Sherwood Forest Hospitals NHS Foundation Trust was keen to introduce the Royal College of Nursing's (RCN) Rest, rehydrate and refuel initiative, and did so through a project undertaken by one of the chief nurse clinical fellows. Staff were surveyed to understand the current situation and any barriers employees may face, followed by a trial on two pilot wards and a trust-wide campaign.
Key benefits and outcomes
The rest, rehydrate, refuel project has:
- engaged staff in self-care and promoted the importance of staff rest, hydration and nutrition
- initiated and embedded new ways of working
- provided staff with top tips and advice
- worked with key stakeholders at the trust to improve staff hydration and access to nutritional food.
What the organisation did
In February 2020, a survey was sent out to all staff via the trust’s weekly communications bulletin to identify the greatest barriers to staff rest, hydration and nutrition. The barriers identified in the survey results were:
- Rest – staffing issues and clinical workload.
- Rehydration – lack of time and forgetting to drink.
- Refuel – the location of food outlets. Staff needing to leave their work areas to access them, as well as lack of healthy and cultural options.
COVID-19 hit just as the survey results were to be analysed, resulting in the project being put on hold while staff were redeployed. Although the pandemic brought obvious challenges, it also provided the opportunity to collaborate with newly developed committees to organise, structure and introduce new ways of working.
The project resumed after after three months and project was initiated that included working with two pilot wards along with a trust-wide campaign.
The hydration of staff became particularly important with the added complications of wearing personal protective equipment (PPE). Although two years previously the trust had introduced hydration stations (designated areas for leaving water bottles) the survey highlighted inconsistencies in their use. A further survey was emailed to staff on the pilot ward to gain a better understanding of their hydration and use of the station.
One wards hydration station was located in the middle of the ward, far from the main staff working areas and therefore ineffective. In response, a further two stations were set up at either end of the ward allowing staff easier access to both hot and cold drinks. The infection, prevention and control team agreed to let staff have drinks on these hydration stations providing they were in cups/bottles with lids and they were not kept in patient areas. As an additional trial, the pilot used the trusts charitable funds to provide staff with a travel mug. Staff were given a project pack which included information about the importance of hydration, what to drink and tips for staying hydrated at work.
Three strategies were used to promote rest and embed staff breaks. The procedure for breaks on the pilot wards involved staff taking breaks as and when with no set times or organisation. The wards trialled organising and setting their break times as a team at the beginning of their shifts. This allowed staff to choose which break times would best fit with their caseload and to plan their shift around them. It encouraged staff to think of breaks as an essential job on their to-do list. An information pack was also shared with them which included information about the importance of rest, tips for improving sleep quality and advice in relation to night shifts.
A staff catering user group had recently been set up and the rest, rehydrate and refuel survey results fed through to them to help determine provision and services. The hospitals main restaurant was difficult for staff to use within their allocated break time due to its location. In response, vending machines were relocated to aid quicker access and machines providing hot food 24-hours a day were evaluated. The hospital restaurant increased its dietary and healthy options and extended its opening hours. The trust also sought out and created a number of new rest areas so that staff could remain socially distanced whilst eating. The hospital restaurant is currently trialling a delivery service to support colleagues who are struggling to leave wards and clinical areas. As part of an information pack, staff were given information in relation to the importance of nutrition and top tips and advice for the best things to eat whilst at work including during a night shift.
The second part of the project involved a trust-wide campaign. The project promoted its key messages in a number of different ways to engage as many staff as possible. A pack was developed with information about the project, the importance of it, key facts and top tips to help with the three key areas. The trusts clinical illustration department produced posters, animations and a short video. The campaign ran over a three-week period via their communications channels with a different topic in focus each week. Communications channels included the trust bulletin, screen savers and social media. In addition a live lecture was delivered during the trust’s health and wellbeing digital fayre.
Results and benefits
Increasing the hydration stations addressed the two key barriers identified by staff in the survey: lack of time and forgetting to drink. The hydration stations now take less time to access, allowing staff to drink more regularly, additionally they became a visual prompt for staff. Feedback on travel mugs was positive, they were viewed as the trust giving staff permission to drink whilst on the ward and that they no longer had to hide beverages. Staff also felt they helped to maintain hydration as they could store a hot drink on the hydration station and drink it throughout their shift. Due to the increased number of stations there were never too many mugs/bottles allowing staff to easily identify their own and to keep them tidy and professional. Staff reported that the changes to the stations have improved their hydration whilst at work.
Setting break times as a team at the beginning of the shift allowed staff to see them as a priority and must do on their jobs list as well as increasing the likelihood of having them. Staff chose their break times dependent on their caseload for that shift and then planned work around their breaks rather than squeezing them in. This brought about a change in mindset of how missing their break is not only detrimental to themselves but also the people they work with, their patients and their relatives.
Moving the vending machines has increased usage and feedback from staff on the increased choices and opening hours of the restaurant has been positive. Increasing the number of rest areas so that staff can remain socially distanced whilst eating and resting has also been welcomed.
The trust-wide campaign received positive feedback with staff accessing and engaging with all aspects of the campaign information. Staff have been able to print the posters and display them in their work areas. By using various formats and channels the project has reached and engaged with a large proportion of the workforce.
COVID-19 created many obstacles to negotiate during this project. Engaging staff to prioritise their own health and wellbeing at such a busy and challenging time continues.
As the project was trust wide, the information given to staff had to be understandable and appropriate for a broad range of people. Whilst not all the information will be relevant for every member of staff the take home messages of the campaign are relevant to all.
Culture within the NHS can be difficult to change. During this project the pilot wards were challenged with adapting their way of thinking and trying new ways of working. Some of the barriers included long passed on myths of things that are not allowed to happen on wards. Understandably these beliefs and attitudes cannot be changed overnight and therefore the message of this campaign will continually need to be reinforced.
Support from senior leaders has proved to be one the biggest determining factors of the success for the project. Staff at ward level felt they needed the permission of seniors to prioritise their self-care. With this support, the team spirit and health and wellbeing flourished. However, when senior support lacked, everything ground to a halt. To achieve this support, presentations were given to senior leaders to provide evidence and rational, to keep them informed and provide an opportunity for feedback and discussion.
A change or improvement in one area cannot be simply replicated in another. Each and every ward and department has unique challenges that will need to be addressed on an individual basis. Whilst the guidance, tips and advice are appropriate for everyone, how each area implements them will depend on their own environment and team.
- Senior leadership is key to support and encourage any staff health and wellbeing improvements.
- One size does not fit all, each area is unique and any changes will need to be adapted to suit.
- Team work is vital, one persons health and wellbeing can influence and affect everyone around them. It is therefore important that a team approach is taken.
- Engage staff through different methods and use of technology to gain the biggest impact.
- Having one person who is an influential part of the team to help drive the project forward helps the sustainability and embeds any changes.
For more information about the work in this case study, contact Rachel Hart, Chief Nurse Clinical Fellow, Sherwood Forest Hospitals NHS Foundation Trust, Rachel.email@example.com
Take a look at our back to basics infographic for key facts about the impact of hydration, nutrition, sleep and regular breaks on workforce wellbeing.