Longer Shifts, Poor Diet and Low Physical Activity Linked to Reduced Quality of Life for Nurses

Research shows that poor health behaviors, including low physical activity and an unhealthy diet, can lead to physical and emotional stress reactions. Unfortunately, however, little is known about these constructs as they relate to the perceived stress and quality of life of nurses. A team of Cleveland Clinic nurse researchers is working to change that with a new study investigating how stress affects the well-being of the largest group of healthcare professionals.

The study, which was conducted during the COVID-19 pandemic, showed that diet, stress, physical activity and shift work correlated with nurses’ perceived quality of life. Researchers also found that the pandemic had the greatest negative impact on mental quality of life for nurses working in jobs they considered to be lower stress pre-pandemic.

“This shows that there’s more work to be done,” says Beth Abood, BSN, RN, a nurse manager in endocrinology at Cleveland Clinic and principal investigator for the study. “We’re never going to completely remove stress in the nursing field, but we can focus on promoting self-care and finding other ways to help ourselves and our nursing teams.”

The study highlights the need for more nurse-driven research, she adds. Researchers sent surveys to more than 2,630 Cleveland Clinic nurses working in both inpatient and ambulatory settings in Northeast Ohio. Of these, 429 nurses completed surveys.

The surveys included questions designed to measure perceived quality of life, sleep disturbance, physical activity and perceived stress. Researchers note that few validated nutrition questionnaire tools were available, so they focused on evaluating participants’ consumption of sugary beverages, water and fast food.

Nurse scientists also recorded participants’ demographic data, including information about their shift work, length of shift and years working as a registered nurse. Finally, they asked participants to rate how the COVID-19 pandemic affected their quality of life.

Long shifts and well-being

Researchers found a significant correlation between consuming a higher number of fast-food meals per week and lower perceived physical quality of
life. Stress and physical activity were also important correlates for mental
quality of life.

In addition, study investigators identified shift work as an important factor. Nurses who worked 12-hour shifts reported a higher consumption of sugary drinks, greater sleep disturbance and greater stress levels compared to those working eight-hour shifts. Nurses who worked night or rotating shifts were also more likely to have a higher consumption of sugary drinks compared with those who worked day shifts.

“In the inpatient hospital environment, most nurses work 12-hour shifts, so it’s worth taking a more careful look at the nutrition resources available to shift workers to determine if we can enhance their health and, ultimately, their quality of life,” Abood says. “The long shifts might be great for work-life balance, but we are uncertain if they support a high quality of life.”

One surprising finding was the impact of the COVID-19 pandemic. Nurses who had a high level of perceived stress before the pandemic did not report a significant change, but nurses with lower or normal stress levels prepandemic reported a greater impact on their quality of life, she notes.

Looking ahead

Although the rest of the study’s findings may not be entirely surprising — it’s generally well known that nurses’ health behaviors can negatively affect their quality of life — Abood says the research provides important evidence about these previously studied issues.

“As we embarked on this study, what really resonated with me was the lack of health literature on these topics,” she says. “I would have thought we would be inundated with literature on nurses’ stress and quality of life, but that was really not the case.”

“More data is needed to highlight the connection between nurses and nutrition,” she notes.

Since conducting the study, Abood’s nursing team has implemented changes designed to support well-being, including a regular wellness check during their weekly huddle and addressing nurses’ self-reported sources of stress.

“Leadership has an important role to play in ensuring we communicate and promote healthy self-care practices,” Abood says. “Healthy behaviors may also lead to better nursing workforce retention and a healthier nursing workforce overall.”

Although making time for research can be challenging for busy nurses, Abood encourages colleagues to try it.

“Even if nursing research is not your top professional priority, going through the process at least once is a great experience,” she says. “It opens your eyes to other areas of nursing, and it can give you a new or different perspective on the topic of interest.”