Exclusive: Short-staffing pressure threatens nurses’ well-being, survey shows

Nurses’ well-being is threatened by staff shortages that result in many regularly working shifts without time to take a break or even eat or drink anything, a Nursing Standard survey shows

Nurses’ well-being is threatened by staff shortages that result in many regularly working shifts without time to take a break or even eat or drink anything, a Nursing Standard survey shows

  • RCN says health and well-being initiatives aren’t working
  • MPs want assurances on nurses being given time for handovers and breaks
  • Workplace cultures blamed for variations in breaks and hydration
  • Schwartz rounds seen as one way to help ease stress on staff

Schwartz rounds could help ease the stress on nurses.
Picture: Southwest News Service

Nurses are regularly struggling to find time to take breaks, eat or even have a drink of water during shifts, which is having a major impact on their well-being, a survey by Nursing Standard shows.

The scale of the problem was starkly illustrated by the survey, which drew responses from nearly 2,000 nurses. Three quarters (1,415) said they regularly work shifts without time for a break and over half (1,128) said they were unable to have a drink of water.


of nurses regularly work shifts in which there is no time to take a break

The RCN has expressed concern that an inability to meet such basic needs has become the new norm and questioned the efficacy of NHS-wide health and well-being initiatives that appear to be failing to have the necessary effect.

In January, the House of Commons health and social care committee published a report into the nursing workforce that put these issues into the public spotlight.

Policy priority

The report asked the chief nursing officer for England to write to all directors of nursing in England and seek assurances that nurses had time for appropriate handovers and to take their breaks, as well as access to food and drink.

Kim Sunley: ‘Initiatives aren’t
working as they should be.’

‘There needs to be a greater focus on staff well-being in all areas,’ the report said. ‘This work should be driven forward as a national policy priority, and nurses of all grades and settings should contribute to it.’

RCN national officer Kim Sunley says: ‘The committee's report is very helpful and it is good to have that message from the chief nursing officer about breaks coming from the top.’

Ms Sunley says that while much work and effort has gone into improving the health and well-being of the NHS workforce with various incentive schemes and initiatives over the years, she does not feel they are working as they should be.

No nutritious food available

In the online survey of Nursing Standard subscribers, 57% of respondents said they did not have access to nutritious food while at work.

‘If more than half of organisations are not offering nutritious food, then all these initiatives don’t seem to be hitting the nursing workforce, which is pretty worrying,' Ms Sunley says.

She says even in some organisations that are doing well at offering breaks and ensuring nurses are hydrated, there could be a lot of variation and it is often dependent on the culture in a workplace.

‘There might be a ward or department where nurses are encouraged to take breaks, while across the corridor in a similar area, dealing with similar stresses, there might not be a nice atmosphere and people might be afraid to take breaks and things are very different.

Need to break bad cultures

‘It is not acceptable, and there is health and safety legislation around these areas for a reason. Somehow, organisations, leaders and individual nurses need to try and break this culture.’

Worryingly, more than half of nurses (1,079) responding to Nursing Standard’s survey felt their manager was not concerned about their well-being.


of nurses regularly work shifts without being able to have a drink of water

‘The role of the manager is really important in leading by example,’ says Ms Sunley, who pointed to Guy’s and St Thomas’ NHS Foundation Trust as a role model.

‘They have these huddles during the day where they check whether people can take their breaks and there are good team relationships. The culture is set at the top of an organisation.’

Ms Sunley says the NHS staffing crisis is not an excuse for nurses being unable to have their needs met by their employers.

‘These are just basic fundamental needs that organisations should be addressing. We cannot excuse a lack of staff for not looking after the basic needs of the nursing workforce.

‘Maybe the solution is to go back to basics and focus on nurses being able to rest, rehydrate and refuel, rather than putting on things like yoga classes that nurses can’t necessarily access.’

No time to go to canteens and shops

In 2016, NHS England started offering financial incentives to organisations if they made efforts to reduce sugar and saturated fat levels in products for sale on their premises.

Today it says that more than two thirds of NHS trusts have signed up, but comments by nurses in the survey show it can be a challenge for them to reach canteens or shops when they have little or no time for a break.

Jane Cummings: ‘We take the
health and well-being of NHS staff
seriously.’ Picture: Grant Humphreys

Chief nursing officer for England Jane Cummings says: ‘We take the health and well-being of NHS staff seriously, as their dedication and skill is fundamental to delivering high-quality care to patients and they rightly deserve to be supported themselves.

‘We know that staff are working in demanding roles and it is important we practise what we preach, so we are providing a financial incentive for schemes that actively improve access to mental health services and musculoskeletal services and provide healthier food options on NHS premises.’

Forum for staff to talk

Initiatives that have had a demonstrable positive impact on staff well-being in the NHS include the use of Schwartz rounds – a forum where staff from all disciplines come together regularly to discuss the emotional and social aspects of working in healthcare.

A recent research evaluation of Schwartz rounds, which will be published in full this July, found they had a positive impact on the psychological well-being of staff.

University of Surrey professor of health services research and nursing Jill Maben, lead author of the research report, says: ‘Our study found that in those staff who regularly attended rounds the proportion with poor psychological well-being halved – down from 25% to 12%.

‘Conversely, there was little change in staff who hadn’t attended rounds – a third of whom reported poor psychological well-being.’

But more than three quarters of nurses responding to the Nursing Standard survey said their organisation did not operate Schwartz rounds, and many nurses had never heard of them.

A chance to share feelings

Healthcare charity the Point of Care Foundation offers training for organisations to run Schwartz rounds. Its programme manager, Aggie Rice, says the rounds can help normalise emotions as people share feelings such as grief, shame, joy or pride.

‘This has a hugely positive impact on well-being,’ Ms Rice says, adding that the rounds can also help change the culture within healthcare organisations.


of nurses says there is no healthy or nutritious food available at their workplace

‘Often nursing, like other teams and disciplines, in order to help deal with the difficulties that come from the role, develops tribes and silos.

‘Being part of Schwartz rounds can dissolve these tribes, flatten the hierarchies that are present, and reduce silos, as hearing stories from others can increase insight and awareness and promote connectedness and openness.’

Ms Rice says the organisation is ‘very aware’ of nurses not having heard of rounds or being able to get to them, which typically are held once a month for one hour. ‘We are trying to urge directors of nursing to join a steering group or be a panellist for a round.

‘If a director of nursing is engaged from early on, they can put processes in place within staff rotating to ensure this is reaching nurses, and nurses can prioritise it.’

Crystal Oldman: ‘Staff planning
should enable nurses to take
reasonable breaks and stay
hydrated.’ Picture: Kate Stanworth

Currently, 181 healthcare organisations in the UK and Ireland run Schwartz rounds, according to the foundation.

Collaboration appears key for organisations in addressing the challenges they face.

Practical solutions

Queen’s Nursing Institute chief executive Crystal Oldman says: ‘All staff should be able to work with their managers and colleagues as a team to develop practical solutions to these challenges. It’s easier said than done, but is absolutely essential to a happy and productive workplace.’

Dr Oldman says the results of the Nursing Standard survey ‘would be troubling at any time’ but says when there are such high vacancy rates in the nursing profession they make even more worrying reading.

‘Staff planning and workload allocation should enable nurses working in any setting to take reasonable breaks and stay hydrated, particularly where shifts are very long.’

She says that staff who are tired and dehydrated find it harder to deliver high quality patient care and may be putting their own health at risk. ‘It is in the interests of employers, patients and nurses themselves that they should be supported to perform at their best.’

‘Always too much to do and you end up feeling guilty…’

Nurses shared with Nursing Standard what has the worst effect on their well-being. Here is a selection of comments:

‘I work on a very busy gastro ward on the top floor of the hospital. It is stiflingly hot. This combination makes you very thirsty. It is nigh on impossible to leave the ward to get a drink as our fridge has been removed from the store cupboard where it was kept into a room on the opposite side of the hospital.’

‘On a daily basis, staff only manage to have two drinks a day in their break time, bearing in mind that often we are too busy to leave the ward for a break. There are days when we have not even been to the toilet.’

‘Worried to go to work’

‘There are posters on the walls or the toilets to check the colour of your urine to determine how hydrated you are. It’s laughable, as according to the posters we are all severely dehydrated. This has a huge impact, causing headaches and lethargy.’

‘Continuously getting home late is affecting my marriage.’

‘Not feeling enough time to take breaks. Always too much to do and end up feeling guilty by stopping.’

‘Continual low staffing makes me very anxious and worried to go to work, worried I am going to miss something important. I take herbal medicines to try and calm me down.’

‘Having nowhere to take a break on night duty.’

Rest, rehydrate, refuel

The RCN’s new Rest, Rehydrate, Refuel campaign is being highlighted at the college’s annual congress starting on Saturday.

The college wants nurse managers to understand that breaks for their staff are not a luxury but an important means of preventing fatigue-related incidents.

Missed breaks pose a patient safety issue, as does dehydration in nursing staff.

Dehydration leads to reduced cognition, which can affect decision-making, so it is important that nurses stay hydrated during their shifts.

Having access to healthy eating options at work is also a priority for nurses, who as shift workers especially need a balanced diet to stay healthy.

RCN national officer Kim Sunley says solutions to keep nurses hydrated need not cost much money and might include the ward housekeeper regularly checking to ensure that nurses have a drink and topping up water jugs, or trusts buying water bottles for nurses.


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