Holly Blake: ‘Should nurses be role models for health?’

Research has shown that the health behaviours exhibited by NHS staff can be less than exemplary; many are overweight or obese, many are not active enough to benefit their health, are smokers or have a poor diet. Nurses are the largest occupational group within the NHS and similar patterns have been found both for nurses, and for student nurses, who are our next generation of “health promoters”.

Given the rising prevalence of preventable diseases caused in part by poor lifestyle choices, encouraging people to think about their health, whatever their profession, is important. However, the health of NHS staff has received particular attention, especially following the NHS Health and Wellbeing Review, which flagged high levels of sickness absence in the NHS and associated lost working days, which if reduced by one-third would lead to an estimated annual direct cost saving to the NHS of £555m.

So aside from the implications for the health of individual nurses, the resource implications of a healthier NHS workforce are therefore indisputable, particularly given the known link between employee health and wellbeing, productivity and performance, sickness absenteeism, and even workplace accidents and errors, which can have potentially serious consequences for patients.

“There can often be a tension between the nurse’s personal choices, and their role as health educator”

The Prime Minister’s Commission on the Future of Nursing and Midwifery stated that nurses should take responsibility for their own health and should acknowledge that they are public role models for healthy living. The concept of “practising what you preach”, however, is a contentious one, often generating intense reaction and debate.

The current trend of “do as I say, not as I do” does, however, require due consideration, as whether we like it or not, nurses are often viewed by the general public as role models for health, who guide by example.

Research shows that an overwhelming majority of nurses demonstrate self-awareness to this effect, and recognise the potential impact of the image they portray, and the lifestyle choices they make, on the general public. This focus is not intended to be judgemental, but rather a shift in focus from a personal perspective about health behaviours, to viewing an issue through the eyes of a patient.

Having the most direct contact with patients and their families, nurses are in a prime position to exert a positive influence on the lifestyle choices of those in their care, and while part of their role is to “sell” healthy habits, there can often be a tension between the nurse’s personal choices, and their role as health educator.

There is an issue of credibility here, since nurses may be viewed as less “credible” by recipients of advice if they appear hypocritical, and promote health behaviours that they have clearly not chosen to engage with themselves. Nurses and patients alike have suggested that patients are more likely to listen to, respect and follow the advice of a health adviser who models the same health habits and behaviours that they are recommending, and conversely, will “tune out” to those who do not.

This is compounded by the potential implications for the quality of patient care, since research has shown that nurses who are overweight or obese, for example, have reported feeling less willing, or even less able, to promote healthy diet and exercise in their patients.

Of course, expecting health professionals to be perfect role models may be unrealistic since nurses are subject to the same temptations of sedentary behaviour, overeating, smoking, alcohol and drug use as anyone else. Additionally, the typical nurturing and caregiving role of a nurse all too often means that they invest well in others, but less in themselves, which can result in the development of the same physical and mental health problems that they see in many patients. There is also no doubt that nursing can be a stressful and demanding role, with increasing pressure to deliver high standards of care now coupled with the extra burden of high expectations placed on nurses to be “healthy role models”. While we should always promote personal choice, for those who wish to make changes to health behaviours, balancing pressures of the job role with healthy lifestyle choices is not always easy; diet and exercise, for example, may take a back seat if healthy food is not easily accessible and time away from busy working environments is hard to achieve.

Whether nurses adopt and maintain healthy lifestyle behaviours is a personal decision, but employers also have a responsibility to create environments that reduce barriers to healthy living and provide nurses with opportunities for making health a part of their daily lives. This may include a place to unwind, healthy activities before or after shifts, protected breaks, access to healthy food and more. An example of excellent practice in this respect is Nottingham University Hospitals Trust; a pioneer of workplace wellness, this trust has developed over a number of years, a successful and sustainable programme accessible to more than 13,000 NHS employees across three hospital sites. The service is continually evolving but strives to provide services based on employee needs and preferences, and is an exemplar for NHS health and wellbeing.

Holly Blake is lecturer in behavioural sciences at University of Nottingham

today.