The Social Determinants of Work Health

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Justin Montgomery is a nursing director in the Dartmouth Hitchcock Health System. In a recent retention webinar, we talked about factors that promote healthy work environments and nurse retention. Justin noted the following in the chat, “Much like we know that improving health is not happening solely by interactions with healthcare, rather it’s better handled by addressing Social Determinant of Health; our ability to retain staff means addressing their work environment AND the Social Determinants of their Work Health. That’s really challenging and different.”

I think Justin has made an important observation. His ideas are supported by Gallup’s recent research on wellbeing at work published in Wellbeing at Work. We often fail to look at our nurses’ social determinants of work health and then wonder why our retention strategies are not working. Social determinants of work health are the conditions in which nurses are born into, grow up in, go to school, live in, and work in that shape their work health. For nurses, social determinants of work health could include factors such as:

Level of student loan debt
Educational achievement
Safety/crime in the geographic area where one works
Availability of childcare
Access to healthy food while working
Household debt
Support systems in the community
Cost of living in the geographic area
Housing costs
Community attitudes relative to believing scientific evidence about vaccination, mask-wearing, and social distancing
Access to public transportation and parking
Caretaker for family members
Social integration into the work team
The stress level in one’s personal life
Engagement and a sense of belonging in one’s community

Above is just a shortlist of social determinants that can substantively impact one’s wellbeing at work. Suppose I am a new graduate today who has accepted a position in a major city. In that case, I may be coping with a long commute, high rents, parking challenges, concerns about safety on nights/weekends, a high student loan burden, and social disconnection from others on my work team. Without support and help, I may decide what had seemed like an exciting first job is, instead, very stressful on many levels. I may see myself as never getting ahead in this setting. Like many in my age group, I will look at travel roles to explore less expensive geographic areas, pay down debt and live in paid housing. This may lead me to feel more in control of my life and time.

Our nursing workforce in 2021 is a different workforce than in 2019. Nurses today are younger, have grown up in a complex society, and may have different social determinants of work health than previous generations of nurses. Examining the current workforce shortages strictly through the lens of nurse supply and demand is an outdated paradigm.

Much like in healthcare, where we know how social determinants can impact health outcomes and risks, our retention strategies or efforts to maintain a healthy work environment may not be enough without looking at a given nurse’s social determinants of work health.

Read to Lead

Clifton, J. & Harter, J. (2021). Wellbeing at Work: How to Build Resilient and Thriving Teams. Gallup Press.

Our Most Popular Right Now – Become the Boss No One Wants to Leave Nurse Retention in Turbulent Times

Give your leadership team the gift of a highly rated webinar – Nursing Leadership in 2022: Rebooting after a Life-Quake A Nursing Leadership Reboot Workshop.

Read the Nurse Leader Coach – Available at Amazon and Other Book Sellers.

Recommended Book by the Association of Critical Care Nurses – The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success