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Excessive work demands, staff shortages and diminishing resources are leading to poorer mental health among UK nurses and midwives and impacting their ability to deliver high quality care to patients, according to a new study.

The report says nurses and midwives are at higher risk of work-related stress, burnout and mental health issues such as depression and anxiety, attributing rising rates of poor mental health to increasing work demands.

Commissioned by the RCN Foundation, the report, The Mental Health and Wellbeing of Nurses and Midwives in the United Kingdom, authored by Professor Gail Kinman and Dr Kevin Teoh from the Birbeck University of London, and Professor Anne Harriss, a nurse and President of the Society of Occupational Medicine (SOM), undertook a systematic review of 100 studies published in the last decade to uncover the prevalence of poor mental health among nurses and midwives, contributing factors, its impact on the workforce and patient care, and what interventions have proved successful.

The report found poor mental health and wellbeing among UK nurses and midwives impairs the quality of patient care and job satisfaction is lower among nurses and midwives than other professional groups in the UK due to stress and burnout. Additionally, nurses and midwives, especially from Black and Minority Ethnic Backgrounds (BAME) were at higher risk of harassment and bullying.

Other key findings revealed the demands on nurses and midwives to provide patient-centred care mean they are at higher risk of compassion fatigue, work-life balance is generally poor and a significant cause of stress, nurses and midwives often continue to work when they are unwell, and that the stigma often associated with mental health problems and a perceived “failure to cope” means many nurses and midwives are reluctant to access support.

The report makes 45 recommendations and says urgent action was required to address the issues threatening the mental health of nurses and midwives, with occupational health departments, managers, professional bodies and organisations all with a role to play in improving the situation.

Key priorities include addressing organisational factors found to underpin poor mental health and wellbeing in nurses and midwives such as high work demands, poor leadership, lack of resourcing and bullying; optimum staffing levels; nurses and midwives being required to take their full entitlement to breaks; organisations being required to implement a mental health strategy; managers and shift coordinators needing a better understanding of the impact of shift work on health and how it can be mitigated; regular audits to assess the scale of mental health issues and leading contributing factors within the workforce; and tackling bullying among the BAME nursing and midwifery workforce.

“The report clearly highlights the lack of knowledge and training of managers to deal with the high level of stress experienced by nurses and midwives,” Professor Harriss said.

“For example, many ward managers receive minimal, if any training regarding the impact of shift work on the health of staff. This knowledge is essential when planning staffing rotas to mitigate any possible impact on health.”

The report also recommends phased approaches to returning to work for nurses and midwives struggling with their mental health and says they should be able to self-refer to services rather than go through their managers.

While the report was undertaken before the COVID-19 pandemic hit, it argues the crisis will have further impacted the mental health and wellbeing of nurses and midwives and that the issue must become a priority in the International Year of the Nurse and Midwife.

“Action is urgently needed to improve the mental health and wellbeing of UK nurses and midwives, and the COVID-19 pandemic has raised additional concerns,” Professor Kinman said.

“The additional demands placed on staff by the pandemic means their wellbeing is likely to deteriorate further if the findings of our report are not acted upon. Our report has highlighted the need for evidence-informed, systemic interventions to tackle the causes of work-related stress in the sector, and we have identified some initiatives that might be particularly effective.”