Workplace stress is a serious business, says Cary Cray-Webb, who describes how and why she took a break from her job as a dental nurse.
A year ago I resigned from my post as a dental nurse. I’d had enough of the pressures associated with working in a business – a corporate chain of dental practices - where the over-riding priority was UDA completions. The final straw came when I was asked by my manager to carry out a time-saving short-cut that I felt jeopardised our compliance record. I refused and was censured.
I decided to find a job that wouldn’t force me to sacrifice the quality of my work in favour of simply doing more. I wanted to reduce the mental and emotional stress to which I constantly found myself subjected and which prevented me from doing my best for my patient (or my employer, for that matter).
I’m in the fortunate position of being a co-director of a small PR consultancy run by my husband, so I was able to be more involved while I looked for a new job. And that’s when it dawned on me. As well as being a full-time nurse, just like everyone else, I have other stresses and responsibilities. I am a company director, a student, a full-time Mum and a grandmother. Added to the sheer fatigue of commuting, no-wonder I was stressed out. I was in the fortunate position of being able to walk away for a while. I chose to take a break from nursing to save my mental heath.
Causes of stress in dentistry
The structure of UK dentistry (independent businesses, small chains and a few big chains) makes it hard to gather good quality evidence. So this is my own overview of the top five causes of stress for dental nurses, based on my experience and that of my friends in the profession;
Poor management. Too few practice managers and principal dentists have any qualification, training or wider experience of people management, operations management or financial management. The result is often, from the perspective of a chair-side nurse, chaos. We are frequently asked to work without basic items, or deal with defective equipment and instruments. And if we raise a problem it is too often deemed our fault by managers who won’t listen.
Clinical compromise. We are asked to take short-cuts that make our actions non-compliant with best practice and regulations. Yet, very often, especially when something goes wrong, we are left to take responsibility for our actions, even when it wasn’t our choice. But it’s hard to speak up – see point 1.
Grumpy colleagues. Dentistry is a people business, and dental treatments require a team effort. Being rude, snappy, sullen and bullying towards colleagues is simply not acceptable and surely damages patient care as much as working relationship. But, when the pressure builds, it happens.
Bad time keeping. Every nurse I know complains that their dentist starts late, over-runs lunch breaks or brings patients into surgery before everything has been cleaned down and readied. Some dentists are even guilty of all of these things. As a diabetic, maybe I need a predictable lunch break more than most; but we all get hungry and tired, we all need time to make calls to schools, garages, and loved ones. Those of us with small children and long journeys home need to get to child minders on time. On top of this, once we’re running behind we have to constantly deal with (understandably) annoyed patients, stressed reception staff (who are dealing with annoyed patients) and angry practice managers who blame nurses because they clearly don’t fancy ‘having a word’ with an equally stressed and tired dentist!
Pace and volume of work. The number of patients seen in a day in one surgery in general practice can be as high as 40. This is just too many. We are required to watch for signs of problems and abuse, particularly in children, but with this volume of patients, how do you spot an issue, let alone deal with it? Mental health conditions, diabetic hypoglycaemia, and even asthma attacks turn into ‘problems’ when they should be patients we are caring for.
Given that so many practices are short staffed and that it takes so long to recruit, problems like these are magnified when someone goes sick or leaves the practice, and this rapidly ramps up the pressure and stress felt by the other staff members.
Respect for human dignity
I have a close friend who is a dentist. I nursed for him when we worked at a big corporate. My friend often sees 30 or 40 patients a day. He is in his surgery for up to 5 hours at a time without a break. So is his nurse. He is highly qualified and very experienced. He does an extremely delicate and skilled job. It requires concentration, physical and mental dexterity, and is often highly stressful.
Yet when it comes to breaks, he and his nurse get the absolute legal minimum – assuming they don’t over-run. In his early 40s, he has developed Carpal Tunnel Syndrome so badly that at one point he couldn’t hold a pen. Although he was able to get treatment, he still wears a brace, a physical reminder of the pressure he faced.
I think it’s time that corporate practice managers (and probably principal dentists) gave some thought to the commercial risks which they are exposing their business to. An overworked clinician is an expensive loss. Another factor, of course, is a respect for human dignity which we should all be able to take for granted.
Associate dentists are becoming harder and harder to recruit. Likewise, qualified nurses are becoming increasingly difficult to retain. While many nurses move to another practice or to roles that use their qualifications and skills, many find easier and better paid work at supermarket checkout tills. It’s not just the money – workplace stress plays a very large part in the decision to leave a profession that most of us love.
I believe practice managers need to think about better rotation of nurses and providing cover for shorter shifts and more breaks. They could perhaps look at three appointment sessions with two breaks. Or else a proper, old-fashioned ‘tea break’ for their dentists and hygienists.
By reducing the physical stress on staff in this way they will also reduce the mental stress. By reducing over-all stress they may well find that they also reduce levels of illness and ‘industrial injury’ (such as Carpal Tunnel Syndrome) and make their practice a happier and more enjoyable place to work, leading to better staff retention.
Ideas to reduce workplace stress
I think that our professional bodies and the CQC owe it to all dental professionals, the businesses we work for (independents and corporates), and our patients, to run (and act upon) a proper study on workplace stress. If we all wore heart-rate monitors in the way that many people wear dosimeters, the CQC could review the data to check stress levels of staff during their regular inspections.
Meantime, some practical steps dental practices could take include;
Management training. Our leaders should take business management, marketing and HR courses and qualifications. Maybe designate (and train) a member of staff to act as HR manager and impartially manage ‘differences’ between staff and management.
Respect everyone’s professional integrity equally. If someone feels something is non-compliant, work through the process and check the appropriate standards. A new nurse might be inexperienced, but may have recently studied legislation that you haven’t looked at in years. And remember that everyone who works in a non-compliant manner is risking sanctions from the regulators, so don’t simply shout them down.
Deal with unacceptable behaviour in a positive manner. Bullying is now a business risk and is harshly dealt with by industrial tribunals. It is the responsibility of the practice manager and principal dentist to eliminate bad behaviour. But address it in a thoughtful and conciliatory manner. A heavy-handed approach just makes things worse. Develop a positive, team-based culture through being fair to all and open to everyone.
Deal with bad time keeping. If someone is late, address the issue with that person – don’t ask the nurse to ‘hurry them up’. That is not our job.
Proactively manage workloads and staffing. Time is a finite resource, so if you don’t have the staff, don’t book the patients. If you can’t find a locum you simply have to reduce the number of patients until you do.
Finally, remember that flexibility is a two-way thing, and if your staff put themselves out to help, make sure you do something meaningful to them by way of compensation.
Cary Cray-Webb is a director of Precision PR Limited, a specialist marketing company whose clients include the Pearl Dental Software brand. Cary is also a registered dental nurse. She qualified in 2015 and has worked for both of the ‘big-two’ corporate chains. She has gained experience at four very different practices and currently works as a locum nurse and a marketing consultant.
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Dentistry can be harmful to your (mental) health. BDJ Team 6, 19038 (2019). https://doi.org/10.1038/bdjteam.2019.38