Let’s talk about the elephant in the room – retention is the topic for April as part of the #NurseBloggers2020 challenge.
#NurseBloggers2020 April topic
I have to be honest, I have struggled to write this post for April. As COVID-19 has taken hold globally it didn’t feel right to write about retention when all hands are on the pump where nursing is concerned. There are record numbers of nurses stepping up coming out of retirement to support their colleagues. Nurses have rejoined the professional register, nurses who have been redeployed to areas of need. Public support has never been more evident than in these current challenging times.
Before all things COVID-19, I wanted to write about the value of coaching as part of a wider psychological approach in supporting clinical nurses. I wanted to highlight how those organisations that are proactive now in working to address the emotional labour of nursing and the challenges that modern-day nursing brings will become the healthcare employers of choice in the competitive world of nurse recruitment in the future.
I write about coaching because I am passionate about the difference it can make for nurses and nursing teams, it is my mission to make coaching accessible for nurses everywhere. This blog post has taken a wider view and looked at what will be needed beyond COVID-19 as a result of my reflections.
Globally nursing is facing a major challenge in sustaining a workforce that will meet a rapidly rising demand for healthcare. This, however, is only part of the picture. In order to understand the size of the elephant in the room, there are other factors that need to be understood alongside the rising demand for health care globally.
Demand for healthcare
Rising demand for healthcare is attributed to an ever-increasing ageing population that will require specialist interventions later in life as mortality becomes compressed. People will live longer due to advances in healthcare but will become sicker much more quickly as they enter their 80 and 90th decade. There are now more people living to be over a hundred than ever before.
These demographic changes are also applicable to nursing as a profession, with many nurses, born in the ’60s and known as the ‘baby boomers’ retiring in the next few years. There are not as many people training to become nurses as there are nurses who will be retiring from the profession in the not too distant future and this will leave a shortfall.
Psychological support for Nurses
There is one topic that doesn’t receive as much attention and that is how does the nursing profession support nurses to manage stress and maintain a positive work-life balance? An important approach to recruitment and retention that could make a huge difference in a highly competitive health care environment in the future where nursing resources are scarce. The nursing academic literature is awash with articles on resilience, burnout and stress. The larger debate acknowledging that nursing as a workforce is still largely gendered and made up of nurses from different generations with different approaches to training, expectations, understanding of technology and data collection and even different career aspirations is still largely unspoken. There needs to be a number of different approaches that take account of generational differences and expectations in planning for strategies to support the psychological wellbeing of the nursing profession.
There is no doubt that the retention of Nurses is a topic that warrants a more robust debate about how to support all generations of nurses to retain skills and experience and to grow the next generation of nurse leaders. The International Year of the Nurse and Midwife is a great opportunity to highlight some of the issues that will impact on recruitment and retention in nursing in years to come.
The emotional labour of nurses
Nurses are expected to care for patients who are often acutely ill or have suffered significant trauma. Many nurses have significant caring responsibilities outside of the workplace for example; older relatives, young children and friends who may also have emotional needs. Nurses are expected to be professional in everything that they do. This involves managing their feelings and emotions whilst being compassionate and suppressing strong emotions that may surface in the process of caring for patients. This is often referred to as the “emotional labour of nursing”
The suppression of strong emotions in the quest to remain professional can affect personal resilience and the literature suggests can cause ‘burn out’. The literature also suggests that there are no widespread systems of support that help nurses to cope with the emotional component of their work. Putting the needs of others before their own is a challenge for many and impacts on nurses ability to prioritise their own self-care.
Shame and stigma around acknowledging burn out
There are many things that have changed in nursing for the better. However, scratch under the surface and there is still shame and stigma within the profession around admitting that you are not coping and are heading towards burnout. For many nurses, this is often not recognised by themselves but by those who are closest to them every day. Nurses continue to push themselves often to the point where stress begins to impact on their physical and mental health and well being.
2019 figures from the Office of National Statistics in the UK showed the suicide rate among nurses was 23% higher than the national average, with female nurses at, particularly high risk. There are similar statistics across Australia and America in Nursing.
Sadly support for nurses experiencing symptoms of burnout is often not put in place until the nurse is off sick and unable to work and already suffering from burnout.
There is a need for healthcare organisations to have systems in place that work with nurses to prevent the extremes of burnout happening in the first place. Nursing needs to retain its nursing workforce for all the reasons previously mentioned.
In my work coaching nurses in resilience there is always one topic that comes up with every nurse-client without fail; a lack of time for self-care. Often coaching can be the only time that nurses have a dedicated hour of time to focus purely on themselves and the goals that they would like to achieve.
As nurses in a caring profession, we are not good at putting our self-care first, caring for others is our top priority. The ability to take care of ourselves is strongly correlated to our personal levels of resilience. The big concern currently is that time for Self-care is on the back burner for many nurses right now and levels of resilience in nursing are being tested to the max in this pandemic.
As a coach working with nurses and midwives, I come across nurses who are experiencing stress, burnout, bullying and often struggling to be heard and recognised for their experience. It always saddens me that there are not systems in place to support nurses before they get to the point of burnout and sometimes leave the profession altogether.
Benefits of coaching
Coaching is a forward-facing modality that works by asking clients questions that help them to identify their goals and set actions to achieve their goals. Coaching is not something that has traditionally been offered to clinical nurses either on an individual or team level. The nurses that I have coached come to coaching after experiencing workplace issues such as bullying, loss of confidence, career progression difficulties or wanting to develop their leadership skills.
Coaching is not about performance in the workplace and there are often misconceptions about the role of coaching in relation to performance.
It is also valuable for nurses to learn coaching skills that can be used with their teams, improving listening skills, how to have a difficult conversation and how to ask great questions that help a team member to see things from a different perspective are some examples. Team coaching will become the coaching of the future as it can be argued that team coaching supports organisational objectives in a greater way than individual coaching alone.
Coaching is not about the coach and is always about the client and what they want to achieve and focus on in the sessions. It is always about their goals and not what I think they need to work on. I am trained to be their facilitator of change, keeping them accountable for the goals that they set.
Rewards of coaching
What I love about coaching nurses is seeing the change in someone from an increase in their confidence levels to acknowledging that they do have knowledge, skills and experience that are valuable in the workplace. Being able to have a difficult conversation with humility and in a way that is meaningful brings out the best in the person with whom they are needing to have that difficult conversation. Coaching can help grow the nurse leaders of the future.
To help someone to see a way forward when they may have fallen into a hole of negativity, losing sight of how to go forward with a situation that has challenged their personal resilience is a hugely rewarding part of being a coach.
In March 2020 the Australian College of Nursing announced that it was making career coaching available across its entire membership. I am very proud to be a part of this initiative supporting Australian nurses through career coaching. It takes me one step forward to achieve my goal of making coaching accessible to nurses and gives nurses an opportunity to experience coaching.
With respect, we need much more than “thank you’s”; whilst it is great to recognise the challenging work that nurses are doing currently; saying “thank you” is not enough. Identifying the need for psychological support for nurses is also not enough. Action is required now taking a collaborative approach to determine how best to provide psychological support to nurses now and in the future. This will enable the right psychological support to retain our nurses and healthcare workers in the years to come, encouraging younger people to continue to enter into the nursing profession. The importance and significance of this is and will continue to be crucial when we reach the other side of COVID-19.
My hope is that resilience coaching can be seen as part of a whole psychological approach to supporting the nursing profession. Maybe the COVID- 19 Pandemic has given us an opportunity to recognise that psychological support can no longer be ignored within the nursing profession. Health service providers who recognise and prioritise psychological support will be employers of choice in this new post-COVID-19 world going forward.