Curbing Nurse Obesity Can Shrink Hospital Costs

One of the troubling ironies of nursing is that many of the people who dedicate their lives to healing patients do so at the expense of their own health. It doesn't have to be this way.

Hospitals can be dangerous work environments for healthcare professionals. There is the threat of exposure to an alphabet soup of hepatitis and tuberculosis strains, along with other dangerous pathogens. There is also the threat of violence and injury at the hands of angry, frightened, drugged out, drunk, and mentally unbalanced patients, their friends, and family.  

And now a recent study in Journal of Nursing Administration that examined survey data from 2,103 female nurses has determined that 55% of them are obese. For context, 34% of adult Americans are considered obese, while another 34% are considered overweight but not obese, according to the Centers for Disease Control and Prevention.

Of course, there is no reason to expect that nurses should be exempt from the overweight and obesity epidemic that is plaguing this country. However, it is disheartening to learn from the JNA survey data that nurses are actually at greater risk than the general population.

Kihye Han, PhD, RN, the lead researcher for the study, and a postdoctoral fellow at the University of Maryland School of Nursing, says she was drawn to the topic when she first came to United States from her native South Korea and confronted our overweight and obese epidemic firsthand.

"I was shocked when I came here and saw so many people (more than half) who looked so heavy," Han wrote in an email exchange with HealthLeaders Media. "This was no exception in hospitals. (In Korea, the obesity rate is not as high as here.)"

It shouldn't be surprising because Han says nurses are "surrounded with obesity risk factors."

"First of all, hectic work schedules. Non-standard work schedules affect normal eating time and habits among nurses," she writes. "For example, night shift nurses require additional efforts to get healthy food and to access facilities for exercise, and they also eat junk food during their night shifts. Extended work hours make nurses sleepy and lack of sleep is an important independent risk factor for obesity."

"Moreover, nurses, a female-dominant workforce, have double care-responsibility at work and home," Han says. "They take care of their children at home and this is another stress source and requires support from work, e.g., providing day care service, modifiable work schedules for mom nurses."

Job-related stress and fatigue induces nurses to find comfort in sweet and fatty foods.

Han's findings are the latest in a series of University of Maryland School of Nursing studies examining nurse health and productivity and the linkage to quality of care. Other UMD studies led by Profs. Alison Trinkoff, Carla Storr, and Jeanne Geiger-Brown, have linked nurses' 12-hour shifts and irregular schedules with sleep deprivation, health problems, and patient-care errors.  

"When I presented the preliminary results of this study at a national nursing conference in 2010, a lot of nurses showed me their interest," Han wrote. "They agreed their working conditions influence their eating/exercise habits and finally their weight. But also they said they felt nobody cares for their health, especially for their lifestyle-related health. Usually hospitals show attention for nurses' occupational health, such as needle-stick injuries. Nurses are assumed to have desirable lifestyles and be healthy and in addition, to be a caregiver rather than a care receiver."

Han believes that hospitals can take steps to create a healthier work environment for nurses. These could  include educational interventions to make nurses aware of the risks they face, improvements to work schedule flexibility, and even instituting naps  in the workplace to prevent sleep deprivation during 12-hour shifts.

Hospitals should also provide affordable and easy access to healthier foods, and give nurses sufficient time to eat properly, Han believes. In South Korea, for example, she says hospitals often offer free and healthy meals to nightshift workers. 

"Some hospitals offer on-site farmer's markets to increase access to healthy food for healthcare workers who work nonstandard hours," Han says. "Healthy vending machine choices and food delivery services to the work unit can also increase food quality and access for nightshift nurses."

Of course, even the best preventive measures will fall short if the healthcare workplace is understaffed, Han concedes. "Sufficient staffing should be employed to provide nurses to decrease their workloads and job stress. However, we all know it's hard to make organizational level changes," she says.

In the end, adequate staffing levels will be the biggest obstacle because of the cost.

However, hospital and healthcare organization leaders who are reluctant to acknowledge or act on the problem of nurse obesity and overweight should remember that this isn't just about "employee wellness." There is more at play than the upfront costs of providing for a healthier workforce. This is also about reducing labor costs and medical errors while improving outcomes.

Healthier nurses mean reduced absenteeism and turnover. They provide better care and make fewer errors, all of which save lives and money.