Nurses Have to "Run the Gauntlet": Achieving Healthy Eating While Working in Hospitals

Background/significance: As the largest health care profession, healthy nurses are imperative to meet the health care needs of the nation (U.S. Department of Health and Human Services & Health Resources and Services Administration, 2010). Nurses, like the general American population, are not meeting dietary recommendations for health promotion and chronic disease prevention (American Nurses Association, 2017; Centers for Disease Control and Prevention, 2010). Dietary choices, including those made while at work, significantly impact nurses’ health. Most nurses in the United States work in hospitals where staffing is required 24 hours a day; 10-12 hour shifts are typically used for coverage (U.S. Department of Health and Human Services & Health Resources and Services Administration, 2010). Extended shift work has been associated with obesity and unhealthy eating across various industries, including nursing (Amani & Gill, 2013; Han, Trinkoff, Storr, & Geiger-Brown, 2011). However, there are unique and complex factors associated with the hospital nurse role that influence workplace dietary behaviors, including environmental, social, affective, and cognitive issues. Additionally, little is known as to what extent nurses prioritize healthy eating while at work or what nurses perceive as major influencers in the hospital setting.

Purpose: The purpose of this study was twofold: 1) to explore nurses’ experiences with dietary behaviors in the workplace; and 2) examine nurses’ perceptions of barriers and facilitators related to shift work and the hospital setting on making healthy nutritional choices.

Methods: This qualitative descriptive study was guided by the Theoretical Domains Framework in both the design and analysis (Atkins et al., 2017). After obtaining IRB approval, Registered Nurses working 10-12 hour shifts in any specialty within a regional hospital system in South Carolina were interviewed individually or in focus groups. Sessions were audio-recorded and transcribed. Data were analyzed using a thematic analysis approach, and included iterative readings of the transcripts, code identification, and theme generation.

Results: Findings revealed influences from all 14 domains of the Theoretical Domains Framework; however, those that appeared most often and had the most relevance to shift-work nurses in hospitals were: 1) Environmental context and resources; 2) Social/professional role and identity; 3) Memory, attention, and decision processes; 4) Social influences; 5) Emotion; and 6) Behavioral Regulation. Further analysis revealed four major themes that had the most influence on eating behaviors for hospital-based shift work nurses were: 1) Nursing role and responsibilities restrict freedom of movement and minimize individual control over dietary practices; 2) The Hospital Food Environment is oppressively unhealthy; 3) Free food is currency and influences consumption; and 4) Shift work is a major barrier to healthy eating.

Implications: Diet is the leading contributing factor in long-term health promotion and chronic disease prevention, and should take priority in programs targeting nurses’ health (Murray et al., 2013). Nurses in the hospital setting, especially those working long shifts, experience unique influences on dietary choices. These findings should inform hospital food policies, workplace wellness programs, nursing administration practices, and nursing education. To achieve healthy eating practices in the workplace, nurses need supportive systems and policies that target and reduce the many barriers inherent in hospital-based nursing shift work.