The Use of Allostatic Load for Health Promotion with New Graduate Nurses in the U.S.

Purpose: With over 2.6 million practicing Registered Nurses in the U.S., nurses represent the largest sector of the health professions (American Nurses Association, 2011; Bureau of Labor Statistics, 2010). While nurses’ education prepares them to promote the health of the patients and families they serve, too often they fail to adequately care for themselves and engage in unhealthy lifestyle behaviors. Some of the profession’s most vulnerable populations, new graduate nurses, often struggle between the transition from school to work. Successful transition of newly licensed nurses into practice is essential for safe nursing practice (Roth, 2010). Yet, the transition of nursing graduates to their first position often results in very high turnover: 35-60 percent of new graduates leave their first nursing position within the first year (Advisory Board Company, 2006) and up to 25% of new graduate nurses leave nursing altogether (Hwang, 2004). Nurse internship/residency programs have been created to address the new graduate nurse dilemma and have been somewhat successful in reversing these trends. Our university hospitals sponsor a robust program in which Nurse Interns participate in a year-long program that is designed to increase new graduate confidence, autonomy, and satisfaction. This study is focused on determining if the integration of a two-day workshop about personal health and well-being conducted during the Nurse Intern residency improves health behaviors in new graduate nurses.

Methods: A descriptive correlational design was used with baseline data from new graduate nurses attending the two-day Nurse Athlete^TM  program, a workshop that focuses on nutrition, energy management and physical activity (some results reported previously).  Among the psychosocial and biometric markers that have been collected on this population of new graduate nurses, a relatively new measure, the Allostatix Load Test^TM, has been collected and analyzed.  Allostatic load is the physiological wear and tear on the body that results from ongoing adaptive efforts to maintain stability (homeostasis) in response to stressors. Typical health risk assessments do not predict future health problems well; in fact, Sacks’ seminal 1980 article on the reliability of the health hazard appraisal found that only 15% of participants studied gave consistent answers at baseline and follow up, giving little accuracy to what is likely to happen to an individual’s health in the future. More than 20 years ago, a group of noted scientists from UCLA, Rockefeller University, Princeton, and the University of Wisconsin began a decades-long study of the application of allostatic load to predicting future health. Thousands of individuals were followed for many years as they developed diseases or died. The subjects were between 18 and 70 years of age at the start of the studies. Several peer-reviewed research papers have been published from these data, illustrating the clear efficacy of using allostatic load as a reliable measure of future health (Carr, et al., 2005; Seeman, Karlamangia & Singer, 2006; Seeman, et al, 2004).  The Allostatix Load^TM (AL) test score is calculated by combining the results of various blood and physiologic tests, chosen to provide information on the functioning of multiple body systems. Individual test results are combined algorithmically to produce a single score that represents the cumulative impact of stress on the individual at the time of the tests. The algorithm takes into consideration the full range of test results, not just whether the results are within or outside the standard reference ranges, as well as the interactions among the test results from a whole body system perspective. 

Results: For allostatic load, we tested whether there was an on average difference in baseline and six month scores. Change scores for participants (n= 38) were computed by subtracting the baseline score (Time 1) from the six-month (Time 3) score.  Overall, there was no significant difference between Time 1 and 3 (-1.26, SD = 24.96, p = -.76). 

Conclusion: Analysis of allostatic load is another indicator of overall health with predictive ability.  The findings so far in this study have not been significant regarding the impact of the Nurse Athlete^TM  intervention upon allostatic load.  The test itself, however, provides additional information that could be used as a motivational tool in promoting improvement in health behaviors.  More research is needed to explore this facet of the data.