WORLD MENTAL HEALTH DAY 2024

“I am good at walking away,” I said as I concluded my exit interview with a former manager. I had started getting panic attacks every morning when I reported to work. This had never happened to me before. I had started doubting my skills, second-guessing myself as a nurse and ultimately watching over my back. I was not being a nurse. I was protecting my Nursing PIN (nursing license in the UK). This was my cue to call it quits.

?So many things had gone wrong at work and my effort to bring change was met with an iron fist from the management. I believe in safe staffing models so I spoke up on behalf of my patients. I spoke up because they expected me to advocate for them. I complained when they were not given food while on dialysis machines. I complained when their transport to and from the hospital was delayed. I wrote incident reports when transport teams collected patients late, making them miss their sleep and?routine, among other issues, on top of a late dialysis session. I spoke up. I got marked. I was rocking the boat. ?I became a target. This is when I walked away.

It was a good job. I loved my patients. I miss them still, but I had to walk away. This is the story of many nurses across the globe. There seems to be a concerted effort to highlight the importance of mental health safe spaces at the workplace, which starkly forgets the hospitals. When we do address mental health at the hospital, the focus is on patients, not the people who work there. As they make up the?majority of the healthcare workforce, nurses’ mental health needs to be incorporated into every healthcare microcosm.

Besides unhelpful nursing leadership and a culture of victimization in some quarters, other factors affect the mental well-being of a nurse. Here are some of them and suggestions on how to handle them:

Duty rostering

I recently met a nurse from the Middle East. Naturally, we started comparing notes about nursing. I sadly learned that in one of the countries (name withheld for safety reasons), nurses are rostered to work based on their age and marital status. Married nurses do not do night shifts, and?nurses over a certain age do not do night shifts either. My jaw dropped. It got me thinking about our duty rostering. Perhaps we are not as radical as this anonymous country in the Middle East but do we pause to think about the nurse when we plan our rota or are we focused on the needs of the department?

Research has shown that grave mistakes occur when people are mentally tired. Many drug errors tend to occur toward the end of the shift as opposed to the beginning of the shift. Having this in mind, we need to create room for nurses to rest in between shifts, especially in the United Kingdom where the shifts are still 12 hours long.

Besides nursing, nurses have lives outside work. As such, rotas ought to be flexible enough to promote work-home balance. I refuse to call it ‘work-life balance’ as you know it because, to me, they are two conjoined twins. One is always an extension of the other and both are part and parcel of life. A flexible rota allows nurses to swap shifts around if need be. Rigid rotas make it hard for nurses to plan their social welfare activities.

More Nurses in the profession

We cannot practice considerate rostering without skilled nurses. This calls for the?elimination of bottlenecks that limit nurse employment. The?United Kingdom needs to expand the?hiring of nurses from overseas to other countries not just Asian countries. I know there are bilateral agreements between the?UK and some of those countries but Africa too trains nurses! They are applying directly for jobs in the UK and the NHS among other employers is conveniently ignoring those applications. This is unfair for a system so reliant on overseas nurses. Unless, of course, ‘overseas’ does not include African countries. There goes your Black History Month sermon!

Open Discussions on Mental Health

Ever heard the phrase ‘Nurses eat their young?’ It would be funny if it were not so sad. Nurses victimize and stigmatize one another whenever the issue of mental health challenges crops up. It is like we are insulated from life’s storms. We behave as if we are unbreakable pillars of infinite strength. We have become robots who think not of the people doing the job but of tasks to be completed, the person be damned. We need to re-educate ourselves and extend the same grace to our colleagues as we extend to our patients. Nursing is an emotionally demanding job and no amount of resilience will negate this fact. It is a labor of love.

Addressing compassion Fatigue

I have been a nurse for over ten years now and I am yet to meet a nurse who does not carry a slice of their patient’s pain home. Once again, being emotionally resilient is not an antidote to compassion fatigue. As such, we need to be open and transparent in our teams enough to discuss cases that go well and those that do not.

Regular debriefs are important so that we can untangle our thought processes. Nurses need reassurance from one another in times of trouble and in times of happiness. They need to know that they have done their best even when honest,?mistakes occur because they do. Regular debriefing meetings help the team to gel and create a unity of purpose. They are also great avenues for managers to identify any training gaps.

Trauma-informed practice

Nursing is an emotionally tasking career. We need to understand that people come into nursing while carrying their trauma from the past. One mark of a great clinical psychologist, for instance, is that they are aware of their own biases based on their own life experiences. It should be the same for nurses. There are things every one of us has had to deal with in life and this either gives us strength to take certain roles or excludes us from certain roles. Being trauma-informed builds a?sympathetic presence and reduces stress from emotional overload.

Leadership Support

A chain is as strong as its weakest link. This is the truth in nursing teams. Managers, practice development nurses, and clinical leads are in an enviable position to grow the capacity of every nurse in their teams. As such, it is critical to mention that resilience as a blanket prescription does not mean staying at the same place where you are facing all manner of abuse. Sometimes, often, resilience is the self-awareness that there is a limit to what you can take, and happily walking away. Walking away is sometimes the strength that nobody talks about.

In conclusion, addressing mental health in the workplace for nurses is one way to ensure staff retention. After all, nurses do not just quit challenging jobs. They leave unsupportive environments.

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