Posted on Monday 3rd March 2014
Yvonne Sawbridge, Senior Fellow at Health Services Management Centre
"I am fed up watching our nurses’ cry. I am fed up watching doctors standing in the corridors and the only thing they need is a hug because it has broken their hearts."
This is what a union leader was quoted as saying recently when the A&E Department of the Royal Victoria Hospital in Northern Ireland reached breaking point. (http://www.bbc.co.uk/news/uk-northern-ireland-25672554; Accessed 19/02/2014). Surely if there is one thing we should commit to changing on NHS Change day, it is the way we support NHS staff?
This news report caught my eye particularly because it reports powerful emotions being expressed by professional health care staff. It is rare to see this reported, and yet, whether openly expressed or not, dealing with the emotions of themselves and others is part of the day to day lives of these staff groups. This work has been termed “emotional labour”, and is the subject of a National Learning Set – “Developing Compassionate Organisations” which has been launched here at HSMC to help support organisations address the negative impact emotional labour can have on their staff, which can then impact on patient care.
Our work in this area (Sawbridge and Hewison 2011) has taught us to understand the complexity and invisibility of emotional labour- meaning it is rarely accounted for in management practice. Boards are very clear about their responsibility for the health and safety of their staff, and recognise the impact that physical labour can have- hence the provision of hoists on wards to prevent nurses injuring their backs when lifting patients. However the effect on people’s hearts is much less well accounted for.
The role of the nurse involves supporting people at vulnerable times in their life. Often they are dealing with distress, tragedy, death and dying. This is not a typical working experience for most of the British public. Menzies (1960) described nursing as fulfilling the primary purpose of the hospital as they are the only workforce which “....must provide continuous care for patients, day and night, all the year round. The nursing service, therefore, bears the full, immediate, and concentrated impacts of stresses arising from patient care” (p97). She also said that “Their work involves carrying out tasks which, by ordinary standards, are distasteful, disgusting and frightening”.
For normal human beings therefore, dealing with these extraordinary emotions on a daily basis takes its toll- unless purposeful action is taken to support staff to surface these emotions and find ways to support them to contain the accompanying anxiety this work brings.
This is where our National Learning Set comes in. It was launched in December and attended by a range of healthcare professionals from a variety from Trusts across the country. The purpose is to create a community of practice where individuals and organisations can share their learning about how best to implement models of support. It is clear that one size does not fit all. The format of these events is for expert speakers to share the evidence about their work in the morning, followed by action learning sets, to enable participants to share stories and experiences in a safe environment, and to give them new ideas, energy and enthusiasm to continue their endeavours. So far, we have been fortunate to hear from Sonya Wallbank, outlining the model of Restorative Supervision, and Jo Goodrich and Mark Stobert providing a national picture and a local case study of Schwartz rounds. Forthcoming attractions include an international perspective delivered by Sharon Mastracci, who has studied crisis response practitioners in the USA. But it is the discussions which are the most powerful. One participant shared her learning about making a small financial investment and a minor environmental change (buying additional computers to be able to base staff in bays rather than at a central base on a ward). Not only did this improve the patient experience- the primary motivation for this change- but it had an unexpected impact upon staff morale. Menzies (1960) might say this was because the anxiety for staff was reduced, as they were given a more manageable area to take responsibility for. However the point is that the invisibility of emotional labour as a concept to be addressed complicates organisational responses. By sharing the learning we hope to raise the visibility and create environments which enhance the delivery of compassionate care, by recognising the need to support emotional labourers whatever form their work takes.
There are two more learning sets as part of this series, and we hope they continue to raise the profile of this important work and we start to recognise, celebrate and support the emotional labourers in our NHS and more widely.
Certainly our pledge is that we will continue to do this at HSMC.
Contact Yvonne Sawbridge, firstname.lastname@example.org for more information.
Sawbridge Y and Hewison A (2011) Time to care? Responding to concerns about poor nursing care. HSMC Policy Paper 12. Health Services Management Centre, University of Birmingham, Birmingham.
Menzies IEP. (1960) A Case-Study in the Functioning of Social Systems as a Defence against Anxiety: a Report on a Study of the Nursing Service of a General Hospital. Human Relations 13(2): 95-121.