in a caring profession

Many stresses and strains are putting nurses under growing pressure at work, contributing to physical and mental health problems. With care and the right policies, however, these can be managed. 

Despite the risks, nursing is a highly rewarding career. Being able to work to flexible schedules, to specialise in a range of fields and make a meaningful difference in people’s lives are all attractive prospects.

Feeling tired, bullied or close to burn out? If this litany of troubles sounds familiar, you will not be surprised to learn that every year nursing ranks as one of Australia’s most stressful professions. There is no indication that 2014 will be any different.

Ever-growing demands on our health systems’ resources, combined with a slowdown in much-needed funding, is putting nurses under growing pressure at work. One of the significant consequences of this is an increased likelihood of exposure to psychological risk factors. These range from physical and psychological fatigue to bullying, stress and anxiety, all of which can have a debilitating effect on health and wellbeing.

Employed in places that are often understaffed, where they are overworked and at high risk of workplace bullying and aggression, nurses are in many cases being forced to choose between their patients’ wellbeing and their own.

Incidents of workplace bullying and problems with managers are increasing in the hospital and healthcare sector at a rate well above that in other industries, with junior staff in particular regularly experiencing unacceptable behaviour at work. In many cases, employees who are concerned with their workload or work conditions are afraid of speaking out publicly, or even internally, in fear they may lose their job or that their situation may become worse as a result.

Nurses working in a culture of bullying may experience excessive scrutiny of their work, deliberate changing of rosters with the intention of causing inconvenience, unwarranted isolation or exclusion from workplace activities, verbal abuse and professional denigration or dressing down by other professionals in a public space.

New research has also revealed nurses are experiencing alarming rates of violence. According to a recent survey by Nursing Careers Allied Health, almost 40 per cent of Australian nurses have experienced violence at work in the past five years, whilst 79 per cent have experienced patient aggression more than once. Nurses working in the areas of aged care, mental health, drug and alcohol treatment and emergency departments experience physical abuse at one of the highest rates in the country.

In addition to physical injury, employees who experience violence have an increased likelihood of experiencing a mental illness and are more likely to experience post-traumatic stress disorder if not provided with appropriate psychological care. In the short term, it is natural to feel anger, frustration and sadness, which may limit a nurse’s ability to care for patients. Over the longer term, nurses who have been assaulted are more likely to suffer occupational strain, job dissatisfaction and fear of future assaults, which may lead them to leave the profession.

For health service employers, workplace violence has a significant impact on absenteeism, productivity, workers’ compensation and litigation risk as well as decreased morale and reputation and higher staff turnover.

Another major concern for nurses is the widespread problem of understaffing. With an ageing population, there are now more chronically ill and dependent elderly patients needing more complex medical care in nursing homes and hospitals across Australia than ever before. At the same time, there are fewer medically-qualified workers and this can place excessive strain on a small number of registered nurses who may be left with an often unmanageable workload.

It is no surprise that this can leave nurses feeling disillusioned and demoralised; they want to provide first-rate care, but a demanding workload makes this a challenge.  When they cannot deliver the quality of care they aspire to, nurses can be left feeling stressed, anxious and fatigued.

In such a demanding environment, inexperienced workers may be pressured to complete tasks beyond their training. Having to deal with difficult circumstances with limited experience can take a significant psychological toll on nurses in the early stages of their career. Guilt is a common emotion and can drive nurses to work longer and harder, again putting their own mental health at risk.

Nursing often involves long working hours, frequently with limited breaks or back-to back shift work. Whilst working extended hours is not uncommon in many industries in Australia, it is an unhealthy work pattern when it becomes normal practice or is continued over long periods and poses high risk for employees.

For nurses, most of this time is spent on their feet, carrying out physically demanding work whilst remaining gentle and caring towards patients. Many health facilities may also require workers to stay vigilant to physical risks such as hazardous chemicals and cleaning agents, as well as needle prick incidents; staying vigilant is difficult when working in a state of fatigue.

The impact of fatigue on performance is significant. Staying awake for a total of 17 hours has the equivalent effect on performance of a blood alcohol content of 0.05 per cent, whilst staying awake for 21 hours has an impact equivalent to a blood alcohol content of 0.1 per cent.

Shift work in particular has been shown to be detrimental to workers’ health, and can lead to sleep disorders, health problems, diminished performance at work, job dissatisfaction and social isolation. A recent study by UniSA’s Centre for Sleep found that shift workers need longer to recover from the irregular hours they work than workers with regular hours and are often still groggy after waking. This is a particular concern for nurses, who may be on call and required to drive if needed at work.

Whilst there are significant psychological safety and wellbeing risks in the nursing sector, there are a number of proactive initiatives that can be taken by employers and employees to improve the experience and the wellbeing of staff. The two most critical risks are fatigue and workplace bullying and harassment. Some of the most effective measures to deal with these from an employer perspective include the following.

• Assess your risk – most organisations can draw on a significant amount of data such as employee assistance program information, absenteeism and turnover data, employee survey and exit interview trends, difficulty recruiting or higher than normal turnover in certain areas.
• Have critical policies in place (fatigue management, respectful workplaces, professional behaviour, etc) and ensure they are reviewed and updated regularly and – more importantly – are widely available and promoted.
• Ensure that business values address key issues and are modelled at all levels, with performance measured against demonstration of these values, not just the work performance.
• Provide education for your workforce – managers first and then employees. With managers it is particularly important to focus on their responsibilities and accountabilities.
• Ensure you have safe support mechanisms in place and these are well-known and readily available to employees.
• Provide information to employees and their family members on the known challenges of the work environment and provide practical strategies to assist. These may include an introduction to support networks and providing practical information on risk areas such as fatigue.
• Provide direct programs on building a respectful workplace culture. This requires acknowledgement at the most senior levels, building a culture of zero tolerance of transgressions as well as providing training in managing bullying in the workplace.

At an employee level it is important to acknowledge any problems and take action to address them. This may include following these recommendations:

• Have the courage to act – this is the single most effective strategy to address workplace bullying and related problems.
• Don’t tolerate inappropriate behaviour – draw on the resources provided by the organisation to raise and address concerns.
• Look at what’s happening around you and show genuine care for others. Don’t perpetuate the difficulties by treating poor behaviour as normal or OK.
• Know the support mechanisms that are available (such as employee assistance programs) and use them or refer others to them.

Michele Grow is the CEO of Davidson Trahaire Corpsych (DTC), Australia’s leading provider of employee assistance programs, critical incident management and employee wellbeing services. 

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