How many glasses of water have you had today? Do you always have time for a cup of tea while working? Dr Nidia Rodriguez-Sanchez from the University of Stirling, who has a PhD in hydration physiology, explains why nurses, managers and employers should take hydration seriously.
In the fast-paced environment of nursing, both in secondary care, general practice and community, nurses often face long, demanding shifts. The physical and mental toll of these hours can be exacerbated by a commonly overlooked issue: dehydration.
Hydration is not just a minor concern; it’s a critical factor that influences nurses’ ability to provide the best possible care to their patients.
At the University of Stirling, the exercise and nutrition research group have recently collaborated with the nursing team to explore the importance of staying hydrated.
In line with the Royal College of Nursing’s 3 Rs (rest, rehydrate, and refuel), we’ve created a handy infographic to emphasise the importance of staying hydrated and offer practical, science-led tips for busy nurses and student nurses.
The impact of dehydration on nursing performance
Gillian Beattie, lecturer in nursing and Emergency Department nurse, emphasises the significance of hydration, suggesting that we probably don’t talk about staff hydration enough.
Shifts can be long and hard: it’s physical work and you are on your feet a lot.
She says that being dehydrated impacts concentration and the ability to make decisions; you feel fatigued and just ‘not right’, which does have an impact on your role.
As the RCN’s campaign emphasised, even mild dehydration can impair cognitive performance and concentration.
For general practice nurses, whose decisions will often have significant consequences, maintaining optimal hydration is vital.
Practical hydration tips for busy shifts
To ensure adequate hydration during busy shifts, here are some practical tips to consider:
- Start as you mean to go on: Studies of healthcare professionals have found that many start their shift dehydrated. Aim to drink 500ml of fluid two hours before you start your shift to help maintain hydration levels.
- Carry a refillable water bottle: Having a water bottle within arm’s reach can encourage regular sipping throughout the day. Choose a bottle with a straw or spout for ease of use.
- Set reminders: Use phone alarms or apps to remind yourself to take sips at regular intervals. Small, frequent sips can add up and make a big difference.
- Hydration stations: Establish hydration stations in the practice. Ensure that water is easily accessible to all staff members, making it convenient to refill bottles.
- Plan hydration breaks: Take advantage of every opportunity to hydrate, even if you do not feel thirsty. Planning hydration breaks can help maintain consistent fluid intake throughout the day.
- Monitor fluid intake: Use bottles with measurement markings to track fluid intake. This visual cue can help you monitor and ensure adequate hydration. Keep an eye on the colour and the volume of your urine, if it is dark and a low volume, you might be dehydrated.
Recognising the signs of dehydration
Awareness is key to preventing dehydration. Common symptoms to watch for include:
- Headaches
- Tiredness
- Dry mouth and sore throat
- Halitosis (bad breath)
- Dizziness
- Dark urine.
Mild dehydration symptoms such as dizziness, headaches, tiredness, and dark urine can worsen if not properly addressed, potentially leading to severe health problems like kidney stones. Additionally, lack of proper hydration can lead to impaired cognition and poor judgement.
The use of personal protective equipment (PPE), when worn, can trigger behaviour changes that negatively impact hydration status. PPE can act as a barrier to ingesting fluids and raise body temperature, making it even more challenging for nurses to stay hydrated.
Hydrating fluids and snacks
Not all fluids are created equal. Here are some optimal choices for hydration:
- Water: Always the best choice.
- Skimmed milk: Provides hydration along with essential nutrients such as protein and electrolytes.
- Decaffeinated beverages: These can be beneficial in moderation.
- Sugar free herbal teas: Offer a flavourful alternative to plain water.
- Sugar free caffeinated drinks: Moderate amounts of coffee and tea can also contribute to your daily fluid intake.
For snacks, consider:
- Fresh fruits: High water content fruits, such as oranges, strawberries, and watermelon.
- Vegetables: Hydrating options, such as carrot sticks, celery, and cucumber.
Research and recommendations
A study published in the Journal of International Nursing Research aimed to clarify dehydration prevalence in nurses and examine dehydration factors before and after their shifts. The study found over 70% of nurses were dehydrated after their shift.
This highlights the role of management in promoting better hydration practices, such as instating easily accessible hydration stations for nurses.
Special considerations during menopause
The workforce includes many mature nurses, particularly women who may be dealing with menopause. This stage of life presents unique challenges, such as an increased risk of dehydration due to hormonal changes.
Employers and the NHS should consider how to support these nurses by encouraging better hydration practices and understanding the health benefits this brings for managing menopause symptoms. This is equally true for pregnant and breastfeeding nurses.
Maintaining hydration as self-care
Keeping track of how often you go to the toilet (ideally around 4-6 times per day) and ensuring your urine is the colour of pale straw can help monitor hydration status. Staying hydrated is an important form of self-care for nursing staff, but equally, employers have a duty to support their staff. This isn’t just a moral duty; it’s a legal one too. Health and social care managers must ensure that staff are taking their breaks, are well hydrated, and have access to nutritional food.
By recognising the signs of dehydration and incorporating practical tips into their routine, general practice nurses can maintain their health and energy levels. Encouraging self-care and asserting the right to a break are crucial steps in this process.
Let’s support our nurses by promoting hydration, ensuring they are as healthy and effective as possible in their vital roles. A well-hydrated nurse is a healthier, happier, and more effective caregiver.
Dr Nidia Rodriguez-Sanchez is physiology and nutrition lecturer at the University of Stirling
Further reading
Armstrong LE. (2007). Assessing hydration status: the elusive gold standard. JANA 26(5 Suppl), 575S–584S. https://doi.org/10.1080/07315724.2007.10719661
Batt AM, Kent G, Mason P. Eat, sleep and be healthy – a paramedic’s guide to healthier shift work. Canadian Paramedicine. 2016;39(2):31–33
Kase R, Tanaka Y, Amemiya A, et al. Dehydration of nurses working in the day shift and its factors: A multicenter cross-sectional observational study. JINR 2022 Feb 24;1(1):e2021-0007.
Maughan RJ, Watson P, Cordery PA, et al. (2016). A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index. AJCN 103(3), 717–723. https://doi.org/10.3945/ajcn.115.114769
Oliver D. (2020). Staff hydration matters more than keeping up appearances. BMJ (Clinical research ed.), 368, l7088. https://doi.org/10.1136/bmj.l7088
Perrier, E T, Armstrong LE, Bottin JH, et al. (2021). Hydration for health hypothesis: a narrative review of supporting evidence. EJN 60(3), 1167–1180. https://doi.org/10.1007/s00394-020-02296-z
Purushothaman PK, Priyangha E, Vaidhyswaran R. (2021). Effects of prolonged use of facemask on healthcare workers in tertiary care hospital during Covid-19 pandemic. Indian Journal of Otolaryngology and Head and Neck Surgery, 73(1), 59–65. https://doi.org/10.1007/s12070-020-02124-0
Royal College of Nursing. (2018) Rest, Rehydrate, Refuel: A Resource to Improve the Working Environments for Nursing Staff
Royal College of Nursing. (2018) Healthy Workplaces campaign
University of Stirling, Tips for nurses to stay hydrated: bit.ly/hydration-tips-for-nurses
