Self care is an important role for nurses; nurses must take care of their own well-being at work so they can continue to care for the well-being of their patients.

The increasing complexity and accountability in health are challenging for all the health care team. When the health care environment cannot match the standards acceptable to the profession and when resources are no longer available, practitioners make choices regarding employment. This can mean leaving nursing altogether.

Two researchers found that "when discomfort becomes too great, people experiencing it can react in very different ways. Some may express outward compliance but feel inward dejection and protect themselves by distancing themselves psychologically, ie "it's only work. They may vote with their feet and choose a less problematic way of earning a living, hence the recurring recruitment and retention problems experienced by health care employers." (1)

Health system 'riddled' with problems

In the past months, the media has highlighted situations in the health system where senior clinicians have spoken out about public safety and have resigned from positions in district health boards. At a recent conference, the Minister of Health Pete Hodgson was critiquing the health system. The Minister admitted the health system was riddled with problems and was a system in which "fiefdoms, traditions, egos and rituals" abounded. Delays, poor and inequitable access to care and adverse events such as drug errors were part of the "unreliable" practice of medicine, Hodgson said. (2)

Such events and publicity increase the burden of responsibility on those who remain in the health care team to ensure public safety is maintained. While nurses continue to provide quality care in stressful environments, it is important to ask what we are doing to ourselves along the way. Many NZNO members report stressful working conditions, ethical dilemmas and restructurings that affect an employee's health and well-being. How we look after ourselves at work and the strategies we need to adopt to protect our well-being are important, so we can continue looking after others.

Employees' health and well-being

The context of practice is continually changing to adapt to the health needs of New Zealanders. However, the conditions of the workplace and health of employees is also important to consider. In 2005, Best Practice Australia and New Zealand Ltd surveyed 7075 health sector respondents across private, public and aged-care settings in New Zealand. The results showed how organisational cultures and workplace structures can affect the choices employees make. Significantly, 61 percent of the respondents reported that their organisation was not a "truly great place to work" and only 27 percent stated there was a climate of "trust and respect" throughout the organisation. However, 47 percent of respondents wanted to "improve the way things work" in their organisation. (3)

Many health care organisations are redefining models of care and workforce cultures, and mostly there is a willingness for health workers to be engaged in developing and implementing these changes. However, there is a need to consider outcomes so these changes are positive for patients, organisations and employees. Research in an Australian neonatal unit (NNU), revealed three themes emerging from discussions with the staff. The first theme was the impact of the global nursing shortage, which affected retention and recruitment of skilled staff; the second was decision making and accountabilities between nursing and medical staff; and thirdly the increased demand on services in the NNU. (4) Focus groups and discussion forums led the participants and the researchers to understand the issue and the environment. They were able to implement successful and sustainable strategies to develop a positive culture and address these serious issues.

Best Practice Australia Ltd resurveyed this NNU and found significant changes in the survey data after the changes had been implemented. The NNU has been able to sustain this change for more than three years and nursing vacancies and costs have been considerably reduced. (3)

Managing stressful situations, such as change at work, is a vital skill to have. At the recent South Island Respiratory Nurses' Forum, clinical psychologist Jaki Horn presented some useful self-care strategies for nurses. These included valuing what you are doing, taking regular holiday breaks and re-energising the passion for the job, through identifying your important contribution within the health sector.

The report of NZNO/District Health Board New Zealand Safe Staffing and Healthy Workplaces Committee of Inquiry recognised these types of strategies in its recommendations. (5) The theme for International Nurses Day 2007, Positive Practice Environments, advocates strongly for a positive workplace climate for nurses, so they are free from stress and violence and are able to contribute to improved patient outcomes. (6)

Self-care measures

During our busy working lives with their multiple demands, it is important we all consider our own health and well-being. Accessing clinical and professional supervision and employee assistance programmes are important adjuncts for all members of the health care team. Initiating these strategies and other self-care measures will enable us to thrive and not just survive. This is important for the well-being of our patients, our families and ourselves.

References

(1) Mortan- Cooper, A. & Palmer, A. (2000). Mentoring, preceptorship and clinical supervision: a guide to professional support roles in clinical practice. 2nd Edition. United Kingdom: Blackwell Science.

(2) Davis, J. (2007) Minister slams health system. The Press. Christchurch: Fairfax Media.

(3) Best Practice Australia and New Zealand (2005) Health workforce database--New Zealand. http://www.bpanz.com/content/bpanz-health_workforce_database_nz.htm. Retrieved 21/03/07.

(4) Mulcahy, C. & Betts, L.O. (2005) Transforming culture: an exploration of unit culture and nursing retention within a neonatal unit. Journal of Nursing Management; 13, 519-523.

(5) District Health Boards New Zealand and New Zealand Nurses Organisation, (2006) Report of the Safe Staffing/Healthy Workplaces Committee of Inquiry. http://pdfwww.nzno.org.nz/Site/Campaigns/safestaffing.aspx. Retrieved 21/03/07.

(6) International Council of Nurses. (2007) Positive Practice environments: Quality workplaces=quality patient care. Information and action tool kit. http://icn.ch/indkit2007. Retrieved 21.03/07.