The last few weeks have not been particularly unusual, but I have had a couple of very long days with long periods of time without eating or drinking. When I finished my working week I felt physically and mentally exhausted. I logged into my emails and there was a request to approve a video to accompany my Trust's campaign supporting the Royal College of Nursing (RCN) 3Rs campaign (Rest, Rehydrate, Refuel).
I had seen the first edit of the clip; however, watching the video and re-looking at the background to this campaign following such a tiring week, really made me consider what nurse leaders should be doing to engage with this campaign. At the extreme, comments such as those quoted in the campaign material—‘I've told my staff to take their breaks, it's not my problem if they don't take them’—are typical from equally tired nurse leaders, and I felt that there was an opportunity to have a professional debate among our nurse leaders to support the culture of wellbeing required.
Among the resources to support the campaign is a guide for managers to consider how to promote nursing staff taking their at-work breaks, supporting them to keep well hydrated and enabling them to have access to nutritional food (RCN, 2018a). The resource outlines the case for making improvements and the legal responsibilities of employing organisations and provides tips and case studies to support the implementation of improvements. It also has a ‘myth busting’ section, sharing how we can have a conversation locally to overcome the numerous barriers that, over time, have stopped nurses from considering practical solutions for wellbeing such as water bottles on wards—it even advocates ‘power naps’ during on long shifts..
The RCN 3Rs campaign has also been designed to encourage nursing staff to look after themselves while at work (RCN, 2018b). It highlights the physical impact of dehydration, for example, being dehydrated affects concentration and cognitive function, which is a patient safety concern given the safety-critical decisions that nurses make. Kim Sunley, the RCN National Officer who was part of the online launch of the 3Rs campaign in 2018, recognised the need for leadership to take action. She said that:
‘Employers and managers need to recognise that in order to create safe and healthy working environments, nurses should be able to have regular breaks and have access to drinking water and healthy food during a shift, be that in the community or on a ward … Missed breaks have become the norm and this is not sustainable.’
Although the RCN campaign is focused on nurses, this issue affects all colleagues. A study by El Sharkawy et al (2016) involving 88 nurses and doctors on medical and surgical admissions wards at Nottingham University Hospitals NHS Trust found that 36% were dehydrated before they had even started their shift. By the end of their shift 45% were dehydrated.
In a recent opinion piece for the BMJ, Brennan et al (2019) raised the issue of breaks. The three doctors and one pilot called for hospitals to remove barriers to doctors eating and drinking during the working day. As with the RCN campaign, they recognised the risk to patients being cared for by dehydrated, hungry staff and briefly explored some of the publications that link concentration levels to capacity to deliver healthcare safely. The comment piece called for employers to take action over a range of areas including a ‘top-down’ campaign, and guidance around maximum times for activities such as ward rounds and mandating timings that staff can work without a break. This was in addition to:
Probably the most important simile that Brenan et al used was to liken our approach to our own wellbeing to that of the instructions for oxygen masks on an aeroplane: put your own mask on first before helping others. To give our patients the best care possible and to reduce the chance of medical error, we must make sure we look after ourselves too. This vital prerequisite to safe practice needs to be supported.