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Pressure to cope is damaging our mental health

Nursing needs to acknowledge it’s okay not to be okay

Nursing needs to acknowledge it’s okay not to be okay


Picture: iStock

There is growing recognition that all is not well with the mental health of the professions within the NHS.

Staff are leaving the workforce due to stress-related conditions, and tragically there are cases where individuals have taken their own lives. Can we look to those who employ us to resolve this situation or does the answer, and indeed responsibility, rest with the individual?

We have to recognise that mental health is as individual as the person who owns it. There are people who appear to thrive on stress and shrug off excessive demands, and others who find such situations so adverse that they will consider leaving the role for which they have worked so hard. The individual nature of mental health suggests that simple and blanket responses are not the best way forward.

We should also acknowledge that society generally is becoming more aware of mental health and there is greater readiness to discuss and consider the effect of adverse events on individuals and communities.

Facing stark realities

There is growing concern about the mental health of the population generally, as well as the demand for services and interventions.

One could argue that nurses are only too aware of the consequences of national policy. They see on a daily basis the effects of reductions in services, with rising access thresholds for young people and delayed discharges for older people as gaps widen in service provision.

As politicians discuss the complexities that lead to violent crime, nurses face stark realities in clinical settings with both perpetrators and victims.

‘Admitting that you find work, or indeed life, too challenging has been subtly discouraged’

Our profession often deals with situations that most would shy away from, and with people society rejects. There is a cost to this exposure, and there always has been. The ‘dark humour’ we are often accused of is something we consider to be legitimate behaviour that helps us to just carry on.

Expectation of coping

Within nursing culture there has always been a subtle and coercive expectation of ‘coping’. Along with it comes a belief that those who cannot cope are just not up to the job. Admitting that you find work, or indeed life, too challenging has been subtly discouraged.

Perhaps one of the most positive developments of late has been the recognition that such a culture is unhelpful and corrosive. An encouraging change that could have a positive effect on the mental health of the nursing profession is the recognition that it is okay to not be okay.


Taking regular exercise can alleviate some of the effects of stressful situations. Picture: iStock

This seems to be gradually dawning on those who employ nurses – structures, processes and, importantly, resources are beginning to be used to address concerns. Employers are realising that the most precious resource they have is their staff, and if the physical resources they use have the benefit of a commitment to maintenance then why not the staff?

Duty to ourselves

But there is such a thing as personal responsibility. This is not to exonerate employer indifference, where it is present, but we owe a duty of care to ourselves. Coping mechanisms can be effective, but an honest appraisal of how we are managing the stress of work can lead us to consider how we may need to change what we do.

‘A profession characterised by compassion to its clients and also to itself would be a positive influence for mental health’

Spending time with those we care about, exercising, and sharing how we feel can help alleviate the impact of adverse situations. Some protective factors may be genetic but our mental health is not a biological given – we can influence how we are and how we respond to situations we find difficult.

Sense of self and purpose

If the culture we work in is unhelpful, if we feel it needs to change, then we can be the agent of change.

Nursing has a strong and vibrant sense of its past. Its origins are taught and researched, and the cultural values we carry can protect our sense of self and purpose.  Perhaps the greatest untapped protective factor for our collective mental health as a profession is an unashamed sense of worth and kindness to those of our number who are struggling.

A profession characterised by compassion to its clients and also to itself would be a positive influence for mental health both in its work and in wider society.


Ian Hulatt is consultant editor, Mental Health Practice

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