Why Do Nurses Wear Compression Socks?

Nursing is a dynamic profession with specialties that range from home health care to administration and management. According to The Gypsy Nurse, a popular nursing blog, "Travel nurses are required to stay active, work long shifts and stay on their feet. This is the reason almost all the nurses complain of feet fatigue." Travel nurses are not unique in this respect. Whether you travel from patient to patient, work in a hospital, or provide care in a private practice, if you're a nurse, your job often involves long periods of standing. By the end of the workday, you may find yourself complaining about swollen and aching legs. 

EveryNurse.org recommends the following actions for nurses who suffer from tired legs and feet:

• Stretches and exercise
• A foot soak with Epsom salts
• Elevation of legs
• Orthopedic shoes or insoles
• Compression socks

Luckily, beyond providing comfort, compression socks also allow nurses to reduce the risk of developing dangerous blood clots and vascular problems. For many people, including nurses, compression socks offer immediate relief from swelling and pain. Compression socks also provide a low-cost, convenient solution to the leg and foot pain experienced by most nurses after a long shift. 

What Makes Nursing Unique?

The list of modern professions that demand long periods of standing is long. From working as a cashier to bartending, many jobs require multi-hour shifts without any breaks to sit down. Nursing could be considered an extreme example of this larger trend, especially since 12-hour shifts are quite common within the medical field. "One study exploring the effects of breaks on staff nurses showed that in 10% of the shifts worked, nurses reported having no opportunity to sit down for a break or meal." (Witkoski 490) Because labor laws vary by state, nurses frequently work extended shifts. Some have reported shifts of up to 23 hours and 40 minutes. (Rogers 206) Employers frequently require nurses to work overtime, so long periods of time standing have become the norm within the nursing profession. 

Many studies have shown that these long shifts negatively impact patient outcomes. For the nurses themselves, long shifts have proven similarly problematic. Based on a 2010 study, "Extended work hours and shift work have been associated with numerous deleterious cognitive, psychomotor, and behavioral effects, including errors, emotional disturbances, and occupational injury." (Witkoski 495) By extension, one can imagine that any type of job that requires long periods of standing could endanger an employee's health. Indeed, studies have shown an increased risk of health complications for all occupations that involve standing. 

When Do Sitting and Standing Become Dangerous?

By examining the scientific literature, you can see that maintaining the same position for long periods may cause problems, whether you're sitting or standing. Either posture can decrease circulation in the lower legs. Whereas arteries pump blood and oxygen away from the heart, veins deliver deoxygenated blood and waste fluid back to the heart. For a person seated in a chair or in a standing position, their veins must pump against the force of gravity. Over long periods, this action can cause undue stress on the body. 

Standing

A huge range of jobs necessitate standing and, although such occupations vary in skill-level and compensation, their impacts on health appear to be consistent. A 2018 study suggests that all standing jobs have the same health implications: "Occupations involving predominantly standing were associated with an approximately 2-fold risk of heart disease compared with occupations involving predominantly sitting." (Smith) Some of the risk factors associated with prolonged periods of standing include blood pooling in the lower limbs, increased hydrostatic venous pressure, and oxidative stress. Oxidative stress occurs when reactive oxygen species (ROS) accumulate in the bloodstream. Any professional who stands all day, such as a nurse, may be susceptible.

Another study published in Occupational Medicine, which examined healthcare workers, may explain one potential cause for this twofold increase in heart disease. The researchers write, "Healthy workers who stand for >90% of their working time have increased production of ROS which is reversed through the use of compression stockings." (Flore 340) If oxidative stress continues unchecked, it can become toxic to cells. High levels of ROS have been associated with systemic diseases like atherogenesis, chronic venous insufficiency, and even cancer. Compression socks reduce the accumulation of ROS in the lower limbs, thereby reducing the risk of major health problems. The study concluded: "The use of compression stockings should be considered in workers who stand for prolonged periods when other preventive measures such as breaks and posture change are not possible."

Sitting

As with standing, a seated posture is also linked to health problems, especially when such a posture is maintained for many hours at a time. In a review of the existing scientific literature on occupational sitting, researchers summarize that, "...Recent studies have led to a renewed interest in the health effects of prolonged sitting. These have demonstrated associations of sitting time with obesity, metabolic syndrome and diabetes, markers of cardiovascular disease risk, and premature mortality." (van Uffelen) Whether someone sits for prolonged periods while engaging in leisure activities, working at a desk job, or engaging in long-haul travel, evidence indicates that such behavior may negatively impact health in a number of ways. 

For example, the risk of deep vein thrombosis (DVT) appears to increase during long flights. As Harvard Health Men's Health Watch advises, "Sitting for prolonged periods, such as on a long flight or car ride, increases the risk of blood clots forming in your leg veins." Since blood clots within deep veins can break off and cause pulmonary embolisms (blockages in the lungs that can be fatal), many doctors recommend moving around and wearing compression socks during a long-haul flight. Similarly, nurses who sit for prolonged periods may benefit from wearing compression socks to keep blood circulation moving. Knee-high compression socks with True Graduated Compression, such as Companions, offer more compression at the ankle and less at the calf. By exerting an upward pressure against gravity, these socks help prevent blood from pooling in the feet and lower legs during long periods of sitting. 

How Do Compression Socks Help?

To see why nurses wear compression socks, it's important to understand the health implications of stagnant blood flow and impaired circulation. Compression stockings and compression socks help to prevent the following conditions, and they also alleviate existing symptoms.

Deep Vein Thrombosis

As previously mentioned, DVT happens when blood clots form in the deep veins. DVT may develop without any symptoms and lead to fatal complications. Sometimes, blood clots break free and travel through the bloodstream, causing blockages. A pulmonary embolism, a blockage in the lung, is one of the most dangerous outcomes resulting from limited blood flow.

Graduated compression therapy, like the kind we use for our socks, has been shown to reduce incidence of DVT in airline passengers (Clarke) and hospital inpatients (Cayley). A pair of compression socks can keep your vascular system functioning properly, which reduces your risk of developing blood clots in the first place. If blood clots have already developed, doctors also recommend compression therapy to treat DVT and post-thrombotic syndrome. 

Chronic Venous Insufficiency

Normally, the veins in your legs work in one direction, transporting deoxygenated blood and waste fluids up from your feet to your heart. Chronic venous insufficiency (CVI) occurs when the valves inside your veins malfunction, allowing the blood to flow backwards towards the feet. When venous valves fail, the blood no longer flows in one direction. Instead, in the vicinity of the failed valve, blood begins to flow down. As a result, those with CVI can develop varicose veins and spider veins, which can be unsightly and painful.  

Not only do compression socks prevent the valves inside your veins from failing, but they also provide support for existing varicose veins and spider veins. By exerting a gentle upward pressure on the leg, compression socks keep your blood moving in the correct direction—from your feet to your heart.

Aches and Pains

Nurses often complain of soreness in the lower extremities, leg fatigue, leg pain, plantar fasciitis, or pain in the feet. By improving blood circulation, compression socks leave legs feeling energized. Even after a long shift, graduated compression prevents blood from pooling in the lower legs. This reduces feelings of heaviness, fatigue, and discomfort. Additionally, evidence suggests that compression socks can help aid in muscle recovery. (Ali) So, during a long day with patients, you may be able to avoid soreness and swelling by using compression socks. When you forget to wear compression socks, opting for compression therapy after work may help sore muscles recover faster. 

Fabric Choice

There are lots of socks to choose from. For nurses, footwear and socks should be practical. When considering which compression sock to buy, I would advise avoiding fabric that will cause blisters over the course of a 16-hour shift. At Comrad, we've designed SmartSilver antimicrobial fabric with nurses in mind. Not only is the fabric for our signature knee-high socks moisture-wicking, but it's also been treated with silver to prevent bacteria and odor. Plus, our stay-up cuffs stop socks from sliding and drooping. 

Nursing is hard work, but that doesn't mean your socks have to be serious. We offer a variety of colors and patterns, so that you can express yourself on the job. No matter which style you choose, you can count on a padded toe and heel to make your day a little bit easier—especially during the final hours of your shift. 

Compression Level

Our 15-25 mmHg Companions give healthcare professionals the perfect blend of comfort and support. They offer a mix of mild and medium compression, designed to give all the benefits of medium compression without feeling too tight. 

Mild Compression: 15-20 mmHg

This is the most commonly available over-the-counter compression strength. Doctors often recommend mild compression for first-time wearers. It’s a great option for anyone hoping to prevent swelling, achy legs, and DVT. 

Medium Compression: 20-30 mmHg (Medical Grade Class I)

Class I compression socks offer a number of health benefits. Medium compression offers enough pressure for the management of active ulcers. In addition, symptoms of post-thrombotic syndrome (PTS), orthostatic hypotension, and superficial thrombophlebitis can be considerably reduced by applying medium compression. 

Learn more about compression levels. 

When we created these compression socks to occupy "the compression sweet spot," between mild and medium strength, we gave nurses the perfect option for all-day comfort. Our socks allow you to take care of your own well-being, as you tend to everyone else throughout your shift. 

For the professionals who never get a break—23 hours? Now, that's a long workday!—quality footwear isn't an indulgence. 

Patients depend on the work you do every day. Get your socks to support you, while you care for the people around you. 

Sources:

Ali, A., Caine, M. P., and Snow B. G. "Graduated compression stockings: Physiological and perceptual responses during and after exercise," Journal of Sports Sciences, Vol. 25, Iss. 4, Feb. 20, 2007, pp. 413-419, https://shapeamerica.tandfonline.com/doi/full/10.1080/02640410600718376.

Cayley, William E. “Preventing deep vein thrombosis in hospital inpatients.” Clinical Review, Midlands Business Journal, Jul 19, 2007, https://www.bmj.com/content/335/7611/147.

Clarke  MJ, Broderick  C, Hopewell  S, Juszczak  E, Eisinga  A. "Compression stockings for preventing deep vein thrombosis in airline passengers." Cochrane Database of Systematic Reviews, Iss. 9, 2016, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004002.pub3/abstract.

Flore, R., Gerardino, L., Santoliquido, A., Catananti, C., Pola, P., and Tondi, P. "Reduction of oxidative stress by compression stockings in standing workers." Occupational Medicine, vol. 57, iss. 5, Aug. 2007, pp. 337–341, https://academic.oup.com/occmed/article/57/5/337/1404908.

“Get Healthy for Vacation.” Harvard Health Publishing, Harvard Medical School, May 2019, www.health.harvard.edu/staying-healthy/get-healthy-for-vacations.

Patel, Kunal. "Sure-Fire Home Remedies to Soothe Foot Pain for Travel Nurses." The Gypsy Nurse, 6 Nov. 2019, www.thegypsynurse.com/blog/foot-pain-remedies/.

Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., and Dinges, D. F. “The working hours of hospital staff nurses and patient safety.” Health affairs (Project Hope) vol. 23, iss. 4, 2004, pp. 202-212, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.23.4.202

Smith, P., Ma, H., Glazier R. H., Gilbert-Ouimet, M., Mustard, C. "The Relationship Between Occupational Standing and Sitting and Incident Heart Disease Over a 12-Year Period in Ontario, Canada." American Journal of Epidemiology, vol. 187, Iss. 1, Jan. 2018, pp. 27–33, https://academic.oup.com/aje/article/187/1/27/4081581.

Van Uffelen, J.G.Z., Wong, J., Chau, J. Y., van der Ploeg, H. P.,  Riphagen, I. Gilson, N. D., Burton, N. W,  Healy, G. N., Thorp, A. A., Clark, B. K., Gardiner, P. A., Dunstan, D. W., Bauman, A., Owen, N., and Brown, W. J. "Occupational Sitting and Health Risks: A Systematic Review." American Journal of Preventive Medicine, vol. 39, Iss. 4, 2010, pp. 379-388, https://www.sciencedirect.com/science/article/abs/pii/S0749379710004125.

Witkoski, Amy, and Victoria Vaughan Dickson. “Hospital Staff Nurses’ Work Hours, Meal Periods, and Rest Breaks: A Review from an Occupational Health Nurse Perspective.” AAOHN Journal, vol. 58, no. 11, Nov. 2010, pp. 489–497, https://journals.sagepub.com/doi/pdf/10.1177/216507991005801106.