Overview and Summary: Healthy Nurses: Perspectives on Caring for Ourselves

  • Susan Letvak, PhD, RN, FAAN
    Susan Letvak, PhD, RN, FAAN

    Susan Letvak PhD, RN, FAAN is Professor and Department Chair of Adult Health Nursing at UNC Greensboro. She has conducted numerous research studies and has multiple publications concerning the aging, health, and safety of the nursing workforce, especially in relation to quality outcomes. She enjoys mentoring students and clinical nurses on research and evidence based practice projects.

Every few years this joke goes around, “Did you hear about the body found alongside the road? They don’t know her name but they know she is a nurse because the back was broken, the ankles were swollen, the nerves were frayed, and the bladder was full.” While most laugh when they hear it, the sad reality is nurses “accept” health problems that come from the physical and emotional demands of the profession, and while caring for others often do not care for themselves. A synthesis of 187 international studies on nurse health conducted by Fronteira and Ferrinho (2011) found that nurses experience more musculoskeletal disorders, are at greater risk of acquiring tuberculosis and blood-borne pathogen infections, and have more occupational allergies than the general public.In one study, hospital-employed bedside nurses were found to have a depression rate of 17% compared to the national rate of only 9% (Letvak, Ruhm & McCoy, 2012).

The shift work of nurses has been found to increase health problems. A study of 53,487 female nurses who worked more than 20 years of rotating shifts found a significantly higher risk of endometrial cancer (Viswanathan, Hankinson & Schernhammer, 2007). More recently, a longitudinal study of nurses found that night work and job stress were associated with sleep deficiency, lack of exercise, and increased cardiometabolic risk (Jacobsen, et al., 2014).

While the health of nurses is important to nurses themselves, it is also important for quality of care. A recent study of hospital employed nurses found that nurses who work with pain and/or depression report more medication errors and patient falls and a lower quality of care provided (Letvak, Ruhm & Gupta, 2012). Clearly, the health of nurses can no longer be ignored.

The American Nurses Association (ANA) (n.d.) defines a healthy nurse as one who “actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, spiritual, personal and professional wellbeing. A healthy nurse lives life to the fullest capacity, across the wellness/illness continuum, as they become stronger role models, advocates, and educators, personally, for their families, their communities and work environments, and ultimately for their patients” (ANA, n.d., para 1).  This definition implies that nurses must take an active role in assuring their own health – the physical and emotional demands of the profession are great and without proactive measures health will suffer. he ANA is offering free of charge a comprehensive health risk appraisal for nurses to receive information on their health, safety, and wellness. You can compare your results to the national average and ideal standards. After completion of a health risk appraisal, nurses are directed to a wellness site that contains additional resources. The free health risk appraisal can be found at www.anahra.org.

A recent review of the literature on interventions to improve nurse health found 18 studies (Letvak, 2013). On-site wellness programs that offer Tai-Chi and fitness programs, ergonomic training programs, massage, cognitive based therapy, and grief debriefing have all been found to improve nurse health. An innovative new interdisciplinary program to support caregiver health known as Schwartz Center Rounds® is now being utilized in over 320 healthcare facilities in 39 states (The Schwartz Center, n.d.). This program provides healthcare workers regularly scheduled time during work hours to openly and honestly discuss social and emotional issues that arise in caring for patients. Evaluation of the program has demonstrated decreased levels of stress and improved coping in participants (Lown & Manning, 2010). Of note, most of the literature and studies focused on nurses employed in controlled, hospital settings. There is still a need for more research and publications on how nurses can actively take a role in assuring their highest level of well-being. This OJIN topic fills an important gap in our knowledge by offering specific measures about how nurses can maintain and improve their physical and emotional health.

The first article, “Effective Interpersonal Communication: A Practical Guide to Improve Your Life” discusses the importance of interpersonal communication for your personal and professional life. Considering Maslow’s Hierarchy of Needs theory, effective communication may reduce stress, promote wellness, and improve overall quality of life. Twelve examples of ineffective communication are presented, such as poor conflict management and lack of empathy, along with their consequences and solutions to enhance effective communication. The practical strategies presented are sure to help nurses facilitate their interpersonal skills in and out of the workplace.

The second article, “Social Media and Nurses: Insights for Promoting Health for Individual and Professional Use” presents the issues surrounding social media use, and the potential health consequences. The authors describe how social media can support nurse health because of the social support received, and through the use of apps geared for health promotion. Social media can also support the nursing profession in practice, academics, administration, and research endeavors. Unfortunately, social media can have negative consequences from the demands of being “always available.” The authors provide best practices that all nurses can use in their personal and professional lives to avoid negative consequences of social media use.

The third article, “Practicing Self-Care for Nurses: A Nursing Program Initiative” describes an elective course designed for undergraduate nursing students at Florida Atlantic University called, Caring for Self. The author first presents the common stressors of nursing students, such as the stress of seeing people suffer and academic pressures, as well as of nurses, such as high patient acuity and lack of autonomy, and the importance of self-care. The specifics of the Caring for Self course and an exemplar are presented. Finally, “lessons learned” in teaching the course are provided which would support any nursing faculty interested in developing a similar course.

The fourth article describes a feasibility study entitled the “Implementation of a Participant-Centered Weight Management Program for Older Nurses.” Nearly 50% of nurses are overweight or obese, and combined with high levels of stress, this places them at high risk for health problems. Utilizing a pre-test, post-test design, 25 female RNs over the age of 45 with a BMI > 24 participated in an eight week exercise program that consisted of face to face meetings, Wii video games and dance DVDs, journaling, and health and diet education. Study results showed that participants lost an average of five pounds, increased their fruit and vegetable consumption and increased their time exercising each week, demonstrating that a participant-centered weight management program can be effective in helping to improve health.

The fifth article, “Factors Related to Healthy Diet and Physical Activity in Hospital-Based Clinical Nurses” reports on a research study designed to determine if individual and behavioral factors were associated with healthy diet and physical activity among clinical nurses in a healthy lifestyle workplace program. Two hundred and seventy-eight direct care nurses with a median age of 31.5 years participated. Only 20.9% were confident with how their bodies looked, though 66.3% had a moderately healthy diet. Not surprisingly, those with healthier diets were more likely to be physically active and exercise away from work. Of significance, this study found new evidence that nurses who work on units that require much movement during a typical work day may still not be sufficiently active. Work programs that are designed to improve nurse health should be utilized by all nurses, even by those who have high work activity levels.

The sixth article, “Designing Exercise and Nutrition Programs to Promote Normal Weight Maintenance for Nurses” describes Inova Loudoun Hospital’s comprehensive wellness program focused on exercise and nutrition. Over 1000 people have participated in the program. The specific challenges for healthy eating are described and specific components of their program are identified, including annual walk or run events, conferences, and exercise programs.; Lessons learned in developing and implementing the program are presented along with implications for education and research which the author hopes will motivate other nurses to design exercise and nutrition wellness programs for nurses.

The seventh, and final article, “Healthy Eating for Healthy Nurses: Nutrition Basics to Promote Health for Nurses and Patients” is authored by a dietician. This article presents updated information on the role of stress, inflammation, and diet’s impact on obesity as well as how sleep impacts nutrition. For those of us who have forgotten our undergraduate nutrition course, this article presents the basics of nutrition for healthy living. Finally solutions to avoiding “pitfalls” of unhealthy eating are presented which will encourage us all to maintain healthier diets.

The articles presented in this topic will greatly benefit nurses both professionally and personally in leading healthier lives. Through individual measures, participating in workplace health promotion programs, teaching our student nurses about self-care, and educating ourselves about proper nutrition, we all can strive to be “healthy nurses” who are physically and emotionally prepared to provide the best possible care to our patients. The journal editors invite you to share your response to this OJIN topic addressing Heathy Nurses either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Susan Letvak, PhD, RN, FAAN
Email: Susan_Letvak@uncg.edu

© 2014 OJIN: The Online Journal of Issues in Nursing
Article published September 30, 2014


American Nurses Association (n.d.). Healthy nurseTM . Retrieved from www.nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse.

Fronteira, I., & Ferrinho, P. (2011). Do nurses have a different physical health profile? A systematic review of experimental and observational studies on nurses’ physical health. Journal of Clinical Nursing, 20(17-18), 2404-2424. doi: 10.111/j.1365-2702.2011.03721.x

Jacobsen, H.B, Reme, S.E., Sembajwe, G., Hopcia, K., Stiles, T.C., Sorensen, G.,… Buxton, O.M. (2014). Work stress, sleep deficiency, and predicted 10-year cardiometabolic risk in a female patient care worker population. American Journal of Internal Medicine, 57(8), 940-949. doi: 10.1002/ajim.22340

Letvak, S. (2013). We cannot ignore nurses’ health anymore. Nursing Administration Quarterly, 37(4), 295-308. doi: 10.1097/NAQ.0b012e3182a2f99a

Letvak, S., Ruhm, C. & Gupta, S. (2012). Nurses’ presenteeism and its effect on self-reported quality of care and costs. American Journal of Nursing, 112(2), 30-38. doi: 10.1097/.01NAJ.0000411176.15696.f9

Letvak, S., Ruhm, C., & McCoy, T. (2012). Depression in hospital employed nurses. Clinical Nurse Specialist: The Journal for Advanced Nursing, 26(3), 177-182.

Lown, B.A.& Manning, C.F. (2010). The schwartz center rounds: evaluation of an interdisciplinary approach to   enhancing patient-centered communication, teamwork, and provider support. Academic Medicine, 85(6), 1073-1081. doi: 10.1097/ACM.0b01e3181dbf741.

Schwartz Center Rounds (n.d.). The Schwartz Center for Compassionate Health Network. Retrieved from http://www.theschwartzcenter.org/.

Viswanathan, A.N., Hankinson, S.E., & Schernhammer, E.S. (2007). Night shift work and the risk of endometrial cancer. Cancer Research, 67(21), 10618-10622.

Citation: Letvak, S., (September 30, 2014) "Overview and Summary: Healthy Nurses: Perspectives on Caring for Ourselves" OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 3, Overview and Summary.