Selected Podcast
Empowering Nurse Leaders to Support Staff Well-Being and Resilience
This session will engage participants in a discussion of research findings of several modifiable factors in the work environment affecting the well-being and resilience of nurses during the pandemic. The session will provide leaders with actionable takeaways to better support the well-being of the nursing workforce of the future.
Featuring:
Lindsay Thompson Munn, PhD, RN is Director of Interprofessional Research at Atrium Health where she leads the translational workforce development program for researchers across the enterprise. She is also an assistant professor in the Department of Emergency Medicine at Atrium Health. Lindsay’s research interests primarily focus on the healthcare work environment, especially at the nursing unit level, and resultant outcomes of these work environment factors on clinicians and patients.
Maureen Swick, PhD, MSN, RN, NEA-BC | Lindsay Thompson Munn, PhD, RN
Maureen Swick, PhD, MSN, RN, NEA-BC is Senior Vice President and Enterprise Chief Nurse Executive for Atrium Health where she represents over 17,000 nurses to ensure consistency in nursing policy, strategy, practice, and quality. Maureen previously served as chief executive officer of AONL as well as senior vice president and chief nursing officer of the AHA. Additionally, Maureen has served as a board member for both AONL and the AHA, most recently as past president of the AONL board.Lindsay Thompson Munn, PhD, RN is Director of Interprofessional Research at Atrium Health where she leads the translational workforce development program for researchers across the enterprise. She is also an assistant professor in the Department of Emergency Medicine at Atrium Health. Lindsay’s research interests primarily focus on the healthcare work environment, especially at the nursing unit level, and resultant outcomes of these work environment factors on clinicians and patients.
Transcription:
Bill Klaproth (Host): This is a special AONL podcast, as we speak with session presenters from the AONL 2022 Conference. With me is Lindsay Munn, Director of Interprofessional Research and Assistant Professor at Atrium Health and Maureen Swick, Senior Vice President and Enterprise Chief Nurse Executive at Atrium Health.
This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Lindsay and Maureen welcome. Great to see you both. So we're going to talk about empowering nurse leaders to support staff wellbeing and resilience. Lindsay, let me start with you. Why is this a topic? Why is this a problem that we're facing today?
Lindsay Thompson Munn, PhD, RN (Guest): Well we have known that wellbeing overall is a challenging problem for the healthcare workforce at large even prior to the pandemic. There are studies that demonstrate this. And when COVID came to the forefront, we talked about how could we understand some of the problems and factors that were affecting our healthcare workforce so that we knew how to better address them. And so we actually did a really large study during COVID-19 trying to understand those factors in the work environment and things that we could actually fix that were impacting the wellbeing and the resilience of nurses, respiratory therapists, APPs, a lot of members of our healthcare workforce.
Host: Yeah. So you said there were problems even before the pandemic, what were some of the big things you uncovered?
Lindsay: So during our study, we found that the factors that most significantly impacted wellbeing were perceptions of PPE availability, workload, staffing, psychological safety amongst the team. The use of wellbeing resources, we actually found that the people that were reaching for those resources were actually the people that needed the most help. They were the people that had the at-risk wellbeing, where we thought previous to the study, that the people that used the wellbeing resources, like mindfulness apps and employee assistance programs. And, um, resources that we had provided to them, we thought that they would be in a better place. But what we actually found is that people who were reaching for those resources actually were struggling the most. And so that was a really important lesson we learned. And then organizational support was important. That was an important factor to wellbeing.
Host: Yeah. All right. And you said there were some things you found that hey, we can fix this. We can apply a strategy to that. So Maureen, what were some of the tactics or initiatives that you use to address or solve the things that you uncovered?
Maureen Swick, PhD, MSN, RN, NEA-BC (Guest): One of the biggest things, which was rather surprising, being part of the incident command is we were communicating multiple times during the day to our teams and what we heard from the clinicians who participated in this study was they did not get any of the communication that we were passing along, especially related to PPE. What we also learned was the power of the media. And so even though we kept communicating that we had adequate PPE, they would go home from their shift, turn on the news and see the shortages and people not having masks, not having appropriate PPE to wear during COVID and taking care of COVID patients. So that was something that we felt we needed to address right away. So we quickly changed our communication tactics and had more of our leaders rounding on the COVID units to make sure that the teams knew that we had adequate PPE and were supporting them. So that was a big takeaway.
Host: Yeah. Interesting how you say they were influenced by what they were seeing at home when it was a different story actually in the hospital itself. Any other initiatives or strategies that you put in place? We'd be interested to hear those too.
Maureen: Yes. So prior to COVID, I run a chaplaincy program and they have developed a program called code lavender, and it's really about supporting our teams with compassion fatigue. So they go out, they respond to teams if someone has dealt with a difficult patient or a trauma. So there was a lot of difficulties, as you can imagine, during COVID a lot of patient deaths. And so we really stepped up our game. Prior to COVID, we had about 10,000 interventions with our code lavender and at the peak of COVID, we had about 55,000 events where our teams had responded to our teammates.
Host: Yeah, really interesting. And thank you for sharing that with us and Lindsay, this is all really important because nurse wellbeing is so important, not only for their personal lives, their professional lives, but this also translates to better patient care as well. Right? When their wellbeing is at the top of that is as good as it can be, translates to better care. Is that right?
Lindsay: Yes. I mean, we know this from existing research, as well as studies that we continue to do. Previous research, and this is even prior to the pandemic, we know that burnout rates, which is the negative end of wellbeing. So if you think of a wellbeing on a continuum where the positive is joy in work, engagement, fulfillment at work and on the negative side is burnout. Previous research shows that burnout is important to clinicians. We see it in their own health. It's associated with type two diabetes, hypertension, some of those physical effects, but then it's also tied to patient outcomes. It's tied to mortality, length of stay for patients, patient experience scores, those things that are really important for patients, but then it's also tied to the organization itself. So we know that burnout is associated with a reduction in work hours, as well as turnover. Those are all really significant.
Host: So retention is very important, right Maureen. So this really speaks to trying to retain the. 'cause you don't want that churn. You don't want to have to be hiring new nurses or onboarding new nurses. Right? So talk about retention.
Maureen: Absolutely. So right. Retention is key, but the key leader for retention is the nurse manager on the unit. They are the chief retention officer and what we saw and heard in our comments during the study, was they lost that connection with the nurse leader, because many of our nurse leaders, because of the surge in COVID, were taking care of patients.
Host: Right. They were had to go on the floor and, and right, because, because of this,
Maureen: Because of that, and because we had so many more patients than we ever had before, we just could not staff up. And so nurse leaders stepped in to take care of the patients. But what we started to see in comments was, you know, staff if they were having a difficult time, would be go to their nurse leader and they would talk to the nurse leader about it, or work out their issues or whatever. Many times they were their confidant, their support, and they lost that piece of it, which was so evident. And then the concern about retention, right? So then the nurses don't have that. We have that cycle of nurses being emotionally and physically drained, and then we saw our turnover start to slowly creep up.
Host: Yeah. So I love that phrase that you use, Chief Retention Officer. I think that's really sums it up well. So for a nursing leader, the Chief Retention Officer, are there general tips or strategies that you've uncovered that you can share with us that they can be more empowering? They can give more support to the staff.
Maureen: Absolutely. One of the things that we're working on now, that we heard directly from our nurse leaders because we have a council of nurse leaders from across the organization. And it was a lot of the nonclinical work that they have to pick up. And there was a lot of that, especially during COVID with some of our ancillary support. So we implemented different roles, operations managers that can take over the supply chain management and that kind of work. We had management associates that picked up the payroll, took all of that off of their plates. So we're really trying to look at what are those things that keep you from being able to engage your team and support your team. And it's a lot of that nonclinical work that we developed these other roles to support.
Host: So you're trying to clear the path if you will, so they can really be present and give their all to the support to the staff.
Maureen: Absolutely. Many of these extra duties would take hours and hours of their time to do that. So those are some of the key things that we're taking away. And some of the other places we're looking at, even patient advocates, especially in our emergency departments, because you have a limited number of people. You've had so many patients there, we needed to make sure that we gave the nurse leaders in the EDs enough support. And we looked at patient advocates in there, and those are people. that can help with the basic patient and family needs and keep the communication going.
Host: I think that's really important what you said there about kind of clearing the plate. So they really can be more present and devote the time needed to give that support, to enhance that wellbeing.
So, Lindsay, how are you going to in the future? I know you've done these surveys and you've learned a lot. You have uncovered these things and you've applied the strategies to them. What happens moving forward, you'll continue to research and adapt and tweak and new strategies is that what's going to happen?
Maureen: I'm keeping Lindsay very busy. So one of the things that another intervention and strategy that we're thinking about is onsite wellbeing coaches. So what we learned is even though the organization had all of these different support things in place, it took the team to reach out, to get that. And if you don't know that you're a bad way, psychologically and emotionally, you're not apt to reach out. So we wanted to put trained wellbeing coaches onsite, and we're piloting it in two critical care units in one of our facilities. And it probably will be kicked off in the next couple of weeks to see if that has an impact by them working directly by identifying where can see some emotional distress in our team and be able to offer onsite coaching right there. So, that's work for us to look at.
Host: So what was the name of that person? Again, it sounded like a new position. What does that person, wellbeing coach, and that person is going to be available to all nursing staff.
Maureen: Well, we're starting with the critical care units. We want to see what are the interventions that this coach is doing, that has a positive impact on their wellbeing. And then the second thing is, is to develop what that program will look like so that we can train the trainers moving forward. And spread that across the organization.
Host: Yeah, that's really cool. I think that's really important making a dedicated person for that role. Was there funding involved with that? Did you have to go to top leadership to get this person approved? How'd you pull that one off?
Maureen: Well, everything is timing. And right now there's a lot of eyes and support our nursing for what we just went through. And so, I went right to the CEO of the organization. And we got support to, contract someone outside, who's going to help us pull this program together. And so you're right. The funding, is significant, but that's how our top senior leadership team thinks of nursing and supporting nursing. So Gene Woods has just been an incredible support.
Host: That's great. Well, as we wrap up, thank you both for your time. I'm going to ask you both the same question as we close out. So when it comes to empowering nurse leaders to support staff wellbeing and resilience, Lindsay, any final thoughts you want to add to that?
Lindsay: The only other thing that I would add that we've found is that psychological safety, I think, is something that an individual nurse manager can work on or individual leaders can work on. We found that that was important about wellbeing and resilience and psychological safety is that trust that you have with your team, that willingness to vulnerable. And so it's important for that trust to be within the team itself, but also between the leader and the staff. And I think encouraging nurse managers, those people who are right on the front lines of care with their staff to really work on building psychological safety would be the other thing I would add.
Host: Yeah. Trust that's really important and when people feel heard and they feel recognized when they feel listened to you start to build that trust and rapport, and that's really important. That's, you're really building a strong foundation then. So Maureen, same question. Any final thoughts you want to add as we talk about staff wellbeing and resilience?
Maureen: I would just say it starts with their nurse leader and our focus is going to be on supporting those nurse leaders. I mean, we've always known that the nurse manager is pivotal and that engagement with their teams and retention and recruitment. And so for us, it's really how can we really support them in a better and more meaningful way? And it starts with their own wellbeing and their own sense of wellness and making sure that they're taking the time that they need so that they can rebuild what I think a lot of us have lost over the past few years and to heal emotionally and physically.
Host: Yeah. Well, really important work both of you were doing, and I love the way finding out you're researching and you're applying strategies to make things better. So that's great. Well, Lindsay and Maureen, thank you so much for your time. I really appreciate it.
Maureen: Thank you for having us.
Host: And once again, that's Lindsay Thompson Munn and Maureen Swick. 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 (Host): This is a special AONL podcast, as we speak with session presenters from the AONL 2022 Conference. With me is Lindsay Munn, Director of Interprofessional Research and Assistant Professor at Atrium Health and Maureen Swick, Senior Vice President and Enterprise Chief Nurse Executive at Atrium Health.
This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Lindsay and Maureen welcome. Great to see you both. So we're going to talk about empowering nurse leaders to support staff wellbeing and resilience. Lindsay, let me start with you. Why is this a topic? Why is this a problem that we're facing today?
Lindsay Thompson Munn, PhD, RN (Guest): Well we have known that wellbeing overall is a challenging problem for the healthcare workforce at large even prior to the pandemic. There are studies that demonstrate this. And when COVID came to the forefront, we talked about how could we understand some of the problems and factors that were affecting our healthcare workforce so that we knew how to better address them. And so we actually did a really large study during COVID-19 trying to understand those factors in the work environment and things that we could actually fix that were impacting the wellbeing and the resilience of nurses, respiratory therapists, APPs, a lot of members of our healthcare workforce.
Host: Yeah. So you said there were problems even before the pandemic, what were some of the big things you uncovered?
Lindsay: So during our study, we found that the factors that most significantly impacted wellbeing were perceptions of PPE availability, workload, staffing, psychological safety amongst the team. The use of wellbeing resources, we actually found that the people that were reaching for those resources were actually the people that needed the most help. They were the people that had the at-risk wellbeing, where we thought previous to the study, that the people that used the wellbeing resources, like mindfulness apps and employee assistance programs. And, um, resources that we had provided to them, we thought that they would be in a better place. But what we actually found is that people who were reaching for those resources actually were struggling the most. And so that was a really important lesson we learned. And then organizational support was important. That was an important factor to wellbeing.
Host: Yeah. All right. And you said there were some things you found that hey, we can fix this. We can apply a strategy to that. So Maureen, what were some of the tactics or initiatives that you use to address or solve the things that you uncovered?
Maureen Swick, PhD, MSN, RN, NEA-BC (Guest): One of the biggest things, which was rather surprising, being part of the incident command is we were communicating multiple times during the day to our teams and what we heard from the clinicians who participated in this study was they did not get any of the communication that we were passing along, especially related to PPE. What we also learned was the power of the media. And so even though we kept communicating that we had adequate PPE, they would go home from their shift, turn on the news and see the shortages and people not having masks, not having appropriate PPE to wear during COVID and taking care of COVID patients. So that was something that we felt we needed to address right away. So we quickly changed our communication tactics and had more of our leaders rounding on the COVID units to make sure that the teams knew that we had adequate PPE and were supporting them. So that was a big takeaway.
Host: Yeah. Interesting how you say they were influenced by what they were seeing at home when it was a different story actually in the hospital itself. Any other initiatives or strategies that you put in place? We'd be interested to hear those too.
Maureen: Yes. So prior to COVID, I run a chaplaincy program and they have developed a program called code lavender, and it's really about supporting our teams with compassion fatigue. So they go out, they respond to teams if someone has dealt with a difficult patient or a trauma. So there was a lot of difficulties, as you can imagine, during COVID a lot of patient deaths. And so we really stepped up our game. Prior to COVID, we had about 10,000 interventions with our code lavender and at the peak of COVID, we had about 55,000 events where our teams had responded to our teammates.
Host: Yeah, really interesting. And thank you for sharing that with us and Lindsay, this is all really important because nurse wellbeing is so important, not only for their personal lives, their professional lives, but this also translates to better patient care as well. Right? When their wellbeing is at the top of that is as good as it can be, translates to better care. Is that right?
Lindsay: Yes. I mean, we know this from existing research, as well as studies that we continue to do. Previous research, and this is even prior to the pandemic, we know that burnout rates, which is the negative end of wellbeing. So if you think of a wellbeing on a continuum where the positive is joy in work, engagement, fulfillment at work and on the negative side is burnout. Previous research shows that burnout is important to clinicians. We see it in their own health. It's associated with type two diabetes, hypertension, some of those physical effects, but then it's also tied to patient outcomes. It's tied to mortality, length of stay for patients, patient experience scores, those things that are really important for patients, but then it's also tied to the organization itself. So we know that burnout is associated with a reduction in work hours, as well as turnover. Those are all really significant.
Host: So retention is very important, right Maureen. So this really speaks to trying to retain the. 'cause you don't want that churn. You don't want to have to be hiring new nurses or onboarding new nurses. Right? So talk about retention.
Maureen: Absolutely. So right. Retention is key, but the key leader for retention is the nurse manager on the unit. They are the chief retention officer and what we saw and heard in our comments during the study, was they lost that connection with the nurse leader, because many of our nurse leaders, because of the surge in COVID, were taking care of patients.
Host: Right. They were had to go on the floor and, and right, because, because of this,
Maureen: Because of that, and because we had so many more patients than we ever had before, we just could not staff up. And so nurse leaders stepped in to take care of the patients. But what we started to see in comments was, you know, staff if they were having a difficult time, would be go to their nurse leader and they would talk to the nurse leader about it, or work out their issues or whatever. Many times they were their confidant, their support, and they lost that piece of it, which was so evident. And then the concern about retention, right? So then the nurses don't have that. We have that cycle of nurses being emotionally and physically drained, and then we saw our turnover start to slowly creep up.
Host: Yeah. So I love that phrase that you use, Chief Retention Officer. I think that's really sums it up well. So for a nursing leader, the Chief Retention Officer, are there general tips or strategies that you've uncovered that you can share with us that they can be more empowering? They can give more support to the staff.
Maureen: Absolutely. One of the things that we're working on now, that we heard directly from our nurse leaders because we have a council of nurse leaders from across the organization. And it was a lot of the nonclinical work that they have to pick up. And there was a lot of that, especially during COVID with some of our ancillary support. So we implemented different roles, operations managers that can take over the supply chain management and that kind of work. We had management associates that picked up the payroll, took all of that off of their plates. So we're really trying to look at what are those things that keep you from being able to engage your team and support your team. And it's a lot of that nonclinical work that we developed these other roles to support.
Host: So you're trying to clear the path if you will, so they can really be present and give their all to the support to the staff.
Maureen: Absolutely. Many of these extra duties would take hours and hours of their time to do that. So those are some of the key things that we're taking away. And some of the other places we're looking at, even patient advocates, especially in our emergency departments, because you have a limited number of people. You've had so many patients there, we needed to make sure that we gave the nurse leaders in the EDs enough support. And we looked at patient advocates in there, and those are people. that can help with the basic patient and family needs and keep the communication going.
Host: I think that's really important what you said there about kind of clearing the plate. So they really can be more present and devote the time needed to give that support, to enhance that wellbeing.
So, Lindsay, how are you going to in the future? I know you've done these surveys and you've learned a lot. You have uncovered these things and you've applied the strategies to them. What happens moving forward, you'll continue to research and adapt and tweak and new strategies is that what's going to happen?
Maureen: I'm keeping Lindsay very busy. So one of the things that another intervention and strategy that we're thinking about is onsite wellbeing coaches. So what we learned is even though the organization had all of these different support things in place, it took the team to reach out, to get that. And if you don't know that you're a bad way, psychologically and emotionally, you're not apt to reach out. So we wanted to put trained wellbeing coaches onsite, and we're piloting it in two critical care units in one of our facilities. And it probably will be kicked off in the next couple of weeks to see if that has an impact by them working directly by identifying where can see some emotional distress in our team and be able to offer onsite coaching right there. So, that's work for us to look at.
Host: So what was the name of that person? Again, it sounded like a new position. What does that person, wellbeing coach, and that person is going to be available to all nursing staff.
Maureen: Well, we're starting with the critical care units. We want to see what are the interventions that this coach is doing, that has a positive impact on their wellbeing. And then the second thing is, is to develop what that program will look like so that we can train the trainers moving forward. And spread that across the organization.
Host: Yeah, that's really cool. I think that's really important making a dedicated person for that role. Was there funding involved with that? Did you have to go to top leadership to get this person approved? How'd you pull that one off?
Maureen: Well, everything is timing. And right now there's a lot of eyes and support our nursing for what we just went through. And so, I went right to the CEO of the organization. And we got support to, contract someone outside, who's going to help us pull this program together. And so you're right. The funding, is significant, but that's how our top senior leadership team thinks of nursing and supporting nursing. So Gene Woods has just been an incredible support.
Host: That's great. Well, as we wrap up, thank you both for your time. I'm going to ask you both the same question as we close out. So when it comes to empowering nurse leaders to support staff wellbeing and resilience, Lindsay, any final thoughts you want to add to that?
Lindsay: The only other thing that I would add that we've found is that psychological safety, I think, is something that an individual nurse manager can work on or individual leaders can work on. We found that that was important about wellbeing and resilience and psychological safety is that trust that you have with your team, that willingness to vulnerable. And so it's important for that trust to be within the team itself, but also between the leader and the staff. And I think encouraging nurse managers, those people who are right on the front lines of care with their staff to really work on building psychological safety would be the other thing I would add.
Host: Yeah. Trust that's really important and when people feel heard and they feel recognized when they feel listened to you start to build that trust and rapport, and that's really important. That's, you're really building a strong foundation then. So Maureen, same question. Any final thoughts you want to add as we talk about staff wellbeing and resilience?
Maureen: I would just say it starts with their nurse leader and our focus is going to be on supporting those nurse leaders. I mean, we've always known that the nurse manager is pivotal and that engagement with their teams and retention and recruitment. And so for us, it's really how can we really support them in a better and more meaningful way? And it starts with their own wellbeing and their own sense of wellness and making sure that they're taking the time that they need so that they can rebuild what I think a lot of us have lost over the past few years and to heal emotionally and physically.
Host: Yeah. Well, really important work both of you were doing, and I love the way finding out you're researching and you're applying strategies to make things better. So that's great. Well, Lindsay and Maureen, thank you so much for your time. I really appreciate it.
Maureen: Thank you for having us.
Host: And once again, that's Lindsay Thompson Munn and Maureen Swick. 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.