By Meagen Voss, associate director of communication and public relations, UNC School of Nursing
A cultural exchange between the School of Nursing at the University of North Carolina at Chapel Hill and the Florence Nightingale School of Nursing at King’s College London brought nurse researcher Jill Maben to campus in December 2013. Maben, who is chair of nursing research and director of the National Nursing Research Unit at King’s, presented her findings to nursing faculty and students about the connections between staff well-being and patients’ health-care experiences.
Maben began her talk by describing a scandal that erupted at a hospital in Stafford, England. A public inquiry determined that at least 400 patients died unnecessarily due to receiving poor care. One recommendation, out of 290 recommendations resulting from the investigation, was that hospitals select health professionals who have the “ability and motivation to enable them to put the welfare of others above their own interests.”
“I think the assumption under this recommendation needs some challenging,” said Maben. “What if we haven’t been getting recruitment wrong? Perhaps we have been recruiting nurses with great values and great nursing ideals only to have them dashed, eroded and crushed in challenging practice environments.”
In her first study, Maben collected surveys and interviews at four acute health care settings (such as a hospital) and four community health settings (such as a rural clinic). She found that patient experience mirrored staff well-being. Patients cared for by staff who had higher work well-being, including high job satisfaction and more organizational support reported better experiences.
Maben revisited her hypothesis that challenging practice environments have the potential to erode nurses’ ideals by conducting a study in which she interviewed nursing students about the type of care they wanted to give patients, and then re-interviewed them 4-6 months, 11-15 months and three years later. What she discovered was that most of the nursing students had become what she called “compromised idealists,” or individuals who compromise at least one of the ideals they learned in school each day they are at work.
One reason for the erosion is what Maben calls “covert rules.” The rules are messages that are at odds with how nurses envision ideal care that are conveyed to new staff by colleagues. These messages, said Maben, might include “hurried physical care prevails at the detriment of psychological care.” Other “rules” could be “don’t get involved with patients” (keep an emotional distance) and “don’t rock the boat” (don’t try to change practice). Thus in many healthcare work environments, care can become task-oriented rather than patient-oriented.
“Their ideals were thwarted by structural and organizational constraints that were beyond their control,” said Maben. “You can’t take work environment for granted. You can’t just send to nurses out to do this intimate, difficult and emotional-demanding care work without supporting them and providing supportive environments that allow them to flourish.”
While in Chapel Hill, Maben received a tour of the hospitals at UNC Healthcare and met with Dean and Alumni Distinguished Professor Kristen Swanson, who has presented a keynote address at King’s and was recently appointed to the Scientific Advisory Board at the Florence Nightingale School of Nursing. Maben also spent time developing research plans with UNC nursing professor Donna Havens, with whom Maben began collaborating when Havens began an appointment as a King’s visiting professor in 2012. Havens has conducted numerous studies about nursing work environments in the U.S., and together, she and Maben are planning to work together to develop not only to better health care work environments in the U.K. and the U.S., but around the world.
“Work environment is a universal issue in health care,” said Maben. “Nurses are not supported enough in practice all over the world. I think we have a lot of shared interests and can develop ideas that could lead to improvements in practice. There are systems approaches I think that we can share and investigate together.”
A full video of Maben’s talk can be viewed online.
About the UNC-King’s Strategic Alliance
UNC-Chapel Hill and King’s College London have developed a wide-ranging strategic alliance that combines the strengths of two global academic research institutions. An alliance was initially signed in 2005 between UNC College of Arts and Sciences and King’s School of Humanities and School of Social Science and Public Policy, and it continues to grow and include additional disciplines campus-wide. The alliance offers opportunities for student exchange, faculty exchange, and research collaboration.