My mother, a New Englander who loved lighthouses and all things ocean, had a small wooden plaque in her New York City kitchen depicting a beach house and inscribed with a message about heartaches being healed by the sea. Cheesy, yes, but there is something renewing about the ocean. Perhaps it's the vastness and the constancy, or the sun and salt air, or the rhythm of the waves. Or maybe it's just being outdoors in a setting different from our home that enables us to escape, rest, and recuperate from the stresses of our daily routines. We offer this month's summer cover as a visual “day by the sea,” a reminder to make some time for much-needed “R and R.”
A respite for nurses may be more needed than ever. Workplaces are more complex than they used to be and seem to be changing faster. Think of the changes that have occurred in your workplace in the last five years—how many new nurses are there? What changes have been implemented to meet requirements for determining hospital-acquired versus present-on-admission pressure injuries or infections, or for tracking HCAHPS scores? And there never seems to be enough people to do what needs to be done, no matter where one works.
I recently spoke with Danielle Pierotti, PhD, RN, CENP, vice president of quality and research for ElevatingHOME, a nonprofit that represents 12,000 home health agencies and 6,000 hospice organizations. Pierotti says that home health nurses deal with many of the same issues as hospital nurses: recruiting, retaining, and mentoring new staff; managing more (and sicker) patients as the population skews older and more older adults want to age in place; tighter financial resources; and changing payer policies. But while home health nurses face similar stressors as hospital nurses, she notes that “hospitals typically have greater resources, with education teams, HR teams, and better digital infrastructure than most home health and hospice agencies.” There's an isolation factor, as well. Home health nurses are on their own, she says, with “no colleague down the hall to call for help.”
A recent article in the New York Times, “The Business of Health Care Depends on Exploiting Doctors and Nurses,” has received widespread attention. In it, New York City physician and writer Danielle Ofri posits that health systems are taking advantage of health professionals’ commitment to their patients, relying on them to “do what's right.” This means forgoing meals to meet patients’ care needs or working extra shifts because staffing levels are at bare minimum or doing charting at home on one's own time. She doesn't believe this is a purposeful plan, but that it's necessary to keep the system functioning.
It's becoming increasingly obvious, however, that while the system may be functioning, its health care professionals are not. Physician burnout and suicide have garnered attention, and in January, the National Academy of Medicine released a paper, “Nurse Suicide: Breaking the Silence.” In it, authors Judy Davidson and colleagues note that while there is a paucity of research on nurse suicide, anecdotal reports indicate it may be more prevalent than once thought. She urges more openness when it happens and better prevalence data so that risk assessment and prevention measures can be established.
Many nursing organizations have been addressing workplace issues with the aim of improving the work environment, offering on-the-job stress breaks (like relaxation rooms) or supporting initiatives to deal with stress and grief (see “Helping Health Care Providers and Staff Process Grief Through a Hospital-Based Program” in the July issue). The American Nurses Association has addressed this with its successful Healthy Nurse, Healthy Nation campaign (www.hnhn.org), which provides nurses with online resources, support, and networking opportunities; more than 10,000 nurses have enrolled. But until workplaces change for the better, we need to make sure we take care of ourselves.
A recent study of almost 20,000 British adults, published June 13 in Nature, noted that spending two hours per week outdoors was associated with better health and a greater sense of well-being. So whether forest bathing (see the December 2018 Editorial) or sunbathing, get outdoors this summer, take a deep breath, and let your shoulders down.