This study demonstrates significant benefit for nurses physically active and sleeping at or above the recommended level. Specifically, the findings conclusively show that those attaining the recommended physical activity and sleep profile are most likely to be productive, experience reduced barriers to workplace and external physical activities, have a reduced risk of disease and be more likely to report ‘better’ health. Moreover, we hypothesize these “healthier” nurses would have a greater capacity for caring. To this end, affirmed are the benefits to nurses that actively pursue personal wellbeing and to the efforts of employers who support employee healthy lifestyle promotion.
Across all populations physical inactivity and sedentary behaviour are established precursors to premature mortality; and poor sleeping patterns are linked to reduced wellbeing, increased morbidity and diminished productivity [11
]. For nurses, the impact of daytime fatigue associated to poor sleep, reduces workplace productivity and lowers cognitive function [14
]. When coupled with shift-work, consistent poor sleep has been shown to play a significant role in reducing work and post-work safety, and specifically the increased risk of post-shift road fatality [20
]. In our study, 32% of the sample reported getting less than optimal sleep, which is consistent with norms that report greater than one third of adult populations have poor sleeping patterns [27
As a countermeasure, there have been a number of reported strategies targeting improved sleep. Recently, Steffen et al. [29
] demonstrated the value of an 8-week workplace healthy sleep program, where following a 1 hour session per week that delivered improved sleep technique education, participants reported reduced stress and fewer nights of “poor sleep”, as well as an improved quality of life and energy levels. Other strategies specific to nurses that have been successful have included structured workplace napping and permanent night or day duty rosters [30
]. Given the extended duration of nurse shifts and the impact of rotating rosters on life balance, workplace interventions hold potential for improved sleeping profiles [20
]. These considerations should also be extended to physical activity. Workplace based interventions and/or educational seminars either; (a) targeting improved activity participation, or (b) lobbying holistic healthy lifestyle behaviours, have been consistently demonstrated successful [32
]. For participants, workplace interventions are convenient to access and are reported to improve markers of disease and quality of life as well as reduce job stress and improve productivity [34
]. For the employer, the investment of delivering workplace interventions is associated with reduced absenteeism and staff turnover [33
The current study findings indicate that when physical activity participation is coupled with good sleep practice, nurses achieve a psychosomatic benefit. With the exception of congestive heart failure, LS1 reported an enhanced level of disease resistance to all other groups for osteoarthritis, elevated cholesterol and depression. Moreover, when compared to those not achieving sufficient sleep and physical activity, the LS1 health profile extended to a reduced risk of high blood pressure, elevated triglycerides and anxiety. This disease disparity between those with the highest profile and those with the lowest, speaks to the value of a healthy lifestyle. With increased disease risk comes other personal and financial implications [38
]. For osteoarthritis alone, individuals can incur medical cost 28% - 30% higher than their non-arthritic counterparts, with the cost increasing in the presence of a secondary diagnosis such as high blood pressure [39
]. With an ageing population, and the increase in chronic illness and complex health care needs, the demand for nursing services will increase [40
]. Therefore, the promotion of a healthy nurse workforce is paramount to meet the increased demands for services and reducing the potential for nurses prematurely being consumers of health care services themselves.
Work to date demonstrates that within the nursing profession, turnover is high and consistently associated with reduced patient care and nurse burnout [41
]. Recent work by Wang et al. [42
] reported emotional exhaustion and depersonalization as underlying factors in nurse burnout. Supported by previous research, Wang et al. urged workforce administrators to seek means of improving nurse self-efficacy and reduce environmental stressors [10
]. This and previous work (undertaken by our group), has consistently demonstrated an association between improved workplace vitality, emotional capacity and general health among nurses adhering to one or multiple lifestyle health behaviour [8
]. Workforce administrators need to take note of this if they wish to reduce nurse staff turnover, extend staff workforce retention and the attendant quality of care.
The present study limitations include the following. Firstly, data are self-reported and the development of the sub-grouped units of analysis is informed by a two stage categorization process in a convenience sample. However, this form of delivery is common in epidemiological evaluation, with large internet population-based surveys and other web-based questionnaires having demonstrated acceptance and feasibility. In an electronic age, web-based surveys have greater accessibility and integrity, with improved cost-effective outcomes over traditional telephone contact and/or face-to-face collections [22
]. For this work, categorization is substantiated by that BMI increased across groups (LS1–4) as would be expected with decreasing levels of physical activity participation [43
]. In addition, the cohort figures for physical activity (<28%) and sleep (>70%) guideline adherence are consistent with national estimates [27
]. While barriers to participation are an important consideration not discussed here, for workforce administrators looking to intervene in poor nurse health the underlying fact delivered by this work is that adherence and participation play an undisputable role in an individual’s health and wellbeing. Finally, the current data was drawn from nurses working in the southern hemisphere and the findings reported here may not be generalizable to nurses working elsewhere. That said, similar results have been reported in a study of nurses working in the northern hemisphere [9