Ensuring a healthy health-care organization for nurses

Mental health is becoming a concern for all Canadians. Incidence rates are rising and people are not receiving help early enough. This manifests itself through absenteeism, low morale, and illness. The hospital environment, a place of high stress, is no different and it’s often nurses who feel the brunt.

Hospital nurses, especially those in trauma and emergency departments, are under a lot of pressure. They are on the front line, deal with life-and-death issues and patients who are concerned with their health, and are under pressure from doctors. The profession suffers from high burnout, high turnover, and lack of retention. What’s more, recruitment is becoming more of a concern.

In March 2010, the Registered Nurses’ Association of Ontario (RNAO) released The Health Work Environments Quick Reference Guide for Nurse Managers. One of its strategies for success was: ‘Contribute to developing, implementing and supporting policies and practices that promote the health, safety and well-being of nurses.’ The RNAO says a healthy health-care organization is a place where nurses and other staff help each other, there is teamwork among nurses and other staff, and there are adequate staffing and supports available in the system.

Research shows that workers with depressive disorders have almost four times more health-related lost productive time than those who don’t suffer from such problems. The Mental Health Commission of Canada estimates that mental illness costs the Canadian economy $51 billion a year in terms of health-care service use, lost workdays, and work disruptions. Dr. Martin Shain – a member of Morneau Shepell’s Mental Health Advisory Board which helps us advise clients about mental health solutions in the workplace – said that $3 billion to $11 billion could be saved every year in Canadaif mental injuries caused by the actions of employers were prevented.

The Conference Board of Canada report Building Mentally Healthy Workplaces: Perspectives of Canadian Workers and Front-Line Managers provided a national perspective from working Canadians on their work environment. It said 44 per cent of employees surveyed had experienced a mental health issue, only 26 per cent felt that their supervisor effectively managed such issues, and 44 per cent of managers had no training in how to manage employees with these problems.

According to a 2002 report by CCHC, more than 450,000 employed people aged 25-64 had experienced depression the previous year. Its highlights included the following: those with a chronic health condition were more likely to experience episodes of depression, workers with major depression were not able to carry out work for 32 days over the previous 12 months, and 13 per cent of workers who had experienced depression the previous year reported at least one day suffering from depression in the two weeks before the study.

Those are serious numbers. In any organization, the health of the workforce has a big impact on the bottom line and the effective delivery of services. Nurses will be asked to do more as the ratio of patients to nurse increases. Add to that the fact that complexities we have in our lives makes life more complicated and demanding.

Irmajean Bajnok is the RNAO’s Director of International Affairs and Best Practice Guidelines, and the Centre for Professional Nursing Excellence. She says that 12-hour shifts, caring for acutely ill patients, and working in an environment with high noise levels and a general state of chaos all contribute to a high-stress situation for nurses. “This is why they experience burnout and often have to take stress leave. We find that there is not enough support in the system to assist  nurses to be better  taken care of, and I refer to  individual hospitals and the healthcare system as a whole.”

According to a U.S.study (Health, Absence, Disability and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers, 2004), the economic cost of lost productivity at work due to the ten most chronic conditions averaged 12 per cent of total payroll. Those conditions included allergies, asthma, depression, migraine headaches, and hypertension, and many of them are at least partly rooted in mental health issues. There is no reason to believe the situation in Canada is any different.

What can be done to alleviate the toll on nurses? Here are some suggestions:

1. A comprehensive, strategic approach to absence management will promote sustained attendance at work and prevent downstream costs. But you must shift from standalone, absence-administration programs to health strategies aligned with hospital objectives, cost-management goals, and strategies related to employee engagement and retention.  The focus is a nurse accessing the right support.

2. Programs lead to improved employee mental health and higher productivity. According to our study – EAP Improves Health Status and Productivity, and Demonstrates a Positive ROI – EAP intervention led to a 34 per cent reduction in costs due to lost productivity.  Most disability programs and return to work do not leverage the integration of other support programs (EAP). Using experts who can integrate these programs will lead to proper support to have sustained health. A nurse off work may require counselling, eldercare, childcare, or financial and nutritional counselling which can be accessed through a referral from their case manager to EAP.

3.Develop a strategic partnership with your EAP provider who can recommend strategies to optimize EAP use as a preventative measure.  Nurses know health strategies, but may need to be reminded.  They often care for others, not themselves.

4.Train supervisors on how to manage employees with mental health problems. Many supervisors are not aware of the signs, symptoms and support available for those with mental health issues.

Also, consider workshops about mental health in the workplace; experts who can design programs to address the problem; a disability program that focuses on the identification, support and access to mental health care; and the drug analysis program which provides trends, benchmarks and best practices in mental health, along with manager support.

All these are excellent ideas that will help any hospital develop a healthier workplace for its nurses.