By Don Sadler
The saying, “Physician, heal thyself,” could just as easily apply to perioperative nurses. Unfortunately, too many OR nurses fail to maintain good health.
According to the American Nurses Association (ANA), the health of U.S. nurses is often worse than that of the average American. For example, nurses are often overweight, have higher levels of stress and get less sleep than the average American, states the ANA.
“Because health care delivery requires 24/7 support, the demands of shift work exacerbate the health of nurses,” states the ANA on its website. “In addition, hazards such as workplace violence and musculoskeletal injuries are contributing factors to poorer health.”
Don’t Neglect Yourself
“As a nurse, you’re used to looking after the needs of others, but far too often nurses find that they are neglecting their own health and safety needs,” says David Taylor, MSN, RN, CNOR, president of Resolute Advisory Group LLC.
“This is especially true when they are working long hours and have added responsibilities at home,” Taylor adds. “It’s important for nurses to make the time to take care of their own health. This includes getting enough rest, eating healthy foods and doing the things that bring them joy outside of the workplace.”
Linda Groah, MSN, RN CNOR NEA-BC, FAAN, the CEO and executive director of the Association of periOperative Registered Nurses (AORN), concurs.
“Many OR nurses do not take breaks or eat lunch, and when they do eat, it’s not consistent with current nutrition recommendations,” she says. “For example, they’ll substitute processed foods for fruits and vegetables.”
“Also, many nurses consistently volunteer for hours above and beyond the standard 40-hour work week, or they work two jobs,” Groah adds. “And too few are committed to a consistent exercise routine, either before or after work.”
A Grand Challenge
To help nurses improve their personal health, the ANA has instituted the Healthy Nurse, Healthy Nation Grand Challenge. This is a social movement designed to transform the health of the nation by supporting nurses to take positive action to improve their own health.
The Grand Challenge is focused on helping nurses take actions to improve their health in five focus areas: physical activity, sleep, nutrition, quality of life and safety. It encourages nurses to:
- Sleep for at least seven hours of restorative rest every day. According to the ANA, 12 percent of nurses have nodded off while driving. Healthy sleep leads not only to safer driving, but also to heightened alertness, increased energy, better concentration and judgment, more stamina and improved learning.
- Maintain the correct Body Mass Index (BMI). According the ANA, the average nurse’s BMI is 27.6, which is considered overweight. In addition, only 16 percent of nurses eat the recommended daily amount of fruits and vegetables.
The Grand Challenges recommends that nurses eat a balanced diet with reasonable portion sizes; enjoy sweets, fats, and alcohol in moderation; drink more water and less sugary drinks; and move more and sit less.
- Quit smoking. “The literature is clear: Smoking is bad for you,” says Taylor. The ANA has compiled a self-help guide to help nurses with tobacco cessation, which can be accessed at www.nursingworld.org/practice-policy/work-environment/health-safety/healthy-nurse-healthy-nation/tobacco-cessation/.
Taylor adds a few more health recommendations of his own, including getting regular exercise. “Granted, nurses are on their feet all day so it can be hard to find the motivation to exercise,” he says. “But exercise is critical to good health.”
Less than half of all nurses exercise regularly, according to the ANA.
Nurses also must guard against substance abuse, says Taylor.
Safety in the OR
Staying healthy also means practicing safety in the workplace. There is a wide range of potential safety risks within the OR itself, including sharps injuries, exposure to surgical smoke and the physical challenge of moving and handling obese patients.
According to the CDC, 385,000 needlestick and other sharps-related injuries are sustained by hospital-based health care personnel each year. “Nurses have the highest incidences of sharps injuries, so staff education is critical to reducing this risk,” says Groah.
AORN has produced a sharps safety toolkit that includes a video, PowerPoint presentations, guidance documents and more tools designed to help increase sharps safety in the OR. The toolkit is available to AORN members at www.aorn.org/guidelines/clinical-resources/tool-kits.
Meanwhile, an estimated 500,000 health care workers are exposed to potentially dangerous surgical smoke each year. In fact, being in an operating room for a full day could expose OR nurses to the same amount of smoke plume as smoking more than a pack of cigarettes.
Eliminating the dangers of surgical smoke requires changes in OR practices as well as the use of technology like smoke evacuators, disposable tubings, filters, ESU pencils with tubing and in-line filters. Groah emphasizes that smoke evacuation must be used on every procedure that generates smoke, regardless of how much smoke is generated.
Safe patient handling and mobility (SPHM) has become more important due to the dangers inherent in transporting, lifting, positioning and holding patients in the OR. “Therefore, hospitals should take steps to reduce the risks involved when physically moving and handling patients,” says Groah.
These include using the right SPHM devices and technologies to move obese patients, like overhead tracks with slings, in order to reduce or eliminate manual patient handling.
The ANA has published the Safe Patient Handling and Mobility Interprofessional National Standards, which can be purchased at www.nursingworld.org/nurses-books/safe-patient-handling-and-mobility-package/.
Avoiding Job Burnout
If health and safety are neglected by OR nurses for too long, this can lead to high stress and eventually job burnout. According to Beth Genly, MSN, the co-author of “Save Yourself From Burnout: A System to Get Your Life Back”, one-third of all nurses experience burnout at some point in their careers.
“It’s a vicious cycle,” says Genly. “Numerous safety issues have been linked to nurse stress and burnout, including medical and medication errors, substance abuse, injuries and illness, depression, and even suicidal ideation.”
Genly says there’s a common misperception that burnout is simply fatigue after a long day or a big case. “But it goes much deeper than this,” she says.
“Burnout is felt as ‘soul-deep’ exhaustion, withdrawal from work and life, and deep doubts about one’s ability to make a difference,” Genly adds. “It typically has three dimensions: emotional fatigue, cynicism and inefficacy.”
Genly believes that personal self-care among OR nurses is flawed in two main ways.
“First, many nurses live almost like they’re superheroes in a blockbuster movie,” she says. “They absorb immense punishment with no more recovery needed than a wisecrack and a wry grin.”
“And second, nurses tend to define self-care within narrow physical boundaries, like ‘Did I eat?,’ Have I slept?,’ and maybe, ‘Did I exercise?,’” Genly adds.
“Expanding the commitment to self-care to a wider framework is necessary to protect objectivity, empathy, reaction times, judgment, and the physical and mental capacity required to handle the demands of the work,” says Genly.
To reduce stress and combat burnout, Genly recommends that OR nurses focus on five specific areas: self-care, reflection and recognition, capacity, community and coping skills.
Taking a Toll
Whether it’s in the workplace or at home, Taylor says that poor health, unsafe practices and high stress can take a toll on OR nurses.
“They’re not good for nurses and they’re not good for patients, either,” he says. “OR nurses should prioritize good health, safety and stress reduction in order to serve patients better and lengthen their careers.”
