Recognizing the importance of social support for health and work life

Research on the relationship between social support and health has important implications for nursing practice today. The literature suggests that a positive relationship exists between the presence of social support and health and coping with illness (Komblith et al, 2001; Adams et al, 2000). In a study of the work environment of secondary school teachers, co-worker support had an inverse relationship to anxiety and depression (Mahan et al, 2010). Employers are looking at ways to support nurses in order to reduce stress and promote recruitment and retention. The American Nurses Credentialing Center (2010) defines criteria for the selection of healthcare organizations that demonstrate sustained excellence in nursing care in the Magnet Recognition Program, by supporting nurses in professional practice. Nurse administrators are challenged to take the leadership role in creating work environments that support nurses by asking nurses how they want to be supported, being sensitive to nurses’ stress, and understanding the emotional risks nurses face at work (Ingala and Hill, 2001; Kerfoot, 2001). Leaders are encouraged to demonstrate their own compassion and to recognize the economic benefits of institutional compassion in times of trauma. For example, Mayor Rudolph Giuliani’s public display of grief strengthened people’s resolve to rebuild and restore confidence in New York after the bombing of the World Trade Center on September 11, 2001 (Dutton et al, 2002).

Determining the support you need at work or school

In the broadest sense of the word, support is anything that helps you work more effectively and feel better about how you are functioning. This general notion of support is vague and does not help you specifically articulate what you need or guide you in getting it. Conceptualizing support as being cognitive, affective, and physical can help you assess your needs and secure the support you require to work effectively as a nurse.

Cognitive support helps you think intelligently about your job, decide how to approach problems, and discover the how and why of doing things a certain way, and it also provides some criteria for doing your work. One method of providing nurses with cognitive support is through mentors. In a study using a mentorship model, newly graduated nurses who were mentored demonstrated a higher level of competency as evaluated by their head nurses than they did in two evaluations prior to the mentorship (Komaratat and Oumtanee, 2009). From mentors, nurses receive career advice, intellectual stimulation, and role modeling. New nurses receive needed support to promote retention, and experienced nurses are challenged to advance their knowledge base, sharpen consultative skills, and initiate needed change. Peer mentoring is another potential solution for support. At a university in southern Ontario, senior nursing students became role models and resources for other students in relationships that were mutually beneficial (Dennison, 2010). See “Looking for a Mentor” later in this chapter.

Affective support is acknowledgment for the work you do and a feeling of nurturance. Nurse managers need continued support and confirmation of their important role in today’s world, in which nursing practices are changing, clients’ conditions are more acute, and recruitment and retention are challenging issues (Sala, 2002). Respect, honor, and recognition of employees by the acknowledgment of positive performance are needed frequently, not only during an annual review. Expressing gratitude and appreciation can create feelings of goodwill and nurturance among nurses, which is a form of job gratification that makes them feel better about their workplaces, clients, and colleagues (Doherty, 2002). Mentoring can also provide affective support. In a study of a mentorship program initiated when the nurse turnover rate increased to 31%, nurses working in inpatient units, surgery, and emergency rooms who participated in a 1-year pilot program had a 0% turnover rate. Three years after the program continued and was expanded to other departments, the hospital staff turnover rate decreased to 10.3% (Fox, 2010).

Callahan (1990) believes that burnout occurs when nurses realize that no matter how developed their talents are, they receive no recognition. She urges hospitals to initiate a system of positive incident reports that can be posted on the unit’s bulletin board and then be included in the staff nurses’ personnel files. A commendation for work well done might look as follows: “I’d like to commend Sheila Jersey, RN, for the empathy she showed the client in room 1039 on the night of 10/12/98. Her words cut through his pain and delirium, grounding him in reality and allowing him to rest without further medication. She has a special ability to say just what the client needs to hear.”

Physical support is being provided with the staff, materials, and processes needed to get work done. Staffing requirements, an essential aspect of physical support, are discussed in the abundance of articles on retention. In this era, the belief is that the provision of adequate cognitive and affective support will attract nurses. The requirements for supplies, equipment, and environmental conveniences have likely been met in most nursing workplaces through technology, computerization, and adherence to stringent occupational hazard and safety regulations.

As nurses, we need to be assertive about securing the support necessary to function comfortably and confidently at work. The clearer we are about the support we need to do our jobs, the more likely we are to secure it. We devote a lot of energy to attempting to improve the health status of our clients. Getting the support we need to do our work can help us maintain our own health and enhance how we feel about both our work and our co-workers.

Conceptualizing cognitive, affective, and physical components of support provides you with an organizing framework for your individual support assessment. The first step in your systematic approach is to determine whether you are satisfied with the quality and quantity of each facet of support. Quality refers to the nature or characteristics of the support; quantity refers to the amount of support.

Look at the checklist in Box 17-1, grab a pencil, and indicate the pluses and minuses in your support system.

After you have completed this checklist, take note of those areas in which you do have the support you need at work or school. It is easy to take for granted the support we do have, and noticing the benefits makes us more appreciative.

Next, look at those areas in which the support you would like is not available. Answer the following questions about those instances in which you are not satisfied with the quantity or quality of the support you receive:

Be as specific as possible in answering these questions. The clearer and more detailed you can be about the gaps in your support system at work or school, the greater are your chances of rectifying the situation. By answering these questions, you indicate your desired outcome.

Requesting the support you need at work or school

The first step is to identify your needs for support. The next step is to decide if you wish to pursue the acquisition of this support. Can you manage without it, or would the presence of that support really enhance your working situation? Once you have decided to try to obtain the support, your next step is to design your strategy. You need to answer the following questions:

Let us take an example from each domain—cognitive, affective, and physical—and demonstrate effective and ineffective methods of seeking support.

Making a request for cognitive support

You are a student nurse in a small college. Although the school has several computers with access to databases, you and most of your classmates have your own computers and would prefer to work in your dormitory rooms. You could work more efficiently if there were telephone lines in each room so that modems could be used. In the area of cognitive support, you need better access to information. Knowing that several other colleges have recently decided to equip rooms with telephone jacks, you decide to approach the dean of your school of nursing with your request.

After making an appointment with the dean, you begin to prepare your strategy. In the 20 minutes you have been allotted, you must make the dean aware of the problem and how it is affecting the students’ ability to access recent information. You want to urge the dean to explore your recommendation so that you and your colleagues will have the support you need.

You obtain information on comparably sized schools in your region and learn that these schools have completed or begun the process of providing in-room telephone access. Next, you survey your classmates to see how many have computers or would get them if they had the facilities to use modems, and how many have used modems in the past. You also obtain specific information from your colleagues about how often they have been delayed in their work by having to wait for computer access in the library.

Armed with this information, you next prepare yourself for the interview with the dean. You envision yourself looking relaxed and calm. In your mind’s eye you see yourself presenting your arguments in a clear, straightforward, assertive manner. You notice how the dean is paying attention to what you are saying and taking notes. You visualize the dean agreeing with your concerns and promising to explore the feasibility of installing the necessary equipment.

Here is an example of how your interview with the dean might go if you were assertive:

Assertive approach

Assertive you: “Thank you for seeing me, Dr. Thomas. I want to talk to you about the library resources and the students’ concerns about their ability to do timely literature reviews by computer.”

Dr. Thomas: “Oh? Is that the case? Can you tell me any more about the situation?”

Assertive you: “Yes, I can. Although our library has excellent computer access to information, there are too few terminals to allow us to get our work done in a timely way. Most of us have our own computers or would bring computers if we had phone access in our dorm rooms. I have checked with other schools of comparable size in this region and can show you their progress on this issue. I have surveyed the student body and have responses that indicate how many students are affected by the problem. I have made a copy of the information I have compiled that you may keep [hands dean a well-organized information packet]. We are excited about the quality of education we are getting here, and the complexity of the assignments makes them challenging. We believe we could work more efficiently if we could use modems in our rooms, especially since, as you can see by the survey, most of us have been accustomed to doing our research in this manner.”

Dr. Thomas: “I can’t argue with your facts. You have certainly done your homework. Your suggestion sounds like a good solution to the situation. I certainly want our students to have access to the most current information. I assure you that I will bring the matter up at the next faculty meeting. We have been talking about this, and your concern and initiative on behalf of the students to get the support you need are impressive. We have a faculty meeting this week. I’ll share your data and get back to you in 1 week. Thank you for bringing this important matter to my attention.”

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