By Rose O. Sherman, RN, EdD, FAAN, NEA-BC
For the past few years, I have been talking to nurse leaders about the social determinants of work health. Justin Montgomery, a Dartmouth Health nursing director, first raised this concept several years ago during a webinar. 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 or well-being 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.
Social determinants of work health resonate with nurse leaders and also help to explain why many well-being initiatives are not as successful as leaders would like them to be. Nurses bring their authentic selves to work, including the problems and challenges in their nonwork lives. 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 such as:
- Student loan debt
- The availability and cost of childcare
- The demands of caretaking with elderly parents and family members
- Safety/crime in the geographic area where one works
- Household debt
- Support systems in the community
- Cost of living in the geographic area
- Housing costs
You can probably add others from your experience as new social problems emerge. I thought about this as I read Dr. Jonathan Haidt’s new book, The Anxious Generation. For more than a year, nurse leaders have asked me the question – Are our youngest generation of nurses more stressed and anxious than previous generational cohorts, or do they talk more about their mental health? Haidt’s book, which is a review of the psycho-social research on the topic, concludes that the rates of stress, anxiety, and clinical depression are twice that of previous generations for those who spent their formative years after 2010. Interestingly, there is no change in the rates of bipolar and schizophrenia, which are thought to be genetic versus environmental.
Haidt proposes that Generation Z’s baseline mental health is lower because of a trifecta of events, including growing up digital in a phone-based culture, staying connected to the internet 24/7, and using social media platforms in place of in-person relationships with others. He seems to confirm what nurse leaders have been telling me about the intense conversations they now have with younger staff around mental health. It also explains why academic institutions invest so much in counseling and support services. Nursing Deans today will readily tell you they have growing concerns about the mental health accommodation under the Americans with Disability Act that they now provide students. Accommodations that health systems are unlikely to be able to provide if the nurse is hired.
This decline in the baseline mental health of our youngest generation of nurses is a social determinant of work health and highlights why so many are focused on their well-being. We are in an environment where the work has never been more challenging. The transition of new nurses is always complicated, but when you add the problem of high baseline levels of stress, anxiety, and clinical depression, things become even more challenging. 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.
Haidt, J. (2024). The Anxious Generation: How the Great Rewiring of Childhood is Causing an Epidemic of Mental Illness. Penguin Press.
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