Hands-on clinical nursing is hard work; it is often physically exhausting and emotionally draining. This may seem an obvious statement, but the experience of many clinical nurses that I have talked to in recent years is that this has now become accepted as the norm. Many areas of clinical nursing are by their very nature physically demanding and emotionally challenging, but should this lead to them becoming exhausting and draining? What can the nursing leadership do to help maintain the positive holistic health of the clinical nursing team?
Identifying clinical stressors
Every clinical areas will place different demands on the healthcare staff. For some areas, such as the emergency department, it will be the sheer volume of patients at peak times. Those working in oncology areas will be combining specialist drug administration with intense emotional support. For others, it will be the demands of confused, high-dependency or complex-needs patients. In addition to the nursing needs of our patients are the problems associated with staff shortages, lack of sufficiently qualified and experienced staff, increasing computerised records and many more individual stressors. These are not to be avoided; meeting and coping with these everyday stressors is part of nursing practice, it is the ability to cope with these stressors in a positive way that enhances the quality of our nursing care. Left on their own, individual nurses will cope for a while in these difficult situations, but their reserves of physical and emotional energy will be drained and they will risk the danger of emotional and physical burnout.
Looking for solutions
How can individual nurses and team leaders help to prevent this physical and emotional draining? There are various structural levels from which this can be addressed: political and NHS levels, hospital trusts, unit or ward and individual staff levels. Political levels, the NHS and hospital trusts, are outside the focus of this series and the ‘solutions’ explored here are those that the individual nurse and the team leader can influence and control.
Looking after yourself
Nurses are very good at recognising when their patients or friends are in need and are quick to offer support and care, but we are not so good at identifying our own needs and seeking support for ourselves. The first point in looking after ourselves is to acknowledge that we are important—not only to others but to ourselves. Give yourself time for your physical health; this may be going to the gym, walking in the countryside, gardening, eating a decent diet, reducing your alcohol intake, or whatever is useful and important to you. Then think of your emotional health; this means making some time for you. You may have children, elderly parents or dependent partners, but you need time for you. Many nurses find it difficult to prioritise themselves, but you must learn to do this; you need to recharge your batteries.
Looking after your team
When I was a very junior staff nurse I was employed on the most physically and emotionally demanding ward that I have ever worked on. It was a ward for people with severe dementia and behavioural problems. Few patients if any were self-caring or continent, all required some assistance with feeding, all had a degree of confusion, many with behavioural problems—yet the ward was one of the most positive areas in which I have ever worked. The ward sister led by example; she treated each patient with great respect, she never avoided the ‘less favourable’ areas of personal care, she had high standards of nursing care, ward hygiene and interpersonal interactions. As well as leading by example, she cared for her staff; after the patients had their breakfast and were ‘toileted’ she had a routine for the staff to sit down at the patients’ breakfast table and have coffee and toast (possibly against the hospital rules, but the nursing officer knew to avoid visiting the ward at this time!). This not only cared for the staff following a 6:00am start, but it also allowed us to chat and review the day so far and the day ahead. In the afternoon, she would put on some old-time music and encourage nurses and patients to do a gentle dance around the ward. The ward sister overtly valued her staff, trying to make sure ‘off duty’ requests were met and holiday leave was well organised. She gave us feedback on our nursing care and fought ‘the system’ for equipment and facilities for both patients and staff.
Moving forward positively
Nurses will never be paid what they are worth, there will never be enough staff to give the care we would like to give. Nursing will always be an emotionally challenging job, most areas of nursing are physically demanding—these are the demands of the qualified nurse. The skills of individual nurses and team leaders are not just clinical expertise and interpersonal skills; we cannot function without these. But if we as nurses want to maintain our own holistic health and that of the people we work with, then we must learn to move forward in a positive way over the barriers we are bound to meet.