Should nurses be expected to be role models for healthy lifestyles?

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Whether they like it or not, nurses are often expected to be public role models for healthy lifestyles. Although this expectation is often expressed in professional journals, there is little research on whether it is reasonable and realistic. UK researchers investigated the views of different stakeholder groups on the subject, with their study finding that opinions on the matter differ widely among participants talking from different viewpoints.

The study, “Should nurses be role models for healthy lifestyles? Results from a modified Delphi study” published in the Journal of Advanced Nursing investigated the expectation for nurses to be healthy role models and the assumptions attached to this expectation.

The study looked into the views of different stakeholders on the expectation that nurses should role model healthy behaviours. The researchers said that as there are contradicting views on the subject, it was important to consider a range of opinions. The study recruited people from different backgrounds who have a stake in and influence the role of nurses; with 25 participants participating in the first round and 17 in the second.

Arguments for healthy role modelling behaviour

The researchers said that three arguments were often proposed for this healthy role model expectation. 

First, nurses should have healthy lifestyles that can be seen as credible by patients when engaging in health promotion and behaviour-changing initiatives. Lead researcher, Kelly Muireann from the London South Bank University’s School of Health and Social Care, said the premise was that “as the largest workforce in healthcare, [nurses] are well-placed to advise patients on lifestyle. However, if they are unhealthy themselves, nurses might avoid raising lifestyle issues for fear of being seen as hypocrites, and patients might ignore advice given by visibly unhealthy nurses.”

The researchers said the second argument is that nurses should have healthy lifestyles to be efficient, resilient and able to cope with the demands of their jobs. According to this argument “this is important to reduce sickness absence and improve retention in an ageing workforce,” Muireann added.

Thirdly having a healthy lifestyle is a professional expectation. Muireann explained that this means that “given their professional knowledge and health literacy, nurses should ‘know better’ than to live unhealthily. Nurses have an ethical duty to practise what they preach because this is socially expected of them as a professional group.”

Key findings of the study

The study findings suggest that there is a disconnect between what front line nurses and patients expect.

Nurses participating in the study argued that demonstrating healthy behaviours was less important than providing evidence-based, patient-centred care. Whether the front line nursing workforce believes nurses should be expected to be healthy role models or not, the reality may be that patients do expect nurses to lead by example. Patients were more likely to say they would be less willing to follow advice from visibly unhealthy nurses. Even though nurses’ professional behaviours may define the patient experience, it may also be influenced by whether nurses are visibly healthy.

"Patients viewed unhealthy nurses negatively, questioning credibility and competence"

“There was no shared view of the expectation for nurses to be healthy role models, either within or between stakeholder groups. Practising nurses and student nurses did not perceive being a healthy role model as part of their professional duties. Student nurses in particular felt that nursing was ‘just a job’ and that leading a healthy lifestyle was a personal matter,” Muireann said.

“The patients viewed unhealthy nurses negatively, questioning the credibility and competence of those who were visibly unhealthy. Although they appeared to conflate health with a healthy appearance, they did expect nurses to ‘practise what they preach’ and were in favour of a stricter monitoring of nurses’ lifestyles, for example, using regular physical fitness appraisals.”

The researchers said though that simply appearing healthy is not likely to affect how patients receive a public health message. However they said that some patients may find it easier to relate to someone who also struggles with lifestyle issues and understands the difficulty of changing behaviour. Ms Muireann said that “some felt that the ideal role model was a nurse who had struggled with unhealthy behaviours but eventually made a successful change, for example, an ex-smoker.”

The influence of educational and workplace factors

Nurse education is an obvious starting point to emphasise the importance of a healthy lifestyle within nursing practice, both for student nurses and those in postgraduate continuing professional development (CPD) programmes. The researchers said that training providers should acknowledge the impact that nursing can have on an individual’s ability to lead a healthy lifestyle in order to better prepare nursing students for the reality of their future careers. Support for healthy lifestyles during education would ingrain the benefits of a healthy lifestyle and help nursing students to maintain their health at the outset of their nursing careers. The nursing students in this study reported that they imitate the behaviour of staff on placement to “fit in” and adapt to the work environment.

The ability to lead a healthy lifestyle may be mediated by inherently unhealthy workplaces

Nurses strongly expressed that they could not be expected to be healthy role models because the environments they work or train in do not support healthy lifestyles. “The nursing workplace was in itself considered inherently unhealthy because of lack of breaks, poor provision of healthy options and lack of access to catering at night. The ability to lead a healthy lifestyle may be mediated by busy and stressful workloads, long working hours, shift-working patterns, and the emotional labour of nursing work. Initiatives to improve nurses’ health should recognise that it would be more appropriate to try to tackle these constraints rather than focusing entirely on individual behaviour change,” Muireann said.

The study authors concluded that arguments that assert that nurses should be healthy role models were seen as unrealistic and unhelpful. Contrary to the view that nurses should epitomise and demonstrate healthy behaviours to encourage patients and to be credible in advice, stakeholders agreed that it was more important to be seen as ‘human’ and understand the challenges of health behaviour change.

Ms Muireann said “the study has shown there is no agreement on what a healthy nurse role model should look like, but that is not to say that nurses’ lifestyles are not important.”