The Health of Health Care Professionals

Abstract

Health care professionals represent a population at high risk for poor health. Although this may be counterintuitive given their expertise in health, the high stress and long hours of many medical work environments present challenges for health care professionals to engage in healthy lifestyle behaviors. This is extremely problematic for the health and well-being of both health care professionals and the patients they treat. Medical settings are encouraged to implement interventions that intervene at both the enviornmental and personal level to help faciliate behavior change among health care providers.

Health care workers also often report being stressed, physically inactive, and sleep deprived.

After their many years of training and experience providing medical care, health care professionals are considered experts on how to live a healthy lifestyle. However, as discussed by Romito et al¹ in this issue, the health care work environment poses substantial barriers to living a healthy lifestyle. Compared with the general population, health care providers are at an increased risk for coronary artery disease, type 2 diabetes, obesity, musculoskeletal injuries, and some cancers.^2-5 Health care workers also often report being stressed, physically inactive, and sleep deprived.^3,4,6 These issues have been found across health care teams, including administrative workers, medical assistants, nurses, medical residents, and physicians.^7-9 Although barriers to engaging in healthy lifestyles differ both within and between professions, barriers such as inflexible schedules and long work hours are common among most health care workers. It is important that health care professionals prioritize their own health not only to provide safe and effective patient care, but also for their own well-being.

Behaviors That Increase Health Risk

A truism in behavioral psychology is “Knowledge alone does not lead to behavior change.” This may be especially true for those that provide care for others in terms of healthy lifestyle behaviors. For example, nurses report high levels of nonadherence to public health guidelines such as physical activity recommendations and dietary guidelines even though their job consists of promoting health among others.³ Similarly, physicians in multiple settings report agreement that eating well and being physically active are beneficial to personal health, but less than 25% reported actually engaging in these activities.¹⁰ Finally, although smoking in health care settings has dramatically decreased since the 1970s, 25% of licensed practical nurses still smoke.¹¹ Often, nurses begin smoking prior to starting their job and, consistent with the general population, have trouble quitting.¹²

Health care jobs are often physically and emotionally taxing. The hands-on work required of many health care professionals such as patient handling, transferring, lifting, positioning, and long hours spent on their feet is thought to contribute to the higher incidence of musculoskeletal injuries among health care workers than in the general population.² Providing patient care is also mentally stressful, and this increases as shift length increases.¹³ Health care workers tend to work long hours compared with the general population, with 12-hour shifts being the norm for nurses, and medical residents routinely work shifts lasting longer than 24 hours.¹⁴

Health risks and consequences are further exacerbated among health care professionals who work night shifts. Shift work has been shown to reduce the quantity and quality of sleep, particularly when shifts occur in succession.¹⁵ Working night shifts is associated with an increased incidence of irritable bowel syndrome, greater abdominal pain, increased risk for breast cancer, and higher rates of suicide and suicidal ideation.^13,16-18 Likely as a result of high stress levels, poor sleep hygiene, physical inactivity, and poor dietary consumption, health care workers have increased body mass indices and higher risk of developing obesity than the general population.^13,19

Barriers to Change

The health care environment contains unique challenges that can prevent engaging in healthy lifestyle behaviors. For example, many health care professionals experience a work environment that is highly inflexible and has long work hours, unique schedule challenges, and an overall decreased opportunity to meet general health guidelines.^2,7 Although there has been some concern from the public over the long work hours, health care professionals generally view this as a necessary part of their training and have expressed frustration at regulations limiting shift lengths.²⁰ These factors create an environment that is prone to disrupting the circadian rhythm, which puts health care workers, especially those who work the night shift, at greater risk for the development of lifestyle diseases and increases the severity of chronic diseases.^15,21 This predisposes health care workers to negative health outcomes, even if they attempt to eat well and be active. Furthermore, the psychological toll of caring for critically ill patients and witnessing unfavorable outcomes is stressful and can affect an individuals’ ability to engage in health behaviors, including those that health care professionals know are important for health.

Potential Impact on Patient Care

Another concerning issue is the impact that these health behaviors have on patient outcomes. Impaired health among physicians has been linked to poor work performance, medical errors, decreased alertness, and unfavorable patient outcomes.^6,9 Higher stress levels in health care workers may cause a psychological overload, which decreases functioning and is related to adverse patient outcomes and increased critical incidents.²² The difficulty experienced in coping with high stress levels can lead to depersonalization and impersonal feelings toward patients receiving care, creating an environment where patients may receive decreased quality of care, especially concerning their emotional needs.²³ Along with stress, fatigue is another issue that has significant impacts on patient care. When physicians work more than 16 hours, their level of fatigue intensifies greatly. This has been shown to increase the number of preventable adverse events leading to patient death by 300%.²⁴ Medication, diagnostic, and procedural errors are the most common errors that occur as a result of health care worker fatigue.²⁵

The lifestyle behaviors of health care providers correlate strongly with increased patient counseling on a wide range of health promotion topics. Physicians who engage in healthy behaviors are more likely to advise patients to do the same, and physicians who do not engage in healthy lifestyle behaviors report that it is more difficult to counsel patients on this topic, and they spend less time doing so.²⁶ This pattern was seen for physicians who currently follow healthy behaviors and for those who were attempting to make a lifestyle behavior change as well. When health care providers practice healthy lifestyle behaviors, the quality of care delivered to patients improves and physicians are able to build better rapport. Patients reported that physicians who disclosed their own health practices seemed more trustworthy and credible and were up to 2 times more likely to implement the health promotion that was discussed.²⁶

Recommendations

In recognition of these issues, several interventions have been created to address the specific needs of health care workers. Hospitals have implemented a variety of programs ranging from employee health promotion, mindfulness workshops, individual incentives, and hospital-level changes to reduce health barriers. These efforts have had varying results. Not surprisingly, interventions containing only educational materials are the least effective in changing the behavior of health care workers, and those that take a systematic approach are the most effective.^27,28 A systematic approach addresses both individual health behaviors and the workplace environment, so that health behaviors are easier to implement. This includes identifying staff needs at all levels, engaging upper-level staff members and management, providing flexible programs that enable participation from a diverse staff group, and focusing on the benefits to the employee rather than improved patient outcomes.²⁷ Examples of intervention components include individual motivational counseling, team goal setting, physical activity classes, and relaxation techniques. Programs using this approach have resulted in improvements in employee dietary habits, body mass index, waist circumference, physical activity levels, perceived stress, and the onset of work-related disabilities.^3,29 Overall, interventions using techniques to increase opportunities for health professionals to implement positive health behaviors can lead to improved mental and physical health.

Conclusion

Medical professionals see the consequences of lifestyle behaviors such as smoking, overconsumption of energy-dense foods, physical inactivity, sleep deprivation, and stress among their patients on a daily basis. Yet health care professionals as a group engage in these behaviors as much or more than the general population. This is illustrative of how powerful environmental conditions can be in determining an individual’s ability to change health behaviors. Just as effective interventions among health care providers require a systematic approach that includes both personal behavior change and changes to the environment, health care providers are encouraged to help patients understand their conditions and treatment in terms of both personal responsibility and structural constraints. It is important for medical settings to take systematic approaches to improve the health and well-being of health care professionals and ultimately their patients.