Ep 7: Stress management programs for student nurses – effective, or not? A conversation with Becky Petley.

Posted November 14, 2022

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Show Notes —

Interested to know more about stress management programs for student nurses? Then you’re in the right place.

We talk to Becky Petley in this episode. Becky is finishing her Ph.D. at Winchester University in the UK and was investigating what aspects of wellbeing programs for student nurses actually work.

In this conversation we cover:

Why it’s important to understand what elements of wellbeing programs are effective and not just whether the whole package ‘worked’.
The moral imperative of organisations to implement culture change to support student nurses.
How a flexible, and not a one-size fits all approach is needed to address student nurse stress.
The context of attrition of student nurses – many (up to 33%!) drop out early from training. We discuss the obligation of organisations to address this.
Some reasons why student nurses drop out.
We discuss Becky’s review article and why she looked at stress specifically in student nurses.
How stress interventions vary a lot. Becky talks us through the types that were most effective, such as those that involve training coping skills and ways of thinking about stress differently.
Why future work needs to address coping but also helping reduce the actual things that are making students stressed (e.g. high placement demands and academic work, financial pressures)
How expectations around professional identity clash with student nurses’ personal identity, sometimes leading to deteriorating wellbeing.
Becky shares her advice for new nurses – to practice self-compassion and be kind to yourself.

Find her article here: “The effectiveness of interventions and behaviour change techniques to reduce stress in student nurses: A systematic review”.

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E-mail us: nathan@nursewellbeingmission.com

Transcription —

Nathan Illman
Welcome to another episode of the nurse wellbeing mission podcast with me, Nathan Illman. So in this episode that you may have seen from the title, we’re going to be covering something really important. And that is how to support student nurses with stress management. So if you’re a nurse educator out there, someone supporting student nurses, or perhaps you are a student nurse yourself, you may be aware that there is quite a large literature looking at different ways to help student nurses with managing stress. And obviously, as we know, it’s a really stressful time with the balance of academic work, clinical work, the balance of having a family at home, and sometimes financial pressures, not to mention the potentially highly stressful or even traumatic things that people might witness or experience as part of their training. So this is really important stuff. And in this conversation, I talk to Becky Petley, who at the time we spoke, which was earlier in 2022, was finishing her Ph.D. and looking at various different interventions and measures around well-being and stress in student nurses. And in a particular piece of research that she conducted, which we’re going to be talking about, she comes to a really important question, and that is why certain things work. So we’re not just looking at what particular interventions work, it’s actually what makes an effective intervention for stress management. And I’m not going to go into all of the minutiae of that, because Becky can tell you more about it. But we have a really interesting conversation about this, but the importance of thinking about, okay, well, what are the constituent parts of an intervention that help provide that relief, that support, and how that’s important for sort of replicating interventions and thinking about what works for whom. So before we start the conversation, I just have another reminder for people. If you haven’t already, join our community, you can do that. We’ve got a free Facebook group, you can just search for us on Facebook nurse and midwife wellbeing mission, or you can head over to our website. By the time most people listen to this, I’m very excited, our learning platform will be live. So you can join our nurse wellbeing mission community for free and get access to some free courses. And I’m very excited that in the coming months, I will actually be releasing a stress management course for nurses and midwives. So in 2023, if you’re listening to this, that will probably be available. So I highly encourage you to head over to our website to have a look at the free resources and the sort of more advanced other paid resources as well. So I’m not gonna delay this conversation any further here is Becky Petley talking about effective stress management interventions for student nurses. Welcome to the Nurse wellbeing mission podcast hosted by me, Nathan Illman. This is the place where nurse and midwife well-being is at the top of the agenda. Each episode aims to help nurses and midwives around the world flourish through informative, inspiring, and practical content and conversations. So Becky, thank you so much for joining me today to talk in the podcast. We’re here to talk about why your Ph.D. research and a bit more specifically after that around this great review, you’ve done around stress management and behavior change interventions with nursing students, if it’s okay, just to begin with, would you like to just introduce yourself and maybe talk a little bit about your background and nursing and your qualifications after that, and why you got into this kind of research area?

Becky Petley
Yeah, brilliant. So thank you very much for having me. So my name is Becky. I am a Ph.D. student at the University of Winchester. And my nursing career started, I was a healthcare support worker for two years in elderly care. And that was doing palliative care and rehabilitation. I absolutely loved that developed a real passion for nursing. So I then went on to study child and adult joy-filled Nursing at the University of Southampton, and again, absolutely loved it. And one thing that really stood out to me was that I was really well supported. I had a brilliant academic tutor, I had really supportive supervisors on placement. And so I managed to make it through so because I was joy-filled. It was a four-year course I made it through successfully. However many of my peers didn’t, and many of them struggled with their well-being. And it really made me reflect on why was it that I managed to get through and some of my peers had had to, unfortunately for a variety of reasons, stop their programs. And I also was very passionate about research. I did a lot of research activities on the side of my bachelor of nursing. And that led me to do a master’s in psychology. So I went to the University of Surrey, and I completed the psychology conversion course there. And then I was very lucky to be offered the opportunity for a funded Ph.D. looking at student nurse wellbeing. So I was very keen to accept and I went on to create the question of what are the necessary components of an intervention to improve the well-being of student nurses. So I’ve been studying this for the last three years. And I have conducted a systematic review, which we’ll be discussing today. I’ve also conducted a case study. And I’ve also gained some stakeholder feedback on the intervention components I’ve suggested. And I’m really happy with the outcome of my Ph.D. And I feel I’ve got some really great findings that I hope will contribute to this area and hopefully improve the experience of student nurses.

Nathan Illman
Amazing. And I guess I’m interested, so this research project to merge to look at the effective components of well-being programs, and you want to just talk us through a little bit around why that emerged as a research question, what was the kind of problem before that led to that sort of question needing to be answered?

Becky Petley
So I think one thing is that student nurses are individuals they are people in their own right, they will have a variety of personal things that will influence their well being they’ll have a variety of organizational things that will influence their well-being. So that means that there’s not going to be a one size fits all intervention. On the individual level. However, universities also vary. So what happens in student nurse education is that the Nursing and Midwifery Council regulate student nurse education, and they provide standards that universities have to meet in order to be able to have students who will become registered professionals with the NMC however, the way universities decide to implement that is going to vary, and therefore, the stresses students experience are going to vary as well. So it’d be really hard to have a very specific and bounded intervention that’s going to work in every single setting, by taking the approach that I’ve taken and I’ve created, sort of a checklist of student nurse well-being that is based on three components, I’ve found to be necessary for an intervention, which is a component to reduce the stresses experienced by students, a component to increase the support provided, and a component to help them cope with the inevitable stresses they will encounter during their studies. And by doing it this way, the universities are then able to reflect on their own course, and individuals can reflect on their own lives. And that way, you get that degree of fidelity to the intervention. And by that, I mean that the core components are being implemented, as I suggest, without it being really, really rule-based and narrow in how it needs to be approached.

Nathan Illman
I love that. So it’s providing that flexibility, isn’t it? It’s my line of flexibility. I think, as we were discussing before, all too often people kind of try and use this one size fits all people jump on an idea that seems to be effective, and try and apply that to everyone. It’s like the sort of using the hammer to what was that saying? Using thinking a hammer is the right tool to, you know, approach every problem, basically, as you need different tools, don’t you different approaches? So yeah, I’ve been really interested. Just going back to your own experience. You mentioned that you had really good support, which was one of the things which helped with your own well-being that something that you noticed with your colleagues as well, that people sort of, didn’t get as good mentorship and supervision was one of the contributing problems, you think?

Becky Petley
I think so I was on a dual field program, which meant within my specific course, there were only 12 of us that dropped to 10. But two of them had very extreme individual circumstances which led to them withdrawing. But what that meant was that my tutor group was only made up of 10 of us. So that meant my academic tutor had more time for us, when we met as a group, it was very much we got on really well, we were a sort of a group of 10, who were really cohesive or we could support each other, it was a very safe environment. Now, if you’re looking at a program, such as adult nursing specifically, they will have huge tutor groups. And there’s also quite a lot more variation in terms of staff leaving staff joining. So there’s not that continuity of support. So their academic tutors, I think we’re just so overworked, they didn’t always have enough time to provide that support that was necessary. I also think I was lucky to have great peer support, whereas sometimes that’s lacking if you’re in such a big cohort. And then on placements, I also often got on with my supervisors. And that was key because it meant that even if there was a very stressful environment, for example, the emergency department is over. Right. And as we all know, the NHS is really struggling, but I had supportive supervisors who, for example, would always debrief me at the end of a day if it had been really hard if I’d been through a traumatic experience or something. They would always spend sort of five minutes working through that with me allowing me to reflect, which meant that I didn’t sort of panic when I got home as to how I was going to cope with the impact it had on me. So I think a part of it was probably, that I was just incredibly lucky to have had that support put me, but I also think I made the most of it. So I would say when I was struggling, and I think some of my peers didn’t feel able to do that, I was happy to send that email and say, Look, I’m having a tough time, can you help with X, Y, Zed, and nine times out of 10, they were able to help.

Nathan Illman
Again, is this kind of complex interaction, isn’t it between the support and resources that are available and individual kind of responsibility in the way we interact with that, isn’t it because you’re a person who was more willing to reach out for the support and the support was there, and those two combined to give you an experience in which you felt nurtured and supported, and that obviously helps carry you through? And ultimately, I guess, grow from those experiences, whereas other people might not have the support, they might not necessarily have the individual inner resources or willingness to reach out. And it’s quite complex, isn’t it?

Becky Petley
I think about that as well, in my research, some students have said that they feel judged when on placement, and one quote that really has stuck with me, as they said, I feel I’m expected to be inhuman. So things aren’t allowed to affect me, I’m not allowed to have difficulties. And because they, they were saying they kind of want to seek help from the people who are going to be assessing and judging them, they felt like the expectation was, they just got on with it. And they couldn’t speak up, they couldn’t complain, because they were worried about what people would think of them. And I think that, to me, says that lack of authenticity, that lack of ability to really be true to who you are or to seek help, is going to be a huge barrier to helping students with their well-being. And I think that’s a cultural thing. We need to be able to encourage students to seek help when they’re struggling. And it’s not to be a weakness, actually, to be a strength to say, look, this is going on for me, I really need help in this area. And then for the help to be there, as you say,

Nathan Illman
Yeah. And of course, that has to be modeled by leaders, doesn’t it? That vulnerability, and sort of demonstrating that it’s okay to speak up about things and to ask for help, and not kind of creating a culture of perfectionism and everything has to be perfect here. And we can’t make mistakes. And, you know, I guess a shame-based culture often kind of will extinguish anyone’s willingness to sort of speak up about things. Because if there’s an implicit expectation that they’re going to be judged as being inferior or not good enough, basically, which I imagine as we’re talking about before, you know, identity and trying to try to become the right kind of nurse is something that those young students whilst but it’s not always student, student nurses at a younger but to student nurses are trying to sort of navigate that kind of complex identity shift. And

Becky Petley
I think I want one question I asked the student nurses in my research, is there a difference between your personal and professional identity? Now, this was only answered by 45 students, because it was a case study. So 87% said, yes, my personal and professional identity is different. I then asked, Does this difference influence your well-being? And 56% said, Yes, it does. And what I found was that those who said that the difference between their personal and professional identities influences their well-being were basing their professional identity on external things such as what others thought of them. Those who felt that it didn’t influence their well-being were very much based on internal things like values are, who they were as a person. And I found that so interesting because that gives us such great scope for intervention to try and get someone to think about, I guess, Acceptance and Commitment Therapy in the way of values-based living, rather than focusing on how they’re being perceived by others.

Nathan Illman
Yeah. So I mean, as we were talking about before, like, I think we were both really big believers in that, aren’t we, and being guided by our values, that that kind of inner guidance system basically is so important? It’s really interesting, because, you know, we’re talking about this idea of stressors. And it almost sounds like it’s a kind of, it’s existential stressor, isn’t it? This whole thing of like identity, and not necessarily one, that without speaking to people, like you have actually asking the questions and really getting into people’s minds about it, you wouldn’t necessarily uncover that would you as a kind of important stressor that we need to consider and work on?

Becky Petley
I think it really speaks to the value of mixed methods research you did from a very researchers perspective, like my systematic review was very quantitative that was focusing more on data as quantitative data, whereas my qualitative work my qualitative data, gave it the depth and the nuance I needed to really understand the student experience and I think that’s one of the things we need more in this area is actually speaking to people because you can only know so much from a number like it’s really hard to be able to understand given their lived experience if you’re focusing on a statistic,

Nathan Illman
Absolutely. And I think I find that myself when I’m looking through the research literature, looking at things centered around nurse well-being and mental health, is that it’s, you know, it’s great to have a paper that talks about the epidemiology and something or the quantitative data, then actually backing that up and triangulating with people’s experiences is really essential, isn’t it? Everyone’s the same and I don’t know. Yeah, it’s great that you’ve done that. So one of the key kind of contextual factors, then is this idea of attrition, isn’t it? So nurses leaving study but also leaving the profession? So do you want to just talk a little bit about that sort of background contextual factor then and why this stuff is important?

Becky Petley
Yeah, definitely. So the figures of attrition for student nurses, and I know attrition is very isn’t the definition, but essentially people who are not completing their programs. So these are students who start the program and then do not finish. So it’s very variable. But there was a big study called the repair project. And this was by Health Education England and Professor Mary Lovegrove. And it was looking at attrition throughout a variety of healthcare education programs. So we’re talking radiology, nursing, and a whole host of things. And the number they settled on, I think, was around 33%. So that means that 33% of students who start their course are not finishing, and some of the factors that are influencing that attrition rate, but things that I deemed to be preventable. So of course, in any program, you’re always going to have necessary attrition. So this is the number of students who perhaps fail their course or you’re never going to get a 100% completion rate. But 33% is way more than that necessary attrition rate. And the preventable reasons people were leaving with things such as finances or stress, or mental health difficulties. And there was also another report by Health Education England that looked at the mental well-being of learners in practice. So that was, was thinking of medics and student nurses, a whole host of people. And again, what they were finding was that there were preventable causes of poor mental well-being. And these were things like cultural factors helped to seek some of the things we’ve been discussing. So I think there’s a whole moral imperative for us to ensure that students aren’t negatively impacted by their course and that they feel well and able to fulfill what they went into nursing for, you know, a lot of people enter nursing because they want to help people and so it’s really fostering that and letting them thrive in that environment. But we also have a more pragmatic issue of we don’t have enough nurses in our current workforce, to sustain the NHS in the form it is at the moment. So not only is preventing attrition, and student nurses going to boost the workforce, however, it will also hopefully, keep the nurses in if we can prevent poor well-being throughout that training. And then hopefully, that would reduce the number of nurses who are leaving once they’ve qualified.

Nathan Illman
That’s right. And this sort of stuff around prevention is just absolutely essential in this area, but also just in society in general, isn’t it? We need to focus more on prevention rather than treatment of things. And of course, because nurses are a huge population of the country, aren’t there? I think is it something around 700,000 registered nurses and midwives in the UK.

Becky Petley
Yeah.

Nathan Illman
It’s an enormous number, isn’t it? So, you know, nurses aren’t like a small group of people in the UK. It’s huge. So that does a lot of people’s mental health and physical health and just wellbeing in general that we’re thinking about here, isn’t it?

Becky Petley
Definitely. Yeah.

Nathan Illman
Okay. So shall we talk a little bit about the review that you did, then System Review? Do you want to just talk us through, you’re supposed to, you’ve talked a little bit about the background, maybe just talk about what you did, and a little bit more about some of the specifics of because you chose to look at behavior change interventions, as well as stress to just talk about the school background to that and why you looked at that?

Becky Petley
Yeah, absolutely. So just to say what a systematic review is, in case anyone doesn’t know. So essentially what we’re doing is we’re systematically looking at all the literature in a specific area to answer a question. So what happens is you will have a research aim, and then you’ll create your method, and that will include your search strategy. So it will say the databases you’re searching on final journal articles, it will say your inclusion and exclusion criteria, and it will say how you’re going to extract the data. So when I was looking at interventions to improve the well-being of student nurses, I found there were so many out there and there were many that had overlapping concepts. For example, resilience was poorly differentiated from well-being, and stress was poorly differentiated from burnout, for example. So it would have been impossible for me to systematically review all interventions that look at all of those different cons saps, so I had to focus on one. And what I found was that interventions focusing on stress was quite well-defined. So they had quite a good theoretical basis in some cases, and it was enough of a pool of research to draw from that I’d be able to meet my research aims. So I decided to consider, yes interventions to reduce stress in the student population. And I drew on what is Lazarus and Faulkman’s model of stress. Now, this is stress as an appraisal or relationship between the person and the environment. And this is the reason I chose that framework. Because it’s not saying that the environment doesn’t matter. But it’s also appreciating the role of the individual and that the way they interpret stresses, and the way that they cope with stressors can have a huge impact on well-being. So what I did was I separated interventions into three categories. So we’ve got those that focused on stressors. So they are the things in the environment that create stress in an individual. We’ve got cognitive reappraisal, which is the way that individuals view those stresses. And then we’ve got coping, which is how individuals cope with the stressors they encounter. So when I started doing this, I became very aware that many of the interventions were focused on behavior change. And I think it’s really important to understand exactly how an intervention is having an effect. So this led me to draw on behavioral theory. And one part of the behavioral theory is something called behavior change techniques. Now, these are the smallest component of interventions that are observable, replicable, replicable, irreducible and designed to change behavior. So essentially, things like demonstration of the behavior, instruction on how to perform a behavior, or behavioral practice and rehearsal. So I then did have I not only separated the interventions into the categories I described before based on the model of stress, but I also looked at what behavior change techniques they were using. And I think for me, that meant that when I came to analyze the findings, I had a really good understanding of what was effective in these interventions and what was less so

Nathan Illman
I think it’s a really important sort of finer-grained distinction to make, isn’t it? I think there’s there’s a big call within the psychological research community, which has been more sort of prevalent in the last 10 years to sort of dismantle specific components of therapies that are actually working. So we know that there’s a big evidence base for particularly cognitive behavioral therapy for a range of conditions, tons of studies, but then it’s a case of why what is it specifically within a package of therapy that’s working for people. And it’s really nice that you went to that extra effort of going beyond just the review of do these things work for reducing stress to what is it about these things, which is working? And you actually did, you found some interesting results with that. And so do you want to talk a little bit about, I suppose just how many studies you extracted in this review, and there was quite a wide variety of interventions? So if you can just talk us through the sort of variety of interventions? That’d be really good as well.

Becky Petley
Yes. So I found thousands and thousands in my search strategy. And so I went through all of those. And I had one of my supervisors check the way that I was doing it, just to make sure that you know, I was making some empirically based judgments. And so overall, the ones that met my inclusion criteria, there were 22 studies reported in 23 articles. And these were from a whole variety of countries. And there were, I think it was 1638 participants who were randomized. So that was a starting number. And there was a 93% retention rate, which means that there was quite a lot of data for me to work with. So in terms of the interventions across the 22 studies, there were 28 interventions, because some of the studies analyzed more than one intervention. And what I found was that most of the studies were aimed at coping. So 19 of the 28 interventions were aimed at coping alone. And so this included things such as mindfulness and meditation, we also had sort of some quiet out-there ideas such as dark chocolate, like some people ate dark chocolate to see if that would help. I have to say the methodological quality of that study wasn’t brilliant, but you know that that was an idea someone had, we had other Mind Body interventions like yoga or something called auricular therapy, which is sort of needle-based therapy. And a lot of these did have a positive effect, but it was quite short-lived. So they didn’t do a lot of long-term follow-ups and a long-term follow-up that was done didn’t find the effect was sustained over a long period of time. Then there were very few studies looking at the stressors. So no study looked at the stressors in isolation, but some studies looked at like the stressors and coping together, or the stressors and cognitive reappraisal together, and they did find some positive results. But because there were so few a number, it was really difficult for me to conclude whether it was the stressors being targeted or cognitive reappraisal being targeted, or the combination. And the ones that kind of spoke most to me that I felt were really good, were the ones that targeted all three of the stresses of cognitive reappraisal and coping. Now, only two out of those three studies found positive effects. But it’s worth saying that the third study was a pilot study. And so that means it was based on a very small sample of participants, and doing some fancy statistical tests, they found if they’d had a larger sample, it is likely that they would have found some significant effects. Now, of course, that is very hypothetical. But I think it would be unfair to say that was unsuccessful and there is a potential it would work, then in terms of behavior change techniques, there was quite poor reporting in terms of the content of the interventions, which meant that it was really hard for me to systematically code these techniques. So for example, a lot of them would have used social support, which is a behavior change technique, but because they didn’t specifically state this, I couldn’t prove it and be sort of confident in that. So the ones that I found were used most commonly were demonstration of the behavior, behavioral practice and rehearsal instruction on how to perform a behavior, and bodily changes, and bodily changes as things inducing relaxation. And most of these were successful. But again, the numbers were so small, I think these conclusions do have to be interpreted with a quite significant caution. And I am calling for a lot more evidence in this area was really, really clearly articulated intervention so we can understand these techniques a lot more. So certainly sounds like there are some things missing in the research. And something really did surprise me actually, he was he said, there weren’t any papers that looked specifically at targeting stressors, which is really surprising and shocking, isn’t it that no one is thought to look okay, asking, or even the kind of like you have asking student nurses, what are the stressors are working with organizations as well, and then targeting those too, because I guess, in some of the traditional, there are stress management approaches that look at, obviously reducing stressors in your life, basically, from helping the individual do that. And of course, there is some in the sort of organizational psychology literature, there’s there are a few studies that I’ve come across that look in organizations at helping shift workplace-based factors. So basically helping reduce stressors. So yeah, there’s definitely scope for future research. I guess that’s one of the big things you’re calling for. Right? Yeah, I think as well, as were saying that are some studies that look at stresses, but I was only including what’s called randomized controlled trials in my systematic review. So they are like what’s deemed to be the top quality, why now, of course, is a debatable thing that’s probably outside of this conversation. But that’s the decision I made based on a number of studies that were there and the need for methodological quality when I was evaluating them. But there were studies that were looking at reducing the travel to placement, but the methodology was so poor, it would be really hard to trust those findings. So I think actually, you know, perhaps there is a whole wealth of literature out there on the stressors, but because it’s not being done at such a rigorous or evaluated in a rigorous way, it’s really hard for us as researchers to know whether it’s, yeah, whether they’re helpful or not.

Nathan Illman
Yeah. And that’s the sort of strange thing about research, isn’t it? Even if it’s published? It’s sort of it’s then it’s, there’s a different quality of research, isn’t it? It varies. So should we talk about some aspects, you know, before we talk about some of the wider implications, another question I had was actually, around cultural differences, because I, obviously, with a range of interventions, I know there’s there was some more mind-body type practices. And I didn’t look at all of the references in your study. But I was wondering whether you sort of perhaps just happened to notice whether the stress management approaches did you notice there tended to be any difference between studies that are published in certain parts of the world? Because I noticed sort of 13 countries I think you found studies from so

Becky Petley
Yeah, I think what’s really interesting is, if you look, there was a big review a few years back that looked at the sources of stress geographically to see if they varied, and they found they were incredibly similar internationally, even though cultures and health systems vary, there was a lot of similar things that were coming up and there’s some seminal work by someone called Menzies from the 1960s. And they found some similar sources of stress to what’s impacting students today, which is kind of to me saying, We really need to move forward with this, you know, 60 years later, and we’re still not really much more forward based on the research we hadn’t back then. But I do think a lot more of the Mind Body interventions weren’t conducted in the UK. So mindfulness was more sort of Western in terms of it had been adopted by the US or the UK, but things like auricular therapy, which was that the needle points that was based in the east. So I think there were definitely some geographical differences. But I think what’s really important is that we learn from all these different places where this research has been conducted, particularly as similar sources of stress are found internationally.

Nathan Illman
Yeah, that’s the importance of looking far and wide, isn’t it? We shouldn’t just be biased in I mean, it’s hard not to be biased by things published in the English language, but yeah, certainly looking to the East as well as the West. Alright, so should we talk about the sort of practical implications then if the research you found, so perhaps you could just talk a little bit about, I mean, we’ve sort of mentioned a little bit from a research perspective, but also on a practical level with individual student nurses, education institutions, what’s the sort of relevance of your findings here, then.

Becky Petley
So I think, firstly, based on the evidence I’ve been able to access, it seems that improving coping is going to be beneficial, whether that is short-term or long-term. So I’m not completely excluding the need to support students to develop those coping skills, because you could have as many resources and organizational perfection as you like if such a thing even existed. But individual’s still experienced stress if they feel unable to cope with the demands placed on them. And doing a higher education degree is hard work it is, is really challenging. And I think although these conclusions are tentative in terms of the benefits of coping due to the long-term follow-up, or the poor methodological qualities, I’m pretty confident that the volume of literature I found in this area means that I can confidently say, intervention would benefit from including coping within it in some form. But, and this is huge, we also need organizational change. I feel like this has been neglected for too long. So I think it’s unfair to place the onus solely on the individual. And I don’t think we’ve explored enough the organizational impact of student nurses working in the culture that they might experience and with the resource constraints that currently exist, or the structure of programs where academic and clinical work overlap, or where students are struggling financially, so they’re having to take on part time jobs, or they have caring commitments, or they have a disability, that means that they struggle in other ways. So I think, although my review did support coping, the reason for that is because there just wasn’t the literature on stressor-focused interventions. And I think, for me, that is the real, real-world implication is that I really hope in the next few years, we get some more stressor-focused things coming out to hopefully be able to show that we need a multifaceted intervention that appreciates the individual and appreciates the environment in line with the transactional model of stress.

Nathan Illman
And the work that you’ve done as part of your Ph.D. is, I guess, an effort to address that, right?

Becky Petley
Yeah, absolutely. So in my Ph.D., the most important thing has been stakeholder involvement. So that has been from the very word go, I have talked to students, academics, educators, policymakers, nurse leaders, and those who are part of health education, in England who help run nursing programs, I’ve tried to make sure I speak to as many people as possible to see what we can change organizationally in a way that is feasible because I don’t want to come in with some huge organizational suggestion. And then people to say, well, that’s just not pragmatic. So we’re not going to do anything. It’s getting that balance between what the students need, and what is practical within the current systems we’re working in.

Nathan Illman
And also there’s going to be differences on a local level, isn’t there? Courses and the buy-in of different stakeholders and their particular local needs and what sort of populations they have. So it’s, yeah, it again, it’s the flexibility is really important, isn’t it? As we were discussing before.

Becky Petley
Yeah.

Nathan Illman
Okay. And I think just to finish off, do you want to just talk about what you’re going to be doing next? So you might imagine you had a job interview. Actually, we’d have to tell us where or anything for confidentiality. But what do you hope to do here, you’re finishing a Ph.D. soon. Tell us about what you’d like to be doing next, and what your plans are.

Becky Petley
So yeah, so my intermediate aim is to publish my findings because I really would like to share them with the wider community and to show, you know, the student nurses and academics and educators have contributed to my Ph.D., they’ve given me such amazing insight that it’d be a shame for that to not be shared. So over the next few months, I’m hoping to publish, and then going forward, I want to extend my research and my research skills and become a more independent researcher. I’m also really keen on lecturing because I’ve done some lecturing throughout my Ph.D., and it’s meant I’ve been able to apply my findings directly to the student nurse population, which I think in a program such as nursing that has such a big practice component, it’s a really, really great way to make sure that the research I’m conducting is really relevant to the current health system. So my plan is to get research-based or a lecturing, post, and develop those skills in order to ensure that I continue to contribute to improving the workforce of the NHS because I really think you know, you have some incredibly special people who are trying to do their best for patients. And I’m just really passionate about ensuring that they’re cared for as well.

Nathan Illman
Such valuable work and I’m sure you’ll be a real asset to, you know, whoever you work for, and it’s such a pleasure to talk to you about this stuff, and need more people doing it. Don’t we need more people doing the research, but also the kind of translating that research into policy and actual change?

Becky Petley
Definitely. Well, thank you very much for having me. It’s lovely to have the opportunity to talk about it.

Nathan Illman
Yeah, no problem. I actually got one last question I want to ask you was, you know, you have obviously been having been a student nurse yourself, and maybe some student nurses listening to this. Do you have any advice for sort of nurses who are early in their careers?

Becky Petley
I think most importantly, it’s, we’ve spoken about this slightly, but it’s the self-compassion piece. So I think that the Dr. Seuss thing that everyone always says you are you that is truer than true, no one else can be youer than you. And I think that is the thing like you’re sometimes and you’re overwhelmed by life, or by your course, or you failed an assignment or you’ve made an error in placement or whatever. You can feel like you’re a bad person, or like the whole world is going wrong for you, when actually like you are your superpower. So I think it’s to really work on your identity and your authenticity. And just to make sure you spend time caring for yourself because you can get so caught up in caring for other people that actually you forget, you know, you can’t help others if you don’t help yourself first. So I think for all members of staff, whatever stage of career they’re at, I just, I really, really recommend that self-compassion.

Nathan Illman
Thank you. Thank you once again for joining me on my podcast.

Becky Petley
Thank you for having me.