Fitness to Practice versus Fit to practice?
The Nursing and Midwifery Code of Conduct (NMC, 2010) distinguishes four essential elements in the statement regarding ‘fitness to practice’. It is recognised misconduct, lack of competence, character issues and serious ill health are contributory to fitness to practice, however physical fitness remains un-encompassed in this (NMC, 2010). With regard to the NMC Code Revalidation (2014) there is no new comment on physical fitness within fitness to practice. But, surely physical fitness is integral to patient safety in emergency situations and fundamental in exemplary health-promotion. Nursing is a physically and mentally demanding role. It is noted that the NMC (2010) require balance in mental-health; it is stated that individuals with mental-health issues must be in the process of addressing these issues to be fit to practice. However, physical fitness is considered to be self-certifiable. Critical care nurse, Claire Topham-Brown is quoted in 2011 as stating nurses should be subject to annual health checks to ensure mental and physical wellbeing. The support of the development of annual health checkup evidences that a certain level of fitness is required to be a nurse.
Burns (2008) articulates in the assessment of student nurse capability more reliable methods should be developed to calculate competency, however this discussion correlates only with clinical assessment, and does not notice physical fitness to be a factor in fitness to practice. With reference to this, a study by Song et al (2001) of clinical nurses and student nurses confirmed exercise to be an activity they participated in least frequently. Conversely, previous studies denote that exercise is beneficial to health, improving cardiopulmonary function, strengthening immunity, reducing psychological stress and enriching overall wellbeing, and thus quality of life (Lu, 2002). It is determined nurses who engage in physical activity regularly are identified as experiencing less mental, emotional and physical stress (Fend and Hwang, 1999). Therefore should physical fitness tests not be considered significant to nursing when it is evidenced that physical fitness and engaging in exercise is beneficial to health on an array of levels?
Other ‘emergency’ professionals are subjected to rigorous physical fitness testing prior to employment. Physical fitness is vital to interview processes and remains principal throughout the duration of many emergency-service careers, with mandatory testing fundamental in ensuring the individual is capable of their employment. For example, those applying for the police undergo endurance and dynamic-strength testing, fire-service applicants are conditioned to 6 physical fire-service specific tests, including casualty evacuation and ladder climbs; such careers are weighted with considerable physical demands. Nonetheless, nurses are subject to patient handling and lengthy shift patterns in fast-paced, unpredictable environments, necessitating a certain level of physical fitness, surely? Could it not be considered to ensure patient safety that nurses should endure physical fitness testing, when considering emergency situations and cardio-pulmonary resuscitation (CPR) physical fitness significantly impacts performance. In pre-hospital CPR attempts, cessation of resuscitation efforts is accepted at the point of complete exhaustion of the rescuer; therefore the chances of survival would be increased if the rescuer were physically fit (Resuscitation Council UK, 2010) (Larkin, 2002). In a hospital environment discontinuation of CPR would not be accepted on this basis, and nurses would provide chest-compressions in relay however those with reduced physical fitness would not be capable of performing to the same standard as nurses who have a moderate to high level of physical fitness.
Improved physical fitness would not only contribute to functioning in emergency situations, it would also reduce fatigue and improve quality of life and reduce musculoskeletal injuries. Health-care work is physically and posturally demanding, and studies illustrate that musculoskeletal injury is common for nurses (Lipscomb et al, 2004) (Trinkoff et al, 2008). This evidences the positive implications of maintaining physical fitness, and subsequently self-protection from musculoskeletal injury also factors in diminishing time-off from work. A quasi-experimental (Yuan et al, 2008) study evaluating the effect of exercise on a nurse’s physical fitness demonstrated that implementation of a fitness regime improves physical-fitness.
Nurse’s physical fitness is also exemplary of health-promotion. The role of the nurse includes positive promotion of healthy living. A common effect of minimal physical activity is obesity, and it is known that obesity is alleviated through engaging in exercise (Hopps and Caimi, 2011). Research exemplifies that a high percentage of nurses are overweight and obese and do not involve themselves in physical activity (Zapka et al, 2009). With acknowledgment to equality and diversity, weight should not be a key determinant in physical fitness. However, whilst granting weight should not equal proficiency, it is noticed there are stipulations on body mass index (BMI). It is stated those with an eating disorder and a BMI below 17.5 should have their fitness to practice questioned unless undergoing treatment. There is a prevalence of eating disorders resulting in low-weight in female health-care students and these are considered to generate concern because often they are consequential of psychological implications, and effect health and work-performance (Szweda and Thorne, 2002). With regard to eating disorders it is only commonly anorexia and bulimia that are recognised, there is no discussion of over-eating disorders that result in obesity and generate similar health concerns and have emotional ramifications and be a product of psychological distress. Eating disorder is a vast term, and in relation to the aforementioned disordered relationships with food resulting in BMI’s at opposing ends of the spectrum should be considered and treated alike. Yearly physical fitness examination would uncover such issues and enable employers to act in a supportive, proactive manner, rather than in reactively.
Recruitment of student nurses currently does not measure physical fitness and nurses currently declare their own fitness to practice, however self-monitoring has been criticised for its reliability (Orr, McGrouther and McCaig, 2014). Individuals applying to naval nursing are required to partake in physical fitness testing, due to the physical exigency of the role. But, isn’t all nursing defined by urgency, and physical demand, and should all nurses not be expected to have physical fitness that enable them to fulfill these demands to the highest standard?
References:
Burns, D., (2008). A test of fitness. Nursing Standard. 22 (33) p61.
Feng, C.K., Hwang, J.T. (1999). Risk factors for musculoskeletal symptoms in the back, lower limbs and shoulders among nurses: results of a questionnaire survey. Chinese Journal of Occupational Medicine. 6 pp.249-260.
Hopps, E., Caimi, J. (2011). Exercise in obesity management. Journal of Sports Medicine and Physical Fitness. 51 (2) pp. 275-283.
Larkin, G.L. (2002) Termination of resuscitation: the art of clinical decision-making. Current Opinion in Critical Care. 8 (3) pp.224-229.
Lipscomb, J., Trinkoff, A., Brady, B., Geiger-Brown, J. (2004) Health-care system changes and reported musculoskeleteal disorders among registered nurses. American Journal of Public Health. 94 pp. 1431-1436.
Lu, J.H. (2002) Correlation between regular exercise and mental-health with the quality of life. National Sports Quarterly. 31 pp.60-73.
Nursing and Midwifery Council. (2010) The Code [policy document]. London: Nursing and Midwifery Council.
Nursing and Midwifery Council. (2014) The Code Revalidation[policy document]. London: Nursing and Midwifery Council.
Orr, J., McGrouther, S., McCaig, M. (2014) Physical fitness in pre-registration nursing students. Nurse Education Practice. 14 (2) pp.99-101.
Resuscitation Council UK (2010). Resuscitation Guidelines [policy document]. London: Resuscitation Council UK.
Song, S.J., Huang, J.M., Yin, L.Y. (2001) Health-promoting lifestyles and its related factors among clinical nurses and student nurses. Veterans General Hospital Nursing. 18 pp.147-158.
Szweda, S., Thorne, P. (2002) The prevalence of eating disorders in female health-care students. Occupational Medicine. 52 (3) pp.113-119.
Trinkoff, A.M., Geiger-Brown, J.M, Carusa, C.C., Lipscomb, J.A., Johantgen, M., Nelson, A.L., Sattler, B.A., Selby V.L. (2008) Patient safety and quality: an evidence based handbook for nurses. Vol 2.
Yuan, S.C., Chou, M.C., Hwa, L.J., Chang, Y.O., Hsu, W.H., Kuo, H.W. (2008). An intervention program to promote health-related physical fitness in nurses. Journal of Clinical Nursing. 18 pp.1404-1411.
Zapka, J.M., Lemon, S.C., Magner, R.P., Hale, J. (2009) Lifestyle behaviours and weight among hospital-based nurses. Journal of Nursing Management. 17 (7) pp. 853-860.