Exclusive: One in ten nurse sick days down to stress or depression
In a special investigation, Nursing Standard looks at the prevalence of anxiety, stress and depression among UK nurses and their consequent absences from work – and what employers are doing to help.
A Nursing Standard investigation reveals worryingly high sickness rates due to mental health issues in nurses across the UK
Sickness absence remains a thorny issue for the NHS.
In 2009, occupational health expert Steve Boorman carried out a major government review of the health of the NHS workforce, highlighting the fact that 10 million days a year were lost to sickness absence.
Dr Boorman found that mental health conditions were a major contributor to NHS staff sickness – many reported significant levels of stress, with links to high rates of bullying and harassment.
Now a UK-wide investigation by Nursing Standard reveals that anxiety, stress or depression remain an issue.
‘It isn't inherently the work task, but rather how staff are managed and supported that drives the risk of sickness absence’
Our data show that more than one in ten (11%) of nurses taking sick leave in the year to April did so due to these conditions.
That figure climbs to as much as one in four (24%) at some organisations.
RCN honorary fellow Dr Boorman warns that Nursing Standard’s figures may be just the tip of the iceberg.
He says our data, and recent work of his own, suggest there is ‘significant under-reporting’ of the conditions among NHS staff.
‘In the health and well-being review we highlighted differences of up to three-fold in sickness absence between trusts doing similar work in similar geographies.
‘This suggests it isn't inherently the work task, but rather how staff are managed and supported that drives the risk of sickness absence.’
At 16%, Wales and Northern Ireland have the most nurse sick leave related to these conditions in the UK, according to our figures.
‘The nursing family is in crisis’
RCN Wales director Tina Donnelly says low morale, understaffing and continued uncertainty over the ongoing cap on nurses’ pay could be playing a part.
‘The nursing family is in crisis,’ Ms Donnelly warns.
‘All areas of healthcare are currently staffed by overworked and undervalued nurses who are doing their best in the most stressful of circumstances. They cannot, and should not, be expected to continue like this.
‘We need to see firm results from all of the health boards and trusts across Wales, to reduce and limit workplace stress.’
A Welsh Government spokesperson said it takes staff health and well-being ‘extremely seriously’ and that recent statistics showed ‘some improvement’ in sickness absence rates across NHS Wales.
Northern Ireland has been without a government since January. The same month, RCN Northern Ireland director Janice Smyth said nurses in the country’s emergency departments were working in ‘intolerable’ conditions.
She said of our data: ‘It reflects the impact of working in a health and social care service that is not fit for purpose and currently devoid of political and strategic leadership.
‘Unless the underlying staffing and workload challenges are robustly addressed, nurses will continue to suffer in this way, and that is wholly unacceptable.’
Northern Ireland’s chief nursing officer Charlotte McArdle says that, along with trust-level measures, the Department of Health and Social Care is taking forward regional workforce initiatives in the areas of recruitment and retention, induction and development, workforce planning and safe staffing.
'Its important nurses are supported in their jobs and this first and foremost is the responsibility of all employers,' she says.
Our investigation also revealed that in Scotland, 12% of nurses have taken time off due to the anxiety, stress or depress in the past year.
‘Nurses are burning out as a result of stress’
RCN Scotland director Theresa Fyffe says rising patient demand, coupled with the highest ever nurse vacancy rate in Scotland – 5.2% of nursing and midwifery jobs were unfilled in the three months to June this year – is taking its toll.
‘Nurses are working longer than their contracted hours and through their breaks. All this means that nurses are burning out as a result of stress.
‘While fully resourced occupational health teams to provide early support for staff who are too stressed to work might help, what would make a real difference is having the right number of nurses in the right place to care for patients.’
Responding to our figures, the Scottish Government said sickness absence rates are lower in 2017 than in 2007, falling from 5.55% to 5.20%, and pointed to a commitment to create an additional estimated 2,600 nurse training places over the current parliament, which runs until 2021.
In England, where 10% of nurses who take sick leave do so because of anxiety, stress or depression, chief nursing officer Jane Cummings says measures are in place to help organisations improve the support they offer to front-line staff to stay healthy.
She says organisations can access a share of a national incentive fund from NHS England if they offer nurses and others access to workplace mental health support and other healthy workplace options.
What the employers say
Responses from organisations with the highest rates of absence due to anxiety, stress or depression (see table below):
Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust interim director of nursing, midwifery and quality Moira Hardy says stress workshops, mindfulness sessions, coaching and a 24/7 employee assistance programme are in place to address work-related stress.
Royal Liverpool and Broadgreen University Hospitals Trust executive director of workforce Debbie Herring says stress and mental health-related absences are taken 'very seriously. She adds: ‘The figure represents a combination of non-work-related and work-related absences – the majority of cases are not work-related and can be due to home, financial, lifestyle or bereavement pressures.’
Cwm Taf University Health Board director of nursing Lynda Williams says various initiatives are in place at the health board in South Wales to support employee health, including flexible working, workshops, training sessions and staff well-being groups.
State Hospitals Board for Scotland director of nursing and allied professionals Mark Richards says the board has invested in more occupational support for staff with common mental health problems and a new absence support system.
‘We recognise that we have more work to do in supporting our nursing staff and have identified a need to invest in preventive interventions to enhance the psychological resilience of our staff.’
South Tyneside NHS Foundation Trust director of nursing and patient experience Melanie Johnson says the trust has services in place for nurses who need help including a wellbeing team which takes a proactive approach to supporting staff. The trust recently became the first employer to be offered ambassador status in the North East Better Health At Work Awards.
A spokesperson for Abertawe Bro Morgannwg University Health Board in south Wales says the board provides a number of preventive and treatment-based approaches on a one-to-one and group basis to manage stress, anxiety and depression.
A spokesperson for the Western Health and Social Care Trust in Northern Ireland says staff health and well-being is of ‘paramount importance’, with initiatives in place to build resilience among staff.
Northern Health and Social Care Trust in Northern Ireland says measures to help inclde a health and well-being group and a support website for staff and their families.
Staff shortages, financial worries, plummeting morale and political uncertainty are among the reasons for high levels of the conditions among nurses, experts say.
Our investigation reveals that one in eight nurses working in some NHS hospitals sought help for the conditions over the past year. It found:
- 1,737 of 14,309 nurses (12%) working for ten UK health service organisations experienced one of the three conditions.
- Overall, one in 20 UK nurses contacted their occupational health or employer support services for help with the conditions in the year to April.
- One in 50 doctors sought help for the conditions in the same period.
- Based on data from 126 NHS organisations, 9,589 nurses sought help for the conditions last year, compared with just 1,328 doctors.
Mental Health Foundation director of development and delivery Isabella Goldie, a trained mental health nurse, says the results should ‘serve as a wake-up call for NHS managers’.
‘In part, this is about ensuring that nurses have the resources and capacity to deal with their workload. But it is also about valuing their work and… making sure that support mechanisms are in place to protect and sustain good mental health.’
The 2009 Boorman review recommended that managers be equipped to support staff with mental health difficulties and that wellbeing services be monitored.
Royal College of Psychiatrists social inclusion lead Jed Boardman asks why more has not been done by now.
‘If we have known how to improve staff health and well-being for almost a decade, we should be asking ourselves why we find ourselves in, if anything, a worse situation now. Priority needs to be given to improving this sad situation.’
Dr Boorman says some improvements have been made, driven by funding incentives for better early support.
Variation in recording
But he highlights the need for better monitoring of the conditions among nurses and improved support systems to ensure timely intervention.
Our investigation also found inconsistency in how data are recorded. Some computerised systems used for freedom of information requests enumerate every contact made with occupational health services, rather than grouping them for each individual.
Employers with either high or low levels of the conditions reported by their nursing staff say their proactive approaches encourage staff to report sickness.
Tameside and Glossop Integrated Care NHS Foundation Trust saw 135 out of 1,123 nurses – or one in eight (12%) – seek help for one of the three conditions last year.
The trust encourages staff to report all illness through a telephone sickness tracking system, which helps identify patterns of illness.
South Tyneside NHS Foundation Trust saw 15% of its nurses (213 out of 1434 nurses) seeking such help over the same period.
Director of nursing and patient experience Melanie Jonson says plans are underway for more coaching and training.
Some employers with low rates of the conditions among nurses have been training managers to support staff, just as the Boorman review recommends.
East and North Hertfordshire NHS Trust just 0.35% of nurses (six out of 1,846 nursing staff) sought help for the conditions from occupational health services in a year.
The trust has confidential helplines for staff run by qualified professionals.
Director of nursing Liz Lees says: ‘We have also been working hard with our nursing line managers to help them spot staff who may be beginning to experience some form of mental ill health and support them through this period.’
She adds: ‘While progress has been made, of course there is always more that needs to be done.’
Case study: Escaping the grip of mental illness
London-based nurse Mandy Stevens had been working in mental health services for almost 30 years when she experienced severe depression that came without warning.
Ms Stevens, a former nursing director for two NHS mental health trusts, says the depression left her feeling suicidal and incapacitated.
‘I hid myself away, scared of my own shadow, and told very few people about what was happening to me. This is what mental illness has the power to do,’ she says.
Within ten days of the first episode last year she was admitted to an in patient unit.
Six months later she was discharged, having recovered.
She won a special achievement award this year from the Cavell Nurses’ Trust for sharing her story on social media to encourage others to seek help.
For nurses who are experiencing stress, anxiety or depression, the RCN can help.
The college's free counselling service gives members free, confidential support and assistance to deal with challenging, emotional issues, whether work-related or personal.
General secretary Janet Davies says: 'Any members experiencing difficulties should try to seek help as early as possible.’
RCNi also has an online resilience resource, featuring a selection of careers, comment, and advice and development articles.
For further information click here: rcni.com/resilience