ImproveWell’s Head of Programme Engagement and Registered Nurse, Anna Lau, talks about nurse wellbeing and burnout.
According to a recent King’s Fund Report, staff stress, absenteeism, turnover and intention to leave the health service had already reached alarming levels in 2019. Since then, the pandemic has further laid bare and exacerbated low morale and burnout against a backdrop where many frontline roles are underfilled and services are under increased stress. Despite mounting pressures, organisations are working hard to find ways to support their staff and improve their wellbeing during this ongoing crisis.
As a former frontline nurse, across several clinical areas – most recently in the emergency department – I know burnout intimately. My experience in dealing with the challenging aspects of a clinical career was a driving factor for joining ImproveWell where I now head up the implementation side of the business. It’s now my mission to support organisations to demonstrably improve the experience for their staff so that they can ultimately deliver better patient care. It’s a win-win.
Not meeting Maslow’s needs
The needs of staff haven’t changed but the situation has. It’s now more complicated to ensure these needs are met – but more important than ever before. The hierarchy presented by Maslow in his 1943 paper on “A Theory of Human Motivation” is still relevant today for anyone’s wellbeing, experience, growth and development. Worryingly, for healthcare professionals, each of the five needs he presents has been compromised by the pandemic.
Self-actualisation – including self-fulfilment and personal growth – has become more difficult to achieve because of the new barriers in maintaining communication channels and supporting infrastructures. We are constantly firefighting, working remotely and under an ever-increasing workload.
Similarly, esteem needs have been affected as leaders and colleagues are unable to continue the feedback loop and provide the recognition so desperately needed. Because of these compromised communication channels, it’s also more difficult to achieve the sense of camaraderie with colleagues that feeds into the need of belonging.
Even the most basic physiological needs have been impacted by COVID-19, as staff deal with feeling unsafe at work, are anxious about the future, and face chaotic and disorganised working environments.
What we require to live happy and fulfilled lives is no different to what we require when developing productive and meaningful careers. And if basic human needs are not met, staff morale, engagement and retention will only continue to suffer. So, what can organisations do to address this? The King’s Fund Report ‘The courage of compassion: Supporting nurses and midwives to deliver high-quality care’ lays the foundation for how to get started.
Interventions that focus on the root cause
The Kings Fund report also highlights needs – focusing on three core requirements for minimising workplace stress: autonomy, belonging and contribution. It then highlights eight key recommendations to address these.
1. Authority, empowerment and influence
Ensure there are mechanisms for nurses and midwives to shape the cultures and processes of their organisations and influence decisions about how care is structured and delivered. This includes enabling teamwork and encouraging an ethos that places greater value on contribution than hierarchy.
2. Justice and fairness
Build and maintain just, fair and psychologically safe cultures as well as ensuring a proactive approach to diversity and inclusion. This includes creating a culture with a focus on learning instead of blame, as well as increasing the pool of nursing and midwifery knowledge, creative ideas and experience.
3. Work conditions and working schedules
Introduce minimum standards for facilities and working conditions for nursing and midwifery staff in all health and care organisations.
Develop and support multidisciplinary teamwork for all staff. This includes working together in teams to develop ideas for improved ways of working to ensure high-quality care and staff wellbeing. Quality improvement should be a core function of all teams.
5. Culture and leadership
Ensure all environments have compassionate leadership and nurturing cultures that enable both care and staff support to be high quality, continually improving and compassionate.
Tackle chronic excessive work demands in nursing and midwifery, which affect the ability of nurses and midwives to lead and deliver safe, high-quality care and which damage their wellbeing. A variety of approaches must be used to address workload, including a programme of continuous process improvements, especially through collective discussion and collaboration.
7. Management and supervision
Ensure all nursing and midwifery staff have the effective support, professional reflection, mentorship and supervision needed to thrive in their roles.
8. Learning, education and development
Ensure the right systems, frameworks and processes are in place for nurses’ and midwives’ learning, education and development throughout their careers.
Continuous assessment is needed regarding inclusivity, workload, culture, leadership, and the other areas organisations are working to improve. This is critical to ensure the work is effective and to ensure equity amongst staff. Organisations should regularly obtain and review feedback from staff to assess and improve their performance.
Time to empower
Nurses and midwives play a vital role in health promotion, disease prevention and the delivery of care. Not only do they make up the largest part of the NHS and healthcare workforce worldwide, but they are very often the first point of contact and are at the frontline during all stages of care, looking after patients from birth to death. They make an impact on innumerable lives every day and are regarded as one of the most trusted professions.
We are passionate about our patients and the work that we do. However, these ongoing stressors and challenging working conditions will wear down enthusiasm, engagement and health. Organisations must ensure needs are met by addressing the root cause of the problems, rather than just helping staff cope – it is now time to act.
The Kings Fund Report: The courage of compassion: Supporting nurses and midwives to deliver high-quality care