When the National Academy of Medicine issues a consensus report, the healthcare industry knows it's going to be big. So it is with "The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity," because as the report acknowledges, "Nurses are more likely to die than are other healthcare professionals, and nurses of color are far more likely to die."
It's the third in a series on nursing created with sponsorship from the Robert Wood Johnson Foundation, the first two iterations produced in 2011 and in 2016 and designed to address social determinants of health and health equity. Work on the latest began pre-COVID-19, which then injected a slate of serious issues that would further impact the profession in ways few had likely imagined.
In addition to loss, the authors say, there was "the promise of lessons learned, including witnessing the nursing profession's commitment to health, nursing innovations that improved healthcare in real time for patients and families impacted by COVID-19, and nurse-driven adaptations in education and practice that will likely drive lasting changes in both."
At 503 pages, it's a formidable and comprehensive read, so Health eCareers picked a chapter that resonates with all nurses, and invited comments of our friends at the Academy of Medical-Surgical Nurses (AMSN) and the American Nephrology Nurses Association (ANNA). Let's dig into Chapter 10: "Supporting the Health and Professional Well-Being of Nurses."
Multiple Stakeholders Must Collaborate
"I'm just happy that nurse well-being was addressed in this way," says Summer Bryant, DNP, RN, CMSRN, and current AMSN president. For her, top takeaways included the "call to work together, with multisector partnerships, to go outside the hospital and to partner in the community."
Now is a great time for the industry and others to value nurses' contributions as revenue creators instead of an expense and "not just a line item," she says. It's about actually changing the value of nurses, the way they're seen and respected, with more power and legitimacy.
"As long as we continue to treat nursing as a cost center—and a large cost for most institutions—we will never get to some of the change we need," says Terri Hinkley, EdD, MBA, BScN, CAE, and AMSN chief executive officer.
The issue of nurses' health and well-being is a big one across the profession and needs to be recognized by multiple stakeholders, the study authors say, and that means policymakers, employers of nurses, nursing schools, nurse leaders, professional associations, and nurses themselves. When well-being is ignored, it impacts not just nurses, but patients, healthcare organizations, and society.
"At an individual and team level, nurses know this is an issue," Hinkley says. "It's easy to say you 'don't know where to start' so you don't start at all, or you think someone else will do it."
Neither is an option for AMSN, she says, so the association is wisely taking time to develop a clear concept of the role it will play in this bigger picture. "It's on us as nurses to actually take actions and drive changes, starting with conversations that distill what is in this report."
Nurses' Health Suffers
"The Future of Nursing" reminds nurses that their physical health is usually worse than the general populations' in the areas of nutrition, sleep, and exercise. That's a great irony for outsiders since nurses are devoted to helping other people be healthier. The report notes that:
- Body mass index averages 27.94, or overweight, for nurses.
- Only half say they can access healthy food choices at work.
- Less than half do strength exercise or vigorous cardio.
- Only 44 percent say they're in good health.
- Only 60 percent get 7 hours or more of sleep.
"They may not be not drinking enough water to stay hydrated, maybe don't have time to go to the bathroom," Bryant says. "There may be no time to eat, and some can't get good nutrition when cafeterias close at night, such as in community hospitals."
"Nurses and doctors make the worst patients, and we know what we should do," Hinkley says. "But coupled with shift work and exhaustion, and trying to balance so much, it's one thing to think about doing these things, and another to actually prioritize them to do them."
The Healthy Nurse, Healthy Nation 2019–2020 report found some of the same results. "In all, 70 percent of nurses surveyed report putting the health, safety, and wellness of their patients before their own, proving that now is the right time to make ourselves a priority."
In the earlier "Nurses Living Fit" program, that group of nurses focused on diet, exercise, and fluids, says Hinkley. "They had good results that were not sustainable: We need to make them sustainable. That's the challenge."
Additionally, "The Future of Nursing" finds that:
- 32 percent of night workers and 26 percent of shift workers report insomnia.
- Risk of a needle stick rises with afternoon/evening and night shifts.
- Shift workers have a 40 percent higher risk of heart disease.
Work Reasonable Schedules
"We shouldn't have to put [nurses'] lives at risk to work the midnight shift," Bryant says.
"We know the manifestation of shift work on nurses, and fundamentally, we have to recognize and do better at supporting them," Hinkley says. "Hospitals also need to ensure nurses take breaks."
Nurses' schedules can be rigorous—12-hour shifts are not normal—so working 8-hour shifts, or 10-hour shifts, and hiring nurses for a few 4-hour shifts may all be feasible options.
"What if we didn't require nurses to work 50 percent night shifts," Hinkley says. "Bouncing back and forth has a significant impact on health. Maybe a model of 75 percent/25 percent would work as an alternative strategy. And let's leverage technology such as artificial intelligence as we take this opportunity to look at how we staff."
"As nurse leaders, we need to normalize work-life balance," Bryant says. "The place isn't going to fall down if you work less."
Accentuate Mental and Behavioral Health
It may seem antiquated and unfair, but Hinkley noted that, as part of the ongoing license renewal process, 22 boards of nursing still ask questions related to mental health.
"That's not in compliance with the American with Disabilities Act, and nurses feel like they can't report if it affects their licensure," she says. "If we continue to treat mental health as a barrier to being able to perform, it will continue to be under-reported and that's not good."
Even much-touted Employee Assistance Programs leave employees feeling that despite the fact that they're "supposed" to be confidential, they worry that employers will still find out.
"In nursing there's an expectation 'to get over it,'" Bryant says. "We lean on each other a lot, and nurses coming out of COVID would prefer to speak to other nurses. Peer support creates a safer space."
"The pandemic amplified many existing issues, and allowed us to start talking about them in a more meaningful and more consolidated manner," Hinkley adds. "We can now recognize the importance of taking action collectively."
COVID manifested at a time when the workforce was already "frayed," Bryant says. "That was due in part to systemic issues such as staffing, and a lack of resources to care for patients, and it created moral distress, which precedes moral injury, and it hit where it matters. We should also ask what education we can give our nurses to help them understand what burnout is compared to moral injury or moral distress."
"It all presented an ethical dilemma about what nurses should be doing versus what they could do or were able to do and highlighted the disparities for nurses caring for patients," Hinkley says. "That all multiplied on an infinite scale, especially in the face of competing values of what a family wants, and what a doctor wants to do."
One of the greatest affronts was one of the most obvious: "Nurses had to go 'into the fire' and fix things, while everyone else was told to stay home. How do you reconcile that?" Bryant asks.
Practice 'Work-Life' and 'Life-Work'
Kindness and support begin "at home," and it hasn't always been a hallmark of nursing teams.
"From a nursing perspective, there's been a mentality of 'eating our young' in the past, says David Walz, MBA, BSN, RN, CNN, FACHE, and president of ANNA.
Walz thinks bullying and discrimination still occur, but ANNA is one of the first associations to have a committee to spearhead initiatives to deal with that and respond. "We know we need to be better tomorrow than we are today," he says.
That can happen on a more personal, day-to-day level, he thinks, to nip potential issues in the bud. "We can be sure we are mentors, and have a buddy system to look out for each other to recognize small changes in well-being," he says. "Then we can have conversations that lead to getting appropriate help."
At ANNA, the focus on education helps assure members of up-to-date, evidence-based research in their practices, so everyone does the same thing and knows they are giving the best care—and that imparts confidence. From a whole body–mind perspective, the association has begun sending wellness tips to members via email each Saturday.
"Determinants of health and health equity ensure we're inclusive and that we promote appropriate care models and well-being for nephrology nurses," Walz says. "We're flipping the paradigm from work-life to life-work, because if we're not, we can't really help others."
He thinks "The Future of Nursing" is "fantastic," and couldn't help but note 304 mentions of well-being in the report.
"At ANNA, we want to ensure we're impacting not only nephrology nurses, but other specialties, so we're working together and rowing in the same direction," he says. "This takes a village, and we must all be on board for the next ten years. There's lots of work to be done, and it can be done."
This article first appeared on Health eCareers. Reprinted with permission.