Thursday, 10 November 2016

Should nurses be role models for healthy lifestyles?

Muireann Kelly
Jane Wills
Rebecca Jester
Viv Speller

This study investigated the expectation for nurses to be healthy role models and the assumptions attached to this expectation. Although frequently expressed in policy and professional discourse, the expectation for nurses to be healthy role models remains a contentious topic for the nursing profession. Arguments in support of nurses being healthy role models refer to credibility in health promotion and view role modelling a healthy lifestyle as a professional duty. Unhealthy nurses may be less willing to discuss lifestyle with patients to avoid appearing hypocritical, and patients may question the credibility of nurses who appear not to follow their own advice. The objection most frequently raised is that the expectation for nurses to be healthy role models is paternalistic and nurses should be free to make their own decisions about their lifestyles.

The study findings suggest a disconnect between front line nurses and service users as to whether nurses should be expected to be healthy role models. Stakeholders from the practising nurse and nursing student groups argued that demonstrating healthy behaviours was less important than providing evidence-based, patient-centred care. The first round findings showed that practising nurses and nursing students felt that being unhealthy oneself was sometimes beneficial to share experiences and develop rapport with patients when discussing behaviour change. This finding has been noted by other research examining nurses’ health behaviours (González et al. 2009; Brown & Thompson 2007). Whether the front line nursing workforce believes nurses should or should not be expected to be healthy role models, the reality may be that service users do expect nurses to lead by example. The service user group in this study reported that they negatively judged nurses who appeared unhealthy and questioned their credibility and competence. There is an absence of research into the factors mediating patients’ decisions to follow or ignore behaviour change advice (NICE 2014). It would be beneficial to understand how the nurse-patient relationship is mediated and in what circumstances nurses’ health behaviours influence patient perceptions and their response to health promotion practices.

Although the stakeholders in this study argued that simply appearing healthy is not likely to affect how patients receive a public health message, the findings of this study should not be taken to imply that nurses’ health behaviours are of no importance. Maintaining a healthy lifestyle is important for the individual health of nurses as well as limiting the impact of unhealthy behaviours on performance, sickness absence, and the associated costs of lost working days within a health care system that relies on resilient workers.

Nurse education is an obvious starting point to emphasise the importance of a healthy lifestyle within nursing practice. At any one time, there are a considerable number of nurses studying in universities, either through pre-registration training courses or accessing post-qualification education or continuing professional development (CPD) programmes. The pre-registration curriculum should acknowledge the impact that nursing can have on an individual’s ability to lead a healthy lifestyle in order to better prepare nursing students for the reality of their future careers. Universities have a role to support healthy choices during education by providing a supportive studying and working environment for nurses (Wills & Kelly, 2016).The nursing students in this study reported that they imitate the behaviour of staff on placement to “fit in” and adapt to the work environment. Support for healthy lifestyles during education would ingrain the benefits of a healthy lifestyle and help nursing students to maintain their health at the outset of their nursing careers.

Employers also have a responsibility to create environments that encourage nurses in making healthy choices part of their daily lives. In this study, the workforce lead and practising nurse groups argued that employers should do more to support healthy lifestyles at work. The nursing workplace was in itself considered inherently unhealthy because of lack of breaks, poor provision of healthy options and lack of access to catering at night. The workforce lead group thought that currently, workplace support for a healthy lifestyle was insufficient. The ability to lead a healthy lifestyle may be mediated by busy and stressful workloads, long working hours, shift-working patterns, and the emotional labour of nursing work. Initiatives to improve nurses’ health should recognise that it would be more appropriate to try to tackle these constraints rather than focusing entirely on individual behaviour change.


Brown, I. and Thompson, J., 2007. Primary care nurses’ attitudes, beliefs and own body size in relation to obesity management. Journal of Advanced Nursing, 60(5), pp.535-543

González, S., Bennasar, M., Pericás, J., Seguí, P. and De Pedro, J., 2009. Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship. International Nursing Review, 56(3), pp.381-386

Kelly M., Wills J., Jester R. & Speller V. (2016) Should nurses be role models for healthy lifestyles? Results from a modified Delphi study. Journal of Advanced Nursing. doi: 10.1111/jan.13173

National Institute for Health and Clinical Excellence, 2014. Behaviour change: Individual approaches (Public health guidance 49), London: NICE 2014

Wills, J., and Kelly, M. What works to encourage student nurses to adopt healthier lifestyles? Findings from an intervention study. Nurse Education Today. 48(1), pp.180-184

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