Viewpoints
Do you pass the
nursing ‘stress test’?
Community nursing is becoming more stressful and some nurses are
at risk of burnout. Angela Hall, a former district nurse and Macmillan
clinical nurse specialist, explores what can be done...
A
little pressure at work can be
a good thing, boosting our
energy and motivating us to
perform well. Yet too much pressure
can have a negative impact, leading
to stress and increasing anxiety. Stress
has been referred to as a ‘modern
epidemic’ and while it has long
been argued that nursing is already
a pressurised occupation, it is clear
from rising sickness and attrition
rates, not to mention mental health
issues, that stress is on the increase.
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The regular Sickness Absence in the
Labour Market report from the Office
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for National Statistics identifies nursing
as a particularly high stress occupation
and this is reflected in the number of
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nurses on stress-related leave from
work. The numbers of nurses taking
time off sick has increased significantly
across the UK and according to the
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Royal College of Nursing (RCN), three-
quarters of nurses feel work-related
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stress is increasing.
Rapid organisational change
and the perception that nurses have
©
little control over their workloads
is a common cause of stress, as are
frequent media reports that highlight
poor nursing care, such as the Francis
inquiry into failings at the Mid
Staffordshire NHS Foundation Trust.
Interestingly, a lot of these reports
neglect to explain how demanding
nursing can be, although Francis did
recognise that when nurses feel they
can no longer do the job properly
they may become negative and
defensive, with a related decrease in
the quality of care.
10 JCN 2016, Vol 30, No 2
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POLICY SHIFTS
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While recent government policy
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dictates that ever-more services are
to be provided outside the hospital
setting, resources and staff numbers
are not rising at the rate needed
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to meet demand. Meanwhile,
community nurses have been tasked
ar
‘Community nurses work
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alone and never know what
might be behind the door.’
with preventing hospital admissions,
ensuring early discharge and
supporting a range of patients to
remain at home.
All these changes mean that
community caseloads are becoming
increasingly complex and with an
ageing population the demands
placed on community nurses
will only increase. In some areas,
caseload numbers and workloads
are already excessive, which means
that community nurses work unpaid
overtime to provide adequate care.
STRESSED OUT
For nurses, the demands of working
under constant stress can have
consequences for their wellbeing.
This may show itself in irritability
with colleagues or patients, over-
sensitivity to criticism, and even in
lifestyle issues, such as loss of sleep,
or reliance on alcohol or cigarettes.
Nurses affected by stress may not
be able to concentrate and may see
d
Lt
a reduction in their performance at
work. Where stress is a long-term
issue, nurses may develop health
issues themselves and become
‘burnt out’.
COMMUNITY CARE
In many ways, community nurses
are more vulnerable to stress than
hospital-based nurses since they
often experience issues that do
not affect their acute colleagues.
Community nurses often work alone
for example, and never know what
might be waiting behind the door
on any particular visit. Factors such
as the condition of patients’ homes,
travel disruption and cost, lack
of appropriate equipment, issues
with pets — especially dogs — and
patients’ drug or alcohol use are all
concerns for community nurses that
do not affect hospital nurses in the
same way.
Similarly, community nurses run
the risk of assault, being witness
to domestic abuse, or visiting
communities affected by disaster,
such as the recent flooding in the
north of England. As well as these
issues, community nurses are also
dealing with the ‘normal’ patient
factors that nurses have to cope
with such as extreme suffering and
even death. It is no surprise, then,
that a particularly stressful single
event can sometimes trigger post-
traumatic stress disorder (PTSD).
As mentioned earlier, all these
clinical stressors that are unique
‘’
Community
nurses run the
risk of assault
or witnessing
domestic abuse
to the community nurse are
foreshadowed by strategic trust-wide
issues, such as chronic understaffing,
frozen posts and increasing patient
numbers. This means that as well as
worrying about their patients, many
community nurses have to deal with
a frequent turnover of staff, being
regularly on-call, and violence or
abuse from patients.
However, it is not always
patients or circumstances that are
the problem. Unfortunately, many
nurses find that the biggest source of
stress comes from their colleagues,
for example the expectations
nd
of employers can be unrealistic
and sometimes there is limited
ou
managerial support. Sadly, nurses can
also face bullying and victimisation
from their direct colleagues.
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Home help
It is an unfortunate fact that many
nurses take work home, particularly
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admin tasks. While this may ease
stress in the short term by allowing
20
them to get through more work, it
also blurs the distinction between
home and professional life and
means that many community nurses
©
may not be taking the time off that
they need.
FUTURE IMPERFECT
So, what does this mean for
community nursing as a whole? We
know that many nurses are leaving,
while others are joining agencies
where they can choose their hours
and in some cases receive higher pay.
This is where workforce planning
must be considered a long way in
advance, since we know that many
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op
For some community nurses, stress is squeezing the joy out of the job...
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experienced community nurses are
nearing retirement age and that
district nurse numbers are declining.
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Stress at work has an undoubted
effect on home life and the current
ar
financial recession will have created
additional pressures for some nurses.
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Research from the RCN has
shown a clear frustration on the
part of nurses at the lack of time
they have to do the job properly,
with caseload pressures often
meaning they cannot give patients
the time they really need. Others
feel that the time they have to
donate to their professional
development is being curtailed due
to work pressures and an inability
to be released from clinical care to
study and reflect. They may also
worry about fulfilling new NMC
revalidation requirements.
THE WAY AHEAD
What can be done to help community
nurses avoid stress? For a start, a
more proactive approach is needed,
which takes into account working
conditions such as safe staffing
levels and having time built into the
working day for regular meal and
tea breaks.
Community nurses also need
the authority to make decisions and
be given input into the design and
scheduling of workload. This means
Credit: Lewis Ronald@wikicommons
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agreeing safe caseload numbers as well
as having systems in place to deal with
fluctuations in workflow. Policies to
protect the health and safety of nurses
should be routinely adopted and
training in early recognition of stress
provided as standard. Protected time
for nurses to reflect on their practice is
also essential.
However, while organisational
changes are crucial, it is also important
that community nurses look after
themselves. Communicating with
team members and addressing any
feelings and fears with team members
can help to head-off stress, while
nurses should not be ashamed or
too proud to take advantage of any
counselling or support that is available.
Some leisure centres also offer cheap
rates for nurses and staying healthy
and engaging with others socially is a
good coping strategy.
Managing community nurses’
stress levels should be a priority,
but where problems do occur,
good pastoral care is vital. Issues
like workplace-related anxiety and
depression require appropriate
counselling and psychological support.
If community nurses feel valued and
cared for by their employers, this will
enhance the care they provide for
their patients. Rather than losing good
nurses to stress and overwork, isn’t it
better to build a happy workforce for
the future? JCN
JCN 2016, Vol 30, No 2 11