Bill Klaproth (Host): This is a special AONL podcast as we speak with session presenters from the AONL 2023 Conference. With me is Rebecca Chambers. She is the Magnet Program Director at SSM Health Cardinal Glennon Children's Hospital. And her session is titled Gratitude To Cultivate Joy In Work For Nurse Leaders.

Host: This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Rebecca, welcome.

Rebecca Chambers: Thank you. Thank you for having me.

Host: You bet. I am so excited to talk to you about this. So, let's understand this first, what is the compelling leadership issue or problem that your session addresses?

Rebecca Chambers: You know, we looked at addressing nurse leader turnover, which has so many consequences, not just for the nurse leaders themselves, but for the organization as a whole. If your nurse manager or your nurse director keeps turning over, there's a loss in momentum for goals or key performance indicators you're trying to reach. And then, there's so many consequences for the staff. The leadership is inconsistent. They're not sure who to turn to. And leader turnover can certainly contribute to staff nurse turnover, which as we know is a very complex problem right now.

Host: Right. And is this nurse leader turnover due to just coming out of pandemic and the pressures and the burnout? Is that what's causing that turnover primarily, the short staffing, all of that?

Rebecca Chambers: It certainly does contribute to it. But being a nurse leader, there's a 24/7 accountability expectation for a lot of us. And the role oftentimes is more intense than individuals thought it might be. A lot of times a really good clinician, a really good staff nurse, "Oh, you'd be a great manager," and you find yourself in a leadership role that you may or may not have been as prepared for as you could have been.

Host: Okay. So, how are you addressing this then, nurse leader turnover? As you said, maybe we're promoting people into leadership or management positions when maybe they're not ready. They're just great employees and they're like, "You're going to be the manager now," even though they might not have any formal training. So knowing this, what did you do? How did you approach this?

Rebecca Chambers: So at our organization, we were looking at over about a two-year period, over half of our managers had turned over. And that's quite significant, both financially and in other costs for the organization. So, what we looked at is something very simple we could do. There's a lot of talk right now about resilience and work-life balance and just what people anecdotally refer to as burnout, really is called compassion fatigue. It's a combination of both burnout, which is some organizational factors that exist in everyone's job, we may or may not be able to control all of them; and then also, secondary trauma, particularly in healthcare, you're exposed to the trauma of the patients, their families. And then in a leadership role, you're exposed to any trauma that your staff experiences as well. And that can create compassion fatigue where you're just not as engaged in your work. You're just kind of coming in, surviving through the day, you're not really thriving. So, we wanted to look at interventions to increase compassion satisfaction, which is that joy in work that we all strive to get. And that is a very good protective factor against compassion fatigue. So if you build that up, you have a little bit of protection.

Host: All right. So knowing this, what did you do?

Rebecca Chambers: So, we looked at this very simple intervention called Three Good Things. It's an intervention of positive psychology. It's also known as Three Blessings. And it could not be simpler. It takes less than five minutes per day. You basically, once a day, most people do it in the evening or before bed, just kind of reflect what are the three good things that happen to me today, and it could be anything. It doesn't have to be work-related. It could be "It's a beautiful spring day," or "You know what, I didn't hit any traffic today," could be the simplest things ever. And you just kind of reflect upon why that happened. And training your brain to notice those positive things and that you're grateful for it can be so impactful on your outlook on life, and you start to notice positive things in yourself and positive things in others. It really is changing your mindset a lot.

And it is very simple and that is basically all it is. It's best to be done daily. So, what we did, we trialed it with about 21 nurse leaders participated in the trial. They did it for eight weeks. We asked them to do their best to do it daily, which is a big ask. But as I said, it is a very simple intervention. And we saw 80% of those individuals had an increase in their compassion satisfaction score. We evaluated them through the professional quality of life scale. So, that was really good to see, like this small intervention could make a huge difference in that person's mindset.

Host: Little things can make big difference. So, I think what's important for me, what I took out of that is, I think this is a great exercise, but learning how to look for the good things that happen every day, teaching your brain to look for those little things that happen daily that are positive in your life and recognizing them. Because right now, all of us have positive things that happen during our day. Like you said, it could be as simple as, "Wow, I made it to work in 20 minutes instead of 35. I hit all the lights." Normally, we wouldn't think about that. But now, it's like, "Wow, okay. I'm training my brain to look for good things in life," right? That's kind of what it is.

Rebecca Chambers: It absolutely is what it is. We're kind of predisposed to notice the bad things.

Host: And dwell on the bad things and ruminate on the bad things, right?

Rebecca Chambers: "Oh, the traffic was terrible."

Host: "Oh, my God, let me tell you what happened to me today. I went to Starbucks and, oh, they screwed up my order. And oh my God..." You want to learn to let that go and focus on the good things.

Rebecca Chambers: Yeah. So, those bad things are still going to happen, you know?

Host: Right. But if you ruminate on them and just let them keep like eating at you, that's where it really can affect your day and turn your day into a bad day.

Rebecca Chambers: Oh, absolutely.

Host: And that adds to the compassion fatigue as you were saying. So, you have seen significant results of this. Can you talk a little bit more about that, the positive outcome of doing three good things?

Rebecca Chambers: So in our organization, in the six months after the intervention was complete, our turnover rate for leaders went down to 3.4%. And then when we expanded that out, another three months, we were just looking at 10%, which is a significant improvement we were really happy with. And we noticed when we were doing the study, the individuals that benefited the most, they had the highest increases in their compassion satisfaction, were leaders who have been there less than five years in a leadership role. So, we really thought, "Wow, that is a group to focus on." When you become a more of a mature leader, things bother you a little bit less, or you've kind of maybe developed your own way of coping with things. But it really was enlightening, like, "Oh, these are folks that we really need to focus on." So, it kind of highlighted transition to practice, curriculum, nurse leader mentoring programs, ways we could incorporate these simple interventions to kind of share it.

Host: So, this small thing has proven to give you meaningful results, positive results. It really has made a difference. And in the satisfaction, that compassion fatigue I'm sure has gone down. When that goes down, probably better health outcomes go up, job satisfaction goes up. So, there's a correlation there.

Rebecca Chambers: Oh, sure. And it's well published literature, you know, job satisfaction goes up, patient satisfaction goes up, safety metrics go up. Like it is a beautiful trickle down effect.

Host: Yeah, for sure. So, how does someone get started in this? How did you implement this? For someone listening, they're saying to themselves, "I love this," how did you get started?

Rebecca Chambers: For us, it was part of my DNP dissertation to do this project. But honestly, it has become so pervasive in the media and in social networking, all these things for resilience and mindfulness, and gratitude is a big part of that. There's several iPhone apps. You know, Google Three Good Things, you will find things. As I said, it's a very simple exercise, but there's different tools you can use. You can write in a journal of your own. There's tons of applications you can put on your phone. Set a reminder, it can remind you to do it every night before bed. So, that's very easy to do. And for me, it really hones in in that self-care, is kind of the responsibility of yourself. You know, your organization can promote it and support it in a myriad of ways. But as the individual, you do kind of have to make that decision to take care of yourself. And I hope this is an easy thing that folks can do and hopefully quickly reap benefits from it and just kind of change their mindset just a little bit, it will make a huge difference.

Host: Yeah. That is great. Well, Rebecca, thank you so much for your time.

Rebecca Chambers: Thank you.

Host: If you could wrap this up for us, any final thoughts you want to share on Three Good Things, the daily gratitude exercise that has proven to be very beneficial?

Rebecca Chambers: I would just like to tell nurse leaders that as much as we try and take care of our patients and take care of our teams, that we deserve to take care of ourselves as well. And this is a really easy way to do that.

Host: Great point. We deserve to take care of ourselves as well. So, everybody should do the three good things exercise. I'm going to start doing it.

Rebecca Chambers: Yeah, do it.

Host: You know what one of my good things today is, Rebecca? Talking to you today. That is one of my good things that have happened today.

Rebecca Chambers: Wonderful.

Host: So that's Rebecca Chambers. Thank you so much. I appreciate it.

Rebecca Chambers: Thank you.

Host: 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.