Nurses struggle to access clinical supervision and employer initiatives to improve well-being
Responses to Nursing Standard survey suggest that while employers are offering activities to combat stress and burnout, they often to do not suit nursing shift patterns
Nurses’ responses to Nursing Standard survey suggest employers’ efforts to provide clinical supervision and relaxation classes are not reaching the workforce
- Workplace-based relaxation classes are not offered or conflict with shift times
- Where clinical supervision is offered most can’t benefit due to staffing and time constraints
- One in ten nurses’ sick days are due to stress or depression
Lack of access to clinical supervision and activities that could help to relieve stress and burnout at work is a major barrier to well-being, nurses have told Nursing Standard.
Nearly 2,000 nurses responded to our survey, with results suggesting that employer-led initiatives to improve well-being may not be reaching the nursing workforce.
Hundreds of nurses said workplace-based classes such as yoga, meditation, mindfulness and tai chi are either not offered at their workplaces or clash with shifts times.
Putting issues into perspective
of nurses are offered mindfulness classes by their employers
A study in Finland shows that nurses who receive efficient clinical supervision feel they have more resources in their job and personally, and are more motivated and committed to the organisation.
Some nurses responding to Nursing Standard’s online survey echo these findings.
One says: ‘Clinical supervision helps put work issues into perspective and often helps me solve them.’
Another writes: ‘Clinical supervision is good as I feel well-supported.’
Nearly 80% of those who responded say their organisation offers some form of clinical supervision, including reflective practice.
But many qualify this by saying that in reality they do not get an opportunity to benefit from it, largely due to staffing and time constraints.
One nurse says: ‘In the three plus years I have worked for this NHS trust, I have received only one group clinical supervision.
‘We are so short-staffed, we have no time for clinical supervision.’
Another says: ‘Clinical supervision was great, but I have only been offered it once in three years.
‘With other staff [such as clinical nurse specialists], it is compulsory and they are allocated protected time. I am not.’
‘Clinical supervision is a potential measure to reduce stress in the nursing workforce because it is a form of engagement and colleague support’
Kim Sunley, RCN national officer
Other nurses note the benefits of yoga and mindfulness in helping with sleep and relaxation, but say they pay for these activities privately and do them outside of the workplace.
‘Classes are not offered at a time compatible with shifts,’ says one nurse.
Another says: ‘Yoga is available at 6pm, which is halfway through a shift. I have tried yoga but not through my organisation and I found it beneficial, physically and mentally.’
Favourite ways to wind down
Nurses who responded to the survey shared some of the ways they relax outside of work, including through gardening, yoga, writing journals, spending time with pets, baking, horse riding, reiki, craftwork, music, cycling, swimming, knitting and card making:
‘I spend time with my dogs doing fun stuff. One of my dogs is a Pets as Therapy dog and going on visits makes a difference. I live alone so I talk to the dogs when I get home after a difficult shift.’
‘I have a long bath after shifts and I take regular long rural walks with my dogs. I keep a diary of bad days and good days in work for reflection. I read books and I have a great family life.’
‘I see a therapist anyway. Stroke the cat, bake, walk, read. Sometimes talk to colleagues.’
Music, yoga, gardening
‘I cope better when I head to the gym, when I plan something to look forward to. I take time to do nothing and will isolate away from others to get myself in a better mindset. I will drink alcohol sometimes or arrange a night out. I use music and I will try find something else to focus my mind on.’
‘Yoga, mindfulness and meditation.’
‘Horticulture. I can lose myself in my garden and on my allotment. Quite frankly horticulture keeps me alive. It is the most therapeutic [pursuit].’
‘Play classical music on way home from work.’
‘Spend time alone in the peace and quiet of my allotment. Enjoy time with family and friends.’
In recent years, efforts have been made to address the well-being of the NHS workforce, prompted in part by high sickness absence rates and stress levels.
In 2015, NHS England chief executive Simon Stevens announced a £5 million plan to improve the health and well-being of NHS staff which included offering yoga classes and improving healthy eating options.
of nurses are offered yoga classes by their employers
Mr Stevens said at the time: ‘NHS staff have some of the most critical but demanding jobs in the country. When it comes to supporting the health of our own workforce, frankly the NHS needs to put its own house in order.’
Financial incentives were also offered to organisations that could demonstrate they were making efforts to improve employee well-being, but change has been slow in coming.
‘When everyone is so busy and working so hard, we all need to look after one another’
Sue Tranka, chief nurse at Ashford and St Peter’s Hospitals NHS Foundation Trust
In a similar vein, NHS Improvement has a programme that offers incentives to employers to have good workplace strategies in place for well-being and mental health, and is reported to be looking to roll that out further.
Occupational health expert Steve Boorman carried out a major review of the health of the NHS workforce in 2009, highlighting the fact that ten million days a year were lost to sickness absence.
Maintaining mental health
Dr Boorman found that mental health conditions were a major contributor to NHS staff sickness, with many reporting significant levels of stress.
Last year, a Nursing Standard investigation found that one in ten nurses’ sick days were down to stress or depression.
RCN national officer Kim Sunley says it is disappointing that some organisations are not providing enough, or any, access to clinical supervision for nursing staff.
‘Clinical supervision is a potential measure to reduce stress in the nursing workforce because it is a form of engagement and colleague support, and it is important for clinical risk and patient safety issues.
‘It all comes back to safe and effective staffing – just because you don’t have enough staff this should not be used as an excuse to put supervision aside.
‘It is a lot more challenging when you have fewer staff, but it is really important and comes back to the retention of the workforce and making sure people don’t go off sick with stress and burnout.’
Ms Sunley suggests that too many employers see well-being as a tick-box exercise – they put on a class at 5pm and think they are doing their bit for well-being.
‘A lot of well-being initiatives are targeted at 9-5 workers and not necessarily shift-working nursing staff, who likely need the support most,’ she says.
‘Poorer health outcomes for shift workers are quite well-documented.’
Find out what nurses want
She adds: ‘It is good that employers are putting on initiatives and investing in them but really they should target and speak to nursing staff working shifts and find out what they want and what the best times would be.’
Ms Sunley says employers should use their staff survey results to identify areas with high stress and absenteeism levels and tailor their well-being initiatives accordingly.
‘If you engage and speak with the workforce, finding out what works for them, this is definitely going to improve morale, which links in to staff retention.’
‘A lot of well-being initiatives are targeted at 9-5 workers and not necessarily shift-working nursing staff’
Ms Sunley says employers could consider providing nurses with vouchers, or financial support, to take part in health and well-being classes in their own time.
‘I have heard of organisations outside of the NHS doing this and it is definitely something the RCN would support, as many nurses have caring or family commitments and are very busy.
‘I heard of one trust that gave nurses vouchers to Slimming World, so there are some pockets of good practice out there.’
of nurses are offered meditation classes by their employers
Better access to activities such as yoga that could support workers’ well-being is starting to be recognised at a political and societal level.
An All Party Parliamentary Group on Yoga has just been established in the House of Commons to raise awareness of the long-term beneficial effects of yoga on health and in the workplace.
Benefits of relaxation classes
Some trusts recognise the benefits of relaxation classes. Ashford and St Peter’s Hospitals NHS Foundation Trust in Surrey runs one along with activities such as Zumba, a running club, local walks, a choir and a healthy eating programme.
Chief nurse at the trust Sue Tranka says: ‘A well workforce is one that is made up of happy and healthy individuals.
‘When everyone is so busy and working so hard, we all need to look after one another and have some fun in the process.
‘To support our staff with this we have a dedicated health and well-being team who coordinate all of our wellness activities.’
‘Group yoga can reach more people than physiotherapy’
Bangor University research officer Ned Hartfiel, who trained as a nurse, carried out research into the benefits of yoga for NHS staff in terms of health and well-being.
The study, at Betsi Cadwaladr University Health Board, in Bangor, North Wales, also looked at the cost-effectiveness of running staff yoga programmes for NHS organisations.
Dr Hartfiel, who created the Healthy Back Programme for workplaces, found yoga practice increased well-being, reduced disability associated with back pain and was likely to be cost-effective.
The study evaluated an eight-week yoga programme, with a six-month follow-up. Of the 151 health board employees who took part, 76 were randomised to yoga, 75 to usual-care.
Better quality of life
The results, published last November, show that at six months on, the yoga participants missed a total of just two working days due to musculoskeletal conditions, compared with a total of 43 days for the participants who had not done yoga.
Dr Hartfiel says: ‘We found a yoga-based programme for NHS staff improved well-being [as measured on the World Health Organization well-being scale] and there was a significant improvement for reduction in back pain and health-related quality of life.
‘These are good results, and since then it has been introduced to more hospitals. The evidence shows the benefits, not just my own study, but other research out there shows that yoga-based programmes can be even more cost-effective than physiotherapy. In a group setting, yoga can reach more people.’