Features

Sharing satisfaction

10 January 2022

It’s been a tough few years, but here community practitioners offer their advice on finding job fulfilment and preserving personal wellness in a time of crisis. By journalist Jo Waters.

Cutbacks in community staffing levels in some areas, rising workloads, plus the pandemic and its resulting social problems have meant it’s not exactly been an easy time to work as a health visitor, school nurse, district nurse or community nursery nurse.

The latest NHS staff survey in England gave a snapshot of morale in October/November 2020, with replies from 595,000 staff. It found that 44% reported feeling unwell as a result of work-related stress in the previous 12 months (compared with 40.3% in 2019, and 36.8% in 2016), while a similar number said they’d gone to work despite not feeling well enough to do their job. More than half said they had worked additional unpaid hours (admittedly down from a high of 59.4% in 2016), and one in five said they would probably look for a new job outside their organisation in the next 12 months (NHS, 2021).

Despite this picture of a stressed and overworked workforce, 58.7% said they often or always looked forward to going to work, and 73% said they were often or always enthusiastic about their job; this clearly illustrates that working in healthcare – despite all the challenges and even during a pandemic – is still a place where job satisfaction ranks highly.

Earlier surveys in Scotland have found similar results, with 50% saying they feel their organisation doesn’t care about their health or wellbeing, but 78% saying they felt they were treated with dignity and respect, and 81% saying their work gave them a sense of achievement (Scottish Government, 2020).

Passion and joy are not what’s lacking in CPs, it’s recognition for what they are doing

It begins with you

Janet Taylor, a public health nurse manager in Northern Ireland and chair of the CPHVA Executive, says that despite all the challenges, community practitioner (CP) work is still rewarding. ‘But a lot of staff are telling us they are exhausted and burnt out – whether that’s because they were redeployed or one of the ones left to keep the service running with fewer staff and a larger caseload,’ she says.

‘Health visitors are having to cope with caseloads that are still mounting due to unfilled vacancies caused by more practitioners leaving and retiring, and there has also been down-banding in some areas of England. The 3% pay rise offered by Boris Johnson to NHS workers has not helped morale either – it is a devastating blow, because with pension changes and national insurance rises people won’t be better off. Practitioners are struggling at the moment and not feeling valued,’ Janet adds. ‘The joy in our work will always be with us, but at the moment the only thing keeping us all going is our passion, care and commitment, sense of duty and the love of the job.’

Paraphrasing mental health nurse Stephen Hamilton (who spoke at the Unite-CPHVA Professional Conference in November), Janet says that if a plane is crashing you have to put your own oxygen mask on first before you can look after others. ‘I think there’s growing recognition that you have to look after your own wellbeing and mental health if you are going to be able to do your job and help others,’ she adds.


How to spot the signs of burn-out

Symptoms include the following

  • Physical exhaustion
  • Trouble sleeping
  • Loss of compassion
  • No longer caring about your job
  • Physical illnesses
  • Making mistakes you wouldn’t usually make
  • Loss of confidence
  • Mental fogginess
  • Loss of focus
  • Doubting your abilities
  • Cynicism
  • Procrastination
  • Pessimism
  • Crying
  • Inability to concentrate
  • Feeling unable to cope.

What keeps us going

Kirsten Godfrey, an independent occupational psychologist based in Cambridge, advises people who’ve lost their sense of job satisfaction to try to concentrate on the positives.

‘Have a stocktake of the positives you enjoyed in your work daily – or weekly – it may help remind you of what attracted you to your job in the first place,’ says Kirsten. ‘You can write them down or just keep a mental tally of the elements of your job you still enjoy.’

Janet adds: ‘If you can try and see the positives, small gains can be hugely rewarding – safeguarding and domestic violence didn’t stop because of Covid-19, neither did the number of mothers suffering postnatal depression.

‘Think of the woman you helped with breastfeeding who is now blossoming because of your advice and support, or the child whose speech delay you helped pick up on who is now doing well with speech therapy, and all the other families you have supported – and think of the difference you have made.’

Asha Day, vice-chair of the CPHVA Executive, agrees: ‘What really kept us all going [during the pandemic] was our clients – making sure they were well and healthy and that we were keeping them all safe. My advice for getting through hard times is to always keep the endgame in mind – to pace yourself, step away, take a breath and make sure you take your screen breaks, lunch breaks, and holidays.’

Kirsten says that being surrounded by negativity from 24-hour news, and perhaps from family or at work, has been overwhelming for some. It can feel as if there’s no escape.

‘That’s when it’s important to carve out time for yourself and switch off from work; see friends, get outdoors or just do something completely unconnected to work and press reset,’ she says. 
‘Go for a walk and forget about work pressure.’

Kirsten also suggests taking a few days off to rest if you’re feeling burnt out and overwhelmed and talking to friends and family about how you are feeling. ‘You may also want to speak to work colleagues or a supportive manager – if you need support, it’s important you reach out and ask for it.’

Janet agrees, emphasising that CPs can’t keep giving if they are ‘running on empty and have nothing left to give. Do talk to your manager and your colleagues and occupational health – CPs have been through a lot for a prolonged period. There is pastoral care in the NHS and it’s there to support you.’


What coping strategies have CPs used? 

Susan*, a 49-year-old HV who lives in Warwickshire, says her experience of being redeployed to a community hospital during the pandemic has given her a fresh perspective.

‘I was working on a ward as a healthcare assistant with older patients with Covid-19 for five weeks. Despite everything, I really enjoyed the experience – I felt I was doing my bit. Some of the patients were really vulnerable with dementia and were separated from their families, who could only see them through the window. We had an important role to play comforting and supporting these patients. I watched nurses sit and, with great compassion, tenderly hold patients’ hands as they passed away. Covid-19 was the biggest thing to happen in my career and by working there I felt part of the response.

‘When I went back to my health visiting job it was obviously less high-profile (although just as important), and we weren’t even seeing families face to face other than in safeguarding cases, so it felt a bit flat. We were also working from home, so I felt quite isolated. I missed my colleagues too – the chance to share things informally, and our team’s sense of humour.’

Because of her experiences, Susan has since taken up a secondment in a non-clinical role. She says: ‘I just wanted to do something different and have some career development. My experience was an eye opener and in the long term I have realised I like face-to-face contact with clients and colleagues. The great thing about working in the NHS is that the world is your oyster as far as career development and opportunities are concerned.’

Susan’s advice: ‘When it comes to getting through hard times, I’d say it’s important to switch off from work and not spend all your time catching up with record-keeping. During lockdown I made sure I got outside every day and later I went back to the gym. I talked to my partner and family about my working days too – it’s important to be able to offload.’

Alison*, an HV in Leicestershire, says her experience of redeployment wasn’t as positive as Susan’s.

‘I’d literally just retired, but volunteered to come back for redeployment as I wanted to do my bit, but I was sent to district nursing. Although the staff were absolutely lovely, I was completely out of my comfort zone as I hadn’t worked as a nurse since I qualified.

‘After three weeks I asked to go back to health visiting and I was so relieved to be allowed back where my skills could be used best – I appreciated it so much more. It was so rewarding supporting families. One of our team’s duties was running three breastfeeding groups via Facebook and Zoom – these women still needed support.

‘The pandemic also made me realise I’d be better coming back as a Band 6 than the Band 7 I’d been previously and shedding some of my admin and technical responsibilities. What I enjoyed about the job was supporting clients and not sitting behind a computer.’

Alison’s advice: ‘If I had to tell my younger self something about getting through hard times, it would be to carve out time for looking after yourself – whether it’s a yoga class or walking your dog. I now do both, but have only been doing so for the past three or four years. I wish I’d started earlier.’

REBECCA*, a community nursery nurse working in the Midlands, had retired but returned to work during the pandemic, and says she still derives great satisfaction from the job she’s done since qualifying as a nursery nurse in 1981.

‘I feel I’ve made a difference to the families I have supported,’ she says. ‘I do a lot of work with families experiencing behaviour problems, and just going back to visit a family who were very stressed a few weeks previously and noticing they are palpably calmer is very rewarding.

‘There’s also that lovely sense of continuity you get when looking after several generations of the same family – seeing children growing up and becoming parents themselves. I remember one woman I saw as a baby who is now a great-grandmother.’ Rebecca’s advice: ‘One thing I enjoy is meeting people from all walks of life and backgrounds – from millionaires to people who are struggling. I suppose the joy of the job is individualising the care for each family, working out who they are and what they are capable of achieving. It’s great when you see a parent, have a lightbulb moment and make a connection.

‘I think it also helps to keep your work more interesting if you develop a sideline, such as play therapy or aromatherapy. Above all, make time to talk to your colleagues, have a natter, catch up, offload, have a laugh together and make sure you’ve got each other’s backs.’

Sarah*, an HV in London, says she was relieved not to be redeployed, as new parents needed and continue to need more support than ever  – especially with families and friends absent and the usual support groups not running or only just reopening. 

She also welcomes the return of more face-to-face consultations, as she worried some problems might have been missed or were more difficult to pick up remotely.

Sarah stresses that the support of her colleagues has been crucial for getting through hard times.

‘I am fortunate to work with a great bunch of colleagues – many are also my friends. The sense of camaraderie is vital, and we try to message each other to arrange meet-ups in the office. For a long time we’d only been in to pick up PPE.’

Sarah’s advice: ‘Unofficial supervision is extremely important in order to keep morale up, and we know there has been a huge spike in mental health problems among nurses and NHS staff in general.’

Amanda Holland, lecturer and programme manager of the PGDip specialist community public health nursing programme (health visiting) at Cardiff University and CPHVA chair for Wales, says she was determined to focus on the positives when her department had to switch to remote teaching and learning during the pandemic. 

‘Despite everything, it was actually brilliant to learn new skills and teach students online – we adapted fast and used a mixture of techniques and technologies to maintain close contact, using a blend of live and pre-recorded lectures, breakout rooms for group activities and discussion, online drop-in sessions, quizzes and polls. And we still managed to involve our wonderful service users and other outside speakers with teaching activities. Students said they really enjoyed the variety and flexibility of online learning. And it worked well for students who had other caring commitments such as young children or older relatives.

‘There is so much joy and job satisfaction in being a HV; it’s such a privileged role. HVs are in a unique position to influence the development of positive parent-infant relationships from the beginning – the first 1000 days. When I was a practising HV, I remember the joy of supporting parents with understanding more about their baby’s unique capabilities, demonstrating how they can see, hear and communicate, for example. It was moments like this when I would literally skip back to the car knowing I had made a difference.

‘I always loved engaging children in the play aspect of the job too – after all, they are central to everything HVs do. The role is perfect for enabling opportunities for children to express themselves and for us to listen to their voice.’

Amanda’s advice: ‘I think for most HVs these are only some of the aspects we enjoy most – leaving the office and organisational politics behind, going to visit children in their homes, and prioritising their needs. That’s what it’s all about. That brings huge benefits to individuals, families, and communities – and to us as frontline practitioners.’

Do you agree? 

Are the CP experiences here similar to yours? Do you have a different perspective? Whatever your experience or advice, we’d love to hear from you. Email editor Aviva Attias at [email protected] or tell us on Twitter @CommPrac


How have CPs fared?

Gavin Fergie, Unite lead professional officer, agrees there is a growing realisation among CPs that they have to look after their own physical health and mental wellbeing. ‘A lot of people have identified that there is a threshold for how much stress they can deal with. In the past, as health professionals, we have tended to carry on and push through regardless. Now NHS employers have acknowledged that staff have been under unprecedented pressure and there is now an active stream to address this,’ he says.

‘Mental health and wellbeing hubs have been set up throughout the NHS to offer support, and there’s no shame in getting help. People who go into health and social care tend to have caring natures anyway, and there’s been a “groupthink” in the past that we’re carers, so therefore we have to go above and beyond, and just carry on – but we know this is not sustainable in the long term.’

This is clearly a positive development, but does that make job satisfaction any easier to achieve?

‘The joy of the job is still there, but it’s smothered under layers at the moment,’ says Gavin. ‘If you talk to practitioners, they will still tell you anecdotes about how they’ve made a difference and the great pride they feel in their work.’

Gavin says that CPs who were redeployed to vaccination centres have spoken of how appreciated they felt by the general public and how they got that direct connection and immediacy with patients.

‘They felt their gratitude and saw the tears of joy in their eyes as they got their injections – that human connection that perhaps was lost to some extent during their CP work during the pandemic, when they mainly communicated by phone or via a computer screen.’

Support is key

‘With face-to-face consultations coming back, CPs are getting that satisfaction back – seeing families and school children and supporting them,’ continues Gavin. ‘They’ve also been back in the office and able to share what they’re doing with colleagues and get instant support and feedback over a cup of tea. The esprit de corps is still essential.’

Asha agrees that support from colleagues and managers is crucial. ‘As a manager at the time the pandemic hit, we realised that supporting the health visiting team was essential – we were all on Microsoft Teams for our meetings and had the right equipment to do the job right from the start.

‘To keep the team connection, we had “Motivational Mondays” and “Wellbeing Wednesdays”, as well as another virtual drop-in session on Fridays, when everyone could share what they were feeling and what they were dealing with. Every month we had a payday quiz, and if someone was retiring and we couldn’t meet up, we compiled a This Is Your Life-style book of memories for them.’

Janet sums up the current situation: ‘Passion and joy are not what’s lacking in CPs – it’s recognition for what they are doing. Money is a good barometer of value, and the government’s pay rise offer is not making us feel valued at the moment.’


Strategies for satisfaction

  • Focus on the difference you make to clients’ lives
  • Take time for yourself
  • Talk to your colleagues and seek regular support
  • Try to be mindful of your wellbeing so you can recognise excessive stress
  • Remind yourself why you went into the profession and what you enjoy about your work
  • As a manager, ensure support structures are in place.

Resources  


References

Barker S. (2021) Burnt Out: The exhausted person’s six-step guide to thriving in a fast-paced world. Octopus Books: London.

NHS. (2021) NHS Staff Survey 2020. See: nhsstaffsurveys.com/results/national-results (accessed 15 November 2021).

Scottish Government. (2020) Health and social care staff experience: report 2019. See: gov.scot/publications/health-social-care-staff-experience-report-2019 (accessed 15 November 2021).

Image credit | Shutterstock

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