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Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review

“…In addition to the data presented in Tables 7-10, some of the papers described 'negative' or dysfunctional solutions to workplace stress, including leaving the profession 105,148 or even suicide. 95,101,105,109 Many also included mention of the need for interventions for students/prequalification, 9,34,114,151 including the need for universities and NHS to work collaboratively to reduce the theory-practice gap 90 (see Chapters 4 and 6).…”

“…In addition to the data presented in Tables 7-10, some of the papers described 'negative' or dysfunctional solutions to workplace stress, including leaving the profession 105,148 or even suicide. 95,101,105,109 Many also included mention of the need for interventions for students/prequalification, 9,34,114,151 including the need for universities and NHS to work collaboratively to reduce the theory-practice gap 90 (see Chapters 4 and 6). Student well-being is outside the remit for this study, so these interventions are not included here, though are acknowledged as being an important focus for any strategy to mitigate mental ill-health in the healthcare workforce.…”

“…For example, Lone working (N, 99,118,119 Poor relationships with colleagues/incivility/ bullying 9,25,30,34,75,83,89,90,96,110,123 Fear of assault/abuse from public/patients (P, 124 but also N and M in some settings e.g. emergency nurses, 23 secure forensic 25,111 ) Challenging relationships with patients, public, clients 23,80,100,105,106,111,124,125 Not feeling able to speak out 9,83,90,94,114 continued one nursing paper focused on newly qualified nurses 73 highlighted that this can mean regularly working with temporary staff (bank or agency staff) and/or being moved to other units (impacting teamwork and collegiality as well as knowledge of the systems and patients), and that such shortages can often mean being the only registered nurse on a shift, leading to feeling "vulnerable, and their units unsafe" 73 (p. 3). Another commonly cited demand is having an unmanageable workload, relating to staff shortages and plugging gaps, but also from increased demands for care.…”

“…in the case of neonatal death) or particularly traumatic, or in the case of students or newly qualified staff when it may be their first experience of death and so not yet normalised. 96,105 The cumulative experience of stress (rather than just acute traumatic episodes), and the emotional labour of healthcare work caused by having to regulate emotions and remain 'professional' (called 'wearing a professional mask' in our stakeholder group) were cited as causes of psychological ill-health cited within papers across all three professions (see Table 6) and discussed in more detail and with a realist lens in Chapter 6. Some also cited feeling controlled as causal factors of psychological ill-health -both by the 'politics' of the organisation in which they worked or the wider healthcare system (i.e.…”

“…reducing retirement age, allowing phased/partial retirement, 77,95 and financial barriers to recruiting/retaining the workforce; 155 and interventions that supported flexible working and/or gave workers more control over their work schedule. 77,94 Several sources also referenced the benefit of or need for policy-level intervention, including the Assault on Emergency Workers Bill 105 and 'zero tolerance' 123 This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/.…”