Sunday, 16 July 2017

A Weighty Issue

I have never been on the skinny end of the body shape spectrum. In my twenties my weight was no problem, I was full of energy and constantly busy, the way you are in your twenties. As I have grown older it has become easier to put on weight and harder to lose it. Eighteen months ago I broke my ankle in three places (1), since then it has been much harder to lose weight.

Working as a nurse has never made it easy to manage my weight. Working shifts played havoc with my metabolic system, going from late to early shifts, working nights and being tired and hungry after a shift. The hospitals I worked in never had the best canteens, most times the only decent things to eat were the chips, that is when I got time to have a meal break. I have forgotten many how times I was too busy to even get a meal break. Moving to work in the community I thought would be better for my weight, but it was still as busy, I often didn’t get the chance to have a lunch break and now the only places to get some lunch are supermarkets or fast food outlets, no chance of a hospital canteen.

It’s all very well to tell someone to eat healthy but so often there is much more involved that a simple choice between eating a salad or eating a burger and chips.

There’s now a project to get nurses to lose weight, it’s called Healthy Weight Initiative for Nurses, shortened to WIN, and is being run by C3 Collaborating for Health, London South Bank University, the Royal College of Nursing, the Royal College of Nursing Foundation and the Burdett Trust for Nursing (2), but C3 Collaborating for Health seem to be the organisation leading on it. All the details are on the C3 Collaborating for Health website (2) are that C3 Collaborating for Health seems to be leading on this campaign (3).

In the nursing press WIN has claimed that 25% of nurses are obese, and that 38% of nurses over 55 are obese (4). Yet nowhere on the C3 Collaborating for Health website (5) can I find how they obtained these percentages. They provide no link to the study were this came from, no details of how them obtained these figures, certainly no link to the data they used. The Nursing Standard article (4) references that the figures come from a report Prevalence of obesity among nurses in England compared to other occupational Groups, WIN, 2016, but nowhere can I find this report.

On the C3 Collaborating for Health website there is a blog about the procession of the WIN campaign (3). This blog links to paper about obesity amongst Scottish nurses, Prevalence of Overweight and Obesity Among Nurses in Scotland: A Cross-Sectional Study Using the Scottish Health Survey (6). This study concluded that two-thirds of Scottish nurses are overweight or obese. Shocking. But a closer look at this study and the data does not support this claim.

Firstly this study did not carry out any original research or data collection, what they did was draw their conclusions from a survey carried out by the Scottish government, the Scottish Health Survey. Every year the Scottish government interviews 4,000 Scottish people on a whole range of different aspects of their health, not just their weight, and publishes the results (7). The Scottish government decides what questions are asked, who is interviewed and how the data is analysed. The authors of the study had no input into any of these details, all they did was take the published data and then draw their own interpretations from it, they were using second-hand data. 4,000 people take part in each Scottish Health Survey, the Scottish population is 5.4 million (8). The Scottish Health Survey samples 0.08% of the population.

Prevalence of Overweight and Obesity Among Nurses in Scotland: A Cross-Sectional Study Using the Scottish Health Survey (6) based their conclusion on a sample of 411 nurses. There are Trusts in England who employ more nurses than that. A study from 2011 looked at health lifestyles of 551 nurses from one England Trust (9). They found 11.5% of nurses were obese, and that study collected its own primary data. So who am I to believe?

Where is the evidence that a quarter of British nurses are obese? Nowhere that I can find.  C3 Collaborating for Health certainly does not provide it.

C3 Collaborating for Health claim that they gathered information about weight issues in nursing, they said they did this through a survey, focus groups and workshops (3). They also say they spoke to overweight nurses at the RCN congress in 2016 (3). From all this they say they gathered nurses’ opinions on the factors that cause their poor health and weight gain. From all this information C3 Collaborating for Health said they have “development of three stimulating intervention design sessions” (3), only one of which they discuss on their website is a “My Health” page added to each nurse’s yearly appraisal (3). My reaction was, “Bloody cheek!”

Nurses’ yearly appraisals are for our professional development, not for fat shaming. Professional development is very important for nurses, we need to be up to date with current healthcare practice. Who wants to be looked after by an out of date nurse? It is hard enough to get the time and space to have a beneficial appraisal, without them being high-jacked. We need good professional development for good and safe patient care. In the current NHS climate it is hard enough to get training and professional development and appraisals are the gateway to these. Often appraisals are squeezed into free half hours on busy wards, there is already enough pressure on nurses’ time and appraisals are being squeezed and reduced. Now C3 Collaborating for Health want to add another element to an appraisal, an element that will take more time away from planning a nurse’s professional development. And what if the person carrying out the appraisal does not have the tact and skill to sensitively discuss the issues of a nurse’s health? A nurse’s self-esteem and confidence could be shattered.

If this is C3 Collaborating for Health’s best idea for improving nurses’ health (I refuse to use their management-speak buzz words) then they have zero idea of what is involved in working as a nurse, the pressures nurses face daily at work. C3 Collaborating for Health say they did all this research, all these nurses that they spoke with, the results of their survey, (The results of all this they haven’t made available on their website, or I simply cannot find them) and the only way they can think of to tackle nurses’ health is a fat shaming page on a nurse’s yearly appraisal. All this shows is the farcically low knowledge they seem to process of nursing.

Nursing is now a very stressful job and the poor conditions many nurses work under are only adding to their poor health, conditions such as:
  • Nurses working 12 hour shifts without being able to take a break because the ward is so busy (10)
  • Nurses being so busy at work that they don’t have time to keep adequately hydrated (10)
  • Nurses not being able to take their breaks away from the wards they work on (10)
  • The high workloads many nurses now face, and with no national safe staffing levels
  • The high number of empty nursing posts, in December 2016 10% of nursing posts in the NHS were vacant (11), which pushes a lot more responsibility onto a unit’s permanent members of staff
  • The poor quality of food available in hospital canteens. In my Trust’s canteen, fried chicken and chips are subsidised but you pay the full price for healthy salads
  • 12 hour shifts run from 08.00 to 20.00, night shifts running from 20.00 to 08.00. Hospital canteens are closed when nurses finish at 20.30 or later, the only option to eat then being local fast food outlets. Staff working night shifts usually have even less choice, bringing food in from home, what’s available in the hospital’s vending machines or ordering a delivery of fast food
  • The poor quality of food available in hospital vending machines.
As a Community Nurse I have forgotten the last time I took a lunch break. I get back to our office, after seeing my morning patients; eat my supermarket bought lunch at my desk as I do patient follow-up; we have handover and then I have afternoon patients to see, while trying to cram in report and care plan writing before seeing them.

We are legally required to have a twenty minute, uninterrupted break if we work more than 6 hours a day (12). C3 Collaborating for Health doesn’t even call for Trusts be forced to ensure all nurses receive their legally required breaks.

In 2014, Simon Stevens, the NHS England chief executive, called for NHS staff to lose weight to set an example to patients (13). He called for NHS canteens to replace burgers and chips with healthy salads, NHS Trusts to build more gyms, for hospitals to become more cycle-friendly and for Trusts to aware prizes to staff who lost the most weight. Strangely, in the last three none of these have been implemented.

The NHS’s greatest resource is its staff and yet still it under-values them. If a large under of nurses are overweight, and I haven’t seen any reliable evidence that they are, then shouldn’t the NHS be looking at why this is occurring? What elements of nurses’ working conditions are so unhealthy? Instead the NHS just seems to be ignoring the problem, working conditions and staff’s health seem to be at the bottom of their agenda.

I am sure that the C3 Collaborating for Health’s idea will be taken up, fat shaming as part of our appraisals. It is easy and very cheap to blame overweight nurses for being overweight, and yet looking at the unhealthy conditions that nurses are forced to work under would take too much time and too many resources. Unhealthy nurses are not good for the NHS but blaming them for their poor health is no answer.

C3 Collaborating for Health has shown me something though, you don’t have to be a nurse to patronise nurses.

Drew Payne

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