Hospital and Shift Work Influences on Nurses' Dietary Behaviors: A Qualitative Study

Background: Nurses working in hospitals face unique influences on their workplace dietary behaviors, but little is known about what nurses experience as dietary influencers in the hospital setting. Understanding these influences is paramount in developing effective programs that target healthy workplace eating. This study aimed to explore hospital shift nurses' experiences and perceptions of influences on making healthy nutritional choices while at work. Methods: This qualitative, descriptive study was guided by the Theoretical Domains Framework and analyzed using thematic analysis. Twenty-one Registered Nurses working 10- to 12-hour shifts in hospitals in South Carolina, USA, in 2018 were interviewed individually or in focus groups about their workplace dietary behaviors and influences. Findings: Framework constructs most relevant to hospital shift nurses included (a) environmental context and resources; (b) social/professional role and identity; (c) memory, attention, and decision processes; (d) social influences; (e) emotion; and (f) behavioral regulation. In addition, four major themes emerged: (a) Nursing roles and responsibilities restrict freedom of movement and minimize individual control over dietary practices; (b) The hospital food environment is oppressively unhealthy; (c) Free food is currency and influences consumption; and (d) Shift work is a major barrier to healthy eating. Conclusions/Applications to Practice: To achieve healthy eating practices in the workplace, hospital shift nurses need supportive systems, policies, and interventions that target and reduce the barriers inherent in hospital-based nursing shift work. To improve hospital shift nurses' workplace dietary behaviors, these findings should inform hospital food policies, workplace wellness programs, administrative practices, and staff education.