She is a faith community nurse for her church, works on short-term contracts as a casual and relief review co-ordinator for home care organisations, and volunteers in Cambodia in her spare time. The registered general obstetric nurse still has an active annual practicing certificate from the Nursing Council and has been nursing for 58 years.

Jenkins trained as a nurse and midwife, delivering babies for 23 years before becoming divisional nurse manager of obstetrics at National Women’s Hospital.

She was headhunted to set up home care organisations, and spent 20 years on the job. Home care organisations continue to contract her – and as long as the work keeps coming, she plans to keep going.

Betty Jenkins in the 1960s, practising nursing at a private hospital. Photo / Supplied

Jenkins credits her personal spiritual beliefs for keeping her working. “I never could find the word retirement in The Bible,” she said.

“I think we’ve become programmed to think retirement is on a certain date … but we’re living more healthily and for longer. Some people can’t keep working, but as long as you can I think one should do so.”

Jenkins also volunteers as a faith community nurse at her West Auckland church, promoting “individual and community health and wellbeing” through counselling, health checks and referrals.

She lives by the mantra of “use it or lose it”.

“Quite often I’ve seen with elderly clients that if they stop work, the first two to three months aren’t bad, but one day they wake up and what have they got?

“The problem is you have a job because you need money – but we have work because we need a purpose.”

Jenkins at a water filter installation, set up in partnership with Never Thirst in a village in the Stung Treng Province, Cambodia. Photo / Supplied

In 1992, Jenkins went to Cambodia to volunteer with a non-profit group called Asian Outreach which was taking a mobile clinic along the Mekong River.

She has been back almost every year for at least three weeks, involved in community development, clean water and sanitation, and helping school kids get an education.

Last year she went to Cambodia three times; another trip is planned in October.

“I’ve decided I’ll keep going if people ask me – the last two contracts they approached me and I’m happy to do it.

“But I told my family – please tell me if you think I’m losing it. I don’t want to be a nurse that’s a burden on anybody else.”

Mike Griffiths, the pastor of Elim City Church in Auckland, where Betty is a member, values the health promotion events that Betty, as a faith community nurse, has led. One of the attendees at a health promotion event was prompted by Betty to visit his GP and is now receiving treatment for a newly discovered cancer.

Ian Yost of VisionWest Baptist Homecare has worked with Jenkins off and on for a decade. He said colleagues describe Jenkins as “a legend” – although she denies that.

“I think you don’t become a legend until after you die. However I think what gives me some satisfaction is, if I’ve touched a life in some way that has benefited them, and enabled them to develop their potential, then that’s a job well done.”

BETTY’S TIPS FOR NEVER QUITTING WORK

• Believe you’re never going to retire – you’ll always be doing something
• Maintain a positive outlook at all times – but you will need to adapt as you get older. If there’s something you can’t do any more, do something else
• Never stop learning or looking for new experiences
• Change should always be welcomed as it stimulates the brain
• Involve yourself with all ages across the spectrum
• Healthy relationships are important for physical and mental wellbeing
• Never lose your sense of humour

The findings indicated that certain occupations may put workers at elevated risk, with male workers in the manufacturing sector found to be at a higher risk than workers in the professional, administrative or technical sectors, and bricklayers and concrete workers at a threefold increased risk. Women in the manufacturing sector did not have an increased risk, but only a relatively small number of women in the study worked in this sector.

The women’s occupational grouping in which there was a slight increase was assistant nurses and attendants, but there was no increase for female nurses, doctors or physiotherapists.

The researchers said the male findings indicated that work-related factors such as airborne harmful exposures may contribute to the development of rheumatoid arthritis. “But a common trait in all four occupational groups associated with an increased risk of rheumatoid arthritis in our study is that they are physically demanding. Physical workload is a proposed risk factor for osteoarthritis, but for rheumatoid arthritis less research has been conducted,” said the study.

The full study can be read here.

More than 920 students responded to the anonymous online survey held two-yearly by the National Student Unit of the NZNO.

Phoebe Webster, the national chair of the student unit, said it was decided as part of the 2017 survey to look at student self-care as this was a “huge” issue for students and obviously nurses as well.

“The idea is that you start as you go on.” And the concern was that if students didn’t develop good self-care habits during their nursing training this was unlikely to change when they became a new graduate and increased the potential they would burnout in the years to come,” said Webster, who presented on the preliminary findings to nursing schools recently.

Sally Dobbs, chair of Nursing Education in the Tertiary Sector (NETS), said the survey presentation highlighted some of the concerns that Heads of School were also noticing around student health. “Certainly from our perspective and their perspective there’s a definite synergy there in terms of some the issues raised by the students.” This included financial and health issues, she said.

Webster said this year’s survey looked at how nursing schools were promoting and supporting students to be well in themselves so they could “do their jobs when out there in the real world”. It also looked at the self-care knowledge and behaviours of nursing students.

The survey asked students for feedback on a number of areas, including whether their schools provided health care and child care facilities, talked about managing fatigue and shift work, provided cultural and religious support on campus, and promoted wellness in general.

Phoebe said for the most part schools were doing an “awesome” job in supporting students. Preliminary findings were presented to a recent NETS meeting and the full survey results are expected to be released shortly.

The findings released to date show that the issues flagged by students as significant and needing more resources or information included managing fatigue and shift work, financial difficulties, managing the emotional response to relatives in distress, and gender identity.

NZNO researcher Dr Jinny Wills said the largest proportion of respondents (41%) was aged 18-21 years and for many of them their nursing training was the first time they had faced grieving and distressed families, so the survey highlighted that students wanted more support in that area.

Also raised were concerns about financial issues and having support available to “nip in the bud” the risk of financial difficulties getting to the stage where students couldn’t continue with their studies. Jinny Wills said nursing students faced the particular issue of long clinical placements making it difficult to undertake part-time work. In addition, around a third of student respondents had responsibilities for children and family members.

Wills said the survey showed that students who had accessed student health services or resources available at their school had been very pleased, with 85 per cent of respondents rating them highly.

Student health issues

Dobbs said schools had been noticing some health issues, and particularly mental health issues, becoming more prevalent amongst some of the younger students.

She said some students are entering programmes having declared they have been treated for depression or anxiety and had health professional sign-off that they were ready for nursing study. “But then various stresses take over and they realise they can’t cope.”

Dobbs said this could be challenging as under the Health Practitioner Competence Assurance Act nursing schools had to be satisfied a student was both mentally and physically fit to be put forward for nurse registration.

Dobbs noted that the survey’s findings were positive overall about the support services available to students. NETS was looking forward to further analysis of the survey findings on how students viewed the pros and cons of online learning.

BASIC SURVEY STATISTICS

The survey had 922 respondents; 90 per cent were enrolled in the bachelor of nursing degree and all nursing schools were represented.

Age of student respondents

18-21 years               42%

22-25 years               16%

26-30 years               13%

31-40 years               15%

40 years or older        14%

Ethnicity* of student respondents to survey:

New Zealand European      70.0%

Māori                               16.6%

Pacific                               6.9%

Asian                                17%

Other                                10%

*Respondents could report more than one ethnicity

Time management, or more specifically balancing your precious time, is a constant challenge for nurse leaders. The following are a few things that work for me. You might notice that some of my tips appear to be contrary to time management; however, if you can’t maintain a good balance during your working day then potentially you set yourself up for a pretty unproductive day!

In no particular order:

• Don’t sit longer than 30 minutes; even in meetings, stand up and walk about.
• Turn off your incoming email alerts.
• When you read your emails, deal with at least 75 per cent of them when they arrive.
• Avoid too much caffeine.
• Block out your diary with tasks you need to do (i.e. writing papers).
• Use headphones or earplugs (a clear ‘do not disturb’ sign).
• Block 30 minutes a day for lunch.
• Always make time for someone who is distressed.
• If you need to work longer hours, compensate yourself with a walk or power breaks.
• Look out the window and see if the sun is shining.

Carey Campbell, Chief Nurse Advisor, Southern Cross Hospitals

How to make the best use of your time (and that of others):

Know your work style and most productive times

• Work out when you are at your most productive – for some it’s first thing in the morning, for others it may be later in the day – and work on your most challenging tasks at that time.
• Try to mitigate any probable interruptions and deal with those before concentrating on your most important and challenging task.
• Work on that most important task for a good period of time before having a short break.
• We can’t all work at 100 per cent constantly – so complete some of the more mundane or easier tasks when your energy levels have waned.
• Strangely enough, I tend to get heaps done on a Friday – so that’s often when I ‘catch up’ with the things that I haven’t been able to finish during the week.

Be on time

• Use your Outlook calendar and set reminders to help you be on time for meetings and appointments.
• If it’s really important, or you have become ‘immune’ to your many reminders, set the alarm on your phone as well (the quacking duck noise is always a good one!).
• It’s such a timewaster for other attendees when meetings don’t start and finish on time, so try not to be THAT person who is always late!

Interruptions

• It is a totally unrealistic expectation never to have any interruptions in your work, especially as one of the key attributes of being a successful nurse leader is being available, approachable and accessible.
• The key to managing the impact of interruptions in your work is in how you react to these.

Some suggestions are:

• Don’t get caught up in others’ emotions and their ‘rush’ (they will always feel their request is urgent; however, most interruptions are not genuinely crisis-driven).
• Take a deep breath and clear your head so you can assess the situation objectively and react appropriately.
• Try to stay calm on the outside (even if you feel rushed on the inside).
• If it’s genuinely important, act.
• If it’s not important, remember that others’ disorganisation/panic/ drama should not make for your emergency!

Submissions welcome

This is the debut of a new regular section sharing leadership and management tips and ideas. If you have any ideas for future topics – or have tips on time management or other areas you would like to share – feel free to email [email protected].

Among your many other requirements, are you accountable for maintaining standards, improving client care and meeting organisational goals and targets [1,2]?

Some research suggests working at this level may be a precursor to increased stress, burnout and job dissatisfaction [3].

Now imagine that amidst your busy calendar of monthly meetings another type of meeting exists, with people who have identical or similar roles and often share the same or comparable issues with you. This meeting is purely for the purpose of mutual support. This support consists of shared learning, problem-solving, and reflecting on practice issues and the achievement of individual successes. The people at this meeting are your peers, with whom you may choose to set up a peer supervision group.

What is peer group supervision?

Els van Ooijen’s 2013 book Clinical Supervision Made Easy describes peer group supervision as a group where “there is no permanent supervisor; group members may either share overall responsibility or take turns at being facilitator”[4].

An ideal group has three to six members [5]. With no defined leader, all group members are trained as both supervisor** and Supervisee prior to forming a peer supervision group [6]. The facilitator for each session ensures that each supervisee has an equal amount of time to reflect on the practice issue they have chosen to take to supervision [7].

All members are presumed to have sufficient skill and resources within themselves as a group to make meaning of their experiences. This supported process enables group members to discover different ways of working [7,8].

What are the benefits?

Current research on peer group supervision is limited. A recent New Zealand article, written by Dianne Harker and her three fellow supervision group members, highlights the benefits of peer group supervision. Reduced stress, improved management of work-related situations and development of knowledge are all identified as outcomes. Improvements in skills and competence, plus the opportunity to discuss career choices and progression, are also identified outcomes of their well-structured, educational and positive peer group supervision sessions [7].

A 2009 article by Lakeman and Glasgow looked at an action research project evaluating the development and implementation of peer group supervision for 10 psychiatric nurses in Trinidad. Outcomes for the participants included feelings of greater satisfaction with their work, shared learning, increased positivity and collegial support [8]. A further benefit noted in both articles was the cost and time effectiveness of group supervision, compared with individual supervision.

The success of these two groups may be attributed to the commitment of the group members. Their tenacity in sticking to the boundaries set when the groups were first developed, together with following a structured process, paid dividends [7,8].

What are the challenges?

People’s perceptions of the term ‘supervision’ are often a challenge when first introducing any form of professional or clinical supervision.

For some the term conjures up feelings or memories of oversight and control. Instead professional or clinical supervision is a supportive and educative process that helps nurses to improve practice [9].

Other difficulties can be a fear of intimidation, breeches of confidentiality and general anxiety around the safety of the process [1,3]. If a group does not follow a structured process, there can be a strong tendency for the group to break into a negative, grumbling mindset rather than trying to create a positive, supported learning environment [7,8].

The reduced amount of time given to individual issues can be a source of dissatisfaction for some. Also, the supervisee may not be skilled in the process, unsure of what to bring to supervision and what feedback they want from the group. This can affect the functioning and dynamics of the group [9].

Bond and Holland, in their 2010 guide to clinical supervision, advise that sharing practice issues in a group situation is fraught with uncertainty, as the risk of disclosure is thought to be higher than one-on-one supervision [9]. Lakeman and Glasgow also point out that a supportive group may be reluctant to challenge colleagues (which limits the critical analysis of practice) as they want to protect the group’s cohesiveness [8]. Recommendations from the Trinidad pilot project included utilising a trained supervisor during the development of the group to help with the management of group dynamics and build facilitation skills.

Another factor impacting on groups is inconsistent attendance. Fluctuating group numbers often arise because of the difficult task of organising and coordinating time away from people’s busy work environments [1,9]. However, if a robust implementation process is followed, with ongoing evaluation, these difficulties can be averted [7].

How is effective peer group supervision implemented?

An excellent starting point is to recognise that peer group supervision can offer many benefits to nurses in leadership and management roles. The greater challenge is to implement peer group supervision that is effective and sustainable. Outlined below are some selections from the literature, and the New Zealand Institute of Rural Health Policy and Guidelines, regarding peer group supervision and the implementation process:

• Promotion of professional and clinical supervision for role development: education through workshops, discussion groups and/or articles is essential in creating an understanding of professional and clinical supervision [7,8].
• Support at all levels: According to English researchers Davis and Burke, support on all levels is essential for allocation of resources to peer supervision [1]. Time, funding for training and staff coverage are all required to enable peer group supervision to be integrated into everyday practice.
• Training in peer group supervision: Harker’s peer group and Lakeman and Glasgow used a single one-day workshop to establish their groups [7,8]. There may be a need for additional training depending on the experience of group members. The presence of a trained supervisor was advantageous in the initial stages of the group development [7]. In Lakeman and Glasgow’s second pilot project, on evaluation, it was recommended that the group started with a trained supervisor [8].
• Guidelines and working agreement: A working agreement to guide the process and function of the group is essential for effective and sustainable peer group supervision. Detailed information can be found in the New Zealand Institute of Rural Health Policy and Guidelines on Peer Group Supervision [5]. In addition, van Ooijen’s book provides quality information on setting up group supervision [4].
• Regular dedicated time and a safe environment: To gain benefits from peer group supervision, a strong commitment to attend sessions on a regular basis and in a dedicated space is paramount. Regular time to reflect on issues and experiences creates cohesiveness, trust and safety within the group. Access to appropriate technology, such as Skype, is helpful for nurses working in isolation. Freedom from interruptions enables the session to be productive for all [8,9].
• Session structure: According to the Harker article and Lakeman and Glasgow, effective peer group supervision works best with a formalised structure [7,8]. The local nursing group used seven tools designed by the New Zealand Coaching and Mentoring Centre. In both cases, the facilitator was responsible for guiding the process, thereby assisting supervisees to meet their initial supervision goal.

Give it a go

Peer group supervision presents a unique opportunity for managers and nurses in leadership roles for personal and professional development through shared learning and peer support. Harker and colleagues in their 2015 article say: “Our experience has been that effective peer supervision groups provide a rich learning environment and increase professional effectiveness. We would urge other nurses to start peer supervision groups.” [7].

About the author: Helen Shaw-Brown RGON, MHSc (Nursing) is a CPIT nursing lecturer, professional supervisor, an associate and peer group trainer for the NZ Coaching and Mentoring Centre, and a peer group participant.

REFERENCES

1. Davis, C. & Burke, L. (2012). The effectiveness of clinical supervision for a group of ward managers based in a district general hospital: an evaluative study. Journal of Nursing Management , 20, 782-793.
2. Sirola- Karvinen, P. & Hyrkas, K. (2008). Administrative clinical supervision as evaluated by first-line managers in one health care organisation district. Journal of Nursing Management, 16, 588-600. Press.
3. Cross, W., Moore, A. & Ockerby, S. (2010). Clinical supervision of general nurses in a busy medical ward of a teaching hospital. Contemporary Nurse , 35(2), 245-253.
4. van Oiijen, E. (2013). Clinical supervision made easy (2nd ed.). Herefordshire, UK: PCCS Books.
5. New Zealand Institute of Rural Health (n.d.). New Zealand Institute of Rural Health: policy and guidelines-peer group supervision . Retrieved from www.nzirh.org.nz/supervision
6. McNicoll, A. (2008). Peer supervision – no-one knows as much as all of us. New Zealand Coaching and Mentoring Centre, 1-5. Retrieved from http://bit.ly/1hLwcnZ
7. Harker, D., Hahn, D., Banks, J. & Gardner Orr, T. (2015). Peer supervision requires ongoing commitment. Kai Tiaki Nursing New Zealand , 20(21), 18-19.
8. Lakeman, R. & Glasgow, C. (2009). Introducing peer-group supervision: an action research project. International Journal of Mental Health Nursing , 18, 204-210.
9. Bond, M. & Holland, S. (2010). Skills of clinical supervision for nurses: a practical guide for supervisees, clinical supervisors and managers , (2nd ed.). New York, NY: Open University Press.

Do you or don’t you?

The 2013 influenza season is upon us in the southern hemisphere, and with it, health care workers are faced with the decision about whether or not to receive the seasonal influenza vaccination. For many, the decision to get vaccinated is ‘a given’ as they rationalise it is part of their professional obligation to keep themselves fit for work; as well as to protect their patients. This rationalisation is shared and recommended by the World Health Organisation (WHO)1. Others view getting vaccinated as unnecessary and too fraught with doubts to be considered a viable option to boost their immunity.

Despite slight increases in the flu vaccination uptakes rates by the New Zealand health workforce in the last three years, actual immunisation numbers remain low. The Ministry of Health’s 2012 (MOH) data revealed that only 48 per cent of District Health Board health care workers were vaccinated for influenza and the figure was lower again for DHB nurses at 46 per cent (6). Virologist and National Influenza Specialist Group spokesman Lance Jennings said this year that nurse vaccination levels still needed to improve and the Canterbury District Health Board had showed higher uptake was possible with 60 per cent of its nurses and 75 per cent of its midwives immunised, which was ‘much closer’ to the levels needed to protect vulnerable patients (7).

Influencing factors for low influenza immunisation amongst health care workers

Vaccination rates worldwide remain low despite strong evidence that immunisation of health care workers (HCWs) against flu is effective in preventing the spread of disease, lowers mortality rates among patients8,9, and that influenza infections in hospital health care workers lead to nosocomial outbreaks (10).

One qualitative research study found that nurses who chose not to be vaccinated did so for reasons of personal health choice and/or the perceived risk of injury or illness to themselves. The nurses viewed vaccination as a personal health choice and not an evidence-based nursing intervention. Patient safety outcomes were also mentioned as a factor influencing their decision to decline vaccination (11).

In another study undertaken in Minnesota, during the 2009 pandemic influenza outbreak, found a significant difference in vaccine uptake between doctors and nurses with 85 per cent of doctors and 62 per cent of nurses being vaccinated. More doctors than nurses chose vaccination because they believed they could accurately estimate their risk of side effects, while others identified a need to meet their professional obligation to be vaccinated and felt an ethical obligation to follow public health authorities’ recommendations and laws mandating pandemic vaccination (12).

A strong sense of professional responsibility was the strongest predictive factor for vaccination in a Saudia Arabian research project, as was previous positive experiences of vaccination (13).

A literature review of global barriers to vaccination uptake revealed consistent emergent themes across the varied nations carrying out the research studies. Themes identified included: fears about vaccine side effects; doubts around vaccine safety, efficacy and benefits in both pandemic and seasonal influenza scenarios; not viewing influenza as a serious illness; fear of contracting influenza; and fears that the vaccine could cause other illnesses such as Guillain-Barre syndrome and even infertility (14,15,16, 17).

Though recommended by many, and mandated by some, flu vaccination rates among HCWs, even in pandemics, remain below optimal levels (12).

Addressing the fears around vaccination

The latest Seasonal Influenza Vaccine report issued in New Zealand by the Centre for Adverse Reactions Monitoring (CARM)(18) reveals the number of adverse events reported in recent years (see Table 1).

The most commonly reported events were injection site inflammation [45 reports], fever [24], arm pain [22], vomiting [20] and headache [20].

On reviewing these results, several conclusions can be drawn. It appears that the number of adverse events reported in contrast to the potentially large number of vaccine doses administered is in fact very small. In 2012, adverse events equated to just 0.02 per cent and none of these events were life threatening. Also, while the type of adverse event reported may dissuade individuals from seeking vaccination, because of the temporary inconvenience of symptoms experienced, the actual or perceived threat of adverse events in this instance appears scientifically unsubstantiated.

A limitation of the CARM data is that only those who report adverse events post- vaccination are included in the results. How many went unreported? The robustness of the CARM data may be enhanced by identifying actual numbers of vaccines administered and providing more detail on those who reported events – e.g. age, gender plus how, where and when they were vaccinated. This may help in identifying trends. It may also be interesting to identify how many individuals actually contracted influenza post-vaccination? There is anecdotal evidence to suggest that some people do experience varying degrees of influenza-type illness post-vaccination and while other factors may contribute to individuals becoming unwell, is this a factor that contributes to reduced uptake of vaccination?

A review of the literature found no evidence to support or substantiate influenza vaccination causing infertility. There was a small link between influenza vaccination and Guillain-Barre Syndrome identified in America in the 1970s but those vaccine components have long since been discontinued and therefore pose no current threat.

Raising influenza vaccination uptake rates

Research study findings have identified a number of recommendations to raise influenza immunisation rates globally among health care workers. These include: improving education around vaccine use for health care workers to dispel myths and raise awareness (21); using the past and present experiences of influenza events to improve pandemic awareness and vaccination programme management targeted specifically at health care workers (22); starting education campaigns much earlier in a pandemic; (23) ensuring health care workers have access to scientific literature; having trust in public health communications and messaging; receiving encouragement from loved ones, physicians and co-workers; having access to vaccine campaigns that emphasise benefits of vaccination and highlight positive cues to vaccination while addressing barriers to vaccine uptake (24); effectively managing media to enhance the scientific validity of vaccination and influenza events reporting (25); and making health care worker vaccination mandatory26.

Vaccination: personal choice, professional responsibility or mandatory expectation?

Making health care worker vaccination mandatory has proved effective in improving influenza immunisation rates. Where this has been implemented, however, this has been met with resistance and caused controversy and substantial discontent (27). Controversy and discontent were in conflict over freedom of choice versus the mandate to ‘do no harm’ and ‘act in patients’ best interests. Freedom of choice breaches have the potential to adversely impact on individuals’ decisions based on religious, medical, or philosophical beliefs. The WHO, while advocating strongly for high health care worker vaccination levels, also respect individuals’ rights to abstain from vaccination on religious or medical grounds.

The costs of low influenza vaccination uptake rates among health care workers.

There is evidence of increased incidences of nosocomial influenza infections in hospital and community health care environments where vaccination rates are low28. The highly infectious nature of influenza can result in decimated health care worker numbers very quickly, even within immunised environments. The costs associated with managing seasonal, epidemic and pandemic influenza events – such as hospitalisation of infected people and replacing ill staff ­­– can be billions of dollars29. Costs not only impact on health spending budget and health care organisations but also on individuals who potentially lose wages if unable to work for lengthy periods because they are unwell. Most sick leave allocations are minimal and just one ill health event that stops you working for even a couple of weeks can use up this precious resource very quickly. The threat of financial hardship is very real. Many colleagues will continue to work while experiencing varying degrees of influenza-type symptoms because the threat of financial hardship often precludes staying away from work or because they believe their own immune system will fight the infection. Unfortunately this only aids the spread of infection to patients and colleagues alike. Organisational policies aimed at containing the spread of influenza by sending sick staff home early, at symptom onset, are often not implemented.

Minimising the costs through managing the risks

Being vigilant with basic hand hygiene practices and following a lifestyle that promotes optimal health and well being have a valuable part to play in minimising the potential spread of influenza. Some other interventions for implementation can include health promotion campaigns such as advising people if they are feeling unwell to stay at home until they are better; to if possible take advantage of influenza vaccination; and to ensure adequate food stocks, medicines and tissues are available should they need to stay home in cases of seasonal, epidemic or pandemic influenza30. On April 1 this year, PHARMAC (New Zealand’s pharmaceutical management agency) extended the eligibility criteria for people receiving free influenza vaccination in a bid to prevent and or minimise disease spread and adverse population impacts31. Organisations may also benefit from reviewing their policies on staff sick leave for people demonstrating flu-like symptoms so that these can be implemented more efficiently and minimise infection spread to patients and colleagues alike.

Conclusion

Research has identified that influenza vaccination albeit for seasonal, epidemic or pandemic containment appears to be a lower priority for health care workers globally, especially nurses. Decisions about vaccination appear to be influenced by and closely linked to personal, professional and ethical beliefs, values and knowledge, which can cause conflict and confusion for health care workers.

Research has also identified that low vaccination uptake rates among health care workers are often related to fear and are not scientifically substantiated. Common fears include: fear of contracting the illness, experiencing vaccine side effects and doubts about vaccine efficacy. Educating health care workers using relevant, evidence-based information presented in a timely and effective manner is one intervention recommended for improving influenza vaccination uptake rates. Recommending mandatory vaccination for all health care workers to improve immunisation rates has resulted in some conflict and resistance. Health care workers believe their human right to choose in this instance has been superseded by the organisational and professional expectations to do no harm and act in the patients’ best interests. The WHO respects individual’s rights to choose to decline vaccination on the grounds of religious or medical grounds. Maintaining optimal health and wellness, coupled with vigilance when implementing basic hand and other hygiene measures are also effective in minimising the spread of influenza.

Responsibility for managing influenzas effectively and efficiently is a challenge for everyone. The costs of failing to do so are significant for nurses, their clients, colleagues, employing organisations, communities, health funding, governments, and global health outcomes. The World Health Organisation has and continues to develop new initiatives aimed at containing and effectively guiding the management of influenza outbreaks globally. The need for ongoing robust discussions, decisions, and actions to effectively manage the constant threat of rapidly mutating influenza virus strains remains ever present as will the debate about the role of vaccination in assisting this.

A quote from Hippocrates in closing: “A wise man should consider that health is the greatest of human blessings and learn how by his own thought to derive benefits from his illnesses”(32).

About the author:

Noreen McLoughlin RN MA (Applied) Diploma Adult Education & Training is an independent health auditor, self-employed professional evelopment consultant for the last seven years, and a registered nurse for 30 years.

This article was peer reviewed by:

• Nicola Russell RN BN M.Phil (Nursing) primary health care nurse, Invercargill and board member of College of Nurses Aotearoa (NZ).
• Gillian Sim RN BHSc, MA(hons) nurse researcher and public health nurse, Southern District Health Board.

Acknowledgements

My thanks are extended to the following people for their assistance in helping me track down and access some relevant research information for this article: Theo Brandt, communications manager for Immunisation Advisory Centre, University of Auckland; Michelle Kapinga and Brenda Saunders of the National Influenza Specialist Interest Group; Dr Michael Tatley, the Director of CARM; and Cory Vessey, Ministry of Health immunisation advisor.

View PDF of this article (and related learning activity) here >>

REFERENCES

1. WORLD HEALTH ORGANISATION (2012) Meeting of the Strategic Advisory Group of Experts on Immunisation April 2012, Conclusions and Recommendations. WER, 2012, 21, 87, 201-216
2. CENTRES FOR DISEASE CONTROL AND PREVENTION (2013) http://www.cdc.gov/vaccines/vac-gen/immunity-types.htm Retrieved May 2013
3. IMMUNISATION ADVISORY CENTRE Duration of Protection, Efficacy and Effectiveness http://www.immune.org.nz/category/tags/vaccine-duration retrieved May 2013
4. CENTRES FOR DISEASE CONTROL AND PREVENTION (2013) http://www.cdc.gov/vaccines/vac-gen/immunity-types.htm Retrieved May 2013
5. IMMUNISATION ADVISORY CENTRE (2013) Immunisation overview 2013 www.immune.org.nz Retrieved May 2013
6. MINISTRY OF HEALTH Workforce Influenza Coverage Rates 2010-2012 (November 20 2012 update) http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/updates-immunisation Retrieved 20 May 2013
7. JENNINGS L Call for more nurses to get ‘flu jabs, Nursing Review News Feed April 2 2013 (from NISG press release March 27)
8. HAYWARD A, HARLING R, WETTEN S, JOHNSON,AM, MUNRO S, SMEDLEY J, MURAD S, AND WATSON J (2006) Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity and health service use among residents: cluster randomised controlled trial. British Medical Journal. 2006 Dec, 333 7581, p1241 retrieved from the Cochrane library April 16 2012
9. CARMAN W, ELDER A, WALLACE L, MCAULEY K, WALKER A, MURRAY G, AND STOTT D (2000). Effects of influenza vaccination of health care workers on mortality of elderly people in long term care: a randomised controlled trial. Lancet 2000 Jan, 355 9198, pp 93-97. Retrieved from the Cochrane library April 16 2012
10. VOIVIN N, BARRET B, METZGER M AND VANHEMS P (2009). Hospital Acquired Influenza. Synthesis using the outbreak reports and interventions studies of nosocomial infection statement. Journal of Hospital Infections 2009, 71: 1-14
11. RHUDY L, TUCKER S, OFSTEAD C AND POLAND G (2010) Personal choice or evidence-based nursing intervention: nurses’ decision-making about influenza vaccination. Worldviews Evidence Based Nursing 2010 Jun 1;7(2):111-20 Epub 2010 Mar
12. HENRIKSEN HELLYER J, DEVRIES A, JENKINS S, LACKORE K, ZIEGENFUSS J, POLAND G, AND TILBERT J (2011) Attitudes and uptake of H1N1 vaccine among health care workers during the 2009 H1N1 Pandemic. Plos One, 2011;6(12) epub 2011 Dec 22.
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Google ‘shoes for nurses’ and a plethora of options pop up from rocking soles to canvas sneakers complete with images of teddy bears in nursing uniforms.

“If part of the job is standing all day, then you do need a good shoe which is going to take into account everyday walking and activities and is going to last a period of time,” says Rome.

The canvas sneakers may be sweet but Rome notes they probably break down very easily and end up being more costly than investing in a good quality shoe.

Rome also has mixed feelings over Croc-style shoes. They have good cushioning, a good wide toe box, and are pretty good for standing. However, he is unsure whether the foot safety and stability is as effective in a slip-on sandal-type Croc shoe as it is in a fully enclosed shoe.

Then there is the new fashion for shoes specifically designed and manufactured to be unstable. Rome says the concept behind the shoes – with curved or rocker style soles ­­­– is that if you make the person unstable, you make their muscles work better or more efficiently. So they advertise that you can actually lose more weight because you are using more muscles.

Because you are causing postural instability the risk is – for an older person, at least – that it can cause you to fall.

Rome says his department has done some research into different types of unstable footwear. He said the immediate effects were instability but the long-term effects of wearing them were unclear and an area for further research.

(Update: In January this year, a lawsuit was filed in the US against the manufacturer of one of the most popular ‘rocker sole’ brands – Skechers ‘Shape-up’ or ‘Tone-up’ shoes – on behalf of 37 people who claim to have suffered serious injuries from wearing the shoes, which are designed to create instability and change the wearer’s gait.)

Regarding cross-trainer or sport shoes, Rome says they are very durable, certainly give support, and provide cushioning. Also, many of them are lace ups or have some kind of strapping mechanism, have a moderate heel height, and good support at the back. So yes, they are a good option as well as other shoes that meet the good footwear criteria listed below.

ADVICE ON GOOD FOOTWEAR FOR NURSES ON THEIR FEET ALL DAY

Comfortable

Your shoes need to be comfortable, sturdy, and good quality if you are going to be on your feet for long periods. For example, on a shift for up to 12 hours, you should have room in your shoes to allow for feet or ankles swelling.

A good toe box

A wide toe box allows room for your toes to move around and can accommodate any swelling. Think of the scenario of trying to put your fingers into a very narrow toe box for a very long time and how it would feel. The long term consequences are toes crunching up, bunions, hard-skin building up, and corns.

Lace-up or velcro

Adjustable tightness shoes are preferable simply because if the foot swells, then you can untie or unfasten the laces or straps and loosen the shoe a little.

Moderate/neutral heel

Wearing high heels for long periods can result in not only foot problems but also leg problems, knee problems, and lower-back problems. Rome believes in the spirit of moderation, so a slight heel during the working day is probably better than no heel at all.

Good cushioned insole

The insole inside the shoe should have good cushioning – an important aspect of any good footwear. If cushioning starts to wear down, the insole insert should be replaced. If someone is overweight, they should particularly ensure good cushioning material that is able to absorb the additional body weight.

Sole

The sole should be shock-absorbing and firm enough to provide arch support.

A deep heel cup

A deep heel cup ensures the foot can fit nicely inside the shoe and prevents rubbing of the shoe against the Achilles heel

Enclosed shoe rather than sandal/slip-on

While sandals may be great in summer to keep your feet cool, most flat sandals do not provide the stability and support of an enclosed shoe.