Eudaimonic well-being in NHS ward nurses, and links to occupational identity – Beyond Pollyanna-ish and happy-ology approaches to psychological well-being.

By Nick Holding (22-23)

“The end, or purpose, of nursing, is the welfare of other human beings.  This end is not a scientific end, but rather a moral end.  That is, it involves the seeking of good and it involves our relationship with other human beings.  The science that is learnt and the technological skills that are developed are both shaped and designed by that moral end.” (Curtin, 1979)

The question of what it is to be a nurse remains as pertinent today as it was for Clinical Professor of Nursing Leah Curtin in 1979.  Historical nursing literature repeatedly identifies a move in the direction of a medical model, with an emphasis on science, technology, and cure.  Schulman writes as far back as 1958 that “Nursing will still be nursing, but it will be carried out by persons of other occupational affiliations”, leading Curtin to ask, “What will nurses be doing while someone else is doing the nursing?”

Whilst it is evident that nursing has become a more technical profession there continue to be efforts to elevate the status of nursing to one of high-level, evidence-based healthcare providers.  The duality of the profession, and the influence on identity, challenges the concept that there is a single and consistent representation of what it is to be a nurse.  The technical, positivist approach, based on research and objectivity, provides the profession with what some might contend, to be the credibility that is needed to elevate the role in the multi-disciplinary structure.  Concurrently, there has been a shift away from the illness-cure model towards a more individualistic, person-centred, and humanistic approach.

The context for the modern nursing workforce

Political and financial pressures over the last two decades have resulted in the NHS facing considerable changes.  Healthcare requirements have grown significantly, driven by ageing, and increased morbidity leading to a change in population healthcare demands and an increase in the need for healthcare services.

To help the NHS deal with changing demand as well as fund improvements in treatment, the NHS budget has historically risen by an average of 4% above inflation each year.  However, since 2010, the average increase has been significantly reduced (Chart 1).  In the 10 years before the pandemic, real-term spending increased per person on average by just 0.4% a year and included four years in which spending fell.  Therefore, the NHS has seen a period of stagnation in terms of the money available to fund improvements in healthcare, develop services to meet the growing demand and meet inflation-related pay demands.

Chart 1.

Annual changes in health spending 1999 – 2020

(Triggle, 2023a)

Furthermore, the relationship between the NHS, the government, and its staff has deteriorated with “once unthinkable” nursing strikes across the UK. Whilst there are various factors contributing to nursing staff dissatisfaction, pay is one of these and reflects how the profession feels unappreciated and under-valued, and the real-term pay cut (Chart 2) reinforces this belief.

Chart 2.

Real terms NHS pay by financial year, consumer price index, 2010/11 baseline

(Dayan & Palmer, 2022)

Findings

This study aimed to explore the eudaimonic well-being of ward-based NHS nurses, how they feel about their sense of occupational identity and if it is congruent with their current role.  It also explored whether psychological well-being interventions meet the needs of nurses in the modern NHS.  The findings portray a revealing illustration of the lived experience of highly experienced nurses (with over 160 years of collective experience) who have spent their long careers providing direct patient care.

The depiction of working life presented in this research suggests an incongruousness between the occupational identity of the nurses and the role they carry out as part of their daily work, leading to frustration, loss of motivation, impacts on their psychological well-being, and high turnover rates.

The findings identified three high level themes, and six sub-themes that help us understand eudaimonic well-being in experienced ward-based nurses.

Trust is very important for nurses and forms a major part of their occupational identity.  This relates to their sense of professionalism and their relationship with patients and family members.  Psychological well-being is affected by an inability to be their authentic selves, due to limited time available for direct patient care, the freedom to act as needed, and reduced opportunity to share their knowledge with others.  Furthermore, connection to their team and relatedness to each other plays a significant role in job satisfaction and personal well-being of nurses on a ward.  The ward team provides the meaningful psychological well-being support that is missing from existing interventions, and is a mechanism to share workload, stress and demands of the role.  When this relatedness and connection is missing, we find an increase in work-related stress, poor psychological well-being, and low job satisfaction.  Together, these themes highlight the opportunity to address existing gaps in the factors that make up a positive work experience for experienced ward-based nurses. 

Where we go from here?

Whilst the NHS faces ongoing vacancy challenges, nursing contributes significantly to overall numbers across the health service in the UK.  Recruitment and retention efforts do not appear to be having an effect and nurses continue to leave the profession because of poor job satisfaction and low psychological well-being.  From the findings of this study, we now know that nurses feel frustrated at an inability to be their true selves, with their occupational identify being incongruous with the role they are expected to perform.

Eudaimonia (living in harmony with authentic self) in nursing is largely ignored, yet these intrinsic motivations have a greater impact on psychological well-being than traditional extrinsically motivational approaches.  A better understanding of intrinsic motivation, and an appropriate response, will have an immediate effect on job satisfaction, psychological well-being, and retention efforts.

Based on the findings from this research, it could be argued that psychological well-being interventions for nurses are not having the intended impact.  The participants demonstrated they are strikingly aware of their intrinsic motivations and what attributes lead to providing good patient care, yet as noted by one, “It [well-being programmes] feels like it’s not really for us on the ward”.  Nursing leaders and well-being practitioners can take the evidence from this study to develop a humanistic, positive approach to psychological well-being in nurses that responds to their eudaimonic drivers and promotes the actualisation of their authentic self.  The strong evidence-based research in this field provides a meaningful case to distinguish it from ubiquitous ‘pollyannaish’ positivity and ‘happy-ology’ which are popular but less scientific.

Leah Curtin describes the purpose of nursing as the welfare of other human beings.  We must therefore ask ourselves, how much of nursing continues to involve “the seeking of good, and the relationship with other human beings”, and how are levels of incongruence having an impact on the psychological and eudaimonic well-being of nurses in your organisation?

By Suki Johal | 22-23

Introduction:

The Life Sciences Industry (LSI) plays a crucial role in the UK’s employment landscape, particularly in STEM (science, technology, engineering, and mathematics) roles. A parliamentary report addressing diversity and inclusion in STEM emphasises the importance of a continuous flow of talent for the UK economy. However, the report notes disparities in the distribution of opportunities across society, with women, individuals from specific ethnic backgrounds, and those from disadvantaged socio-economic backgrounds consistently underrepresented in STEM education, training, and employment (UK Parliament, 2023).

Exploring the Intersections:

We set about exploring and enhancing the existing, albeit limited, literature on the intersection of ethnicity, gender, and motherhood in the context of career development for women of Indian descent within the Life Sciences Industry (LSI). Conducting semi-structured interviews with thirteen women aged 35-55 working across diverse roles in a major pharmaceutical organisation, the research identified three overarching themes, shaped significantly by Indian and varying generational values concerning motherhood and career pursuits.

Our findings revealed despite their high qualifications and eagerness to contribute, British Indian women, frequently experience underemployment restrained by self-imposed or systemic limitations. Notably, the trajectory to leadership positions in the LSI is perceived as an overtly exclusive privilege for white males, relegating women, ethnic minorities, and mothers to predominantly individual contributors or lower-middle management roles.

A Paradox of Passion and Struggle:

Despite being underrepresented, undervalued, underemployed and therefore, underpaid paradoxically, participants referred passionately to their work holding a sense of purpose and meaning from their work. These women aspire to utilise their skills and capabilities in service of patients but emphasise the need for a sense of belonging for themselves and other minority groups.

Practical Recommendations for Change:

1. Address the Ethnicity Pay Gap

A Department for Education report revealed women entering the labour market with higher qualifications than men earned less per hour from the outset (ONS, 2018). Logically, women opting for or needing to work part-time would face additional financial penalties. The ethnicity pay gap across the LSI remains undisclosed as companies cite practical challenges to collecting ethnicity data and yet employees may disclose their ethnicity if it contributes to rectifying pay imbalances. Posing the ethnicity-related question to all employees and assessing volunteered data for pay equity, enables the evaluation and implementation of measures to realign the salaries of the most affected.

2. Provide Practical Career Mentoring and Sponsorship

Female leaders who are also mothers within the LSI play a crucial role in offering essential guidance, reassurance and allyship to dispel myths and reshape perspectives on motherhood and career development. Mentorship and sponsorship programmes should be delivered through various modalities to maximise their impact and cater to the needs of both mentor and mentees. This may contribute to a shift in employees’ mindsets about women applying for promotions during pregnancy, maternity leave, or shared parental leave.

3. Encourage Male Shared Parental Leave

While UK-based companies offer shared parental leave in addition to the statutory paternity leave, very few fathers take advantage of the parental leave entitlement, often relying on mothers to take a career break. Highlighting the benefits of shared parental leave to both parents may help to address gender inequalities at both work and home. Men can form close bonds with their infants without work pressures, and women can pursue their careers without the added burden of childcare concerns. 

4. Collectively Tackle Diversity, Equity, and Inclusion (DEI) Gaps

The industry lacks a representation of female and ethnic minority leaders. Membership in industry forums that collaborate with LSI organisations to benchmark data and address leadership gaps in diversity, equity and inclusion should be deemed mandatory rather than optional. Participating in such forums enables companies to share best practices, showcasing a concerted effort within the LSI to rectify visible inequalities at all levels of leadership, thereby conveying this commitment to both current and prospective employees.

5. Allow Self-Enrolment in Leadership Development Programmes

Existing aspiring leader programmes may be inaccessible for minority groups seeking to enhance their leadership capabilities. Provided these individuals meet performance standards, granting them the opportunity to self-enrol circumvents any biases or misconceptions that managers may harbour regarding an employee’s career aspirations. Such programmes offer benefits at every level; participants develop their leadership skills and are better prepared for career development opportunities and organisations can identify previously overlooked employees for succession management, strengthening their talent pipeline.

6. Embed Inclusive Recruitment and Hiring Practices

Organisations are strongly encouraged to adopt inclusive recruitment and hiring practices. Taking inspiration from the NHS, organisations can actively encourage applications from underrepresented groups, explicitly stating this commitment at the end of each job advertisement. Such practices offer reassurances to those who don’t fit the traditional leadership mould but are actively welcome to shape a new diversified and strengthened leadership team. This not only enhances profitability and innovation (McKinsey, 2020) but also provides a more visible representation of a diverse employee base.

7. Embrace Hybrid Working Models and Technology

The COVID-19 pandemic highlighted many roles within the LSI, particularly client-facing positions, which can be effectively conducted virtually and do not necessarily require constant in-person presence. Embracing hybrid working models enables women to spend more time with their children and less time commuting, thereby contributing to a healthier work-life balance. Additionally, this approach minimises travel costs, allows employees to choose their place of residence, reduces the organisation’s carbon footprint, and optimises employee productivity.

Conclusion:

The peril faced by organisations looms large if they merely pay lip service to addressing inequalities while perpetuating the prevailing white male leadership paradigm. The genuine risk of an exodus of underrepresented talent seeking opportunities in more progressive competitor organisations is a tangible threat. It is incumbent upon the Life Sciences Industry not just to acknowledge these challenges but to implement the proposed recommendations actively and earnestly. Only through such proactive measures can the industry truly harness the diverse talents and perspectives that will drive innovation and success in the years to come. The journey towards equality is not just an ethical imperative but a strategic necessity for sustained growth, relevance, and resilience.

References:

1. Dolan, K., Hunt, V., Prince, S., & Sancier-Sultan, S. (2020). Diversity still matters. McKinsey Quarterly, 19

• Gov.UK. Ethnicity facts and figures, (2023). Report. Retrieved from                                       https://www.ethnicity-facts-figures.service.gov.uk/work-pay-and-benefits/unemployment-and-economic-inactivity/unemployment/latest/. November 2023.

• Gov.UK. Gender pay gap reporting: make your calculations, (2021). Report. Retrieved from

https//www.gov.uk/guidance/gender-pay-gap-reporting-make-your-calculations. October 2023.

• Gov.UK. Life sciences competitiveness indicators, (2023). Report. Retrieved from https://www.gov.uk/government/publications/life-sciences-sector-data-2023/life-sciences-competitiveness-indicators-2023#annex-a-statistics-on-pharmaceutical-expenditure. November 2023.

• Hunt, V., Layton, D., & Prince, S. (2015). Diversity matters. McKinsey & Company, 1(1), 15-29.

• UK BioIndustry Association, (2022). Diversity and inclusion in UK Biotech 2022. Report. Retrieved from

https://diversityinbiotech.org/wp-content/uploads/2023/07/BIA-DEI-Diversity-04.06.2023.pdf. November 2023.

• UK Parliament, (2023). Industries in the UK. Report. Retrieved from https://commonslibrary.parliament.uk/research-briefings/cbp-8353/. September 2023.

• UK Parliament, (2023). Diversity and inclusion in STEM. Report. Retrieved from https://publications.parliament.uk/pa/cm5803/cmselect/cmsctech/95/report.html. September 2023.

• UK Parliament, (2023). Women and the UK economy. Report. Retrieved from https://researchbriefings.files.parliament.uk/documents/SN06838/SN06838.pdf. September 2023