Nurses: Role Models for Healthy Lifestyles?


By Susan Kreimer, MS, contributor

Do healthier nurses translate into healthier patients? This is just one of the questions that comes up regarding whether or not nurses and other health care professionals should be role models for healthy living and be held to higher standards of healthy behavior than the general public.

Kathy L. Rush, PhD, RN, has explored this topic in her research. "There is still the expectation that nurses should be role models of health-promoting practices," said Rush, associate professor in health and social development at the University of British Columbia Okanagan in Canada.

Her work challenges the notion that nurses should follow healthy behaviors to be effective role models. The nurses in her study viewed adopting and maintaining these behaviors as personal decisions they made.

"They either chose to, or chose not to, engage in healthy behaviors, but they could be role models regardless of the choice," said Rush, lead author of "Nurses as Imperfect Role Models for Health Promotion," a study published in the Western Journal of Nursing Research in 2005.

Employers also have a responsibility to create environments that encourage nurses in making health a part of their daily lives. Healthy behaviors enhance job performance by unleashing more energy, stamina and mental sharpness, she said.

"I often hear colleagues who are busy and extra stressed say they don’t have time to exercise or engage in other stress-reducing activities," Rush said. "At the very time we most need to be eating right, exercising, not putting harmful toxins in our bodies, etc., is the very time we often let them go. It is well known that we find time to do the things we value."

"Whether we believe patients should or should not view nurses as role models for a healthy lifestyle, the simple truth is that many patients do expect nurses to guide by example," said Tamara Walker, RN, a pediatric nurse in Edmond, Okla., and host of Ask MomRN, a family and parenting internet radio show.

"Patients are more likely to listen to and follow the instructions of a nurse who is modeling the health habits and behaviors they need to develop themselves," Walker continued. "They are also more likely to tune out the nurse who takes a 'do as I say, not as I do’ approach. Nurses, of course, are only human and cannot be expected to be perfect examples. In some cases, it may be beneficial for the nurse to share with her patient how she is working to overcome an unhealthy habit or trying to develop a healthy habit in her own life."

So, can overworked nurses kick unhealthy habits and become role models for lifestyle changes?

A national effort, Tobacco Free Nurses, recognizes the impact that nurses can make in helping smokers quit. By enabling nurses to give up nicotine, they can motivate patients to do the same.

An estimated 11 percent of registered nurses smoke and 25 percent of licensed vocational nurses smoke, according to the campaign's fact sheet. Tobacco use is the main cause of preventable diseases, resulting in more than 400,000 U.S. deaths annually and costing trillions of health care dollars.

The Tobacco Free Nurses Web site hosts many resources aimed at nurses, including a library of tobacco control references written by or about their peers. One link on the site, Helping Smokers Quit, connects nurses with research funded by the Centers for Disease Control and Prevention. A total of 30 hospitals in California, Indiana and West Virginia are involved in distance learning that coaches nurses in patient smoking cessation.

Hospitals have a stake in whether nurses and patients quit. They are rated by the Joint Commission on Accreditation of Healthcare Organizations according to smoking cessation interventions for patients with heart attack, heart failure and pneumonia.

Health care facilities and other workplaces can do much to promote healthy lifestyle changes, said Linda Sarna, DNSc, RN, AOCN, FAAN, principal investigator of Helping Smokers Quit and a professor in the School of Nursing at the University of California, Los Angeles.

"Addressing the time needed to smoke may actually increase stress at work," she said. "Nurses who smoke must leave the workplace, sometimes for long distance, in order to dose themselves with nicotine."

Many positive outcomes have stemmed from Tobacco Free Nurses, which is funded by a $1.8 million grant from the Robert Wood Johnson Foundation, a national health care philanthropy based in Princeton, N.J.

As the first U.S. program to help nurses stop smoking, it has raised awareness of tobacco cessation, Sarna said. Nurses who browsed the Web site were more likely to undertake patient interventions. Those in leadership roles also devoted greater attention to tobacco control and added policies with that focus in mind.

Like many smokers, today’s nurses often picked up the habit before they could legally buy cigarettes at age 18. "Any worker, including a nurse, who is struggling with nicotine addiction will have a challenging time quitting smoking if they are not prepared," Sarna said, citing the quit line 1-800-Quit-Now (784-8669) as a free resource.

The national telephone quit line is available to any smoker in the United States. Callers receive support and materials to get ready for quit attempts. They also can listen to advice about nicotine replacement therapy.

"Nursing students still have markedly higher smoking rates than medical students," said Sarna, an oncology nurse, indicating further efforts are needed to assist those entering the profession.

"Nursing is stressful, but many smokers may confuse the symptoms of nicotine withdrawal with stress," she said. Medications approved for smoking cessation help reduce these symptoms and increase quit rates. In order to solve the problem, however, nurses and nursing students also need support in their quit attempts.

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