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Mental health as described by World Health Organization (WHO, 2014) is a state of sound mind in which a person knows his or her capabilities, ability to handle stress in day to day basis, able to work effectively and relate to others and be involved in the community. Moreover, a good support system such as friends, family, community and healthcare system can promote mental well being. While mental health promotion upholds the significance for psychological well-being that will enable an individual to develop its coping mechanism rather than enhancement of mental ill-health symptoms (WHO, 2002). It is the duty of healthcare providers in delivering and sustaining an optimum level of patient’s holistic well-being. That is why, nurses have to maintain fitness including physical, spiritual, social, emotional and psychological to obtain a quality nursing care to patients. One of many strengths of being a nurse, Kester and Wei (2018) describes being resilient is essential to develop as it is a skill in which a nurse is able to respond efficiently and remain focused in a hostile environment and a primary key to gain long service in nursing is a positive attitude mind set. In the society, wide variety of psychosocial and environmental aspects such as housing, education, salary, occupation, usage of public services, community aid and individual skills in which all these determinants may turn into risk and protective factors that will affect the psychological health of a person and community (Margaret, 2007). Nursing profession can be mentally challenging so it is essential to have work safety guidelines regulated in the hospitals as well as other organisations.
Some people think that working in the hospital is rewarding but stressful at the same time. Nurses are considered the backbone of hospitals; they see acute to complex cases in daily basis. Like most workers, nurses have three rotating shifts plan each week and there are nurses who works full time and casual employee. Eldevik et al. (2013) found that nurses working with less than 11 hours in between shifts may suffer from shift work disorder (SWD) related to quick returns which means employment timetable is plan during typical sleeping hours. The evidence showed that men have higher number of incidents than women and SWD increased significantly between nurses who had 30 quick returns and no quick return duty. Eldevik et al. (2013) also mentioned that SWD will develop when an individual is unable to coordinate the body clock during work shift schedules. While Uribe and Schub (2018) describe people who are suffering from SWD may show an abnormal circadian rhythm because of disrupted sleeping pattern that can lead to lethargy or insomnia thus limiting from performing his or her daily duties in the hospital. As a result, reduced number of sleeping hours will stimulate central nervous system “fight or flight response” and may contribute to risk factors of illnesses related to stress (Uribe and Schub, 2018). Therefore, shift workers including nurses may have higher chances to experience cardiovascular and gastroenterology diseases, depression and infertility, cancer and altered women’s reproductive function (Costa, 2010). Moreover, Uribe and Schub (2018) found that employees may also suffer from chronic fatigue, inattentive, inability to speak clearly, less productive, job dissatisfaction, higher risks of error incidents and professional burnout. Therefore, quick returns may be avoided among nurses to optimize the quality care towards patients round the clock.
However, rotating shift work is inevitable in the healthcare industry. Costa (2010) suggests that both managers and employees need to be aware on the likelihood of acquiring adverse effects in health when practising shift work. There are several policies both here in Australia and abroad that focuses on minimising if not eliminating stress related to SWD in line with the Ottawa Charter framework for health promotion, one of its goal is to build a healthy public policy at the workplace. There is also a similar policy implemented in the United States by the Washington State Nurses Association as mentioned by Ritcher et al. (2010) to fight fatigue and manage strategies for nurses shifting schedule, firstly, educate hospital management and employees on its negative impacts and acknowledge by the organisation of the potential health hazard of fatigue and ensure workplace safety. Secondly, form instructions and training on methods to alleviate fatigue like periods of rest and lastly, establish polices concerning shift work disorders (Ritcher et al, 2010). While Australian Nursing and Midwifery Federation (ANMF, 2015) specified that nurses, midwives and assistants in nursing are advisable to go for leisure activities, vacation, sports, rest and relaxation as shift work have major impact on mental health, physical, and psychosocial well being. Moreover, according to ANMF enterprise agreement (2016), “when overtime is worked the employees should have at least 10 consecutive hours off duty between finishing the overtime and the next successive shift.” Thereby, the nurses in Australia will benefit from the policies implemented by the government sector in promoting the work life balance by getting enough sleeping hours in between shifts and will improve the quality of life of an individual.
Another risk factor that may contribute a negative impact to mental health of a nurse is the prevalence of bullying in an organization that threaten the professional relationships between leaders and staff members causing lack of confidence and reduced eagerness towards work thus quality of care will then be noticeably deteriorate. World Health Organization (WHO, 2010) explains a healthy workplace is a cooperation between staff members and leaders to demonstrate a developmental process to safeguard and preserve the welfare of all workforce and maintainability of the organisation. Unfortunately, bullying is common in today’s increasingly complex and stressful environment like hospital as evidenced by the Australian Nursing and Midwifery (2018) journal that nearly 50 percent of nurses working in the hospitals have encountered bullying and some are afflicted numerous times per week. Koh (2016) cited some instances in a direct and indirect, subjective and objective responses, including body languages, raising of voices in response to colleagues, commenting offensively, reacting to a situation whereby demoralises the character of a colleague and inability to help others, sabotaging by concealing relevant information, accusation, spreading rumours, breach of confidentiality to nursing supervisors. An immediate action of an individual directly affected by bullying is to avoid provoking the attacker by adjusting one’s behaviour thus feeling stress all the time. The effects of bullying are detrimental to psychological and physical aspect of an individual (Cortina & Magley, 2003). They found that the symptoms of psychological distress include anxiety, irritability, panic attacks, depression, lack of confidence, low self-esteem and changes in mood. While physical symptoms reported by Gilmour & Hamlin, (2003); Graveson (1998); Normandale & Davies (2002); Quine (2001) are sleep disorder, headaches, high blood pressure, loss of weight, gastrointestinal (GI) upset and inhibited sexual desire.
Even though many nurses do not pursue nursing career in their early years due to workplace hostility and after being a victim of bullying, there are still group of nurse who desire to continue on the current job (Vessay et al, 2009). They also found that many nurses reported “intention to leave” nevertheless did not happen due to relevant reasons such as location of workplace, responsibilities in the family, income and benefit package, fear of unable to get good references are the main concern especially the senior nurses. The Australian Human Rights Commission (AHRC) formed a policy against workplace bullying, the sector is providing information and protection to victims when an abuse occurs. Presently in the United States of America, the labourers are protected by law against discrimination of race, gender, colour, age and nationality and Healthy Workplace Bill (HWB) was enacted across the country (Skehan, 2015). In addition to strategies of eradication of horizontal violence in the hospitals, she determined that education programme in the institution with active involvement of senior leaders is beneficial as for example, managers address abusive reports from the staff and disciplinary action will be applied to the attacker therefore it shows that the organisation is committed in creating safe place to work by not tolerating disruptive behaviours. However, becoming successful in the nursing profession in a self-caring behaviour assists individuals to improve resilience to be able to build a restorative environment in times of professional burnout. According to Hu et al. (2017) receiving help from family, friends, colleagues and partner is an essential source of support as several studies have evidenced by Fu and Wang (2013); Rodwell and Munro (2013); Yom & Kim, 2012 that may significantly improve the self-efficacy in nursing profession related to ability of self care. Furthermore, a recognized independent support system for nurses are readily available in Nursing and Midwifery Health Program Victoria (2006) in providing confidential support regarding mental health issues and proven to be effective by 89% of the clients experienced support continue to work, returned to and plan to return in nursing field.
In conclusion, nurses who remains in the medical industry over the period of time are seen capable of handling stress and developed resilience on how well adaptation of an event in one’s life. Factors that may affect the physical and mental well being of nurses are determine by socio-economic needs, education, healthy workplace, salary and work compensation. However, if any of these factors are altered into unacceptable conditions it may lead to chronic diseases like hypertension, gastrointestinal diseases, infertility, dysfunction of women’s reproductive organs, cancer and mental illness related to stress. In order to prevent these issues, it is recommended to regulate work safety policies from government sectors to all hospitals and other organisations covering the guidelines in protecting and promoting the welfare of employees. The daily scope of nursing care responsibilities is broad which significantly impact the lives of people therefore, it is essential for nurses to be mentally healthy and mentally capable to be of service in the healthcare industry
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