Selected Podcast
MEPRA: Cultivating Mindfulness, Ethical Practice and Resilience in Nurses
Nurses experienced varying degrees of moral suffering in response to moral adversity, especially in the pandemic. The Mindful Ethical Practice and Resilience Academy (MEPRA) demonstrated significant impact in cultivating mindfulness, resilience, work engagement, ethical competence and decreasing depression, anger and intent to leave. Collaborative academic/practice partnerships are essential to create multi?faceted, experiential programs to support nurse's integrity and reduce moral suffering.
Featuring:
Cynda Rushton, PhD, RN, FAAN
Cynda Rushton, PhD, RN, FAAN is an Anne & George Bunting Professor of Clinical Ethics; Professor of Nursing and Pediatrics Johns Hopkins University--Berman Institute of Bioethics & School of Nursing. Transcription:
Bill Klaproth: So why is building mindfulness, ethical practice and resilience in nursing so important? Well, let's find out with Cynda Rushton, an Anne and George Bunting Professor of Clinical Ethics, Professor of Nursing in Pediatrics at Johns Hopkins University and Berman Institute of Bioethics and School of Nursing.
This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Cynda, thank you so much for your time. It is great to talk with you on a really interesting topic and one that I wish we would talk more about. So I'm glad we're doing this podcast. So again, thank you for your time. So you did a session at the most recent AONL Conference, Why is Building Mindfulness, Ethical Practice and Resilience in Nursing So Important? So we're going to talk about that today. But first off, what was the impetus to forming MEPRA as we call it, the Mindful Ethical Practice and Resilience Academy.
Cynda Rushton: That's a great question. You know, as an educator of new nurses, we were seeing a trend of nurses leaving their jobs or leaving the profession after just one year. And so our dean, Patricia Davidson said to me, you know, "What can we do about this?" And so that was really the launch of trying to think about how do we better prepare nurses to meet the ethical challenges that are inevitable in our nursing practice. And so we developed this program, 24 hours of experiential discovery learning, that was focused on new nurses, but also experienced nurses. And we've been implementing this program now for about five years.
Bill Klaproth: Wow, this is really good. So tell us more about the tactics and initiatives that you use and what did you learn in forming MEPRA?
Cynda Rushton: It's been an incredible journey quite honestly. We developed the foundational program that up until COVID was in person. We have since done it virtually. But it's really a program that is focused on building capacity in frontline nurses to meet ethical challenges by cultivating a foundation of mindfulness, giving them skills to actually recognize and respond to ethical questions that are coming up every day in their practice and also cultivating their own personal moral resilience, their ability to meet those challenges with integrity. And that requires them to invest in their own wellbeing and to be good stewards of their own scarce resources, which is even more important now as we I look at the impact of COVID on our nursing workforce.
So the foundational program, then we also developed communities of practice where our graduates came together to share what they were learning and how they were applying the skills. And we did annual retreats to bring them back, little booster sessions to remember the skills and tools that they learned in MEPRA and also to really cultivate a community of like-minded nurses who were sharing a similar vision.
Bill Klaproth: Right. So when we talk about the effects of moral adversity that is common in clinical practice, what are some of the effects that were happening to nurses? What are those negative effects that a nurse may be feeling or going through?
Cynda Rushton: Yeah. The kinds of ethical questions that nurses confront on a daily basis often have to do with situations that involve their patients or their families, conflicts about goals of care, questions about informed consent, questions about fairness and equity and how we treat patients in a fair and respectful way. And then there's also the kinds of ethical questions that are more organizational, so things like staffing about how hierarchy and nurses voices as members of the care team are taken account of and how they have the influence to advocate for their patients. And many, many issues that are sort of every day, allocation of their own time and attention to their patients and to each other as members of the healthcare team. So, all of those issues, I think have become exacerbated during the COVID pandemic. And many nurses are struggling with, first of all, how do they deal with the residue of those kinds of issues on a day-to-day basis, how it impacts their own health and wellbeing and how it impacts the way that they provide care.
And one of the core issues is that, for many nurses, when they feel that they cannot provide care that reflects their values as a nurse, it creates distress and a kind of moral residue that stays with them every day that can accumulate and make them feel as if they're not being effective, feel as if they are failing to uphold their ethical responsibilities and that contributes to things like burnout, posttraumatic stress, mental health issues. And so we feel like this is an important key in understanding how to help nurses restore their sense of agency, but also their sense of wholeness as people and as nurses.
Bill Klaproth: There's a lot going on there that you were just talking about ethical responsibilities, burnout, posttraumatic stress, and their sense of wholeness as people and as nurses. So nurses struggling with all of this, I'm sure they were very glad that this MEPRA Academy was created to help them. Is that correct?
Cynda Rushton: You know, it's interesting when we first started, of course, there's always skepticism. And what we learned is after the first couple of cohorts, we're now about to do our 10th cohort in a few weeks, the word of mouth was really the way that we recruited people to participate. And one of our graduates from our program made a really, I think, poignant comment. And she said we are all resilient and courageous. Sometimes, we just need the tools and support to help access what's already inside of us. And I think that quote is really the essence of our work. It's not a deficit model. It is a strengths-based model where we're just helping nurses remember why they're doing their work, what resources they have within themselves, and then their team and in their organization to be the nurse they want to be.
It's just been really gratifying to sort of watch the transition of nurses coming in, feeling so depleted. And by the end of the program, it's like, you know, a lotus unfolding and you see that light come back on and they feel more confident and competent to address those issues.
Bill Klaproth: Absolutely. So you're providing them with the tools necessary to meet the ethical challenges that arise in healthcare. So tell us about a session. You talked about a 24-hour experiential discovery learning program. Take us through what that's like. So I'm a nurse, I'm coming to you, I want to participate in the MEPRA Program. Okay, I'm with you. Now, what happens?
Cynda Rushton: It's not death by PowerPoint. It is very much everybody is engaged in discovering, instead of us telling them. Remembering, for example, why they went into nursing. What are the things that they carry on a day-to-day basis at the end of the day, and having a chance to share that in small groups and dyads to, you know, sort of explore those issues together and to practice communication skills.
So for example, we use high fidelity simulation, which is an integrative session where the participants are given a clinical case. We use actors to simulate a conversation with a clinician. That's difficult where they have to really demonstrate their ability to self-regulate, to use constructive communication, to stand firm in their values. And we practice. What are you going to say? And how are you going to manage, you know, your own biases, your own fear, your own lack of confidence in those situations? And so it's very interactive and it really begins to create a kind of community because many nurses feel that they're the only ones that are challenged with these issues and, very quickly, they figure out that everybody is in the same boat and that sort of creates a sense of belonging and connection that's also a resource to them.
Bill Klaproth: So Cynda, can you share with us some successes? I know you're measuring this. What has the general outcome been since you started the program?
Cynda Rushton: We have been doing pre-, post- surveys as well as three and six-month followup on some key outcomes. And the outcomes have actually been quite important, I think. We've seen statistical improvements in work engagement, in moral competence and perceived confidence, in resilience and mindfulness, as well as decreases in depression, anger, and intent to leave.
And what's interesting is that we are seeing many of those improvements sustained at three and six months after the program, which tells us that something happened. It wasn't just the short-term impact of the program and that's really encouraging to think about how we can use this program as a way to really support nurses, to be able to, first of all, meet these challenges, but hopefully to sustain themselves in the profession over time.
Bill Klaproth: Right. And that is what's most important. So for someone listening to this, how can they do this? How can they get started? How can they use MEPRA?
Cynda Rushton: Well, we are in the process right now of, at this moment, the program delivery has been limited by the bandwidth of our team. But we are in the process of working with a collaborator to try to make this program scalable and available to other institutions. And so I would say watch this space and we look forward to sharing what we've learned, because I feel like, especially right now, we need the kinds of resources and programs to really support nurses.
And one of the important things for nurse leaders, if these kinds of programs for frontline nurses are viewed as their organizational investment in them as people and being able to provide these programs in ways that allow nurses to participate without making it be on their off time is a very important way that organizations can really communicate to nurses that we care about you, we want you to stay in the profession and we want to make it possible for you to continue to do the important work that you're trained to do.
Bill Klaproth: So Cynda, knowing what you know now, what is your key takeaway from this?
Cynda Rushton: I would say the key takeaway is that burnout is a concept that has been overgeneralized and what we need are more specific kinds of interventions like MEPRA that are addressing the very specific components that are contributing to degraded wellbeing in nurses. And this is an example of a more targeted kind of intervention that is needed and has the potential to really transform our nursing workforce.
Bill Klaproth: Yeah, very, very well said. And I think you're right about the definition of burnout and how we need to be more specific with that. I think that's absolutely correct. Well, Cynda, thank you so much for your time. Is there anything else you want to add? The floor is yours. Anything that we didn't talk about that you want to mention?
Cynda Rushton: I think we are at a really pivotal point in healthcare and in nursing, that we need to realize that part of the reason that nurses are leaving the profession is because they experience such distress at not being able to provide care in a way that reflects who they are as a nurse and the values that are foundational to our profession. And so this program is really helping them to reorient toward that grounding and to be able to give them the skills and tools to be able to reclaim that part of what it means to be a nurse.
Bill Klaproth: Very well said and a great way to wrap this up, Cynda. Thank you so much for your time. This has really been interesting and insightful. We really appreciate your time. Thanks again.
Cynda Rushton: Thank you so much for having me and thank you for sharing our work.
Bill Klaproth: Well, that is our pleasure. And once again, thank you for joining us. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today In Nursing Leadership. Thanks for listening.
Bill Klaproth: So why is building mindfulness, ethical practice and resilience in nursing so important? Well, let's find out with Cynda Rushton, an Anne and George Bunting Professor of Clinical Ethics, Professor of Nursing in Pediatrics at Johns Hopkins University and Berman Institute of Bioethics and School of Nursing.
This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Cynda, thank you so much for your time. It is great to talk with you on a really interesting topic and one that I wish we would talk more about. So I'm glad we're doing this podcast. So again, thank you for your time. So you did a session at the most recent AONL Conference, Why is Building Mindfulness, Ethical Practice and Resilience in Nursing So Important? So we're going to talk about that today. But first off, what was the impetus to forming MEPRA as we call it, the Mindful Ethical Practice and Resilience Academy.
Cynda Rushton: That's a great question. You know, as an educator of new nurses, we were seeing a trend of nurses leaving their jobs or leaving the profession after just one year. And so our dean, Patricia Davidson said to me, you know, "What can we do about this?" And so that was really the launch of trying to think about how do we better prepare nurses to meet the ethical challenges that are inevitable in our nursing practice. And so we developed this program, 24 hours of experiential discovery learning, that was focused on new nurses, but also experienced nurses. And we've been implementing this program now for about five years.
Bill Klaproth: Wow, this is really good. So tell us more about the tactics and initiatives that you use and what did you learn in forming MEPRA?
Cynda Rushton: It's been an incredible journey quite honestly. We developed the foundational program that up until COVID was in person. We have since done it virtually. But it's really a program that is focused on building capacity in frontline nurses to meet ethical challenges by cultivating a foundation of mindfulness, giving them skills to actually recognize and respond to ethical questions that are coming up every day in their practice and also cultivating their own personal moral resilience, their ability to meet those challenges with integrity. And that requires them to invest in their own wellbeing and to be good stewards of their own scarce resources, which is even more important now as we I look at the impact of COVID on our nursing workforce.
So the foundational program, then we also developed communities of practice where our graduates came together to share what they were learning and how they were applying the skills. And we did annual retreats to bring them back, little booster sessions to remember the skills and tools that they learned in MEPRA and also to really cultivate a community of like-minded nurses who were sharing a similar vision.
Bill Klaproth: Right. So when we talk about the effects of moral adversity that is common in clinical practice, what are some of the effects that were happening to nurses? What are those negative effects that a nurse may be feeling or going through?
Cynda Rushton: Yeah. The kinds of ethical questions that nurses confront on a daily basis often have to do with situations that involve their patients or their families, conflicts about goals of care, questions about informed consent, questions about fairness and equity and how we treat patients in a fair and respectful way. And then there's also the kinds of ethical questions that are more organizational, so things like staffing about how hierarchy and nurses voices as members of the care team are taken account of and how they have the influence to advocate for their patients. And many, many issues that are sort of every day, allocation of their own time and attention to their patients and to each other as members of the healthcare team. So, all of those issues, I think have become exacerbated during the COVID pandemic. And many nurses are struggling with, first of all, how do they deal with the residue of those kinds of issues on a day-to-day basis, how it impacts their own health and wellbeing and how it impacts the way that they provide care.
And one of the core issues is that, for many nurses, when they feel that they cannot provide care that reflects their values as a nurse, it creates distress and a kind of moral residue that stays with them every day that can accumulate and make them feel as if they're not being effective, feel as if they are failing to uphold their ethical responsibilities and that contributes to things like burnout, posttraumatic stress, mental health issues. And so we feel like this is an important key in understanding how to help nurses restore their sense of agency, but also their sense of wholeness as people and as nurses.
Bill Klaproth: There's a lot going on there that you were just talking about ethical responsibilities, burnout, posttraumatic stress, and their sense of wholeness as people and as nurses. So nurses struggling with all of this, I'm sure they were very glad that this MEPRA Academy was created to help them. Is that correct?
Cynda Rushton: You know, it's interesting when we first started, of course, there's always skepticism. And what we learned is after the first couple of cohorts, we're now about to do our 10th cohort in a few weeks, the word of mouth was really the way that we recruited people to participate. And one of our graduates from our program made a really, I think, poignant comment. And she said we are all resilient and courageous. Sometimes, we just need the tools and support to help access what's already inside of us. And I think that quote is really the essence of our work. It's not a deficit model. It is a strengths-based model where we're just helping nurses remember why they're doing their work, what resources they have within themselves, and then their team and in their organization to be the nurse they want to be.
It's just been really gratifying to sort of watch the transition of nurses coming in, feeling so depleted. And by the end of the program, it's like, you know, a lotus unfolding and you see that light come back on and they feel more confident and competent to address those issues.
Bill Klaproth: Absolutely. So you're providing them with the tools necessary to meet the ethical challenges that arise in healthcare. So tell us about a session. You talked about a 24-hour experiential discovery learning program. Take us through what that's like. So I'm a nurse, I'm coming to you, I want to participate in the MEPRA Program. Okay, I'm with you. Now, what happens?
Cynda Rushton: It's not death by PowerPoint. It is very much everybody is engaged in discovering, instead of us telling them. Remembering, for example, why they went into nursing. What are the things that they carry on a day-to-day basis at the end of the day, and having a chance to share that in small groups and dyads to, you know, sort of explore those issues together and to practice communication skills.
So for example, we use high fidelity simulation, which is an integrative session where the participants are given a clinical case. We use actors to simulate a conversation with a clinician. That's difficult where they have to really demonstrate their ability to self-regulate, to use constructive communication, to stand firm in their values. And we practice. What are you going to say? And how are you going to manage, you know, your own biases, your own fear, your own lack of confidence in those situations? And so it's very interactive and it really begins to create a kind of community because many nurses feel that they're the only ones that are challenged with these issues and, very quickly, they figure out that everybody is in the same boat and that sort of creates a sense of belonging and connection that's also a resource to them.
Bill Klaproth: So Cynda, can you share with us some successes? I know you're measuring this. What has the general outcome been since you started the program?
Cynda Rushton: We have been doing pre-, post- surveys as well as three and six-month followup on some key outcomes. And the outcomes have actually been quite important, I think. We've seen statistical improvements in work engagement, in moral competence and perceived confidence, in resilience and mindfulness, as well as decreases in depression, anger, and intent to leave.
And what's interesting is that we are seeing many of those improvements sustained at three and six months after the program, which tells us that something happened. It wasn't just the short-term impact of the program and that's really encouraging to think about how we can use this program as a way to really support nurses, to be able to, first of all, meet these challenges, but hopefully to sustain themselves in the profession over time.
Bill Klaproth: Right. And that is what's most important. So for someone listening to this, how can they do this? How can they get started? How can they use MEPRA?
Cynda Rushton: Well, we are in the process right now of, at this moment, the program delivery has been limited by the bandwidth of our team. But we are in the process of working with a collaborator to try to make this program scalable and available to other institutions. And so I would say watch this space and we look forward to sharing what we've learned, because I feel like, especially right now, we need the kinds of resources and programs to really support nurses.
And one of the important things for nurse leaders, if these kinds of programs for frontline nurses are viewed as their organizational investment in them as people and being able to provide these programs in ways that allow nurses to participate without making it be on their off time is a very important way that organizations can really communicate to nurses that we care about you, we want you to stay in the profession and we want to make it possible for you to continue to do the important work that you're trained to do.
Bill Klaproth: So Cynda, knowing what you know now, what is your key takeaway from this?
Cynda Rushton: I would say the key takeaway is that burnout is a concept that has been overgeneralized and what we need are more specific kinds of interventions like MEPRA that are addressing the very specific components that are contributing to degraded wellbeing in nurses. And this is an example of a more targeted kind of intervention that is needed and has the potential to really transform our nursing workforce.
Bill Klaproth: Yeah, very, very well said. And I think you're right about the definition of burnout and how we need to be more specific with that. I think that's absolutely correct. Well, Cynda, thank you so much for your time. Is there anything else you want to add? The floor is yours. Anything that we didn't talk about that you want to mention?
Cynda Rushton: I think we are at a really pivotal point in healthcare and in nursing, that we need to realize that part of the reason that nurses are leaving the profession is because they experience such distress at not being able to provide care in a way that reflects who they are as a nurse and the values that are foundational to our profession. And so this program is really helping them to reorient toward that grounding and to be able to give them the skills and tools to be able to reclaim that part of what it means to be a nurse.
Bill Klaproth: Very well said and a great way to wrap this up, Cynda. Thank you so much for your time. This has really been interesting and insightful. We really appreciate your time. Thanks again.
Cynda Rushton: Thank you so much for having me and thank you for sharing our work.
Bill Klaproth: Well, that is our pleasure. And once again, thank you for joining us. And for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today In Nursing Leadership. Thanks for listening.