Health Issues in Nurses

Abstract

This comprehensive review delves into the intricate web of health issues affecting nurses and healthcare professionals (HCPs). The paper explores various facets of this multifaceted issue, from the historical evolution of the nursing profession to the contemporary challenges faced by nurses in their professional roles. It investigates the demanding nature of nursing duties, the often arduous working conditions nurses contend with, and the intricate interplay between health issues and the medical field. A specific focus is placed on the prevalence of medical conditions, infectious diseases, stress-related disorders, and psychological challenges that nurses commonly face. The paper also addresses the alarming issue of suicide among nurses, as well as the pervasive problem of burnout and organic diseases that afflict this essential workforce.

1. Introduction

1.1 Definition

Nursing is one of the oldest professions in the world [1] or, better, as the job or skill of caring for people who are sick or injured (Oxford Dictionary). Nurse means “a person who cares for the sick or infirm” (Merriam-Webster Dictionary). More recently, the word nurse also became a professional meaning: “a licensed health-care professional who practices independently or is supervised by a physician, surgeon, or dentist and who is skilled in promoting and maintaining health” (Merriam-Webster Dictionary).

The etymology of the word derives from the Latin word nutricia, meaning nourishing and was initially used for “feeding an offspring from the breast” (Merriam-Webster Dictionary). From this original use, this noun developed its meaning to the today’s significance. Nursing is very largely a feminine profession; thus, the health topics presented below are mainly referred to women.

1.2 History of nursing

Although the history of nursing starts with the history of mankind and even in other species (apes), the professional nursing was established by Florence Nightingale (1820–1910) [2, 3].

After her seminal activity, nursing as healthcare professional (HCP) spread all over the world and developed training and educational premises to become indeed a profession for the benefit of those in need. Nowadays, nursing is a well-established profession, represented by 28 million persons, however 6 million less than needed worldwide, according to the World Health Organization (WHO) [4]. They are organized in every country in professional associations and own professional codes.

2. Professional duties and challenges of nurses

Nurses are healthcare providers. The main tasks of the nurses are challenging and stressful. They are listed in Table 1.

Taking care of medical records

Recording and retrieving medical data

Surveying and monitoring patients

Physical examination and observation of the patients

Collecting biological samples

Performing medical maneuvers

Performing medical investigations according to individual training and certification

Administration of oral, parenteral, and other therapy

Providing bedside care

Counseling and advising patients and relatives

Collaborating with the medical team and reporting own observations

Maintaining the medical equipment

Recording the inventory of medical equipment and drugs

Educating juniors

Self-continuous education

Table 1.

Professional tasks of the nurses.

2.1 Working conditions in nurses

Nurses may have to practice in different settings, that is, clinical hospitals including wards, emergency rooms, and day clinics; in medical practice offices; in hospices; in rehabilitation facilities; in senior residences; in care centers for disfavored groups; in school; in dentistry practice offices; and in pharmaceutical care. Therefore, the working conditions are very variable and depend on each one particularity. Besides this, the environment is particularly important: countries or even areas in the same countries with facilities of quite different quality, the working colleagues, the terms of the working contract, etc. It means that nurses, like other HCP categories, may be exposed to deterioration of own health, caused by working conditions.

2.2 Health issues in HCPs

The perception of health among HCPs is important. In one study [5], it has been searched for what HCPs mean by health and how this may impact on the healthcare they were providing. In a group of over 70 participants, the HCPs defined health, as expected, the physical, mental, and spiritual well-being. However, they accepted that health means not only the absence of disease but also the good functioning and keeping the chronic disease under control. According to this perception, it means that an ill HCP can fill the professional duties well not only in the absence of the disease but also in condition of psychic and somatic well-being, and even more, when chronic diseases are under control [5].

Indeed, the HCPs may themselves become patients [6]. Their diseases impact the standard of healthcare provided, and this has been obvious during the recent pandemics of COVID-19 [7, 8]. The diseases of the HCPs become relevant not only for the society but also for the patients himself/herself [9]. HCPs may consider themselves immune to disease and, therefore, expose themselves to unnecessary risks [10]. There is a need indeed to educate HCPs how to become patient. In a study, it was found out that disputing the myth of medical immunity to diseases needs not only psychological interventions for individuals but also at organizational level. HCPs should be trained to accept the possibility to become ill and to follow the road map of their own patients [11]. Even guidelines on how to manage the treating doctor-patient doctor have been proposed [11]. Given the pressure under which the HCPs work [12], it has been observed that mental illness is more common, and at risk are HCPs recently exposed to psychological challenges [13]. Indeed, not only medical doctors but also other HCPs are prone to suffer of distress and to lose the mental health [14]. They also may have problems in coping with their own disease [15]. Thus, the HCPs need to be aware of their fragility of the possibility to become themselves ill because of professional challenges and of the need to seek help when in need.

3. Medical conditions in nurses

Given the health issues that can occur in HCPs, it is necessary to evaluate the impact of nursing on the health status of nurses. The risk factors for diseases in nurses are displayed in Table 2.

Factors linked to the profession of nurse

Exposure to infectious agents

Stress-related conditions

Incidental trauma during the work

Injuries or accidents while working with professional equipment or devices

Working in special conditions involving health hazards

Confrontation with the assertiveness of patients or their family members

Exposure to highly emotional circumstances

Bullying or abuse

Factors not linked to the profession of nurse

Aging-related factors

Hereditary risk factors

Environmental risk factors

Table 2.

Risk factors of diseases in nurses.

The diseases that can be encountered in nurses belong to the types of diseases that the general population may present. These are presented in Table 3.

Organic disease

Functional disorders

Mental diseases

Burnout

Traumatisms

Table 3.

Types of diseases in nurses.

3.1 Infectious diseases in nurses

Nurses are exposed to infectious diseases as they stay, such as doctors, in the frontline of the contact with the patient. From the history of medicine, from literature or movies, we know cases of nurses who died of infectious diseases, from pests, and cholera to viral diseases [16, 17].

Nowadays, the long episode of the COVID-19 outbreak caused a lot of casualties among HCPs including nurses. Besides the death toll, many of nurses were infected with SARS-CoV-2 and suffered acute or chronic forms of the disease. This impact is due to specific working conditions [18]. Among factors predisposing to infections in nurses, one should mention the working conditions and shortage of staff [18]. Factors increasing the risk of infection spread are female sex, exhaustion, and lack of specific training, while applying clustering for nurses’ care decreases spreading of infection [19]. Besides the risks caused by the viral infection, the psychological challenge can lead during nursing care in COVID time to mental health disorders [20] or to burnout [21]. In this recent study on almost 500 respondents, there were higher scores for anxiety and depression in nurses than in the general population. Posttraumatic stress disorder was more frequent than army veterans or patients suffering injuries. Nurses working in intensive care units present the trend to leave these jobs because of the challenges caused by COVID-19 [21].

Even before the advent of COVID-19, the contact of nurses with infected patients represented a real hazard [22]. This is what can happen during flu epidemics when contact with suspects from the first visit increases the risk to get the infectious disease and leads to staff shortage when their need is highest [22]. Once the disease contracted, there is the risk to spread it among other patients who are admitted on the wards or seen in ambulatory [23]. It is therefore logical that there is a tremendous need to protect HCPs, including nurses from infectious agents [24].

3.2 Stress-related conditions in nurses

Job is an important source of stress [25, 26]. Nurses are also exposed to stress. This was emphasized after the pandemics with SARS-Cov2 [20, 21], but the facts are well known from earlier data [27, 28, 29, 30]. This stress is related with poor health in nurses and with the intention to quit, hence the shortage of nursing staff in hospitals in many countries of the world. In an Iranian setting, the job stress in nurses was self-evaluated as medium, while in female nurses, the most common source of stress was the range of roles (48.4%), role duality (40.9%), and job environment (39.6%). Comparatively, in male nurses, the range of roles was also the most important (57.5%), followed by job environment (50%) and responsibility (45%). The disbalance between skills and training compared to job requirements was not considered stressful in all genders [27]. However, there is still a lack of consistency in this field. For instance, in another study conducted in the same country [29], many nurses perceived their stress levels as high, ranging between moderate and high. 78.4% of respondents reported that their job was stressful. Explanations were working in shifts, insufficient staff, insufficient payment, discrimination at job place, disagreement with the management, and excessive workload. Being female, married, and with lower education correlated positively with stress levels. Other sources of occupational stress were working in emergency room and working many hours in tertiary centers [29].

In a neighboring country, Saudi Arabia, on more than 400 investigated nurses, the following stress etiology was observed, in order of the importance: organizational structure and climate, job description, management, interpersonal relationships, career and achievement, and homework interface [31].

As one can see, there are several causes of stress in nurses. They are displayed in Table 4.

Difficult working conditions

Critical patients

Emergencies

Work overload

Shifts working

Prolonged working hours

Insufficient staffing

Interpersonal conflicts

Lack of time

Lack of social recognition

Underpayment

Conflicts with colleagues

Conflicts with superiors

Harassment

Unpleasant administrative duties

Personal issues

Table 4.

Stress causes in nurses.

3.3 Psychological disorders in nurses

From the studies dedicated to job stress in nurses, it has been revealed that this can be associated with psychological factors [21, 29]. More recently, a large number of studies focused on this matter showed the importance of the psychological disturbances in nurses [32, 33, 34, 35]. In a Hong Kong study, carried out on 850 nurses, history of chronic diseases and self-perception of poor health were correlated with depression, anxiety, and stress. Depression was correlated with the status of being divorced compared to married nurses. Other factors, which negatively impacted the mood of the nurses, were widowhood and separation, lack of satisfaction with the present job, conflicts, sedentarism, and sleep disturbance problems. Nurses were more depressed, anxious, and stressed than the general population [32]. Similar data were provided also in an Australian study [33]. In this study, more than one-third of study participants reported scores for depression linked to job dissatisfaction. This condition may become harmful for the patients as the professional performance diminishes in such cases. Stress is also linked with the start of the career [34] or with the beginning of another job with different responsibilities or requiring other skills than previously. In a totally different setting, Norway, similar data were reported. Besides this, nurses in night shift had insomnia, fatigue, and depression [35]. Younger nurses have higher levels of anxiety [36] as well as loss of compassion. This means that managers should take care of this aspect and organize training for nurses who are emotionally exhausted [36].

3.3.1 Suicide in nurses

Suicide is a consequence of life disbalance, depression, and loss of hope. Like in medical doctors, where suicide is relatively frequent, mainly in females [37, 38], nurses are also exposed to the risk of suicide [39]. This trend was aggravated during the pandemic, when nurses, such as other HCPs, were more to risk to commit suicide [40]. According to this paper, not only nurses but also physicians are the professional category with the highest suicidal risk in the population (therefore, it is correct to look to suicide as a professional risk in nurses), but the arrival of the SARS-COV2 epidemic led to professional risk, higher workload, fatigue, exhaustion, alcohol and substance abuse, mainly in women, all of these factors favoring the suicidal ideation [40]. Suicide in nurses is linked to smoking [41]. In female nurses surviving suicide attempts, special training programs have to be organized, in order to prevent the repetition [42].

3.3.2 Burnout

Burnout is another expression of professional risks in nurses, as for other categories of HCPs, and it is characterized by the loss of interest in filling the professional duties, fatigue, disinterest, depression, and exhaustion [43, 44, 45, 46, 47]. The risky nursing groups are those working in difficult conditions, mainly for intensive care units, where the rhythm of work and the difficulties of the critical patients are eroding the confidence of the nurses. Thus, nurses have a high level of burnout [48].

The main factors associated with burnout in nurses were being female, being young, marital status, having children, work in night shifts, supplementary administrative tasks, and individual psychological factors, such as neuroticism or extraversion. This means that no model of burnout in nurses should avoid the personality of the nurse [48]. Almost half of the nurses have emotional exhaustion, as reported by very recent research [49]. Working on weekends favored the emotional exhaustion, as well as low collaboration with the job mates; emotional exhaustion is correlated with more days of working incapacity in nurses [49]. Incivility at working place is an important cause of burnout, and this applies also to nurses [50, 51]. Preventing burnout in such cases requires solving the social problems linked with incivility vents at working place. It is expected that different degrees of burnout are detected between different categories of HCPs [52].

3.4 Organic diseases

The nurses may present organic diseases. Some diseases have a prevalence and incidence like in the general population, and others have an association with the job of nurse. The main organic diseases encountered in nurses are presented in Table 5 [53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68].

Disease	Professional risk factor
Cardiovascular	Stress, sedentarism
Metabolic syndrome	Stress, sedentarism, unhealthy eating
Gastroesophageal reflux disease	Night shift, smoking, unhealthy eating
Dyspepsia	Stress, smoking, unhealthy eating
Irritable bowel syndrome	Stress, contact with intestinal infections
Inflammatory bowel disease	Stress
Chronic liver disease	Exposure to infected blood; alcohol, drugs
Breast cancer	Stress
Dermatological	Contact allergy, skin exposure
Musculoskeletal	Physical activity, position

Table 5.

Organic diseases presented by nurses.

There are an increasing number of studies emphasizing the professional risk of female nurses and recommending prevention programs.

4. Nurses and morphological sciences

There are trained nurses working also in morphological laboratories: pathology, histology, anatomy, embryology, etc. These are at risk to develop allergic asthma or skin diseases from the inhalation or contact with aggressive chemical compounds. Despite the paucity of the literature data on this topic, it is to recommend to ladies exposed to such professional toxic compounds, mainly during the fertility period, to respect all the indications and procedures to avoid professional diseases in laboratories of morphological sciences.

Another aspect related to this working place is represented by the sight problems that can occur in people working all the time with classical optic microscopes. New technology created the conditions to improve the health of women working in pathology or anatomy labs.

One can see nowadays that, compared with the state 30 years ago, when the professional health problems of women nurses, caused by their occupation, could simply be divided into four main chapters: biological, chemical, physiological, and psychosocial hazards by Tan in 1991, and now, the landscape of occupational hazards in this category of HCPs is more complex [69]. In other aspects, the risks perpetuated but working conditions and preventive procedures changed also [66].

5. Social image of female nurses and its impact on their occupation

Recent decades contributed to change of the social perception of the nurse as she is perceived in cultural products or in mass media. From the image of a nurse at the beginning, or of a dedicated, virtuous, and very engaged woman, it shifted toward a beautiful assistant of the male physician. This can be reflected by the plethora of cartoons, movies, plays, video clips, etc. These contributed to the erroneous presentation of the nurse of a frivol person, always submitted to her male boss. Besides the caricatural image, the lack of reality and even of political correctness is obvious.

There is a general impression that this perspective is a handicap for the profession of nursing, mainly female nurses [70].

In an Internet survey, it has been observed that in interval of few years, the image of the nurse improved from the caricatural one into a balanced and realistic one [71]. Indeed, after screening about 150 Internet sites where the image of nurses was promoted, one could find out that nowadays the emphasis is put on the professional skills and the scientific activity (even doctoral studies being reflected on the websites) [71, 72]. Therefore, one should use the social media to improve and spread the positive image of the nurses. Indeed, a bad image or reputation is a cause of stress and burnout in HCPs [43]. The job dress, that is, the uniform worn by nurses at work, contributes as well to the image of nurses, as well as in the case of physicians [73].

Due to the representation of the beautiful nurse, many women want to become nurses for plastic or esthetic surgery [74, 75]. In this position, they assist physicians of therapeutics in improving the self-image of their patients, thus harmonizing their profession with their vocation.

6. Conclusions

The nurses have a professional pathology caused by their working conditions. Medical conditions associated with the profession of nurse are organic or functional, somatic, and psychological. These diseases have to be recognized in time and prevented, in order to improve the health of the nurses. Besides this, social and administrative measures have to be taken by managers in respect to the work organization and staffing.

Conflict of interest

The authors have no conflicts of interest to declare.

Funding Sources

The authors have no sources of funding to declare.