This week’s EBN twitter chat on Wednesday 4th February between 8-9 pm (UK time) will focus on whether we should expect nurses to be role models for healthy living. This links very nicely with last week’s Blog “Loosing the fight against obesity”. This week’s Blog has been written by Professor Jane Wills from London South Bank University and provides some areas to think about ahead of the Twitter Chat. The Twitter Chat will be hosted by PhD student Muireann Kelly (@muireanntweets), also from London South Bank University, who is looking at the subject of nurses as role models for her doctoral studies. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

NHS chief executive Simon Stevens has claimed that obesity in the UK is a “slow motion car crash” that could be financially disastrous for the health service. The NHS is now spending more on bariatric surgery for obesity for example, than on the national rollout of the intensive lifestyle intervention programmes. The health service has to “get its own act together” on obesity by helping staff to lose weight. Stevens claims that more than half of the NHS’s 1.3 million staff are overweight or obese.

Whilst the source of the figure is not known, the latest Health Survey for England states that a quarter of adults are obese (24% of men and 26% of women), while 65% of men and 58% of women are overweight or obese. So these figures on the health care workforce reflect those of the general population and nurses are not that different. Weight-related problems are strongly related to economic factors, but so too is the difficult task of rectifying them. For nurses, long hours, shift work, low pay and the work itself of caring for others all make addressing personal health a challenge.

Why does it matter if nurses don’t lead particularly healthy lifestyles themselves? The argument being put forward is that nurses and midwives are credible sources of advice and support to patients about how to improve their own and their family’s health. ‘Making Every Contact Count’ (MECC) is the initiative to train nurses and midwives to find out what motivates people and to work out with them what are the best steps they personally can take to improve their own health. Yet this kind of health promotion is rare to observe in practice. Why? Maybe nurses and midwives think it would not be welcome or may damage a good relationship between the health care professional and patient.

Question: Why do you think there is a reluctance to take health improvement opportunities to talk to patients about their lifestyle?

The national press responded to Stephens’ speech with headlines such as “Weight’s up doc . Fat medics told to slim by NHS chief” (Sun newspaper) and there followed a blaming discourse that, irrespective of the health system’s failure to enable better health, somehow nurses “ought to know better”.

Question: Should nurses and midwives adopt healthy lifestyles themselves so they can act as role models?

Both government policy and professional nursing bodies have shown that they are concerned about nurses’ lifestyles and about nurses being healthy role models. The recent Five Year Forward View called on all healthcare workers to “stay healthy, and serve as health ambassadors in their local communities” (p.11), and the NMC have included role modelling health-promoting behaviour as a competency for all nurses.

The argument being put forward for nurses to ‘practise what they preach’ is multifaceted. Last week, Jane Cummings said staff might find it hard to give advice until they themselves start to make some changes in their own lifestyles. Patients may be less likely to follow the health advice of nurses who do not personally engage in the behaviours they are seen to promote. An Ipsos Mori survey found that 37% of the public would not accept health advice from a healthcare professional who appeared to have an unhealthy lifestyle (http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113549.pdf).

Furthermore, unhealthy nurses may have higher sickness absence rates and lower productivity, which place an avoidable strain upon NHS resources. This may also impact on the quality of care and patient safety.

There is a counter-argument that nurses are only human, and that they should be free to make individual choices about their lifestyles. Nursing is a stressful job which can encroach into an individual’s personal life. The constraints of the job can sometimes make it more difficult for nurses to choose a healthy option. A focus of the Five Year Forward View plan is highlighting the health system’s role in promoting healthy lifestyle change. The plan includes moves to reduce the sale of high-sugar and high-fat products on hospital premises, and all hospital trusts should offer healthy food for their staff 24 hours a day. At present only a quarter of hospitals offer healthy food to night staff, which means they have to rely on vending machines and microwave meals. Trusts will also be told to encourage staff to join work-based weight-watching and exercise schemes via sponsored membership of local leisure centres and gyms.

There is a widespread view that patients are more likely to listen and heed the advice and support given by someone like themselves. A nurse who is overweight or a smoker may be better able to empathise with patients faced with making lifestyle changes. Is nursing more about giving health promotion advice and information with confidence and experience than trying to be an exemplar of healthy living? The views of nurses themselves are not well-researched, and so little is known about how nurses themselves feel about being role models for healthy lifestyles.

Question: What do you think? Is it reasonable to expect nurses to be role models for healthy living?