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Addressing the emotional realities of the job: compassionate care for the NHS workforce

Shilpa Ross and Laura Bennett The King's Fund 26 January 2018

In this blog, originally published on the King’s Fund website, Shilpa Ross and Laura Bennett consider whether organisation-wide forums are helping health care staff to address the emotional impact of their work.

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How do you process your feelings after a stressful day at work? Ignore it? Take it out on others?

What about those who have, arguably, some of the most stressful jobs out there – the 1.3 million people who make up the NHS workforce? I recently heard a nurse describe how she cries at the end of most shifts because the job can be so overwhelming, and it left me wondering what it does to a person to feel like that on an almost daily basis. And what does this mean for the quality of nursing care she will be able to deliver?

The signs of a workforce being pushed to its limits are clearer than ever. Our latest quarterly monitoring report (QMR) highlights staff morale as one of the major causes for concern for survey respondents (NHS trust finance directors and CCG finance leads). NHS finance directors currently think low staff morale is more troubling than A&E performance even amid the busy winter period.

At the same time, our recent analysis shows there are currently 1,300 fewer nurses and health visitors (full-time equivalents) employed in the NHS compared to July 2016. The significant challenges in recruiting and retaining qualified staff have been well publicised lately – and add to the pressures on existing staff.

So, what are the options to address the emotional impact of the work carried out by health care staff? In the wake of the care failings at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis suggested organisations should introduce Schwartz Center Rounds (or Rounds) as a way to support staff. Our former colleagues (now at the Point of Care Foundation) were involved in piloting Rounds in two English hospitals in 2009. The popularity of Rounds has since grown and they are now implemented in more than 150 health care organisations.

Typically, Rounds are organisation-wide forums for members of all staff groups to meet regularly and discuss the emotional challenges of their work. Rounds are carefully facilitated in order for staff to share their feelings in a safe space. The rationale is that, by sharing their experiences, individuals’ emotional wellbeing can be improved which in turn fosters more empathy and compassion towards colleagues and patients. The nurse I mentioned at the beginning of this blog was speaking at a Round that I was observing.

A team of researchers from King’s College London, the University of Sheffield and The King’s Fund was involved in a national evaluation of Rounds in England that sought to evaluate their impact on individual members of health care staff as well as the wider organisation. The research aimed to tease out the specific mechanisms by which Rounds ‘work’, such as how people experience the process of telling the story of a care episode and then reflecting on it as a group in a safe, contained environment. The evaluation found improved psychological wellbeing scores for regular attenders of Rounds over an eight-month period. Staff described Rounds as being a valued opportunity to reflect on the emotional challenges of work. This led to greater feelings of understanding and empathy towards colleagues and patients.

The evaluation found there were some challenges in engaging all staff in Rounds; some attenders questioned the purpose of unearthing feelings of sadness and frustration. It was also challenging for staff at different levels to take their one-hour breaks in order to attend Rounds when wards were busy.

Rounds are not being suggested as a panacea for all the stresses of NHS staff. As pressures on the front line of health care increase, it is all the more important to take proactive steps in looking after the wellbeing of the care givers. Rounds are a unique way to provide collective support across the range of professional groups that care for us, as well as to reaffirm and reinforce values and commitment to compassionate care. Rounds are a step in the right direction towards helping staff manage the emotional realities of the job.

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