CHARLES MILLIGAN
A new menu for a healthier workforce SUMMARY
Nurses are under pressure to be healthy role models, but the food available in hospitals can pile on the pounds. Erin Dean reports There is growing concern about the lack of healthy food options for staff in hospitals. Nurses, particularly those working night shifts, often end up eating junk food. Some trusts are changing the food on offer and setting up staff weight loss clubs. Nurses who have lost weight say they feel more confident giving lifestyle advice to patients. Author Erin Dean is a freelance journalist
Most nurses who have had to hunt for a meal during a shift will know what it is like to be faced with a dispiriting choice between chips from the canteen, microwave-ready fast food or crisps from a vending machine. And then there are the chocolates and sugary treats brought in as gifts by patients and their
relatives. Generally speaking, hospitals are not places where it is easy for staff to eat well. The quality of food available to health service staff at work was recently put in the spotlight by NHS chief executive Simon Stevens. He is reported to have suggested that overweight staff should slim down to set a good
20 october 15 ::from vol 29 no 7 :: 2014 STANDARD Downloaded RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Hospitals need to offer more healthy food so nurses can eat well and deliver better care
example to patients, while acknowledging that the hospital environment often encourages weight gain. ‘A lot of the food in hospital canteens, not just for patients, but for staff, is chips and burgers,’ he said.
Food services
The focus on the food hospitals provide for their staff was sustained by a joint report from the Department of Health (DH) and Age UK at the end of August. The Hospital Food Standards Panel’s report says: ‘Staff need healthier and nutritious food to support them in delivering optimal clinical care, and both staff and visitors need food services that encourage them to make healthier choices. If the NHS is to properly promote health as well as deal with ill health, then it must look to the food it provides.’ The public certainly needs help when it comes to weight loss, as the proportion of the population that is overweight and obese continues to grow, along with the associated conditions including some forms of cancer, cardiovascular disease and type 2 diabetes. And, according to a 2009 DH report, Healthy Weight, Healthy Lives: One Year On, many NHS staff should be doing something about their weight. The report highlighted that about 300,000 of the 1.2 million NHS staff are obese, and a further 400,000 are overweight. The lifestyle advice nurses give patients may be less effective when nurses are overweight, research suggests. A 2009 Ipsos Mori poll found that 37 per cent of the public would not accept advice from a healthcare professional who appeared to have an unhealthy lifestyle. There is limited evidence in this area from the nurses’
perspective, but a small study in the Journal of Advanced Nursing in 2007 reported that larger nurses had concerns about being poor role models. National Nurses Nutrition Group chair Liz Evans says that the odds can be stacked against nurses when it comes to healthy eating. She points out that working shifts can lead to irregular meal times, staff rarely get enough time to eat a proper meal, and the choice of food available in canteens is often limited to high-fat products. ‘When I asked other nursing colleagues around the country about the type of food available to them at work, one said that an option on their salad bar was a whole pork pie, and another said that so-called healthy options were often drowning in mayonnaise,’ says Ms Evans. ‘They said that they could rarely get away from the ward while the canteen was open, and the healthy options could be expensive and not very appetising.
The Eat Well, Nurse Well campaign: principal aims To urge employers to commit to improving food choices and availability for staff by signing up to our healthy helpings charter. To inspire nurses with hints and tips from experts, including other nurses, on healthy eating and portion sizes. To inform nurses on how healthier food choices lead to better patient care.
Changes at York Teaching Hospitals NHS Foundation Trust At York Hospital, when the newly refurbished restaurant opens shortly, staff will have access to a juice and smoothie bar. The idea for juicing was suggested by a staff committee who are keen to support healthier options for NHS workers. York and Selby hospitals retail catering manager Pierre Gomez says that for the past two years food provision for visitors and staff has been moving towards more healthy options, including cheaper prices for fruits and other healthy foods, and smaller portions. There is a salad bar where 90 per cent of the options are considered healthy, with an emphasis on raw food. A fruit and yogurt bar allows staff to create desserts and healthy snacks that count towards their ‘five a day’. ‘We work with dietitians to create recipes, and they do a calorie count of all the hot food,’ Mr Gomez says. ‘When we provide snack items, 40 per cent have to be under 100 calories. ‘We also encourage competitive pricing, so I have reduced the price of fresh fruit and it is available at cost price. There are also meal deals for a sandwich or salad, water and fruit. It is all about having a healthier and happier workforce.’
‘With staffing shortages, staff can rarely leave the hospital, and at night the food options are generally from vending machines,’ she adds. ‘We need a culture where staff can take a break from the work environment, rather than grabbing a snack or some chocolate left as a gift, at their desk. Nurses will not often make the best choices when they are desperate to eat.’ Shift work is a particular problem when it comes to keeping up a routine of three meals a day. Research has linked working night shifts with increased weight. A study of almost 2,500 female nurses in the UK, Australia and New Zealand, published by the American College of Occupational and Environmental Medicine in 2011, found that those working shifts were 15 per cent more likely to be overweight or obese than day workers. Restaurants are rarely open at night in hospitals, leaving staff reliant on either food they bring in from home, vending machines or takeaways. Hospital Caterers Association national chair Andy Jones claims that companies now put a lot more effort into providing healthy choices for staff. He says there are few canteens kept purely for staff now; instead, there are restaurants open to all that may have a section reserved for staff. However, while healthy food
NURSING :: vol 29without no 7 :: permission. 2014 21 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal useoctober only. No15 other uses Copyright © 2015 RCNi Ltd. All rights reserved.
Limiting fat and sugar
Some trusts are taking measures to improve the food on offer to their staff. At Bolton NHS Foundation Trust, changes have been made in vending machines, cafés and restaurants and Royal Voluntary Service shops and trolleys. Drinks high in sugar are limited to small portion sizes of no more than 330ml. Most drinks offered are now low-sugar or diet options. The trust has also removed crisps with the highest fat content and provides only light options of no more than 120 calories, in packs no larger than 30g. Chocolate bars are limited to 60g and large boxes of biscuits have been removed. Trusts are also offering staff weight loss clubs and access to exercise classes and gyms. At the Royal Liverpool and Broadgreen University Hospitals NHS Trust, a free weight loss club for staff has been running for three years. Up to 30 members of staff attend the club, held every Monday lunchtime, where they can be
weighed discreetly and provided with evidence-based healthy eating advice. A greengrocer also visits the trust several times a week to sell fruit and vegetables to staff and visitors. Jennifer Currie, a dietitian at the trust, says: ‘The Weight Loss Challenge Group has been very successful. Those who attend say it is useful to have that commitment of being weighed once a week. One member of staff has lost more than three stone. We have nurses who are losing weight for themselves, and also some who have a health and wellbeing remit and want to set a good example to patients of what can be achieved.’
What should nurses be doing? British Dietetic Association spokesperson Aisling Pigott offers this advice: Regular meals Eating regular meals improves mood and work output and reduces the risk of weight gain. Many nurses start their shifts without eating or skip meals during the working day. This can leave them feeling grumpy, tired and frustrated and more likely to overeat at their next meal. Canteen choices Most hospital canteens have improved their healthy choices, but portion sizes are often far too big. Healthy canteen options include a jacket potato with beans or tomato-based curries or stews. Ask for a small portion.
Talking to patients
Stay hydrated Nursing colleagues should speak with their ward managers and discuss appropriate places and times for hydration during the day.
Limit treats Nurses are regularly exposed to treats and sweets on the ward. Setting yourself a realistic limit – for example, a maximum of two small chocolate sweets per shift – may prevent accidental overindulgence. Meal planning Planning ahead and deciding in advance which meals to have, both in and out of work, can make choosing healthy options much easier. Choose meals that are high in fibre, with plenty of fruit and vegetables and a protein source. Vitamin D Night shift workers are at high risk of vitamin D deficiency because of limited exposure to sunlight. Studies suggest that vitamin D deficiency is associated with low mood, weight gain and many physical and mental health issues. Consider taking vitamin D supplements.
ISTOCKPHOTO
may be provided, it does not mean staff will eat it. ‘There is a better choice of healthy food, but if we did not serve chips we would have a mutiny on our hands,’ says Mr Jones. ‘But there should also be an offering of something healthier, such as new potatoes, and these should not be covered in butter. ‘If we don’t give staff a choice, we know they will go outside to buy it from fast food outlets. I also think we should have vending machines with chocolate in. If someone is on a shift in A&E and it is busy, a bar of chocolate could be their saviour. But we should not be offering multiple packs of chocolate or tins of biscuits in vending machines.’ Mr Jones suggests that some obvious solutions simply do not work in the real world. ‘We can put healthy food in vending machines, but it doesn’t sell.’
Rachael Maiden, a sister in the medical emergency department at University Hospital Llandough in Cardiff, lost just over three stone with a weight loss club. It has made a great difference to how she relates to patients with weight and lifestyle issues. ‘I joined Slimming World after a patient said she didn’t think I should be giving her health advice as I “clearly loved my food”. At the time I was devastated, but I could see where she was coming from and I had also started feeling uncomfortable in my clothes and feeling unhappy with myself generally,’ she says. ‘Since losing weight I feel so much more confident when talking to patients about their health as I have been able to make those positive lifestyle changes myself.’ She adds: ‘When it comes to raising the issue of weight with patients, it’s important that health professionals do it in a sensitive and understanding way. I know from my own experience that it’s a delicate subject and I think that being able to empathise with my patients and talk to them about how I did it makes them more likely to take my advice on board’ NS
22 october 15 ::from vol 29 no 7 :: 2014 STANDARD Downloaded RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
A new menu for a healthier workforce SUMMARY
Nurses are under pressure to be healthy role models, but the food available in hospitals can pile on the pounds. Erin Dean reports There is growing concern about the lack of healthy food options for staff in hospitals. Nurses, particularly those working night shifts, often end up eating junk food. Some trusts are changing the food on offer and setting up staff weight loss clubs. Nurses who have lost weight say they feel more confident giving lifestyle advice to patients. Author Erin Dean is a freelance journalist
Most nurses who have had to hunt for a meal during a shift will know what it is like to be faced with a dispiriting choice between chips from the canteen, microwave-ready fast food or crisps from a vending machine. And then there are the chocolates and sugary treats brought in as gifts by patients and their
relatives. Generally speaking, hospitals are not places where it is easy for staff to eat well. The quality of food available to health service staff at work was recently put in the spotlight by NHS chief executive Simon Stevens. He is reported to have suggested that overweight staff should slim down to set a good
20 october 15 ::from vol 29 no 7 :: 2014 STANDARD Downloaded RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Hospitals need to offer more healthy food so nurses can eat well and deliver better care
example to patients, while acknowledging that the hospital environment often encourages weight gain. ‘A lot of the food in hospital canteens, not just for patients, but for staff, is chips and burgers,’ he said.
Food services
The focus on the food hospitals provide for their staff was sustained by a joint report from the Department of Health (DH) and Age UK at the end of August. The Hospital Food Standards Panel’s report says: ‘Staff need healthier and nutritious food to support them in delivering optimal clinical care, and both staff and visitors need food services that encourage them to make healthier choices. If the NHS is to properly promote health as well as deal with ill health, then it must look to the food it provides.’ The public certainly needs help when it comes to weight loss, as the proportion of the population that is overweight and obese continues to grow, along with the associated conditions including some forms of cancer, cardiovascular disease and type 2 diabetes. And, according to a 2009 DH report, Healthy Weight, Healthy Lives: One Year On, many NHS staff should be doing something about their weight. The report highlighted that about 300,000 of the 1.2 million NHS staff are obese, and a further 400,000 are overweight. The lifestyle advice nurses give patients may be less effective when nurses are overweight, research suggests. A 2009 Ipsos Mori poll found that 37 per cent of the public would not accept advice from a healthcare professional who appeared to have an unhealthy lifestyle. There is limited evidence in this area from the nurses’
perspective, but a small study in the Journal of Advanced Nursing in 2007 reported that larger nurses had concerns about being poor role models. National Nurses Nutrition Group chair Liz Evans says that the odds can be stacked against nurses when it comes to healthy eating. She points out that working shifts can lead to irregular meal times, staff rarely get enough time to eat a proper meal, and the choice of food available in canteens is often limited to high-fat products. ‘When I asked other nursing colleagues around the country about the type of food available to them at work, one said that an option on their salad bar was a whole pork pie, and another said that so-called healthy options were often drowning in mayonnaise,’ says Ms Evans. ‘They said that they could rarely get away from the ward while the canteen was open, and the healthy options could be expensive and not very appetising.
The Eat Well, Nurse Well campaign: principal aims To urge employers to commit to improving food choices and availability for staff by signing up to our healthy helpings charter. To inspire nurses with hints and tips from experts, including other nurses, on healthy eating and portion sizes. To inform nurses on how healthier food choices lead to better patient care.
Changes at York Teaching Hospitals NHS Foundation Trust At York Hospital, when the newly refurbished restaurant opens shortly, staff will have access to a juice and smoothie bar. The idea for juicing was suggested by a staff committee who are keen to support healthier options for NHS workers. York and Selby hospitals retail catering manager Pierre Gomez says that for the past two years food provision for visitors and staff has been moving towards more healthy options, including cheaper prices for fruits and other healthy foods, and smaller portions. There is a salad bar where 90 per cent of the options are considered healthy, with an emphasis on raw food. A fruit and yogurt bar allows staff to create desserts and healthy snacks that count towards their ‘five a day’. ‘We work with dietitians to create recipes, and they do a calorie count of all the hot food,’ Mr Gomez says. ‘When we provide snack items, 40 per cent have to be under 100 calories. ‘We also encourage competitive pricing, so I have reduced the price of fresh fruit and it is available at cost price. There are also meal deals for a sandwich or salad, water and fruit. It is all about having a healthier and happier workforce.’
‘With staffing shortages, staff can rarely leave the hospital, and at night the food options are generally from vending machines,’ she adds. ‘We need a culture where staff can take a break from the work environment, rather than grabbing a snack or some chocolate left as a gift, at their desk. Nurses will not often make the best choices when they are desperate to eat.’ Shift work is a particular problem when it comes to keeping up a routine of three meals a day. Research has linked working night shifts with increased weight. A study of almost 2,500 female nurses in the UK, Australia and New Zealand, published by the American College of Occupational and Environmental Medicine in 2011, found that those working shifts were 15 per cent more likely to be overweight or obese than day workers. Restaurants are rarely open at night in hospitals, leaving staff reliant on either food they bring in from home, vending machines or takeaways. Hospital Caterers Association national chair Andy Jones claims that companies now put a lot more effort into providing healthy choices for staff. He says there are few canteens kept purely for staff now; instead, there are restaurants open to all that may have a section reserved for staff. However, while healthy food
NURSING :: vol 29without no 7 :: permission. 2014 21 DownloadedSTANDARD from RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal useoctober only. No15 other uses Copyright © 2015 RCNi Ltd. All rights reserved.
Limiting fat and sugar
Some trusts are taking measures to improve the food on offer to their staff. At Bolton NHS Foundation Trust, changes have been made in vending machines, cafés and restaurants and Royal Voluntary Service shops and trolleys. Drinks high in sugar are limited to small portion sizes of no more than 330ml. Most drinks offered are now low-sugar or diet options. The trust has also removed crisps with the highest fat content and provides only light options of no more than 120 calories, in packs no larger than 30g. Chocolate bars are limited to 60g and large boxes of biscuits have been removed. Trusts are also offering staff weight loss clubs and access to exercise classes and gyms. At the Royal Liverpool and Broadgreen University Hospitals NHS Trust, a free weight loss club for staff has been running for three years. Up to 30 members of staff attend the club, held every Monday lunchtime, where they can be
weighed discreetly and provided with evidence-based healthy eating advice. A greengrocer also visits the trust several times a week to sell fruit and vegetables to staff and visitors. Jennifer Currie, a dietitian at the trust, says: ‘The Weight Loss Challenge Group has been very successful. Those who attend say it is useful to have that commitment of being weighed once a week. One member of staff has lost more than three stone. We have nurses who are losing weight for themselves, and also some who have a health and wellbeing remit and want to set a good example to patients of what can be achieved.’
What should nurses be doing? British Dietetic Association spokesperson Aisling Pigott offers this advice: Regular meals Eating regular meals improves mood and work output and reduces the risk of weight gain. Many nurses start their shifts without eating or skip meals during the working day. This can leave them feeling grumpy, tired and frustrated and more likely to overeat at their next meal. Canteen choices Most hospital canteens have improved their healthy choices, but portion sizes are often far too big. Healthy canteen options include a jacket potato with beans or tomato-based curries or stews. Ask for a small portion.
Talking to patients
Stay hydrated Nursing colleagues should speak with their ward managers and discuss appropriate places and times for hydration during the day.
Limit treats Nurses are regularly exposed to treats and sweets on the ward. Setting yourself a realistic limit – for example, a maximum of two small chocolate sweets per shift – may prevent accidental overindulgence. Meal planning Planning ahead and deciding in advance which meals to have, both in and out of work, can make choosing healthy options much easier. Choose meals that are high in fibre, with plenty of fruit and vegetables and a protein source. Vitamin D Night shift workers are at high risk of vitamin D deficiency because of limited exposure to sunlight. Studies suggest that vitamin D deficiency is associated with low mood, weight gain and many physical and mental health issues. Consider taking vitamin D supplements.
ISTOCKPHOTO
may be provided, it does not mean staff will eat it. ‘There is a better choice of healthy food, but if we did not serve chips we would have a mutiny on our hands,’ says Mr Jones. ‘But there should also be an offering of something healthier, such as new potatoes, and these should not be covered in butter. ‘If we don’t give staff a choice, we know they will go outside to buy it from fast food outlets. I also think we should have vending machines with chocolate in. If someone is on a shift in A&E and it is busy, a bar of chocolate could be their saviour. But we should not be offering multiple packs of chocolate or tins of biscuits in vending machines.’ Mr Jones suggests that some obvious solutions simply do not work in the real world. ‘We can put healthy food in vending machines, but it doesn’t sell.’
Rachael Maiden, a sister in the medical emergency department at University Hospital Llandough in Cardiff, lost just over three stone with a weight loss club. It has made a great difference to how she relates to patients with weight and lifestyle issues. ‘I joined Slimming World after a patient said she didn’t think I should be giving her health advice as I “clearly loved my food”. At the time I was devastated, but I could see where she was coming from and I had also started feeling uncomfortable in my clothes and feeling unhappy with myself generally,’ she says. ‘Since losing weight I feel so much more confident when talking to patients about their health as I have been able to make those positive lifestyle changes myself.’ She adds: ‘When it comes to raising the issue of weight with patients, it’s important that health professionals do it in a sensitive and understanding way. I know from my own experience that it’s a delicate subject and I think that being able to empathise with my patients and talk to them about how I did it makes them more likely to take my advice on board’ NS
22 october 15 ::from vol 29 no 7 :: 2014 STANDARD Downloaded RCNi.com by ${individualUser.displayName} on Nov 28, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
