The Impact of Social Determinants of Work Health

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

The student loan repayment holiday is officially over, and many nurses now add student loan repayments to their monthly bills. Nurse managers tell me that many nurses are stressed because of the amounts owed by both them and their spouses for education. Student loans are but one important example of social determinants of work health.

Justin Montgomery, a nursing director in the Dartmouth Hitchcock Health System, first used the term on a retention webinar that I did several years ago. 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 challenging and different.”

Justin’s ideas are supported by Gallup’s recent research on wellbeing at work published in Wellbeing at Work. We often overlook our nurses’ social determinants of work health and wonder why our retention strategies are not working. Social determinants of work health are the conditions 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.

One manager told me that she fully expects a number of her nurses will take travel contracts this winter to try to pay their loans off. 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.

© emergingrnleader.com 2023

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