Well-being survey: ‘inhumane’ shifts leave no time even for a sip of water

Exclusive research carried out by Nursing Standard shows understaffing and issues with management are risking nurses’ health

• Three quarters of nurses surveyed said they often work shifts without breaks
• Only one in five say they always have a chance to hydrate during their shift
• RCN brands survey findings ‘inhumane’ and raises patient safety concerns 

Eight out of ten nurses have gone an entire shift without a single drink of water, with more than half saying it happens at least once a week, an exclusive survey for Nursing Standard has revealed.

• RELATED: Advice for nurses and employers as UK faces heatwave

Nurses responding to our survey cited a lack of staffing – and in some cases, 'uncaring' management – as preventing them from taking proper breaks, having a drink or even using the toilet, as they struggle to meet their patients’ needs.

The RCN warns it is 'inhumane' to leave staff without access to drinking water and in danger of dehydration at work.

No time for breaks: what nurses told us

'We are worked to the bone,’ one nurse told our survey. ‘Breaks do not even get considered.’

• RELATED: How to create a ‘take a break’ culture

‘Nurses' breaks and hydration are never priorities,’ another added.

Three quarters of the almost 2,250 nurses who responded to our well-being at work poll said they regularly did not have time for a single break on a shift.

Just one in five said they always had a chance to hydrate at work.

When staff well-being is a patient safety issue

The RCN, which is campaigning for all nurses to have the chance to rest, hydrate and refuel during shifts, says accessing these basic needs is essential for nurses’ well-being, and affects the quality of care they can provide to patients.

Dehydration can affect cognition, which can affect decision making, the college says. Breaks can help prevent fatigue-related incidents. 

• RELATED: Dehydrated nurses in hot weather are a patient safety issue, RCN warns

Kim Sunley, RCN national officer for health, safety and well-being, branded our survey findings ‘shocking and disappointing’.

‘It is inhumane for organisations not to let staff have access to drinking water, along with breaking health and safety regulations,’ she says.

‘We are aware that access to breaks is a problem, and it is a symptom of the wider issue around nursing shortages. When nurses don’t have breaks or are not hydrated, it is a patient safety issue.’

Greater focus on staff well-being

In January 2018, the House of Commons health and social care committee published a report into the nursing workforce that called for a greater focus on staff well-being. 

It 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. 

When approached by Nursing Standard, NHS England would not confirm if these letters had ever been sent.

An NHS England spokesperson said: 'Clearly NHS staff should be able to eat, drink and rest during shifts, but we know nurses and midwives will often put patients’ needs above their own.

'Many local hospital have come up with good solutions to help find the right balance during busy times so – as well as continuing to fill nursing vacancies – the NHS will also be encouraging others to follow their lead.'

Our survey revealed that some employers take the matter more seriously than others.

Best practice examples included all staff being given their own water bottles and set ‘hydration stations’.

Water bottles barred from the nurses’ station 

Yet some nurses reported they are not allowed to have water bottles at work, and one was even barred from putting a jug of water in their staff room.

• RELATED: Readers panel – should nursing staff be allowed water bottles in clinical settings? 

One nurse reported that water machines that had been installed on all wards were being taken out after only a few months, while another said their water stations were not replenished often enough.

‘[We are] often told we can’t have water bottles at the nursing station because of the risk of infection or by the computers or that it looks unprofessional,’ one said.

Failures at management level 

Opportunities for breaks often vanished due to high workloads caused by too few staff, nurses told the survey.

‘[Our] manager tries to help us get breaks but it's so hectic,’ one said.

When nurses fail to fit in breaks, they are sometimes accused of not using their time efficiently.

‘Managers are aware of situation but [we] are just told to manage our time more effectively, which is hard when you have 12-plus complex community patients to visit in a 7.5-hour shift,’ one community nurse said.

More than half (56%) said their manager was not concerned about their well-being.

• RELATED: Revealed – the appalling pressures that threaten nurses’ health every day

Some nurses commented that while their manager was interested in them, they were hampered in what they could do to improve the situation by lack of staff, work pressures, and lack of support from their own superiors.

Some said their managers also did not get a chance to have a break either. Others simply said that their manager did not care.

‘She is more concerned about work being done,’ one said. 

'As long as her boxes are ticked, she couldn’t care less,’ another said.

Some managers did not lead by example. 

‘[My manager] pretends to be [concerned about well-being] yet goes home on time always and expects everyone else to stay if [the] ward is short staffed,’ a respondent said.

Are you a manager? Here are ways to help your staff stay hydrated

• Consult staff on the barriers to drinking fluid and find out what would make it easier for them to do so on a shift
• Ensure adequate and easy access to drinking water for nursing staff – this could be tap water or piped filtered water
• Consider the needs of community staff and ensure they have access to areas where they can top up water bottles
• Cluttered areas with bottles and mugs can pose a risk or make areas look untidy – consider following the case study example (see box, below) of personalised water bottles or use a hydration station
• Hydration stations with a storage area and water supply can be used to keep areas clear and create easy access
• Consider the use of charitable funds to purchase water bottles or hydration stations
• As a manager and a team member, model behaviours for patients and peers by ensuring you drink enough fluids
• Be especially vigilant during hot weather and look out for staff who may be more vulnerable to dehydration, such as those who have long-term conditions or are pregnant/breast feeding
• Consider the use of posters to prompt staff to drink more fluid. Urine colour charts in staff toilet areas may also help prompt staff to drink more fluid.

Adapted from the RCN’s Rest, Rehydrate, Refuel: a resource to improve the working environments for nursing staff

Damaging conditions for staff health

Nurses told the Nursing Standard survey about distressing circumstances that were damaging their health and well-being. One respondent receiving treatment for breast cancer that causes bone pain and fatigue was not allowed to reduce her hours.

One nurse said she was leaving her job to protect her health. 

• RELATED: NMC figures show number of nurses leaving NHS continues to exceed number joining

‘My new manager has offered to change things, but unfortunately my old manager was not supportive of helping change my work-life balance, hence the reason for leaving,’ the nurse said.

‘It’s a shame that it takes an experienced, senior nurse to leave their job before something is done.’

A survey carried out by the Nursing and Midwifery Council in 2017 suggested that this nurse is not alone; it found that 44% of nurses leaving the register for reasons other than retirement cited working conditions.

The employers who are getting it right

But some respondents reported excellent support from their manager through promoting access to water, reducing shift lengths, holding meetings over a drink so staff can rehydrate, and emphasising the importance of breaks.

• RELATED: Revealed – what nurses say about short-staffing and how it’s harming patient care

‘I have a disability. They are good at making adjustments, and I don’t get much hassle over sick time,’ one person told the survey.

A member of staff from a preoperative assessment clinic said that her manager does care that they have breaks and handed out ice lollies during the summer.

Best practice: personalised water bottles for staff

Nurses at Poole Hospital NHS Foundation Trust are encouraged to use their own personalised water bottle at work to ensure they stay hydrated.

Geoffrey Walker, matron for specialist medicine and ambulatory care, says that in hectic departments it can be difficult for staff to access water.

‘We’ve never stopped nursing staff drinking on shift but inevitably leaving water bottles and cups of tea around did cause a mess,' he says.

'They were often knocked over and had the potential to be used as a weapon by patients.’

A colleague in the emergency department came up with the idea of sourcing water bottles that could be personalised with the hospital logo and the name of each member of staff. Some departments, including the emergency department, give staff their own bottle when they start working there.

‘These bottles look professional on wards and show our commitment to encouraging staff to keep hydrated’

Geoffrey Walker, matron, Poole Hospital NHS Foundation Trust

‘The base need of everyone is to be able to drink, and with staff working 12-hour shifts, promoting health and well-being was important to us,’ Mr Walker said.

‘These bottles look professional on wards and they show our commitment to encouraging staff to keep hydrated.

'Improving hydration is so important to all staff working in whatever role they have, especially in this heat we have experienced. The well-being of the workforce is of paramount concern to nurse leaders and I am pleased to say the message is accepted across all our trust.

'Staff are given these bottles when they join and they fill them up at the start of each shift . It sounds like a small thing but it has had such a major impact.’

Mr Walker said he would encourage other trusts to take a similar approach to highlight the importance of staff hydration. 

‘I would recommend that all adopt the line “hydration matters”, and my tip would be to source bottles that all can use and therefore everyone realises it’s an everyday occurrence.'

How nurses cope with workplace stress

Nurses told the survey that they had a wide range of approaches to dealing with work-related stress, including yoga, swimming, dancing, and spending time with their family.

Meditation, mindfulness, reflective practice and speaking to friends and colleagues were also mentioned.

From the responses it is clear that while nurses try many different approaches, including counselling, stress and anxiety caused by work are having a serious impact on their lives.

• RELATED: Too stressed to work: the scale of mental ill health among NHS staff revealed

One respondent pointed out that rotas could make it difficult to maintain hobbies that can help deal with stress, another said they were often kept awake at night worrying about work. Another said they suffered a breakdown after bullying from their matron.

Alcohol was frequently mentioned by nurses feeling stressed. One said: ‘I often need a glass of wine after a shift. It helps me wind down but worries me. I don’t drink the other days.’

‘I’m not sure I deal with it [stress],’ one respondent said. ‘It’s a constant cycle of being under pressure at work and then being at home stressing about the next day.’

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