TOPIC HEADER PROFESSIONAL
Managing work-related stress in the district nursing workplace Michelle Burke
Michelle Burke is Tutor, Florence Nightingale School of Nursing and Midwifery, King’s College London
W
ork-related stress is defined as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them at work’ (Health and Safety Executive (HSE), 2007:7). Under UK law, employers have a duty of care to protect the health, safety and welfare of their employees and to assess the risks arising from hazards at work, including work-related stress (HSE, 2007). Stressful work environments place high demands on a person, without giving them sufficient control and support to manage those demands, with a perceived imbalance between the effort required and the rewards of the job (National Institute for Health and Care Excellence (NICE), 2009). NHS staff are almost four times as likely to be absent from work with stress compared with other occupations (Clews and Ford, 2009) and the rate of sickness absence within nursing and midwifery averages 4.87%, the third highest in the NHS (Health and Social Care Information Centre, 2012).
© 2013 MA Healthcare Ltd
Environmental work stressors In 2012, a national survey of nearly 3000 nurses captured aspects of the working conditions of nurses in 31 acute hospitals across England (Ball et al, 2012). Some 42% of the nurses surveyed were classified as suffering from emotional exhaustion; 70% of the respondents felt there were insufficient numbers of staff to get work done; 80% reported that at least one aspect of care was not done in their last shift due to lack of time and 44% said that they would leave their current job due to job dissatisfaction. These results are supported by previous, smaller studies (Zeytinoglu et al, 2006; Laschinger, 2010). Although district nurses were not represented in the survey by Ball et al (2012), the findings could be tentatively applied to the district nursing setting, as smaller-scale research has identified similar outcomes. A descriptive study by Evans (2002) explored district nurses’ experiences of stressful workrelated events and found that the primary cause of stress for district nurses was an inability to complete work in scheduled hours, with respondents regularly working over their scheduled hours, taking work home and working through their lunch breaks. Storey et al (2009) found that 36% (172) of the district nurses surveyed identified workload and staff shortages as the top barrier to continuing working in nursing. Haycock et al (2008) also highlight the culture of long hours that is evident within district nursing. The study participants likened district nursing to a ‘ward without walls’, a care environment that is constantly expanding, with no limit on the number of patients and little influence on the number
British Journal of Community Nursing Vol 18, No 11
Email: [email protected] of referrals. The district nurses in the study described overwhelming time pressures and a conflict between workload and contracted hours that caused them to use other areas of time, particularly their lunch break, to complete their work. Haycock et al (2008) highlight that this lack of relaxation time does not allow nurses to cope with stress. Witkoski and Dickson (2010) explored nursing working hours from an occupational health perspective and concluded that working without adequate rest breaks results in serious declines in functioning, which can lead to safety issues for patients and nurses.
The district nursing landscape It is evident that although the workplace for district nurses presents a unique caring environment, it can also offer a multiplicity of sources of stress. The Health and Social Care Act heralded the shift towards a more communityfocused NHS, and the NHS care objectives (Department of Health (DH), 2012a) mirror the challenges community health and social care services are facing. An ageing population produces complex health and social care needs and an enduring and increasing focus on long-term conditions management, complex care management and end-of-life care, which are the principal elements of the district nursing role. District nurses undertake multifaceted interventions and assessments in a non-clinical environment, which require a high level of responsibility and risk management (Queen’s Nursing Institute (QNI), 2009). Add to this the increase in the number of older people living alone and the societal changes that have impacted on the availability of family or social network support and the challenges are
Abstract
This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive’s (HSE’s) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.
Key Words
w District nursing w Work-related stress wStaff health and wellbeing w HSE Management Standards w Quality care
535
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
iStock/geotrac
PROFESSIONAL
The nurse’s working environment can offer a multiplicity of sources of stress.
Stress-management strategies Work-related stress management in nursing has predominantly been researched from the perspective of reducing its effects, rather than tackling actual stressors in the workplace (Jordan at al, 2003). Within the nursing literature, an emphasis has been placed on the different strategies or coping mechanisms available to counteract stress in nursing: w Problem-focused strategies (time management, clinical supervision) w Emotion-focused strategies (reflection, peer support) w Lifestyle changes (diet, exercise) (RCN, 2005; 2009; Fearon and Nicol, 2011; Por et al, 2011). While emotion- and problem-focused strategies clearly play a part in stress management, there is now increased interest in investigating stress from an organisational perspective, with primary intervention strategies aiming to
536
attempt to eliminate the sources of stress by focusing on changing the physical or sociopolitical work environment (Jordan et al, 2003; McVicar, 2003; Fearon and Nicol, 2011).
Recent reports A recent large-scale cross-sectional survey of nurses and patients in hospitals in the US and in 12 countries in Europe was undertaken with the objective of determining whether good organisation of care (improved work environments and nurse staffing) affected patient care and nurse workforce stability (Aiken et al, 2012). Although the findings varied considerably by country, it was found that improved work environments and staffing levels were associated with increased care quality and patient satisfaction. It is of note that the research by Aiken et al (2012) in the US showed that
‘investment in staffing improved patient outcomes only if hospitals also had a good working environment.’ In the Nursing and Care Quality Forum’s report, Brearley (2012) also notes that the facilitation of quality nursing care is not only an issue of resources (i.e. staffing levels), but also of leadership and organisational workplace culture.
NHS health and wellbeing report Four years ago, the Boorman Report (DH, 2009) set out the case for the active promotion of a positive workplace
© 2013 MA Healthcare Ltd
compounded. However, at the same time as the need for skilled district nurses is steadily rising, district nursing numbers are dwindling and teams are working within a climate of restructuring, organisational uncertainty and financial constraint (Royal College of Nursing (RCN), 2012). The shift in the configuration and focus of the NHS will inevitably result in changes to nursing career pathways, with a potential increase in the number of newly qualified nurses entering the community nursing workforce. Supporting both the existing and future workforce is pivotal to ensure high-quality autonomous care in the home setting (QNI, 2009).
British Journal of Community Nursing Vol 18, No 11
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
TOPIC HEADER PROFESSIONAL
Figure 1. The Health and Safety Executive employee stress survey tool (HSE, 2007).
culture and made clear links between staff wellbeing and three dimensions of service quality: patient safety, patient experience and the effectiveness of patient care (DH, 2009). It identified that when NHS staff support services were proactive rather than reactive, and prioritised staff health and wellbeing, staff performance was enhanced, patient care improved, staff retention was higher and sickness absence was lower. The Boorman Report (DH, 2009) recommended that all NHS organisations give priority to implementing the NICE (2009) public health guidance, Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers, as a sign of their commitment to staff health and wellbeing. In turn, the NICE (2009) guidance recommended that employers should consider adopting a structured approach to promoting their employees’ mental wellbeing at work, by using frameworks such as the HSE’s Management Standards for Work-related Stress (2007).
© 2013 MA Healthcare Ltd
HSE’s Management Standards approach to work-related stress The Management Standards approach to work-related stress evolved from extensive research carried out on behalf of the HSE. Three theoretical models underpin much of the evidence on work-related stress: the effort-reward model; the demand-control model; and the model of organisational justice (NICE, 2009). The Management Standards refer to six areas of work that can lead to stress if not properly managed (HSE, 2007):
British Journal of Community Nursing Vol 18, No 11
w Demands—includes workload, work patterns and the work environment w Control—how much say a person has in the way they do their work w Support—includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues w Role—whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles w Change—how organisational change (large or small) is managed and communicated in the organisation w Relationships—promoting positive working to avoid conflict and dealing with unacceptable behaviour. A key part of the approach is the employee ‘stress survey tool’ (Figure 1). This is based on a taxonomy of the
LEARNING POINTS w The district nursing workplace is unique, but can offer a multiplicity of sources of stress w Emotion- and problem-focused strategies play a part in stress management, but there is now an increasing interest in investigating stress from an organisational perspective w A Health and Safety Exectutive stress survey tool has been designed to capture employee’s perceptions of their work environment w Pervasive work stressors must be acknowledged and proactively managed if the Government’s future vision of the NHS is to become a reality
537
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
PROFESSIONAL
Conclusion District nursing team leaders could consider making use of the HSE’s stress survey tool to capture their team’s perceptions of their work environments, to identify, with their staff, the areas where improvements could be made and also to communicate to commissioners the issues that affect staff in their roles. Team leaders are fundamental to creating a workplace climate that enhances staff wellbeing and delivers quality patient care. The Government (DH, 2012a) has called for nursing leaders to be empowered and encouraged to manage resources to deliver safe, effective and compassionate care—and interventions such as the Management Standards approach are central to achieving this purpose. Investment in a positive workplace environment that allows a skilled district nursing workforce to develop, and in which staff are enabled to provide quality patient care, is essential. Achieving the government’s vision of an NHS in which
538
quality and outcomes are the best in the world (DH, 2012b) and in which district nurses play an important role (RCN, 2012) will be a challenge if pervasive work stressors are not acknowledged and proactively managed. BJCN Aiken H, Sermeus W, Van den Heede K et al (2012) Patient safety, satisfaction, and quality of hospital care: cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 344: e1717 doi: 10.1136/ bmj.e1717 Ball J, Pike G, Griffiths P, Rafferty A, Murrells T (2012) RN4CAST nurse survey in England. National Nursing Research Unit. http://tinyurl.com/d5dunaj (accessed 4 September 2013) Brearley S (2012) Nursing and Care Quality Forum initial recommendations. Department of Health. http://tinyurl.com/cajfujd (accessed 4 September 2013) Clews G, Ford S (2009) NHS stress driving up nurse sick leave levels. Nurs Times 105(14): 1 Department of Health (DH) (2009) NHS health and wellbeing: final report. http://tinyurl.com/q8wzemw (accessed 4 September 2013) Department of Health (DH) (2012a) Our NHS care objectives: a draft mandate to the NHS commissioning board. http://tinyurl.com/pp9nel3 (accessed 4 September 2013) Department of Health (DH) (2012b). Compassion in practice. Nursing midwifery and care staff: our vision and strategy. http://tinyurl.com/conq7cl (accessed 4 September 2013) Evans L (2002) An exploration of district nurses’ perceptions of occupational stress. Br J Nurs 11(8): 576–85 Fearon C, Nicol M (2011) Strategies to assist prevention of burnout in nursing staff. Nurs Stand 26(14): 35–9 Gupta V, Woodman C (2010) Managing stress in a palliative care team. Paediatr Nurs 22(10): 14–8 Haycock E, Jarvis A, Daniel K (2008) A ward without walls? District nurses’ perceptions of their workload management priorities and job satisfaction. J Clin Nurs 17: 3012–20 Health and Safety Executive (HSE) (2007) Managing the causes of work-related stress: a step by step approach using the Management Standards. http://tinyurl.com/ont2oxz (accessed 4 September 2013) Health and Safety Executive (HSE) (2012a) Business solution case studies. www. hse.gov.uk/stress/experience.htm (accessed 4 September 2013) Health and Safety Executive (HSE) (2012b) Great Western Hospitals NHS Foundation Trust: nurses case study. http://tinyurl.com/nwj4442 (accessed 4 September 2013) Health and Social Care Information Centre (2012) Sickness absence rates in the NHS: April–June 2012. http://tinyurl.com/obzj22c (accessed 4 September 2013) Jordan J, Gurr E, Tinline G et al (2003) NHS stress driving up nurse sick leave levels. In: Beacons of Excellence in Stress Prevention: Research Report 133. HSE Books, Suffolk Laschinger H (2010) New graduate nurses’ expectations of bullying and burnout in a hospital setting. J Adv Nurs 66(12): 2732–42 McVicar A (2003) Workplace stress in nursing: a literature review. J Adv Nurs 44(6): 633–42 National Institute for Health and Care Excellence (NICE) (2009) Promoting mental wellbeing through productive and healthy working conditions: guidance for employers. http://tinyurl.com/papowoc (accessed 4 September 2013) Por J, Barriball L, Fitzpatrick J, Roberts J (2011) Emotional intelligence: its relationship to stress, coping, well-being and professional performance in nursing students. Nurs Ed Today 31(8): 855–60 Queen’s Nursing Institute (QNI) (2009) 2020 Vision: Focus on the Future of District Nursing. http://tinyurl.com/nuvboxy (accessed 4 September 2013) Royal College of Nursing (RCN) (2005) Managing your stress: a guide for nurses. http://tinyurl.com/pd6pkbk (accessed 4 September 2013) Royal College of Nursing (RCN) (2009) Work-related stress: a good practice guide for RCN representatives. http://tinyurl.com/ndax8bn (accessed 4 September 2013) Royal College of Nursing (RCN) (2012) The community nursing workforce in England. http://tinyurl.com/puuzau9 (accessed 4 September 2013) Storey C, Cheater F, Ford J, Leese B (2009) Retaining older nurses in primary care and the community. J Adv Nurs 65(7): 1400–11 Witkoski A, Dickson W (2010) Hospital staff nurses’ work hours, meal periods and rest breaks: a review from an occupational nurse perspective. AAOHN 58(11): 489–97 Zeytinoglu I, Denton M, Davies S et al (2006) Retaining nurses in their employing hospitals and in the profession: effects of job reference, unpaid overtime, importance of earnings and stress. Health Policy 79(1): 57–72
© 2013 MA Healthcare Ltd
six identified work stressors and was designed to capture employees’ perceptions of their work environment (HSE, 2007). The stress survey tool aims to help managers focus on the underlying causes of stress in their workplace and subsequently develop proactive stress prevention interventions. The HSE’s website (HSE, 2012a) offers a variety of resources aimed at managers and also employees. It outlines the key Management Standards message, the person’s role in the Management Standards and their next steps in the process. Case studies provided by NHS trusts that have employed parts of the Management Standards approach are also available to view on the website (HSE, 2012b). One trust used the stress survey tool and found that 32% of their staff were experiencing work-related stress and this was identified as being the main cause of staff absence. Nurses in the trust identified that among the potential causes of their stress were workload (demands), not being able to take breaks (control) and levels of staffing (demands). The trust responded by implementing face-to-face briefings at the end of each shift to raise any workplace issues. Staffing, recruitment and training needs were also addressed. The RCN (2009) also presents examples of solutions identified by NHS trusts following implementation of the HSE Management Standards approach, including appointing more staff to a team when there was evidence of excessive workloads and improved communication during a period of change. Gupta and Woodman (2010) describe a solution-focused stress intervention which was implemented in a children’s community palliative care team and which could be used in district nursing teams. The nine nurses in the team identified their stressors and were then asked to consider solutions, which were divided according to what the nurses thought they could do to reduce stress from an individual, team, and service perspective. Solutions included: w Fewer meetings w Reorganisation of caseloads w Active discharge w An ‘achievable’ time-off-in-lieu system.
British Journal of Community Nursing Vol 18, No 11
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
Managing work-related stress in the district nursing workplace Michelle Burke
Michelle Burke is Tutor, Florence Nightingale School of Nursing and Midwifery, King’s College London
W
ork-related stress is defined as ‘the adverse reaction people have to excessive pressures or other types of demand placed on them at work’ (Health and Safety Executive (HSE), 2007:7). Under UK law, employers have a duty of care to protect the health, safety and welfare of their employees and to assess the risks arising from hazards at work, including work-related stress (HSE, 2007). Stressful work environments place high demands on a person, without giving them sufficient control and support to manage those demands, with a perceived imbalance between the effort required and the rewards of the job (National Institute for Health and Care Excellence (NICE), 2009). NHS staff are almost four times as likely to be absent from work with stress compared with other occupations (Clews and Ford, 2009) and the rate of sickness absence within nursing and midwifery averages 4.87%, the third highest in the NHS (Health and Social Care Information Centre, 2012).
© 2013 MA Healthcare Ltd
Environmental work stressors In 2012, a national survey of nearly 3000 nurses captured aspects of the working conditions of nurses in 31 acute hospitals across England (Ball et al, 2012). Some 42% of the nurses surveyed were classified as suffering from emotional exhaustion; 70% of the respondents felt there were insufficient numbers of staff to get work done; 80% reported that at least one aspect of care was not done in their last shift due to lack of time and 44% said that they would leave their current job due to job dissatisfaction. These results are supported by previous, smaller studies (Zeytinoglu et al, 2006; Laschinger, 2010). Although district nurses were not represented in the survey by Ball et al (2012), the findings could be tentatively applied to the district nursing setting, as smaller-scale research has identified similar outcomes. A descriptive study by Evans (2002) explored district nurses’ experiences of stressful workrelated events and found that the primary cause of stress for district nurses was an inability to complete work in scheduled hours, with respondents regularly working over their scheduled hours, taking work home and working through their lunch breaks. Storey et al (2009) found that 36% (172) of the district nurses surveyed identified workload and staff shortages as the top barrier to continuing working in nursing. Haycock et al (2008) also highlight the culture of long hours that is evident within district nursing. The study participants likened district nursing to a ‘ward without walls’, a care environment that is constantly expanding, with no limit on the number of patients and little influence on the number
British Journal of Community Nursing Vol 18, No 11
Email: [email protected] of referrals. The district nurses in the study described overwhelming time pressures and a conflict between workload and contracted hours that caused them to use other areas of time, particularly their lunch break, to complete their work. Haycock et al (2008) highlight that this lack of relaxation time does not allow nurses to cope with stress. Witkoski and Dickson (2010) explored nursing working hours from an occupational health perspective and concluded that working without adequate rest breaks results in serious declines in functioning, which can lead to safety issues for patients and nurses.
The district nursing landscape It is evident that although the workplace for district nurses presents a unique caring environment, it can also offer a multiplicity of sources of stress. The Health and Social Care Act heralded the shift towards a more communityfocused NHS, and the NHS care objectives (Department of Health (DH), 2012a) mirror the challenges community health and social care services are facing. An ageing population produces complex health and social care needs and an enduring and increasing focus on long-term conditions management, complex care management and end-of-life care, which are the principal elements of the district nursing role. District nurses undertake multifaceted interventions and assessments in a non-clinical environment, which require a high level of responsibility and risk management (Queen’s Nursing Institute (QNI), 2009). Add to this the increase in the number of older people living alone and the societal changes that have impacted on the availability of family or social network support and the challenges are
Abstract
This article aims to highlight the issue of work-related stress within the district nursing workplace. It will acknowledge how the management of work-related stress has previously been discussed within nursing literature and will consider the emerging relationship between staff working conditions, staff wellbeing and quality of patient care. It will reintroduce the Health and Safety Executive’s (HSE’s) Management Standards approach to tackling work-related stress, which provides management support to reduce environmental work stressors and encourage enabling work environments and a positive workplace culture.
Key Words
w District nursing w Work-related stress wStaff health and wellbeing w HSE Management Standards w Quality care
535
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
iStock/geotrac
PROFESSIONAL
The nurse’s working environment can offer a multiplicity of sources of stress.
Stress-management strategies Work-related stress management in nursing has predominantly been researched from the perspective of reducing its effects, rather than tackling actual stressors in the workplace (Jordan at al, 2003). Within the nursing literature, an emphasis has been placed on the different strategies or coping mechanisms available to counteract stress in nursing: w Problem-focused strategies (time management, clinical supervision) w Emotion-focused strategies (reflection, peer support) w Lifestyle changes (diet, exercise) (RCN, 2005; 2009; Fearon and Nicol, 2011; Por et al, 2011). While emotion- and problem-focused strategies clearly play a part in stress management, there is now increased interest in investigating stress from an organisational perspective, with primary intervention strategies aiming to
536
attempt to eliminate the sources of stress by focusing on changing the physical or sociopolitical work environment (Jordan et al, 2003; McVicar, 2003; Fearon and Nicol, 2011).
Recent reports A recent large-scale cross-sectional survey of nurses and patients in hospitals in the US and in 12 countries in Europe was undertaken with the objective of determining whether good organisation of care (improved work environments and nurse staffing) affected patient care and nurse workforce stability (Aiken et al, 2012). Although the findings varied considerably by country, it was found that improved work environments and staffing levels were associated with increased care quality and patient satisfaction. It is of note that the research by Aiken et al (2012) in the US showed that
‘investment in staffing improved patient outcomes only if hospitals also had a good working environment.’ In the Nursing and Care Quality Forum’s report, Brearley (2012) also notes that the facilitation of quality nursing care is not only an issue of resources (i.e. staffing levels), but also of leadership and organisational workplace culture.
NHS health and wellbeing report Four years ago, the Boorman Report (DH, 2009) set out the case for the active promotion of a positive workplace
© 2013 MA Healthcare Ltd
compounded. However, at the same time as the need for skilled district nurses is steadily rising, district nursing numbers are dwindling and teams are working within a climate of restructuring, organisational uncertainty and financial constraint (Royal College of Nursing (RCN), 2012). The shift in the configuration and focus of the NHS will inevitably result in changes to nursing career pathways, with a potential increase in the number of newly qualified nurses entering the community nursing workforce. Supporting both the existing and future workforce is pivotal to ensure high-quality autonomous care in the home setting (QNI, 2009).
British Journal of Community Nursing Vol 18, No 11
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
TOPIC HEADER PROFESSIONAL
Figure 1. The Health and Safety Executive employee stress survey tool (HSE, 2007).
culture and made clear links between staff wellbeing and three dimensions of service quality: patient safety, patient experience and the effectiveness of patient care (DH, 2009). It identified that when NHS staff support services were proactive rather than reactive, and prioritised staff health and wellbeing, staff performance was enhanced, patient care improved, staff retention was higher and sickness absence was lower. The Boorman Report (DH, 2009) recommended that all NHS organisations give priority to implementing the NICE (2009) public health guidance, Promoting Mental Wellbeing through Productive and Healthy Working Conditions: Guidance for Employers, as a sign of their commitment to staff health and wellbeing. In turn, the NICE (2009) guidance recommended that employers should consider adopting a structured approach to promoting their employees’ mental wellbeing at work, by using frameworks such as the HSE’s Management Standards for Work-related Stress (2007).
© 2013 MA Healthcare Ltd
HSE’s Management Standards approach to work-related stress The Management Standards approach to work-related stress evolved from extensive research carried out on behalf of the HSE. Three theoretical models underpin much of the evidence on work-related stress: the effort-reward model; the demand-control model; and the model of organisational justice (NICE, 2009). The Management Standards refer to six areas of work that can lead to stress if not properly managed (HSE, 2007):
British Journal of Community Nursing Vol 18, No 11
w Demands—includes workload, work patterns and the work environment w Control—how much say a person has in the way they do their work w Support—includes the encouragement, sponsorship and resources provided by the organisation, line management and colleagues w Role—whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles w Change—how organisational change (large or small) is managed and communicated in the organisation w Relationships—promoting positive working to avoid conflict and dealing with unacceptable behaviour. A key part of the approach is the employee ‘stress survey tool’ (Figure 1). This is based on a taxonomy of the
LEARNING POINTS w The district nursing workplace is unique, but can offer a multiplicity of sources of stress w Emotion- and problem-focused strategies play a part in stress management, but there is now an increasing interest in investigating stress from an organisational perspective w A Health and Safety Exectutive stress survey tool has been designed to capture employee’s perceptions of their work environment w Pervasive work stressors must be acknowledged and proactively managed if the Government’s future vision of the NHS is to become a reality
537
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 13, 2015. For personal use only. No other uses without permission. . All rights re
PROFESSIONAL
Conclusion District nursing team leaders could consider making use of the HSE’s stress survey tool to capture their team’s perceptions of their work environments, to identify, with their staff, the areas where improvements could be made and also to communicate to commissioners the issues that affect staff in their roles. Team leaders are fundamental to creating a workplace climate that enhances staff wellbeing and delivers quality patient care. The Government (DH, 2012a) has called for nursing leaders to be empowered and encouraged to manage resources to deliver safe, effective and compassionate care—and interventions such as the Management Standards approach are central to achieving this purpose. Investment in a positive workplace environment that allows a skilled district nursing workforce to develop, and in which staff are enabled to provide quality patient care, is essential. Achieving the government’s vision of an NHS in which
538
quality and outcomes are the best in the world (DH, 2012b) and in which district nurses play an important role (RCN, 2012) will be a challenge if pervasive work stressors are not acknowledged and proactively managed. BJCN Aiken H, Sermeus W, Van den Heede K et al (2012) Patient safety, satisfaction, and quality of hospital care: cross-sectional surveys of nurses and patients in 12 countries in Europe and the United States. BMJ 344: e1717 doi: 10.1136/ bmj.e1717 Ball J, Pike G, Griffiths P, Rafferty A, Murrells T (2012) RN4CAST nurse survey in England. National Nursing Research Unit. http://tinyurl.com/d5dunaj (accessed 4 September 2013) Brearley S (2012) Nursing and Care Quality Forum initial recommendations. Department of Health. http://tinyurl.com/cajfujd (accessed 4 September 2013) Clews G, Ford S (2009) NHS stress driving up nurse sick leave levels. Nurs Times 105(14): 1 Department of Health (DH) (2009) NHS health and wellbeing: final report. http://tinyurl.com/q8wzemw (accessed 4 September 2013) Department of Health (DH) (2012a) Our NHS care objectives: a draft mandate to the NHS commissioning board. http://tinyurl.com/pp9nel3 (accessed 4 September 2013) Department of Health (DH) (2012b). Compassion in practice. Nursing midwifery and care staff: our vision and strategy. http://tinyurl.com/conq7cl (accessed 4 September 2013) Evans L (2002) An exploration of district nurses’ perceptions of occupational stress. Br J Nurs 11(8): 576–85 Fearon C, Nicol M (2011) Strategies to assist prevention of burnout in nursing staff. Nurs Stand 26(14): 35–9 Gupta V, Woodman C (2010) Managing stress in a palliative care team. Paediatr Nurs 22(10): 14–8 Haycock E, Jarvis A, Daniel K (2008) A ward without walls? District nurses’ perceptions of their workload management priorities and job satisfaction. J Clin Nurs 17: 3012–20 Health and Safety Executive (HSE) (2007) Managing the causes of work-related stress: a step by step approach using the Management Standards. http://tinyurl.com/ont2oxz (accessed 4 September 2013) Health and Safety Executive (HSE) (2012a) Business solution case studies. www. hse.gov.uk/stress/experience.htm (accessed 4 September 2013) Health and Safety Executive (HSE) (2012b) Great Western Hospitals NHS Foundation Trust: nurses case study. http://tinyurl.com/nwj4442 (accessed 4 September 2013) Health and Social Care Information Centre (2012) Sickness absence rates in the NHS: April–June 2012. http://tinyurl.com/obzj22c (accessed 4 September 2013) Jordan J, Gurr E, Tinline G et al (2003) NHS stress driving up nurse sick leave levels. In: Beacons of Excellence in Stress Prevention: Research Report 133. HSE Books, Suffolk Laschinger H (2010) New graduate nurses’ expectations of bullying and burnout in a hospital setting. J Adv Nurs 66(12): 2732–42 McVicar A (2003) Workplace stress in nursing: a literature review. J Adv Nurs 44(6): 633–42 National Institute for Health and Care Excellence (NICE) (2009) Promoting mental wellbeing through productive and healthy working conditions: guidance for employers. http://tinyurl.com/papowoc (accessed 4 September 2013) Por J, Barriball L, Fitzpatrick J, Roberts J (2011) Emotional intelligence: its relationship to stress, coping, well-being and professional performance in nursing students. Nurs Ed Today 31(8): 855–60 Queen’s Nursing Institute (QNI) (2009) 2020 Vision: Focus on the Future of District Nursing. http://tinyurl.com/nuvboxy (accessed 4 September 2013) Royal College of Nursing (RCN) (2005) Managing your stress: a guide for nurses. http://tinyurl.com/pd6pkbk (accessed 4 September 2013) Royal College of Nursing (RCN) (2009) Work-related stress: a good practice guide for RCN representatives. http://tinyurl.com/ndax8bn (accessed 4 September 2013) Royal College of Nursing (RCN) (2012) The community nursing workforce in England. http://tinyurl.com/puuzau9 (accessed 4 September 2013) Storey C, Cheater F, Ford J, Leese B (2009) Retaining older nurses in primary care and the community. J Adv Nurs 65(7): 1400–11 Witkoski A, Dickson W (2010) Hospital staff nurses’ work hours, meal periods and rest breaks: a review from an occupational nurse perspective. AAOHN 58(11): 489–97 Zeytinoglu I, Denton M, Davies S et al (2006) Retaining nurses in their employing hospitals and in the profession: effects of job reference, unpaid overtime, importance of earnings and stress. Health Policy 79(1): 57–72
© 2013 MA Healthcare Ltd
six identified work stressors and was designed to capture employees’ perceptions of their work environment (HSE, 2007). The stress survey tool aims to help managers focus on the underlying causes of stress in their workplace and subsequently develop proactive stress prevention interventions. The HSE’s website (HSE, 2012a) offers a variety of resources aimed at managers and also employees. It outlines the key Management Standards message, the person’s role in the Management Standards and their next steps in the process. Case studies provided by NHS trusts that have employed parts of the Management Standards approach are also available to view on the website (HSE, 2012b). One trust used the stress survey tool and found that 32% of their staff were experiencing work-related stress and this was identified as being the main cause of staff absence. Nurses in the trust identified that among the potential causes of their stress were workload (demands), not being able to take breaks (control) and levels of staffing (demands). The trust responded by implementing face-to-face briefings at the end of each shift to raise any workplace issues. Staffing, recruitment and training needs were also addressed. The RCN (2009) also presents examples of solutions identified by NHS trusts following implementation of the HSE Management Standards approach, including appointing more staff to a team when there was evidence of excessive workloads and improved communication during a period of change. Gupta and Woodman (2010) describe a solution-focused stress intervention which was implemented in a children’s community palliative care team and which could be used in district nursing teams. The nine nurses in the team identified their stressors and were then asked to consider solutions, which were divided according to what the nurses thought they could do to reduce stress from an individual, team, and service perspective. Solutions included: w Fewer meetings w Reorganisation of caseloads w Active discharge w An ‘achievable’ time-off-in-lieu system.
British Journal of Community Nursing Vol 18, No 11
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