Selected Podcast
Prioritizing Nurse Wellbeing
The effects of the ongoing COVID-19 pandemic are extracting a significant toll on the mental and physical health of our nurses. Prioritizing their well-being by creating and implementing a director of nurse wellbeing has allowed us to build and deliver critical resources, and education to nurses to help repair and improve their mental and physical health.
Featuring:
Crystal Morales, MS, BSN, RN
Crystal Morales is the Director of Nurse Wellbeing at MedStar Health, an inaugural position that was created in 2020. As the wellness director she has the privilege of developing and implementing strategies aimed at improving overall health and wellness including mental, emotional and physical aspects. With experience in research, operations, high reliability and safety Crystal was able to leverage existing peer to peer support programs while building and developing culture and other resources. Transcription:
Bill Klaproth: This is a special AONL podcast as we speak with session presenters direct from AONL 2022. With me is Crystal Morales. She is the Director of Nurse Wellbeing at MedStar Health.
This is Today In Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Crystal, thank you so much for being here. We appreciate it.
Crystal Morales: Thanks for having me. Super excited.
Bill Klaproth: So we're going to talk about prioritizing nurse wellbeing. Why is this such an issue right now? Why is this such a problem?
Crystal Morales: I think the first thing that we need to just kind of level set is that a lot of folks are saying, you know, "This burnout is new" and burnout actually is not new. And when people were talking about these unprecedented moments in healthcare, they in fact are, but burnout, it's not new. That term was coined in 1974 and we just haven't talked about it, but what the pandemic did was it level set it, and it allowed us to talk openly about what we were experiencing instead of wearing stress and anxiety and burnout as a badge of honor. And I think that's the difference, so stepping into the space knowing that.
Bill Klaproth: So when we talk about nurse wellbeing and burnout and anxiety and all those things, what does burnout look like today for a nursing staff? What is going on with them mentally and even the effects physically on them?
Crystal Morales: I would say, again, I think we're beyond burnout and the impact is they're tired from being at work. Sometimes people express having a compassion fatigue a little bit. It's just a sheer exhaustion, because not only did our work life changed our home lives changed as well. So if you're already stressed at home, if you're mom or a dad of two or three kids, and you were homeschooling your kids, and then you were coming to work and working a full-time job, it was super stressful. So you have these big full-time jobs. And I think it made us reflect and just try to level set and prioritize, like what's really important in life and what does that look like right now? And so I think we're in a reflection phase, if you will. The numbers have come down, right? So we're in a much better space that way. I can feel it even when I'm on the units, that we are in a much different space. But having said that, it gives people time to reflect on what's been going on and to really make decisions about what they want in their life.
Bill Klaproth: So when you talk about compassion fatigue, and complete exhaustion and all the stressors that the pandemic certainly brought out basically in many people, especially the nursing community, what are some strategies or things you came up with to address nurse wellbeing?
Crystal Morales: I'm really blessed in this job because when I came in, there was a steering committee that had already been established. And they were small but mighty. And coming into this role, I am representing 8,600 plus nurses. So it's insane. Our breadth and depth is strong. We're geographically blessed and challenged at the same time. But the steering committee that I was able to join, they had actually already established wellness committees at each one of the tertiary care centers. So it was easy for me to go to the wellness committee and say, "Okay, nursing needs to be represented in this space." And they're like, "Yes, absolutely." So I had this robust partnership.
And the first thing that we started to do was align all of our resources and we put it under the umbrella here for you, so one-stop shop where all of our nurses could go for easy access. Like in order for people to utilize resources, they really have to be easy to access and you need to be able to get them to them. So email's not part of their workflow, so it's taking the resources to them. And so we do that through wellness rounds and wellness rounds is a great way. We do it every single month and the committee members also volunteer to do it where we actually have wellness wagons and carts that we fill up with snacks and beverages, stress management tips and strategies, and I can talk about a couple of those. And then we also have different resources that we're sharing, right? I'm building rapport and creating a safe space where it's okay to utilize these resources.
In addition, when we talk about that friction, that day-to-day friction, we have some benefits, so back-up childcare, and then adult care as well along with coaching counseling services that our associates and their families can take advantage of.
Bill Klaproth: Childcare. That's a stressor in someone's personal life. By taking that off of their shoulders, where they can kind of feel at ease or a little bit better about that. I could see where that would be huge dividends to someone.
Crystal Morales: And, with this benefit, you can access it and get that daycare, that childcare benefit within 24 hours. So it's not like, "Well, in two or three weeks, right?" The daycares don't really work like that or the nanny doesn't cancel and say, "Hey, FYI in 24 hours..." Like it usually just happens like that. And you know, these are our providers and nurses and it causes a lot of stress in their life.
Bill Klaproth: Yeah. That's a big stress relief alone. You talked about establishing a wellness committee. What is that? Explain that to us.
Crystal Morales: Yeah. So we have a wellness committee. It's a diverse set of individuals. So we want to make sure that all of our specialties are covered in that area. And I mean everyone, nurse, doc. We have our environmental services, pastoral care, you name it. We're coming together collectively, because the goal is really to provide wellness services to our associates, and so we have that diversity of thought, which we love. And the goal is really to set short and long-term goals for each entity on how you're going to promote and grow wellness within that organization.
Now as the center, we're able to kind of feed things to them. But they're all very unique, so they need to be doing unique things to support their associates at the same time
Bill Klaproth: So you're setting some goals then, some milestones that you're trying to hit as far as wellness of your individual staffs?
Crystal Morales: You know, it's really important. One of the first things that we wanted to do, I found it very difficult when I would be out rounding and speaking with folks and asking them, "Share with me how you're feeling. What's going on? And time after time, they had a really hard time putting into words what exactly was going on. And so the word was always stress. And, so I was like, "You know, there's actually different sources of stress," and we knew we needed to level set and to give them education, like what are the sources of stress? Where do they come from? Not only that, but what do you do when you're experiencing this stress? So we were able to partner with Heather Hartman-Hall, who's actually in our center for wellbeing. She's a psychologist by training and she's brought stress first aid to all of us, which has really level set, allows us to recognize different levels of stress, but then how to take advantage of resources at the same time.
Bill Klaproth: Yeah. So you talked about also creating wellness rounds once a month, which sounds really important for someone to be able to meet with the nurse manager once a month or nurse leader. Sounds like that's really an important strategy that you're employing there. What are some of the other initiatives, strategies, things that you're doing to improve nurse wellbeing?
Crystal Morales: So we have resilience coaches that we've brought into our program as well. And the great thing about them is they have these booking calendars. Again, QR codes are the thing, right? We don't want to make it difficult for folks to take advantage of resources, so they can go into these calendars and set up private confidential time with them. That's huge.
I'm also so excited to share, I just can't wait. We have been given three new nurse wellness coach specialists who are going to be joining our team. And so some of the work that they're going to be doing in there is really helping the nurses kind of assess, level set where they're at, set short and long-term goals and help them work towards those; and then bring in some ethics, that's really important to us; create stress labs where people can learn to work through stress. It's identifying Stress is not just stress. I can't stress that enough with people. Like it runs over, it does accumulate and can actually cause an injury and we need to be very mindful of that.
Bill Klaproth: Yeah. So resilience coaches, you talked about, stress labs. You said you're bringing in ethics people to talk and coach as well. So in your stress labs, is that where you uncover other things, other issues, other things that are important to nurses that need to be paid attention to?
Crystal Morales: Yeah, absolutely. So one of our new nurse coach specialists has run these stress labs for some time and other work that she's done. So it's about identification of, not just in yourself, but in your peers. So that's one of the greatest things about this program is that it's twofold. It's for ourselves and our peers and then recognizing tips and tricks for kind of like what can we do for ourselves, but to kind of deescalate the situation and then to make sure that we normalize it's okay to get help. There's still a lot of stigma on mental health, a ton of stigma, unfortunately.
Bill Klaproth: Yeah, that is so true. So do you have any examples or results you can share with us? Maybe it's, you know, a personal story or, "Hey, our retention rate is really good. We're not losing nurses as quickly as we were before." Any successes you can share with us?
Crystal Morales: Yeah, I would say when we look to the success of the program, we do look at our overall utilization rates of our offerings. And so just doing the wellness rounds and taking the resources to the folks, we've seen a major uptick in the utilization rates. I wish I could tie it back to retention, but we're not there yet. And I don't think anybody really is across the system. It's the world that we live in right now.
As far as personal stories goes, there's so many, and I was thinking I had just shared a couple of weeks ago where I had a nurse who after wellness rounds pulled me aside and she said, "I never realized that children could have depression." And it was like, "Yeah. no, I mean, everybody's lives have changed, right? And she said, "It's really hard for me to come to work. I have a ten-year-old son. I really don't know what to do. Can I utilize some of these resources for my child?" I was like, "Absolutely." So I was able to get her connected and she was able to get her son connected with a counselor. And a couple of weeks later, I was doing rounds again and she comes running out and she was so excited and she clearly wasn't excited the first time I saw her, she was in a bad place. It's really hard to come to work and do great work when you're worried about your family. And so she had come running out and she said, "Ask me how my son is doing. Ask me how my son is doing." And so I was like, "How is he doing?" She was like, "Much better. Thank you so much." And I just think back to my early years when I worked at the bedside and how a program like this could have really benefited me. As I reflect back to those years, it's really important to me that I continue to build and develop it for everybody else now and those that are coming into the nursing force.
Bill Klaproth: Yeah, well, this has really been interesting, Crystal. Thank you so much. Last question then. Anything else you want to add? Anything else we should know about that you can share with us about prioritizing nurse wellbeing?
Crystal Morales: Well, I think from a MedStar perspective, the one thing that I'm so excited to share is that with their commitment and dedication to wellness, we actually went from a steering committee to a center for wellbeing. So it really just shows you their long-term commitment and the direction that we're moving in for wellness as it relates to nurses, but for all of our associates, so really, really exciting stuff.
Bill Klaproth: Absolutely. And I'm sure your nursing staff, I mean, you have 8,600 nurses, you said, it's a huge job, it's a huge lift, but I'm sure they appreciate it, all the things that you've put together establishing the wellness committee and the wellness rounds and the creating of the safe space and the resilience coaches. I'm sure that means a lot to them.
Crystal Morales: Oh, absolutely. And it means a lot to me.
Bill Klaproth: Yeah, absolutely. Crystal, thank you so much for your time. It was great talking with you.
Crystal Morales: Great talking with you. Thanks.
Bill Klaproth: And once again, that's Crystal Morales. 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: This is a special AONL podcast as we speak with session presenters direct from AONL 2022. With me is Crystal Morales. She is the Director of Nurse Wellbeing at MedStar Health.
This is Today In Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Crystal, thank you so much for being here. We appreciate it.
Crystal Morales: Thanks for having me. Super excited.
Bill Klaproth: So we're going to talk about prioritizing nurse wellbeing. Why is this such an issue right now? Why is this such a problem?
Crystal Morales: I think the first thing that we need to just kind of level set is that a lot of folks are saying, you know, "This burnout is new" and burnout actually is not new. And when people were talking about these unprecedented moments in healthcare, they in fact are, but burnout, it's not new. That term was coined in 1974 and we just haven't talked about it, but what the pandemic did was it level set it, and it allowed us to talk openly about what we were experiencing instead of wearing stress and anxiety and burnout as a badge of honor. And I think that's the difference, so stepping into the space knowing that.
Bill Klaproth: So when we talk about nurse wellbeing and burnout and anxiety and all those things, what does burnout look like today for a nursing staff? What is going on with them mentally and even the effects physically on them?
Crystal Morales: I would say, again, I think we're beyond burnout and the impact is they're tired from being at work. Sometimes people express having a compassion fatigue a little bit. It's just a sheer exhaustion, because not only did our work life changed our home lives changed as well. So if you're already stressed at home, if you're mom or a dad of two or three kids, and you were homeschooling your kids, and then you were coming to work and working a full-time job, it was super stressful. So you have these big full-time jobs. And I think it made us reflect and just try to level set and prioritize, like what's really important in life and what does that look like right now? And so I think we're in a reflection phase, if you will. The numbers have come down, right? So we're in a much better space that way. I can feel it even when I'm on the units, that we are in a much different space. But having said that, it gives people time to reflect on what's been going on and to really make decisions about what they want in their life.
Bill Klaproth: So when you talk about compassion fatigue, and complete exhaustion and all the stressors that the pandemic certainly brought out basically in many people, especially the nursing community, what are some strategies or things you came up with to address nurse wellbeing?
Crystal Morales: I'm really blessed in this job because when I came in, there was a steering committee that had already been established. And they were small but mighty. And coming into this role, I am representing 8,600 plus nurses. So it's insane. Our breadth and depth is strong. We're geographically blessed and challenged at the same time. But the steering committee that I was able to join, they had actually already established wellness committees at each one of the tertiary care centers. So it was easy for me to go to the wellness committee and say, "Okay, nursing needs to be represented in this space." And they're like, "Yes, absolutely." So I had this robust partnership.
And the first thing that we started to do was align all of our resources and we put it under the umbrella here for you, so one-stop shop where all of our nurses could go for easy access. Like in order for people to utilize resources, they really have to be easy to access and you need to be able to get them to them. So email's not part of their workflow, so it's taking the resources to them. And so we do that through wellness rounds and wellness rounds is a great way. We do it every single month and the committee members also volunteer to do it where we actually have wellness wagons and carts that we fill up with snacks and beverages, stress management tips and strategies, and I can talk about a couple of those. And then we also have different resources that we're sharing, right? I'm building rapport and creating a safe space where it's okay to utilize these resources.
In addition, when we talk about that friction, that day-to-day friction, we have some benefits, so back-up childcare, and then adult care as well along with coaching counseling services that our associates and their families can take advantage of.
Bill Klaproth: Childcare. That's a stressor in someone's personal life. By taking that off of their shoulders, where they can kind of feel at ease or a little bit better about that. I could see where that would be huge dividends to someone.
Crystal Morales: And, with this benefit, you can access it and get that daycare, that childcare benefit within 24 hours. So it's not like, "Well, in two or three weeks, right?" The daycares don't really work like that or the nanny doesn't cancel and say, "Hey, FYI in 24 hours..." Like it usually just happens like that. And you know, these are our providers and nurses and it causes a lot of stress in their life.
Bill Klaproth: Yeah. That's a big stress relief alone. You talked about establishing a wellness committee. What is that? Explain that to us.
Crystal Morales: Yeah. So we have a wellness committee. It's a diverse set of individuals. So we want to make sure that all of our specialties are covered in that area. And I mean everyone, nurse, doc. We have our environmental services, pastoral care, you name it. We're coming together collectively, because the goal is really to provide wellness services to our associates, and so we have that diversity of thought, which we love. And the goal is really to set short and long-term goals for each entity on how you're going to promote and grow wellness within that organization.
Now as the center, we're able to kind of feed things to them. But they're all very unique, so they need to be doing unique things to support their associates at the same time
Bill Klaproth: So you're setting some goals then, some milestones that you're trying to hit as far as wellness of your individual staffs?
Crystal Morales: You know, it's really important. One of the first things that we wanted to do, I found it very difficult when I would be out rounding and speaking with folks and asking them, "Share with me how you're feeling. What's going on? And time after time, they had a really hard time putting into words what exactly was going on. And so the word was always stress. And, so I was like, "You know, there's actually different sources of stress," and we knew we needed to level set and to give them education, like what are the sources of stress? Where do they come from? Not only that, but what do you do when you're experiencing this stress? So we were able to partner with Heather Hartman-Hall, who's actually in our center for wellbeing. She's a psychologist by training and she's brought stress first aid to all of us, which has really level set, allows us to recognize different levels of stress, but then how to take advantage of resources at the same time.
Bill Klaproth: Yeah. So you talked about also creating wellness rounds once a month, which sounds really important for someone to be able to meet with the nurse manager once a month or nurse leader. Sounds like that's really an important strategy that you're employing there. What are some of the other initiatives, strategies, things that you're doing to improve nurse wellbeing?
Crystal Morales: So we have resilience coaches that we've brought into our program as well. And the great thing about them is they have these booking calendars. Again, QR codes are the thing, right? We don't want to make it difficult for folks to take advantage of resources, so they can go into these calendars and set up private confidential time with them. That's huge.
I'm also so excited to share, I just can't wait. We have been given three new nurse wellness coach specialists who are going to be joining our team. And so some of the work that they're going to be doing in there is really helping the nurses kind of assess, level set where they're at, set short and long-term goals and help them work towards those; and then bring in some ethics, that's really important to us; create stress labs where people can learn to work through stress. It's identifying Stress is not just stress. I can't stress that enough with people. Like it runs over, it does accumulate and can actually cause an injury and we need to be very mindful of that.
Bill Klaproth: Yeah. So resilience coaches, you talked about, stress labs. You said you're bringing in ethics people to talk and coach as well. So in your stress labs, is that where you uncover other things, other issues, other things that are important to nurses that need to be paid attention to?
Crystal Morales: Yeah, absolutely. So one of our new nurse coach specialists has run these stress labs for some time and other work that she's done. So it's about identification of, not just in yourself, but in your peers. So that's one of the greatest things about this program is that it's twofold. It's for ourselves and our peers and then recognizing tips and tricks for kind of like what can we do for ourselves, but to kind of deescalate the situation and then to make sure that we normalize it's okay to get help. There's still a lot of stigma on mental health, a ton of stigma, unfortunately.
Bill Klaproth: Yeah, that is so true. So do you have any examples or results you can share with us? Maybe it's, you know, a personal story or, "Hey, our retention rate is really good. We're not losing nurses as quickly as we were before." Any successes you can share with us?
Crystal Morales: Yeah, I would say when we look to the success of the program, we do look at our overall utilization rates of our offerings. And so just doing the wellness rounds and taking the resources to the folks, we've seen a major uptick in the utilization rates. I wish I could tie it back to retention, but we're not there yet. And I don't think anybody really is across the system. It's the world that we live in right now.
As far as personal stories goes, there's so many, and I was thinking I had just shared a couple of weeks ago where I had a nurse who after wellness rounds pulled me aside and she said, "I never realized that children could have depression." And it was like, "Yeah. no, I mean, everybody's lives have changed, right? And she said, "It's really hard for me to come to work. I have a ten-year-old son. I really don't know what to do. Can I utilize some of these resources for my child?" I was like, "Absolutely." So I was able to get her connected and she was able to get her son connected with a counselor. And a couple of weeks later, I was doing rounds again and she comes running out and she was so excited and she clearly wasn't excited the first time I saw her, she was in a bad place. It's really hard to come to work and do great work when you're worried about your family. And so she had come running out and she said, "Ask me how my son is doing. Ask me how my son is doing." And so I was like, "How is he doing?" She was like, "Much better. Thank you so much." And I just think back to my early years when I worked at the bedside and how a program like this could have really benefited me. As I reflect back to those years, it's really important to me that I continue to build and develop it for everybody else now and those that are coming into the nursing force.
Bill Klaproth: Yeah, well, this has really been interesting, Crystal. Thank you so much. Last question then. Anything else you want to add? Anything else we should know about that you can share with us about prioritizing nurse wellbeing?
Crystal Morales: Well, I think from a MedStar perspective, the one thing that I'm so excited to share is that with their commitment and dedication to wellness, we actually went from a steering committee to a center for wellbeing. So it really just shows you their long-term commitment and the direction that we're moving in for wellness as it relates to nurses, but for all of our associates, so really, really exciting stuff.
Bill Klaproth: Absolutely. And I'm sure your nursing staff, I mean, you have 8,600 nurses, you said, it's a huge job, it's a huge lift, but I'm sure they appreciate it, all the things that you've put together establishing the wellness committee and the wellness rounds and the creating of the safe space and the resilience coaches. I'm sure that means a lot to them.
Crystal Morales: Oh, absolutely. And it means a lot to me.
Bill Klaproth: Yeah, absolutely. Crystal, thank you so much for your time. It was great talking with you.
Crystal Morales: Great talking with you. Thanks.
Bill Klaproth: And once again, that's Crystal Morales. 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.