This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Researchers reviewed the literature to investigate the causes of psychological ill-health (stress and anxiety, for instance) among nurses, midwives and paramedics. They identified solutions, and recommended that senior leaders, managers and team leaders, along with nurses, midwives and paramedics:
- improve working conditions (through regular breaks and appropriate facilities, for example)
- address the blame culture and assume staff are doing their best in difficult situations
- expect staff to experience psychological ill-health and take a preventive approach
- shift from individual interventions only (such as mindfulness or resilience training, which can be important) to include a focus on system-level culture change.
The researchers produced guidance for NHS leaders at all levels, and staff, to help implement the suggestions.
The issue: the impact of NHS staff psychological ill-health
The NHS needs healthy, motivated staff to provide high-quality patient care. Nurses, midwives and paramedics make up more than half (56%) of all clinical staff in the NHS; they have high rates of psychological ill-health.
High-pressure environments, with heavy workloads and staff shortages, are linked to psychological ill-health. The 2023 NHS staff survey reported that almost half (42%) of all staff felt unwell because of work-related stress in the 12 months before the survey. 1 in 3 (32%) felt there were enough staff to enable them to do their job properly; most (74%) said they faced unrealistic time pressures sometimes, often or always. 1 in 3 (30%) felt burnt out because of their work, and rates were highest in nurses, midwives and paramedics.
Psychological ill-health increases sick leave and staff resignations; it can also mean that some staff may be working when not well enough to perform their duties (presenteeism). The quality of patient care suffers as a result. Psychological ill-health among staff costs the NHS an estimated £12 billion per year, or more. The NHS could save up to £1 billion by successfully tackling this issue.
The researchers investigated causes of psychological ill-health in nurses, midwives and paramedics in more detail, and explored what might help.
What contributes to work-related psychological ill-health?
The researchers examined more than 200 research papers and reports.
They found that aspects of the job and workplace, rather than the profession itself, increased the risk of psychological ill-health. For example, staff in roles that exposed them to trauma, newly qualified staff and lone workers were especially vulnerable.
Conflicting priorities and tensions in the healthcare system could make it difficult to promote psychological wellness in staff. For example, where:
- a fragmented approach to staff wellbeing focuses on individuals and acute episodes of stress, and does not recognise long-term workplace challenges
- a blame culture makes staff fearful to speak up if they have concerns, and managers don't listen
- the needs of the system override staff needs so that for example, staff prioritise work needs above their own needs (and take on additional shifts to cover staff shortages, for instance).
How can healthcare organisations improve staff’s psychological wellbeing?
As a result of their findings, the researchers suggest that organisations:
- invest in long-term approaches to staff wellbeing that address organisational stressors (for example, provide wellbeing and psychological support, reduce bullying and harassment, and invest in spaces and places for staff to share experiences, such as in Schwartz Rounds); use an evidence-based framework to evaluate interventions
- reduce stigma and address the blame culture; assume staff are doing their best in difficult conditions
- improve the working environment by prioritising staff’s essential needs (access to hot food, lockers, showers, rest and break rooms, car parking).
The researchers suggest that front-line staff co-design interventions, tailored where possible to local, organisational and workforce needs. For example, staff may need a shared space during times of stress rather than investment in expensive online apps. During the pandemic, staff created What’s App groups to maintain contact with colleagues who had been redeployed elsewhere. These groups helped meet the need for support from each other.
What’s next?
Researchers need to work with service providers to meet the changing needs of diverse groups of professionals. More research is needed to help design, implement and evaluate complex interventions.
The researchers have produced a summary, guidance and a webinar of their work for leaders, nurses, midwives and paramedics.
How can I act on the new knowledge?
You may be interested to read
This is a summary of: Maben J, and others. Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review. Health and Social Care Delivery Research 2024; 12.
Taylor C, and others. Care under pressure 2: a realist synthesis of causes and interventions to mitigate psychological ill health in nurses, midwives and paramedics. British Medical Journal Quality & Safety 2024; 33: 523 – 538.
A guide for nurses, midwives, paramedics, their teams and managers and leaders.
Mental wellbeing at work. National Institute of Clinical Excellence guideline (NG212). March 2022.
Mental health support from the NHS for staff; plus the NHS Practitioner Health website provides a list of national services and support groups for NHS staff.
Strategies and support for stress from the Royal College of Nursing.
NHS Staff and Learners’ Mental Wellbeing Commission report.
A report from the King’s Fund. The courage of compassion. Supporting nurses and midwives to deliver high-quality care. September 2020.
Funding: This study was funded by the NIHR Health and Social Care Delivery Research programme.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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