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Nursing – put your back into it!

Many of us put our backs into our nursing jobs, only to find we actually put them out! Illness, stress and anxiety, bullying and frustration are just some of the reasons why nurses take sick leave. Carole O'Connor looks at the consequences staff absence has on the health service

Carole O'Connor
Practice Nurse
Harold Road Surgery
East Sussex

Over 175 million working days in the general population were lost to sickness in 2006, costing approximately £13bn to the UK economy.1 The last recorded NHS sickness levels between April 2006 and March 2007 were estimated at 4.5% nationally; the north east of England had the highest levels (5.3%) and the lowest levels (4.1%) were in London and the south east of the country.2

In 2007, the British Chiropractic Association reported that approximately 5,000 nurses per year suffer back problems. As a result, many quit the NHS and some retire early, which obviously is not helping the overall nurse shortage.

Many practice nurses, nurse practitioners and community nurses have been in their profession since leaving school. We now have many lifting and sliding aids to help with patient movement; however, when a great deal of us trained in the 1960s, 1970s and even 1980s, these aids were not the norm! How many of us remember the "Australia lift"? We often worked in pairs to lift patients up onto beds, out of beds, onto the bedpans and onto chairs. Yes, we had our manual training days; but how many of today's older nurses had a great deal of strain put on their backs in the "good old days"? We may have bent our knees, and we all agreed to lift on the same count or word (one, two, three, lift!), but as these nurses get older, the wear and tear of the earlier days may be taking its toll.

In primary care there is not much call for lifting patients (hopefully), but lifting boxes of equipment, reaching up into cupboards for equipment and dealing with a patient's foot or leg dressings without pumping the treatment room couch to the correct height are all causes of strain on the back and/or neck. For most, common sense will prevail, and any previous handling techniques and manoeuvres will be remembered. If not, then perhaps a physiotherapist from your local hospital could be invited to attend your workplace to advise accordingly.

In 2004, Pulse magazine reported that a practice nurse on sick leave for 10 months may cost a GP approximately £25,000.3 There were no statistics or figures available at the time of writing to estimate practice and community nurse sick leave – GPs are a private entity so do not have to declare any
sickness figures.

The NHS is the third largest employer in the world.4 NHS Employers represents trusts in England and offers support and advice on workforce issues. It states that most sickness is due to:

  • Stress – for which it will give advice to managers and employers.
  • Bullying – improvements should be made in working relationships, communication and dignity.
  • Violence/aggression – staff must have security.
  • Back injuries – staff must have manual handling course, advice given to employers.

Interestingly, the Economic and Labour Market Review noted that between July 2007 and June 2008, in general terms, customer service occupations had the highest sickness absence rates at 4.8% in the UK.5

In addition to back problems, stress and anxiety are high on the list of sick days for primary care nurses. The foreword to a booklet by the Royal College of Nursing (RCN) entitled Managing Your Stress: A Guide for Nurses states: "You are good at spending a great deal of mental, emotional and physical energy caring for others. Taking time to think about caring for yourself can be daunting and difficult". Obviously, this organisation felt a real need to publish such a guide.6

The Health and Safety Executive lists a total of 442,000 people in Britain who suffer from stress, and they state that a high prevalence of work-related stress is found in the nursing profession.7

A study of community palliative care nurses in Australia in 1998 found that they suffered from stress in their working environment due to poor family dynamics – with families wanting the nurse to be part of the family unit – heavy workloads and others' expectations.8

With so many of us in primary care working towards government targets, meeting deadlines and increasing workloads all at the same time, it is no wonder that so many professional clinicians are tired, anxious and overworked. Perhaps it is easy to see why sick days are taken, and for many nurses it will not be a decision that is made lightly.

Bullying in the workplace
We probably used to believe that bullying would end once our school days were over. Not so! According to the UK National Workplace Bullying Advice Line, between 1996 and 2002 12% of over 100,000 calls received were from nurses and healthcare workers. Surveys by the RCN, Unison and others suggest that a figure of 33% for these workers is more accurate.9

It is easy to advise that those who are bullied should report the matter to their head of department, practice manager or senior colleague; but sometimes the situation is not black and white. Talking to a sympathetic colleague, GP or union representative may help, and there are many websites that offer advice and support. Whatever route is taken, something must be done. Bullying should not be tolerated!

In 2007, Dame Carol Black reviewed Britain's workforce and sickness levels, including those of nurses. She received many replies to her "Call for Evidence" and she finally presented her findings in a report to the government in March 2008.1 Its response was made known seven months later with the document Improving Health and Work: Changing Lives. The document's executive summary states: "We want to create a society where the positive links between work and health are recognised by all, where everyone aspires to a healthy and fulfilling working life, and where health conditions and disabilities are not a bar to enjoying the benefits of work".10

For most nurses, getting back to work and feeling fit and healthy are high on the agenda. In an editorial in the Nursing Times, Julian Topping, Head of Workplace Health and NHS Employers, stated that a move to a possible new electronic fit note, rather than a handwritten sick note, as recommended by Dame Carol Black in her review, was welcomed and would improve the way nurses' sick leave is managed. The new certificates would include details of work that the employee is capable of carrying out, allowing the employer to identify suitable tasks. This would ensure that the person is able to do some tasks rather than a total ban on working.11

I recently ruptured a ligament in my lumbar spine, causing me to take three weeks off from my practice nurse employment. After visiting A&E, my GP and a physio, I was eventually able to return. My workplace were very sympathetic, and it was arranged on the first week back that instead of my normal 31 hours, I would work half days, spending an hour with patients and the rest of the time on my paperwork. This was a gradual move back into my working environment, which was most helpful and appreciated. I wanted to go back to work and I was bored at home. I was unable to carry out my full responsibilities at work due to back pain, so gradually building up my workload really helped. Let's hope other practices and organisations work like this! None of us are infallible, but work colleagues and patients also suffer when we are absent from work.

How many of us say, "I wish I didn't have to work, I wish I was at home!" But if we were really honest with ourselves, we wouldn't want to be at home unwell. If we were genuinely ill, we wouldn't enjoy our time off or gain any benefit from it, apart from recovering from whatever it was that was keeping us from our employment. As professional people, we went into our careers with the aim of helping others, and I suspect that, for most of us (although we joke about not working), our caring and moral obligations far outweigh trying to "pull a sickie". As long as I have my health all I can say is, "Roll on retirement"!

1. Black C. Working for a healthier tomorrow. London: Stationery Office; 2008. Available from:
2. NHS Information Centre. Sickness Absence Rates of NHS Staff in 2005. London: NHS Information Centre; 2006. Available from:
3. Cameron I. Staff sick leave to hit GPs' pockets. Pulse; 2004. Available from:
4. NHS Employers. Facts and Figures: NHS Pension Scheme Review. London: NHS Employers; 2008. Available from:
5. Leaker D. Sickness absence from work in the UK. Economic & Labour Market Review 2008;2(11):18–22.
6. Royal College of Nursing (RCN). Managing Your Stress: A Guide for Nurses. London: RCN; 2005.
7. Health and Safety Executive. Health and Safety Statistics 2007/8. London: HSE; 2008.
8. Wilkes L, Beale B, Hall E, Rees E, Watts B, Denne C. Community nurses descriptions of stress when caring in the home. Int J Palliat Nurs 1998;4(1): 14–20.
9. UK National Workplace Bullying Advice Line. Information on bullying and harassment for UK nurses and healthcare workers. Available from:
10. Department of Health (DH). Improving Health and Work: Changing Lives: The Government's Response to
Dame Carol Black's Review of the health of Britain's working-age population. London: DH; 2008.
11. Topping J. Improving how nurses' sick leave is managed. Available from:

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