Care under pressure 2: examining causes and solutions to psychological ill-health for nurses, midwives & paramedics

Introduction: health service delivery requires healthy, motivated staff. Nurses, midwives and paramedics are the largest collective group of clinical staff in the UK’s NHS but have some of the highest prevalence of psychological ill-health. Building on previous work with doctors (Carrieri et al. 2020), this study explored why psychological ill health in healthcare professionals is a growing problem and how we might change this.Methods: realist synthesis methodology (Wong et al. 2014) involved two rounds of database searching in MEDLINE, CINAHL and HMIC (the second round targetting COVID-19-specific literature and literature reviews) and supplementary searches. Novel methodological approaches were developed to accommodate different-sizedliteratures between professions. We worked closely with a stakeholder group comprising nurses, midwives, paramedics, patients and public representatives, educators, managers and policy makers.Results: we included 75 papers in the first round (26 Nursing, 26 Midwifery, 23 Paramedic), and 122 in the second. We surfaced 14 key tensions from the literature and identified five key findings. For example, we learned that: interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; the needs of the system often override staff wellbeing at work (‘serve & sacrifice’); and there are unintended personal costs of upholding values at work.Discussion & conclusions: healthcare organisations need to rebalance the working environment to enable healthcare professionals to recover and thrive, and identify and nurture future compassionate leaders. The initial focus should be on staff essential needs, system-level change and long-term planning. We recommend that interventions are co-designed with frontlines staff and experts-by-experience