Strategies to promote the emotional health of nurses and other NHS staff

The Government has recognised that NHS staff working in clinical environments must be supported emotionally. Those who deliver direct care to patients may absorb and experience some of their patients’ emotions, including fear and sadness. The empathetic traits common among nurses and other care workers can negatively impact their own emotional health.

In response, NHS Employers launched its ‘How are you feeling today NHS?’ initiative (NHS Employers, 2019). This easy-to-use resource was designed and developed with the help of NHS staff to promote greater awareness of emotional health in frontline care workers. This tool enables nurses and others to discuss emotional health more openly and can help assess the impact emotional wellbeing has on staff members and their patients.

Stress and burnout 

The high level of stress experienced by nurses can lead to burnout and a host of detrimental effects. It is now recognised that greater support is needed for those who deliver frontline care.

Many care staff in the NHS witness scenes of extreme emotional distress, such as caring for a patient dying prematurely in an intensive care unit, and then helping a distraught family in their bereavement. The ability of these staff members to cope with these emotional encounters must not be taken for granted and many frontline clinical nurses who are exposed day after day to such emotional stress need help and support. This is crucial to prevent them from reacting in ways that are damaging to their own health and which can subsequently lead to burnout. This in turn can cause emotional exhaustion, depression and a reduction in performance in the workplace.

Preventing burnout among nursing staff can reduce preventable serious incidents in practice (Kowalski et al, 2010). The wellbeing of these nurses must be optimised if the delivery of positive patient care is to be achieved throughout the service.

In a systematic review of the literature, van Mol et al (2015) endeavoured to evaluate the research related to emotional distress among health professionals in intensive care units with a specific objective of illuminating the prevalence of burnout and compassion fatigue and the use of available preventive strategies. From the literature reviewed they found that there was a range of intervention strategies available to address burnout, such as different work schedules, educational programmes on coping with emotional distress, improving communication skills, and relaxation methods.

What can be done to prevent burnout?

Given the volume of evidence that burnout among nurses can be successfully addressed, it is salutary to consider why strategies to prevent it have not been implemented.

Nurses are expensive to train and retain and every effort should now be made to support those who develop mental health problems as a result of psychological pressures at work. Currently, plans are being developed to help ameliorate stress within the NHS workforce by giving nursing staff and others immediate access to dedicated mental health support when they need it. Health Education England has commissioned a framework to help NHS organisations be more supportive (National Worforce Skills Development Unit, 2019). To help prevent burnout among its staff, one hospital has announced that it has invested in sleep pods to allow tired staff members such as doctors to have power naps. Such initiatives are to be applauded (Thomas, 2019).

NHS Employer's emotional wellbeing toolkit

Launched in January 2019 the How are you feeling NHS toolkit has been designed to help NHS staff reflect on and discuss the emotional wellbeing of themselves and others within the care team.

This easy-to-use resource has been developed with NHS staff to:

• Help bridge a gap in understanding and enable staff to talk openly and regularly about emotional health
• Assess the impact emotional wellbeing has on individuals, colleagues and patients
• Enable staff to make plans to enable more good days than bad

NHS staff who helped design the toolkit identified that emotional wellbeing can be explained in three ways. Individual staff members such as nurses may be:

• ‘On a go-slow’: when staff feel disengaged, finding it hard to build the energy to fulfil their responsibilities. Patients are more likely to see them as uninterested and uncaring. Staff in this mode are slow to respond and may leave things undone because they cannot find the energy or motivation to make them happen.
• ‘Having a good day’: when staff motivation and energy feels easy to find. Staff are interested in what they are doing and have confidence that they can cope with whatever gets thrown at them. Patients feel cared for, they view staff members as responsive and in control. They feel sure that staff are focused on what they are doing and meeting, their needs.
• ‘On the edge’: when the pressure staff face exceeds their ability to cope, and where they feel overwhelmed and out of control, finding it hard to think through problems, often making rushed decisions and losing patience. Patients are likely to think the staff member is terse or even see them as out of control. They may be reluctant to ask for help if they can see staff are overwhelmed. Mistakes are more likely to be made, or things can be missed, when staff are in this mode.

The toolkit asks users to identify which of the three options best describes their current emotional state. The toolkit identifies the probable causes of their feelings and then describes the impact of that emotional state on others. For example, their colleagues may see them as: angry, unsupportive, prone to make mistakes, defensive, inconsistent and easily distracted. The final part of the survey offers the nurse a range of actions that might improve the situation, such as ‘Take time to reenergise yourself—do something that you find enjoyable, relaxing and which takes your mind off work’.

The below link directs you to the 'How are you feeling NHS?' toolkit. This is an excellent tool to help all frontline healthcare workers identify the reasons for their decreased emotional wellbeing and how to encourage improvements:

https://www.nhsemployers.org/howareyoufeelingnhs