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Stress resource for managers

Introduction

There are moral, financial, legal, and quality reasons for managing stress in the workplace. However, evidence from the surveys and reports below demonstrates that work-related stress in the health and care sector is continuing to rise. 

  • In 2021, the RCN Employment Survey found that 67.6% reported they feel under too much pressure at work. Just over three quarters (77.4%) reported having worked when they should have taken sick leave on at least one occasion over the previous 12 months. Of those who had worked when unwell, 66.8% reported they were unwell due to stress and 37.9% stated this was due to mental health issues.
  • The 2020 Labour Force Survey established rates of work-related ill-health due to stress in the health sector is significantly higher than for workers across all industries (HSE 2020).
  • The 2020 NHS Staff Survey (2020) reported 44 per cent of staff felt unwell as a result of work-related stress in the previous 12 months, increasing from 36.8 per cent in 2016. The sharpest rises were seen in acute and community trusts and acute specialist trusts.
  • The Health and Safety Executive (HSE) publication Work-related Stress, Anxiety or Depression Statistics in Great Britain, 2020 identified figures for stress, depression or anxiety in 2019/20 were significantly higher than the previous period. 

In this resource we will start by looking at the HSE Stress Management Approach. We will then look at how you, as a manager can start to make changes that can make a big difference. Finally, we'll look at an organisation-wide approach and the steps to address stress as an organisational priority.

The HSE Standards

What is the stress management approach?

The stress management approach has six standards. Each of those standards addresses a key area of the work environment.
The Management Standards cover six key areas of work design:

  1. Demand: Amount of work being undertaken, working patterns & the working environment 
  2. Control: How much say someone has in the way they do their work
  3. Support: Resources and encouragement 
  4. Relationships: Promoting positive working to avoid conflict and dealing with unacceptable behaviour
  5. Role: Whether people understand their role within the organisation and whether the organisation ensures that they do not have conflicting roles
  6. Change: How organisational change, large or small, is managed and communicated in the organisation.

The six areas will often overlap, combine, or interact; therefore, organisations should avoid acting on just one element of the work - a holistic approach is likely to produce the best result. 
Looking at each of the standards in more detail, we can identify what should be happening and what should not. In addition, research by the Zeal Solutions, a Business, Psychology Consultancy, has identified behaviours for healthcare managers and provided feedback from participants.

Over the next 6 sections, we will explore each standard and how they can be achieved.

 

1. Demand

Nursing and healthcare staff (including nurse leaders) indicate they can cope with the demands of their job.

What might that look like?

  • Being able to cope with the demands of their job. 
  • Have achievable demands in relation to the hours they work.
  • Skills and abilities are matched to the demands of the job.
  • Concerns raised about the working environment are addressed.

What it should not

  • Being asked to undertake tasks they are not capable of doing or are not trained to do.
  • Allocating additional tasks to a person or team when they do not have the resources to cope with it. 
  • Contacting nursing staff by phone or email when they are on leave or otherwise ‘off duty’.

Indicators of concern

  • Staff saying, they are constantly firefighting and feeling under pressure.
  • Staff frequently working longer than their allocated shift.
  • Staff working through meal breaks ‘to cope’, with the quantity of work.
  • Staff being unable to take their breaks, especially where the work is complex or emotionally demanding.

To understand if your staff are able to cope with the demands of their job, you may wish to ask the following questions

  • Do you feel involved in how decisions about your job are made? 
    Think about whether you feel listened to, trusted, and valued
    Are you consulted and given opportunities for input?
  • Do you feel you have a say in how your work is organised and undertaken?
  • What improvements or support could be put in place to help with any of the issues you have talked about? 
    Think about you, your manager, your department, your organisation
 

Workload

  • Develop and maintain adequate systems to be able to effectively monitor staff overtime and bank shifts worked.
  • Carry out regular meetings, both individually and with your team to discuss anticipated staffing arrangements
  • Develop systems to be able to notify nursing staff in advance of unplanned or exceptional need to work longer hours.
  • Identify sufficient time to allow genuine collaborative planning between nurse managers and nursing staff.
  • Understand your team’s current workload when discussing the allocation of additional tasks.
  • Provide training and support (formal or informal) to help staff prioritise.
  • Ensure you and your team have a clear understanding of your escalation procedures where staff or patient safety is at risk, and actively encourage that these procedures are followed
  • Encourage flexible working wherever possible

Working patterns

  • Allow and actively encourage nursing staff to take regular breaks away from their working area, especially when their workload is complex or emotionally demanding.
  • Consider how flexible working can be used to enable staff to balance their work and personal commitments, while meeting the needs of services.
  • Learn to say no to work if your team is already at full capacity.

Physical environment and violence

  • Assess the risk and impact of other potential hazards in your area of responsibility and take steps to deal with them by consulting with employees and others. This may include planning for nursing staff not to be alone with previously aggressive patients, or community nurses visiting in pairs.
  • Provide suitable and sufficient training to help nursing staff deal with and defuse difficult situations to prevent escalation.
  • Take steps to reduce unwanted distraction, disturbance, and noise levels in the working area.
  • Review systems and procedures to avoid frustration, for example queuing and triaging policies.

The demand standard also aligns with the following RCN Nursing Workforce Standards:

  • Standard 3  Up-to Date business continuity plans must be in place to enable staffing for safe and effective care during critical incidents or events.
  • Standard 8  When calculating the nursing workforce Whole-Time Equivalent (WTE) an uplift will be applied that allows for the management or planned and unplanned leave and absence
  • Standard 9 If the substantive nursing workforce falls below 80% for a department/team this should be an exception and should be escalated and reported to the board/senior management
  • Standard 11  Rostering patterns for the nursing workforce will take into account best practice on safe shift working. Rostering patterns should be agreed in consultation with staff and their representatives
  • Standard 13  The Nursing workforce is entitled to work in healthy and safe environments

2. Control

How much say someone has in the way they do their work?

Where an individual perceives that they do not have control over the workload, this increases the risk of burnout. The recommended behaviours suggest more management control in managing workflow and ensuring appropriate staffing with the required skills, but it also recommends that staff can escalate concerns and feel they are being addressed.

What the standard should look like for employees?

  • They are consulted over the way their work is organised and undertaken, e.g., through regular meetings, one-to-ones, performance reviews.
  • They have regular opportunities for discussion and input at the start of projects or new pieces of work.
  • They are encouraged to use their skills and initiative to do their work.
  • They are consulted over things which affect their work.
  • They are encouraged to develop new skills and undertake new and challenging pieces of work.
  • Efforts are appreciated and acknowledged.
What it should not
  • No control or input into how their work is carried out.
  • No opportunities to input into ways of working.
  • No consultation over things which may affect the work being carried out.
  • No encouragement for self-development.
  • Efforts are not acknowledged.

Indicators of concern

  • Staff indicate they don’t feel listened to or have a say in how work is carried out.
  • Staff feel unappreciated, ‘just a number’.
  • Staff don’t feel encouraged to undertake personal development.

 


To understand how much say your staff have in their work, you may wish to ask the following questions:

  • Do you feel involved in how decisions about your job are made? 
    Think about whether you feel listened to, trusted and valued - how you are consulted and given opportunities for input?
  • Do you feel your skills are used to good effect? How could your existing skills be used more effectively? 
  • Do you feel you have a say in how your work is organised and undertaken? 
  • What improvements or support could be put in place to help with any of the issues you have talked about? 
    Think about you, your manager, your department, your organisation.

Communication

  • Help staff to have a say about the way their work is organised and carried out, for example at team meetings, handovers, one-to-ones and performance reviews.
  • Hold regular discussions during the planning stage of any changes to talk about the anticipated methods of working.
  • Where possible, allocate responsibilities to teams rather than individuals. 
  • Allow staff employees to have some control over the pace of their work and when to their take breaks. 
  • Talk about training needs. 
  • Involve a range of staff members in any projects or change initiatives.

Decisions

  • Talk about the way decisions are made, ensuring staff understand how the organisation, department and team make decisions. 
  • Allow and encourage people to participate in decision making, especially where it affects them.

Skills and Training

  • Talk about the skills people have and if they believe they are able to use these to good effect. 
  • Talk about how people would like to use their skills. 
  • Consider personal development/training plans, where you ask employees to think about the skills they would like to develop. 
  • Explore the continuous professional development (CPD) requirements of your team members and how these can be met.
 

The control standard also aligns with the following RCN Nursing Workforce Standards

  • Standard 4  The nursing workforce should be recognised and valued through fair pair, terms and conditions
  • Standard 7  The time for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team
  • Standard 13  The Nursing workforce is entitled to work in healthy and safe environments
 

3. Support

Nursing staff indicate they receive adequate information and support from their colleagues and superiors, including encouragement, sponsorship and resources.

What the standard should look like for employees

  • The organisation has policies and procedures in place to adequately support nursing staff.
  • Nursing staff receive information and support from colleagues and their managers.
  • They know what support is available and how to access it.
  • They know how to access the resources they need.
  • They receive regular and constructive feedback.

What it should not

  • Trivialisation and/or ignoring problems and concerns.
  • Discriminating against nursing staff for any reason (such as race, sex, gender, sexuality).
  • Ignoring and/or condoning discriminating behaviours of others
  • Not knowing the sources of help and support which are available.
 

Indicators of concern

  • Problems being made light of and not taken seriously.
  • Staff feeling intimidated and unable to raise concerns.
  • Feeling unable to talk openly.
  • Not holding regular meetings with staff.

Managers provide an important role in offering support to their staff. Employees tend to look to managers for approval, appreciation, and information
To understand how your staff feel, you may wish to ask the following questions with an individual member of your staff or team:

  • Do you feel that your team/organisation is a positive place to work and that you are valued? Think about the working environment, the support available and the opportunities to talk about support you may need.
  • Do you know who to talk to and where to go when you need support? Think about where you would go for help if you were experiencing an issue and whether you would feel comfortable doing so.
  • Do you feel there are enough opportunities to discuss any emerging issues or pressures?
  • What improvements or support could be put in place to help with any of the issues you have talked about? Think about you, your manager, your team, your department, your organisation
  • Set a date to revisit any proposed changes and agree an action plan
 

Support

  • Hold regular one-to-one and team meetings to talk through any emerging issues or pressures.
  • Include work related stress or pressures as a standing item for meetings with staff and/or performance review.
  • Explore any concerns raised with you in an open, transparent manner.
  • Provide timely and constructive feedback.
  • Consider buddying systems or work shadowing to improve understanding of roles across the team and to foster peer support.
  • Share examples of good practice.
Resources
  • Share information on support available to your staff, for example employee assistance programmes, trade union support, occupational health and external organisations.
  • Talk about the ways your organisation can provide support if someone is experiencing problems outside work, for example, relationship difficulties, bereavement or a health concern.
Training
  • Regularly consult with your staff and HR to ensure training is up to date.
  • Managers should be given the training as well as protected time to carry out performance reviews that are considered high-quality, effective, and supportive of staff development opportunities.
  • Hold local induction session for staff new to your department, including staff who are temporarily deployed from another area, agency staff and new starters.

Environment

  • Assess the risk of physical violence and verbal abuse by consulting with staff and others.
  • Raise awareness of initiatives already in place.
  • Provide training to help employees deal with and defuse difficult situations.

The support standard also aligns with the following RCN Nursing Workforce Standards

  • Standard 3  Up to date business continuity plans must be in place to enable staffing for safe and effective care during critical incidents or events.
  • Standard 4  The nursing workforce should be recognised and valued through fair pair, terms and conditions.
  • Standard 7 The time for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team.
  • Standard 12 The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.
  • Standard 13  The Nursing workforce is entitled to work in healthy and safe environments.

4. Relationships

Nursing staff indicate that they are not subjected to unacceptable behaviours such as bullying at work.

What the standard should look like for employees

  •  Nursing staff are not subjected to unacceptable behaviours such as bullying or harassment at work. 
  • The organisation promotes positive behaviours 
  • Employees share information relevant to their work.
  • The organisation has agreed policies and procedures to prevent or resolve unacceptable behaviour.
  • Systems are in place to enable and encourage managers to deal with unacceptable behaviour.
  • Systems are in place to enable and encourage employees to report unacceptable behaviour.

What it should not

  • Bullying behaviour or harassment of staff being allowed to happen

Indicators of concern

  • Feeling degraded
  • Feeling unable to report poor behaviours
  • Not trusted

To understand how your staff feel, you may wish to ask the following questions with an individual member of your staff or team:

  • Have you experienced or witnessed unacceptable behaviour at work? Do you feel satisfied with how this was dealt with?
  • Do you feel that honest, open communication is encouraged in your organisation?
  • Do you feel that you know where to go and what to do if you experience or witness unacceptable behaviour? Do you feel confident that steps will be taken to stop this behaviour?
  • What improvements or support could be put in place to help with any of the issues you have talked about? Think about you, your manager, your team, your organisation.
  • Have an agreement with employees and senior leaders on which behaviours are unacceptable.
  • Have a written policy for dealing with unacceptable behaviour and procedures for reporting incidents.
  • Regularly communicate these policies and procedures to staff and make sure that they are understood.
  • Have a confidential system for people to report unacceptable behaviour.
  • Encourage good communication and provide training to help, such as listening skills, confidence building and assertiveness.
  • Encourage and provide opportunities for employees to socialise together.
  • Make sure that you are providing the same level of support and communications for staff who work in isolation such as like lone workers or those in separate locations.
  • Find ways to celebrate personal, team and organisational successes.
  • Ensure that as a manager you role model the values and behaviours of the organisation and develop positive cultures within your own team.

The relationship standard also aligns with the following RCN Nursing Workforce Standards:

  • The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.
  • The Nursing workforce is entitled to work in healthy and safe environments.
 

5. Role

Nursing staff indicate that they understand their role and responsibilities.

What the standard should look like for employees

  •  They understand their role and responsibilities.
  • The organisation provides information to enable them to understand their role and all of their responsibilities.
  • The requirements the organisation places on them are clear.
  • They are able to raise concerns about any uncertainties or conflicts they have in their role and responsibilities through the systems that the organisation has in place.

What it should not

  • Making changes to the scope of someone’s job, or their responsibilities (such as a promotion) without making sure that the individual knows what is required of them, and accepts it.
  • Being expected to ‘just get on’ with a task without any training or induction.
  • Being tasked with conflicting roles.

Indicators of concern

  • Job descriptions not being reviewed to consider changes.
  • Staff indicating they are unsure what is expected of them.
 

To understand how your staff feel, you may wish to ask the following questions with an individual member of your staff or team

  • Do you feel clear on what your responsibilities are?
  • Are you clear on what your performance objectives are and what success looks like for you, your area/department and the organisation? Do you feel that they are achievable?
  • Do you feel you understand how work is structured in your department and in the wider organisation?
  • Do you know who is doing what and why, and how your role fts in?
  • What improvements or support could be put in place to help with any of the issues you have talked about? Think about you, your manager, your organisation, your profession, your staff/union representative.

New starters

  •  Give all new staff a thorough induction into your organisation and its policies and procedures. Include details of where to get support or who to speak to about stress or mental health issues

Communication

  • Provide clear work objectives.
  • Define work structures clearly so that all team members know who is doing what and why.
  • Hold regular one-to-one meetings to ensure people are clear about what is planned for the coming months.
  • Agree specific standards of performance for individual tasks and review regularly.
  • Hold regular team meetings to enable staff to discuss any issues.
  • Display departmental/organisational targets and objectives.
  • Introduce or revise job descriptions with the involvement of staff to ensure the core functions and priorities are clear.

Role

  • Introduce personal work plans which are aligned to the objectives of the team/organisation.
  • Introduce or revise job descriptions to ensure the core functions and priorities are clear.
  • Review job descriptions regularly, especially following change and discuss training/retraining regularly too.
 

The role standard also aligns with the following RCN Nursing Workforce Standards

  • Standard 7  The time for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team.
  • Standard 12  The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.
  • Standard 13  The Nursing workforce is entitled to work in healthy and safe environments.

6. Change

Nursing staff indicate that they understand their role and responsibilities.

What the standard should look like for employees

  • The organisation engages with them frequently when undergoing change.
  • They are provided with timely information, enabling them to understand the reasons for proposed changes.
  • They are consulted on changes and provided with opportunities for them to influence proposals.
  • They are aware of the probable impact of any changes to their job and, if necessary, they are given training to support any changes in their job. 

What it should not

  • Communication about changes is delayed or changes are implemented without any communication with staff.
  • The effects of minor changes are underestimated.
  • Change is ‘overcommunicated’.

Indicators of concern

  • Poor job satisfaction.
  • Staff are resistant to changes.
  • Decreased morale.
 

To understand how your staff feel, you may wish to ask the following questions with an individual member of your staff or team

  • Do you feel that your organisation handles change well?
  • Do you feel you are properly consulted when changes are made which affect you and your role? Do you feel the reasons for the change are explained well? 
  • Do you feel that you are involved in the planning process when changes are made?
  • What improvements or support could be put in place to help with any of the issues you have talked about? Think about you, your manager, your organisation, your profession your staff/union representatives
 

Consulting with staff

  • Keep staff up to date and in the picture
  • Defne and explain key steps of changes being made.
  • Consult employees early and throughout the change process.
  • Build in engagement and support as key elements of any change process.
  • Involve employees in the planning process.
  • Provide a system for staff to comment and ask questions before, during and after the change.
  • Review how the change will impact on departmental and individual objectives and workloads.
  • Include training/retraining needs as part of your change process.

Communication

  • Start communication early and, as far as possible, make it a two-way conversation.
  • Explain what the organisation wants to achieve and why it is essential that the change takes place.
  • Explain the timescales of changes and how changes will impact directly on staff.
  • Have an agreed system for communicating to staff why a change is happening.
  • Have agreed methods of communication (such as meetings, notice boards, newsletters, email and feedback forms) and agree their frequency.
  • Don’t rely on a single communication route – most people may have access to a computer in work but what about those who don’t, or those who work off-site or out in the community?
  • Make sure that employees are aware of the impact of the change being made on their jobs.
  • Talk about the potential need for (re)training.
  • Include people on long term sickness, maternity/paternity leave or career breaks, where possible.

The change standard also aligns with the following RCN Nursing Workforce Standards:

  • Standard 7  The time for all elements of practice development must be taken into consideration when defining the nursing workforce and calculating the nursing requirements and skill mix within the team.
  • Standard 12  The nursing workforce should be treated with dignity, respect, and enabled to raise concerns without fear of detriment, and to have these concerns responded to.
  • Standard 13  The Nursing workforce is entitled to work in healthy and safe environments.

You and your team

How you manage your team, and how you role model good practice can have a significant impact. 

Stress can manifest in individuals in many ways, including physical symptoms, changes in normal behaviour and emotions. These symptoms can develop into health conditions including depression and anxiety, heart disease and digestion conditions such as irritable bowel syndrome.

If you notice your staff are starting to act or interact differently it can be a sign that they are stressed, potentially impacting on the delivery of quality care and affecting the physical and psychological wellbeing of your team. It is therefore essential that steps are taken to prevent work related stress from occurring and support staff members who are exhibiting the signs of stress.

As a manager, you might notice someone is:

  • taking more time off
  • arriving for work later
  • appearing nervous or twitchy
  • having difficulty concentrating
  • struggling to make decisions
  • avoiding certain places or people
  • working longer hours or not taking breaks.

Their behaviour might show signs of:

  • mood swings
  • being withdrawn
  • loss of motivation, commitment, and confidence
  • Heightened emotional reactions like being more tearful, sensitive or aggressive.

You might notice or suspect that there is increased alcohol, nicotine or drug intake.

For a fuller guide to the signs and symptoms of stress, see our Stress and You resource [add link]

 

You might find that, as a team

  • Arguments are becoming more frequent
  • There are more complaints which might escalate to grievances.
  • The performance of the team as a whole has decreased
  • Staff turnover is higher than usual
  • Sickness absence is on the increase
  • There are more formal or informal reports of stress

Risk Assessment

As a manager, it is important you understand the importance of working with employees and their Safety Representatives to understand the risks in your area of responsibility. 

When assessing risk, you should have received training in your organisation’s risk process and be aware of your role in this process. As a manager you need to have enough knowledge and understanding of the risk system so that you can make informed decisions about the risks in your area and be able to sign off risk assessments. You also need to know how and who to escalate risk to when you are unable to action the risk assessment, for example, due to staffing issues.

When looking at assessing the risk from work-related stress, using the HSE Stress Management approach, everyone involved in the risk assessment process should have a clear understanding including:

  • Knowing what the six standards are and how they are applied.
  • Identifying how the management standards approach can be translated into your own organisation.
  • Identifying work-related stress risk factors specific to your organisation. 
  • Focusing on preventing and managing the root causes of work-related stress.
  • Focusing on exploring organisational level issues.

The risk assessment process follows five basic steps. These are:

  • Step 1 Know who might be harmed and how they may be harmed
  • Step 2 Know what measures are already in place to control the risks
  • Step 3 Identify what further action is needed to control the risk
  • Step 4 Identify who needs to carry out the identified action
  • Step 5 Set a time scale as to when the action is needed by

For a more detailed exploration, download our Risk Assessment Process guide.

Supporting individuals

Stress can be managed, but the sooner action is taken the better. 

Whilst the main focus of the stress management approach is on groups of employees, the risk assessment process may identify individuals for whom the solutions developed may not be sufficient. Where this happens, an individual risk assessment should be completed.

 

Employers have a duty of care to protect the health and welfare of all their employees and should therefore develop ways for individual employees to raise their concerns. This could include the following:

  • Creating an environment where nursing staff are encouraged to talk, both formally and informally, to their line manager or another person in their management chain.
  • Reminding nursing staff they can speak to their RCN representative and/or human resources.
  • Encouraging nursing staff to talk to someone in the organisation or seek advice from occupational health advisors, or their GP if they are concerned about their own health. 
  • Introducing mentoring or other forms of worker support. 
  • Providing or referring to employee assistance (counselling) services. 
  • If the staff member is an RCN member, they can access Member Support Services.
 

Where stress is ‘foreseeable’, action must be taken to limit the problem, so far as is reasonably practicable. For example:

  • Speak to the individual to find out what has led to their concern and identify what can be done about it. 
  • Always take concerns seriously, and do not belittle or make light of the individual. 
  • Where distress is serious, fault is cited, and things have clearly gone beyond what you as manager can deal with, ask for expert assistance, for example, your occupational health team or human resources team. You can also contact the RCN for advice if you yourself are a member.
  • Where the concern involves relationship issues, for example with the individual’s immediate manager, or other team members, it is useful to involve human resources, occupational health and a representative for the employee (for example RCN representative, trusted colleague, etc) when working through the issue. 
  • Where it is possible to identify a clearly work-related problem, it is essential to rectify the situation as swiftly as possible, even if this involves compromise on either side.
    -  Follow this with a wider formal appraisal of the working conditions in the relevant area, which should include other employees and, where appropriate, their representatives. 
    -  This should be documented. 
  • The risks of stress should be controlled, and an action plan agreed. 
    -  Where ‘home’ influences are impacting on the employee’s performance and perceptions of their work, it is generally in the employer’s interest to support the employee, rather than dismiss the problem as irrelevant to the organisation.
 
Although you are not legally responsible for stress that originates in the home, a well-managed organisation will have arrangements that allows them to address it. This might include such things as access to counselling services, adaptations to the work or changes to working hours. 

Clinical supervision

Clinical supervision is a formal process of professional support, reflection and learning that contributes to individual development.

The opportunity to reflect on a situation with someone who is objective and can support individuals or groups to make sense of their experiences is valuable no matter where you are within your career.

There has been a resurgence of interest in Clinical supervision as we seek ways to support staff reduce stress and avoid burnout. Clinical supervision is widely acknowledged as a strategy to enhance team effectiveness, support innovation, and enable individuals to make sense of their experiences, whilst providing high quality care for patients. 

In addition, clinical supervision is a valuable approach to reducing stress and promoting wellbeing as it, fosters staff wellbeing, builds effective team relationships, and aids the retention of staff, though the ability to have meaningful conversations with peers about aspects of care, team conflict and acknowledge when things have gone well.  

The RCN advocates that: “Effective and regular supervision must be in place help to identify and address issues of moral injury and strengthen patient safety.”

 

There are a variety of approaches to clinical supervision, and it is worth spending some time thinking about the approach you want to take to clinical supervision for your team or service if you do not have a process in place.  

One approach that is gaining momentum is resilience-based clinical supervision, offered by the Foundation of Nursing Studies. This approach is well structured, whilst creating space for personal connection and understanding other viewpoints related to the situation presented.

  • Think about who else you can work with. It is possible to implement clinical supervision across services or departments, which will support the development of clinical supervisors across sites and services. Do you have a practice development team or practice educator that can support you to implement clinical supervision?
  • Review what is working well and what could be better. Engage key stakeholders and your team especially if you have been doing clinical supervision for a while. If your just starting, consider what needs to be in place for you to successfully implement clinical supervision. Don’t be afraid to seek support from others who have implemented clinical supervision, it could save you some time and fosters collaboration and wider connection outside of your work area.
  • Raise awareness in your team. Make sure your team knows what clinical supervision is, how you are going to maintain a consistent approach and ensure all staff have access. Getting your team involved is key to the success of implementation. They may have positive and negative experiences of clinical supervision and it's important not to dismiss these. Use them to inform and shape your vision. Linking clinical supervision to the vision for the team as it gives a sense of the whole team working together, creating a cohesive culture
  • Provide good training. All team members will have a role, either as a supervisor or a supervisee. Training for both roles is incredibly important and will aid your long terms success. Spend time making sense of these roles and providing insight moments for staff to underpin your success.
  • Do what works best. There are multiple ways in which you can implement clinical supervision, the key is to do what works best for you, your team, and your organisation.

Finally, remember to celebrate! Often we move on from projects without really reflecting and reviewing what went well and what we might have done differently.  


Compassionate leadership

Individuals who work in an environment considered to be supportive with clear goals and good team leadership, are less likely to have high stress levels. (West et al 2015). Compassionate leaders will increase staff engagement, produce better outcomes, and improve financial performance for their organisations. 

Compassion can be defined as a ‘sensitivity to suffering in self and others with a commitment to alleviate and prevent it’ (Gilbert 2013) A compassionate leader understands the above definition, their focus is about looking after themselves and others, acknowledging that it is ok to be human, make mistakes and learn from them, and give themselves - and others, permission to do this. 

Compassionate leaders focus on building relationships, supporting, and developing an open and non -blaming working environment, where innovation is encouraged. 

To support employee’s wellbeing and reduce the risk of stress, as a leader your compassion should have a holistic approach that expands beyond the department’s walls. Work life balance is an essential element of reducing stress and as a leader it is important to ensure that your employees can access the resources to be healthy, productive, and financially stable. By promoting work-life balance, allowing a degree of flexibility, and showing empathy and understanding when a team member needs to take time out to care for a child, family member or themselves, will go a long way to support and improve your employees' well-being. 

The by-product of compassionate leadership is a motivated and productive team that has a sharper focus on their goals, duties, and patient care. 

The Royal College of Nursing (RCN) works on behalf of its members to promote the importance of a healthy work life balance regardless of gender, age and caring responsibilities and encourages all organisations to have effective policies in place for all staff, in order to promote balance between the demands of employment and responsibilities outside of work. (Put in link)  

Where there is an absence of compassionate leadership, staff have reported feeling over worked, lack the ability to influence decision making processes, resulting in poorer outcomes for the organisation and for patients. The absence of compassionate leadership contributes to higher levels of stress amongst staff and lowers the rates of patient satisfaction. (West and Dawson 2012) 

Many health care workers have stated they don’t have enough time for compassion as there is a need to focus on administration, regulation and cost cutting (Reiss et al 2012).  While time pressures influence working environments within health, showing compassion to fellow team members and patients doesn’t take any longer. (Trzeciak 2019) 

Leaders and team members can work together to create an environment where team members feel psychologically safe, share learning and review their work regularly to improve quality, which in turn increases productivity and transformation. There are practical tips for everyone, whatever your role or seniority to practice compassion. Link to the Four Pillars of compassionate Leadership 

Low pay can also increase stress levels and the RCN will continue to fight for its members to receive the remuneration they deserve.

 

Assess your management behaviours

Click on the image below to download a questionnaire that has been adapted from the HSE’s stress management competency indicator tool.

It will allow you to reflect on your own behaviours and management style in relation to managing work related stress. The questions explore four behavioural areas identified as being important for managers in order to prevent and reduce stress in their staff.

Screen grab of front page of stress management competency indicator tool

 

Below you will find the recommended behaviour impact statements from Zeal research with a supporting impact statement from research based on staff feedback:

Managers should provide feedback and communicate openly on actions/ decisions taken.
“It’s not just the communication. It’s actually being honest... and answering the questions. And being open.”

Managers should utilise the knowledge, skills, and expertise of their staff.
“Managers should involve the team in how to find solutions to problems. Staff have a great deal of experience, knowledge and expertise that can help to make a difference."

Managers need to consider how best to protect staff from increasing and competing demands.
“We feel like we are fighting a constant battle because there are different demands coming in from different people.”

Managers need to keep staff updated and provide a rationale for actions and decisions taken.
“Managers need to keep you updated on what’s going on, so you know what’s happening and you’re fully aware.”

Managers should be given the training as well as protected time to carry out performance reviews that are considered high-quality, effective, and supportive of staff development opportunities
“More needs to be made of performance appraisals. This is a good source of feedback but rarely used appropriately. It is used as a tick-box exercise, but it needs to be monitored and used properly not just as a once-a-year exercise. We should also consider 360-degree appraisals, so we can appraise our managers.”

Managers should be offered training which makes them aware of the critical role they have to play in employee health and wellbeing.
“Managers need to lead by example and to be made more aware of the impact of their behaviour on others.”

An organisation-wide approach

The Stress Management Standards approach promotes a partnership approach and relies on senior management commitment and worker involvement throughout the process. 

As well as legal duty and ethical considerations placed upon health and social care organisations, there is also the issue of cost from work-related stress to an organisation. This is not only paying someone when absent from work, but less obvious costs such as sourcing additional staff, depleting knowledge base and adding additional pressures on existing staff. 

 

Under Section 2(1) of the Health and Safety at Work etc Act 1974 and The Health and Safety at Work (NI) Order 1978, (The Act) all employers have an overarching legal duty to ensure - so far as is reasonably practicable - the health, safety, and welfare of all their employees when they are at work, no matter what their role is within the organisation.  

Employers also have a legal duty under section 3(1) of The Act/Order to ensure that the work being carried out does not affect the health, safety and welfare of people who are not employed by the organisation such as, patients, visitors, volunteers, contractors etc, so far as is reasonably practicable 

The term ‘so far as is reasonably practicable’ means doing what is reasonable, after considering and weighing up all the relevant matters. For instance, if it is reasonable to put identified safety measures in place to avoid harm occurring– then that should be happening. 

Regulations, which are enabled by the Act/Order place specific duties on employers.  

Regulation 3(1) of the Management of Health and Safety at Work Regulations 1999 and the Management of Health and Safety at Work Regulations (NI) 2000, places a legal duty on all employers to carry out suitable and sufficient risk assessments where there is a significant risk of harm occurring. This must be carried out by a person/s with the competency to do so, and in consultation with employees and/or their representatives (for example a Safety Rep or Steward). 

Setting up a task and finish group, with representation from across the organisation, is a way of steering the organisational risk assessment process forward and securing involvement and commitment.
It allows for wider representation for decision making, including input from employees or others with specific/specialist knowledge. It also allows for the workload, to be shared, enabling the risk assessment process to be completed in an organised and timely manner.

When setting up a group make sure there is satisfactory representation. For example, the group could include representation from the following roles:

  • Senior Nurse Manager
  • Health and Safety Lead
  • RCN Safety Representative and/or Steward
  • Staff Nurse
  • Human resources manager
  • Occupational Health

Following the setting up of the group, a project plan with a timeline, should be developed.

The availability of senior managers to attend meetings

  • Identify whose input is needed and when.
  • Ask yourself if they need to attend the meeting.
  • Don’t have a meeting for the sake of it.
  • Have an agenda with a timetable and keep to it.
  • Look if something can be read or presented to the group and be included in the minutes.

Getting people together at the same time

  • Avoid setting times when attendance will be difficult. 
  • Agenda - who needs to be there to take things forward?
  • If can’t attend – can the person nominate a deputy to represent them and put their ideas forward.

The group loses motivation

  • Keep communication flowing.
  • Encourage managers to motivate teams, encourage responses and to get involved in the process.

There is too much work to be undertaken

  • Avoid duplication of work.
  • Review planning and timescales.
  • Integrate into existing management systems.

Senior Managers aren't visibly demonstrating their support and participating in communication activities

  • Get senior managers to lead communications with all health and social care employees.
  • Try to get in-house publications to feature stories about the work with supporting quotes from senior staff.
  • Make sure meetings are led by senior staff.
  • Encourage senior staff to promoting material to remove the stigma of stress and/or mental health conditions.

The work will need resources (both funding and time)

  • Secure commitment for the time others will spend taking part in the process.
  • Ensure there is available funding to implement proposed interventions.
  • A  commitment to ongoing resources must be secured as there will need to be periodic reassessments and monitoring of control measures.

Who has authority? 

  • Authority should be delegated either to an individual (smaller organisation) or steering group (larger organisation) and that should be clearly communicated.
  • Oversight should be maintained to ensure co-operation from other senior managers.

It may be helpful to your organisation to develop a stress policy. This demonstrates the organisation takes work related stress seriously.
Click on the image to download a sample stress policy you can use to develop your own. 

Screen capture of the sample policy document

 

Further reading

Check out our LibGuide which has a wide range of information and is maintained by our fantastic library team.