STRESS Island life

 Much of the NHS’s work is stressful,1 and chronic high exposure to stress at work can lead to mental and physical ill-health.2 In 2003, the Health & Safety Executive (HSE) issued its first ‘improvement order’ against an NHS hospital trust for failing to protect its staff from stress at work.

The health service has an exemplar role as an employer and should show best practice. The Scottish Executive document Our National Health states that the public values NHS staff, and the NHS must do the same.3 OH departments have a pivotal role in helping employees identify stress management techniques. The document Nursing for Health – Two Years On recommends that all OH departments fully exploit their valuable role in promoting health and well-being.4

We consulted widely within NHS Shetland and worked in partnership with staff to create, implement and evaluate an innovative ‘Stress Awareness’ project, which empowered them to identify their own stress-management techniques.

The objectives were to offer information so that staff could identify alternative methods of coping with stress, encourage them to think and talk about the effectiveness of their own coping mechanisms, and give them a chance to experience activities they may not normally have access to.
We anticipated that this project would also raise the public health role of the OH department and recognise multi-agency working. The project fulfilled the criteria for the Silver Award of Scotland’s Health at Work (SHAW) health improvement scheme, which is a tool to assist employers to contribute to this agenda.

Staff in many of NHS Shetland’s work areas suggested the activities and information to be available. This hopefully generated a feeling of inclusiveness. The Scottish Executive affirms that all NHS staff should be involved in the designing of healthcare projects in a creative and innovative way.3

NHS Shetland’s own ‘Health and Community Care Plan’ recognises the value of giving positive lifestyle information and access to activities.5

The PIN Guidelines

The Partnership Information Networks’ (PIN) Guidelines were compiled in 2003 to assist managers, staff and representatives within the Scottish NHS to effectively manage health and safety at work.6

The guidelines advocate discouraging the stigma surrounding stress, raising the awareness of the causes and associated factors, educating staff in techniques for coping with stress and pressure, providing information and education to encourage everyone to recognise stress-related problems, encouraging staff to get help at an early stage, offering easy access to counselling and other professional support, and ensuring confidentiality.

The guidelines recommend each NHS Board develop its own stress policy, tackling organisational and individual issues. As yet, the Shetland NHS Board does not have a policy addressing this, although following the findings of the 2002 staff survey, a mental health and well-being working group was established by the Local Partnership Forum (LPF). The LPF is part of the Scottish Partnership Forum, which ensures managers and staff in NHS Scotland work together to improve healthcare.

Membership of the well-being group was drawn from the LPF itself, the Health & Safety Committee (HSC), health promotion, staff development and OH departments, and all staff are encouraged to make suggestions.

The group decided how funding from the Scottish Executive was to be spent – such as work-life balance and communication skills workshops, a handling stress course, training for staff on violence and aggression, and equal opportunities.

‘Stress-Free Day for Staff’

The flagship day took place in a local leisure centre in the main town of Lerwick, with workshops, demonstrations, information, talks and stalls. There were staff members from nearly every clinical area and department. Most came at the beginning of the event and stayed to sample the different activities and workshops available. Those who were working on the day came either before or after work, and the programme was planned especially to cater for late, early and nightshift patterns.

The project was evaluated by counting those attending the flagship day and follow-up workshops, and from the results of questionnaires. We analysed discussion between project members and attendees, individual participation and involvement in the workshops.

About a quarter of all NHS Shetland staff attended, and half completed questionnaires. Seven per cent of respondents were men, although about 11% attended.

Forty-eight per cent of respondents were nurses, 19 were administration, and nine belonged to medical. The activities enjoyed most were reflexology, aromatherapy, fitness suite inductions and Indian head massage. Eighty-nine per cent thought that the information provided was very useful and interesting,

When asked ‘Would you contact the OH department for advice and support’ before the event, only 32% of staff said yes, compared to 72% after.
Suggestions from workshop leaders for improving future events included: attracting more men; childcare facilities; shorter activity slots; and putting a stress management team on site.

Conclusion and recommendations

It appears that the project fulfilled its objectives, and many of the recommendations detailed in the PIN Guidelines. Forty per cent more staff said they would now attend the department for advice and support with stress. Following the project, self-referral of staff to the department has increased by one-third.

This project also conforms to the PIN Guidelines by using multi-agency working, underlining how counselling and other professional help can be accessed through the OH department. The confidential role of the OH department is reinforced to all staff at every opportunity and in all literature provided by the department.

Funding for the project came from a staff endowment fund. It came in on budget, as we used the knowledge and skills of Shetland NHS Staff, freely given, for the workshops, wherever possible.

Although initially this project may appear expensive, in the long-term, it will be cost-effective. The whole project, including the ‘Stress-Free Day’ and the follow-up workshops, cost 2,000 – this is equivalent to a trained nurse taking the average length sick leave for a stress-related illness. The cost in time and money of stress-related illness in 2002 was estimated by the HSE at 13.4 million days and 3.8bn.

We have received many letters and e-mails from staff saying they have taken up an activity that they tried for the first time during the project and found it helpful for their physical and mental well-being.

Future projects

We started offering health and lifestyle checks last autumn for all NHS Shetland staff and have had an excellent uptake of these from all staff groups. This initiative is also part of the criteria for achieving the SHAW ‘Silver Award’.

We are also in the final planning stages of a Health, Safety and Well-being Project, which aims to raise awareness of health and safety within the organisation and have also recently introduced ‘Take Time’ risk assessments.


1. Scottish Executive (2003) Towards a Safer Healthier Workplace. Edinburgh: Tactica Publishing
2. Hatchwell, P (1995) Stress Management and Therapy, Occupational Health Review Journal, 56, pp. 26-30. ISSN 0951-4600
3. Scottish Executive (2001) Our National Health. Edinburgh: Tactica Publications
4. Scottish Executive (2003) Nursing for Health: Two Years On. Edinburgh: Astron Publications
5. NHS Shetland (2003) Health and Community Care Plan 2003-2006. Shetland NHS Board
6. NHS Scotland (2003) Partnership Information Network. Managing Health at Work Guidelines. Edinburgh: Partnership Forum

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