Fit for the Future: Australian Nurses' Health Status and Health Behaviours

Purpose:

Global changes in population demographics are forecast to increase demand for healthcare services [1]. Chronic or non-communicable diseases associated with aging are projected to increase by 15% globally between 2010 and 2020. However, good long term health and disease prevention is possible through key healthy behaviours including limiting alcohol use, abstaining from tobacco, eating recommended amounts of fruit and vegetables, being physically active and maintaining a healthy weight. Around 80% of coronary heart disease and cerebrovascular disease have been estimated to accrue due to behavioural risk factors [1], so even small changes in behaviour have the potential to impact on health outcomes.

Long term, healthcare and prevention strategies are crucial to address these population trends and the World Health Organization has emphasised the need to strengthen the capacity of the health workforce to meet these demands. Nurses provide the bulk of healthcare and are the main health education providers; highly visible, they are accessible role models for good health practices for their patients, families and the community. However, the nursing workforce faces the same health issues as the population it serves although nurses have advantages that should support their participation in health behaviours, including education with high health literacy and the economic advantages of employment. Whether nurses’ health and health behaviours reflect this advantage is largely unknown [2].

In high income countries the nursing workforce is aging [3], in many countries to a greater extent than the populations from which they are drawn. Nurses’ health is a crucial consideration for their retention in the workforce. There is some evidence of risk to the health of nurses through obesity, lack of physical activity and poor diet. This may be evident in nurses undertaking preregistration education, so the impact on work capacity and ability to act as healthy role models may be hampered from the beginning of careers [2]. Overall, however, little information is available about the health and health behaviours of the nursing workforce.

Methods:

To address this deficit, this study employed an electronic survey comprised of validated and reliable questions and instruments delivered with the link distributed using the New South Wales Nurses and Midwives Association membership database and publication and snowballed through professional contacts in the nursing and midwifery workforce of New South Wales (NSW), Australia in 2014; 5,347 nurses and midwives responded. This paper describes their overall health and health-related behaviours and will discuss this compared to the NSW general population by age and gender, and in relation to their job satisfaction and future intentions.

Results:

Respondents had a mean age of 48 (SD 11, range 18-78) years; almost two thirds (66%) were 45 years of age and older. Most (88%) were female, worked full-time (53%), and were shift workers (62%), half of whom worked night shifts; just over half (52%) were employed at Registered Nurse grade, and were hospital-based (59%). These nurses were well-educated with most (62%) having at least a Bachelor degree and 39% with postgraduate qualifications. Altogether 72% agreed or strongly agreed they were satisfied with their current job but 23% were planning to leave within the next 6-12 months.

On a scale of 1 (poor) to 5 (excellent) nurses in the study rated their general health at mean 2.5 (SD 1), with 39% indicating good, 38% very good and 13% excellent health. However, in the previous 4 weeks 35% reported often suffering pain whilst 39% were in pain sometimes. Asked about the severity of this pain, 6% reported it as severe/ very severe, 28% as moderate; 7% reported pain interfered with normal work quite a bit or extremely; 12% moderately. Approximately one in six (17%) had experienced a hospital admission in the previous 12 months, 10% for at least an overnight stay. More than half (58%) were taking regular medications. Overall, they reported taking mean (SD) 7 (14) days sick leave in the previous 12 months, 2 (7) of which they identified as ‘mental health’ days.

Respondents were asked whether they experienced a wide variety of health symptoms. Around 50% reported experiencing back pain, severe tiredness, stiff/ painful joints, headaches / migraine sometimes or often; around 30% reported allergies, indigestion/ heartburn and anxiety with similar frequency. However, most were self-managed, with breathing difficulties, urine infection and mouth/ gum/ teeth problems the only symptoms where even one in three affected sought help. Symptoms that could potentially indicate a mental health issue were common, as were sleeping problems. Moderate – very severe difficulties were reported in falling asleep (30%), staying asleep (32%), waking too early (32%). Altogether 31% were dissatisfied or very dissatisfied with their sleep quality.

Reported Body Mass Index values were classified as overweight for 31% of respondents, as obese for 30%. For a small group (between 3% and 9%) their health or emotional problems limited physical activity and stair climbing, and meant they accomplished less than they liked or did things less carefully to a large degree/ all or most of the time.

Conclusion:

Analyses are at an early stage and will be discussed in more detail. A separate paper will present findings with implications for the future health of this workforce: current diagnoses of enduring disease and presence of the major behavioural risk factors of diet, activity, smoking, obesity and hypertension.

In conclusion, a clear pattern is emerging of nurses and midwives functioning, delivering care and achieving a high level of job satisfaction despite substantial symptom burden and health risks. Targeted strategies will be required to ensure the nursing and midwifery workforce are fit for the future. The implications of this for managers, policy makers and the future nursing and midwifery workforce will be discussed.