Bill Klaproth (Host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And with me as Yarisbell Collazo-- although she said I could call her Bell because she's a nice person. So, I'm going to call you Bell, because you said it was okay-- as we talk about Mental Health Resource Nurse: A New Approach to a Healthy Work Environment. Bell, welcome.

Yarisbell Collazo: Thank you. Thank you for having me. Like I said, Yarisbell Collazo here. And everybody else can call me Bell, including Bill. He is my new friend.

Host: That's right. I feel honored. Thank you, Bell. This is great. Okay. So when we talk about mental health and a new approach to a healthy work environment, can you talk about where we're at right now? Work-related, stress, burnout, job dissatisfaction, all those things among nurses, it's still going on. Tell us about the problem of what's happening right now.

Yarisbell Collazo: I think there's a lot of information out there. It's not a secret that not only healthcare and nursing, like mental health and work environments is a big topic right now and how to have better environment, you know, with that being said. So in nursing especially where I did my project, which is a medical-surgical unit, it is very important to address it with the pandemic, with the fact patient-nurses ratio, high task, high volume and acuity of the patient, sometimes we forget that aspect. So, it is something that everybody's trying to focus. I think there's a lot of effort out there trying to make it better. And this is one of many that can help have a better work environment.

Host: Which is really important because nurses want to do or provide the best care they can. And when they're stressed and burned out, they feel like they can't. And this ultimately then affects patient outcomes. So, this is a really important issue, isn't it?

Yarisbell Collazo: Yes, exactly. It goes back to when you are in an airplane that it says you put the mask first and then you take care of the other. So if we are not checking in our mental health ourselves, most of the time, that's something that will affect the patient, because I can tell you by experience, and this is not accurate statistically, only my statistic, like 80% of people that we look at in acute care and ICU, they do have mental health issues, borderline or non-diagnosis. So if we are not in a right space ourselves, it's very hard to overcome and to treat those patients properly.

Host: That's a great analogy. The airplane analogy, put the mask on first.

Yarisbell Collazo: Exactly.

Host: Your tendency is "I'm going to put the mask on somebody else." But if you get sick or fall over, that person also is going to suffer the same fate. So, really important.

Yarisbell Collazo: Historically, as healthcare providers, we always put other people first.

Host: Yes.

Yarisbell Collazo: Now, it's been taught, you know...

Host: That's why you become nurses. You want to help people, that's it.

Yarisbell Collazo: Exactly. But we are in an era right now that we have to make a change. We have to have a space for ourselves.

Host: Yes. So important. It's so important that people like you are bringing this to our attention. So, let's talk about this new approach to a healthy work environment. How are you addressing this issue?

Yarisbell Collazo: So, I am a nurse leader and I have an amazing team. So if they hear this podcast, I love you guys. And something that I realize is even post pandemic, during pandemic, and pre-pandemic is the work is getting harder. Nothing is getting easier, technology wise, everything I mentioned before.

Host: Well, the nursing shortage. That doesn't help.

Yarisbell Collazo: So, what can we do and what do we have to kind of help that aspect of nursing? So, I started noticing, you know, the staff needed an outlet to talk. And it is not like we have different resources like counseling, you know, many institutions have those benefits. But it was having someone next to you that you trust to be that person. So, what I did is, you know, we got some nurses that volunteered to take a course related to crisis management and they identify when there's some issues, depression, anxiety, so they can help others that are their peers.

So, put it this way, it is like Amanda and I were super friends at work and we get coffee every day, but Amanda is the person that I normally talk to. But now, Amanda has other skills developed that is going to help me even better to overcome this, not only from the friend standpoint, but also from a professional standpoint.

So, I got nurses that volunteered. They got the tools and the professional development and then they helped the other peers, and we started that program.

Host: So, kind of staff engagement sort of. You're using nurses to help other nurses, kind of a program like that. Somebody to talk to, somebody to share your stories with or frustrations with that type of a plan or program where people feel like they're not in it alone.

Yarisbell Collazo: Yes. And then, you identify those resources. So, for example, we took pictures and we talk about it. And these nurses in particular had a newsletter talking about the mental health subject of the month. So, a lot of people get sad during Christmas, and Christmas is a happy time for a lot. But you'd be surprised, some others are, you know, sad. And as nurses, we got to work every day. So, maybe this year, you work Christmas and we have to do it because this is our calling as a nurse. But that doesn't take out the equation that we're human, that we're sad, that we want to be with our family. So, having someone there that can listen to those concerns and can provide support beyond just a friendly peer was very helpful.

Host: Yeah. And do you organize this through any, like, monthly check-ins so there's kind of a schedule or assignments or...

Yarisbell Collazo: So, the first thing that the nurses said they went through the first aid crisis course, they got the knowledge, they got the certification. And they create monthly check-in with the subjects. Like, for example, this month is March and everybody know the taxes are in the moment. So, it is abundance. So, one of my mental health resource nurses created a whole newsletter topic about abundance, about saving strategies and taxes and how to work on that. And we look community resources and talk to the staff. They can always reach them, you know, these identified nurses, these mental health resource nurses, and go in depth in that subject, in other subjects. But it's something that we start a subject every month. And then, from there, we have conversations and the talking and that anxiety decrease.

Host: So, these are topics that can be outside of the workplace?

Yarisbell Collazo: Oh, yeah.

Host: Like at home, you might be dealing with the stress of taxes. So, we're going to help you with that. We're going to try to alleviate that stress, even though it's not an in-the-hospital situation, it's a life situation.

Yarisbell Collazo: Correct. But I'll give you an example. It's like we are looking into nurses do a lot of overtime. And overtime, what is it going to do? Increase burnout. So, the financial status of people are very individual. But collectively, as an nation, everybody knows like we are having a hardship. You do overtime, you get more money, but you get more stressed out, more burned out. So, that will contribute to your anxiety, depression, other things. So, we talk about this subject, you know, they come up with ideas of, "Oh, let's try strategies to save money to invest in this. Let's talk about this subject that, at the very end, yes, it's outside of work, but it does affect work. Because if you don't hear it, if you don't talk about it, or if you're not even interested, you will never even know that's an issue.

Host: Yeah. So for someone listening to this podcast and they're saying, I love what Bell is saying, how do I get started myself? How did you put this plan into place. Did you do surveys? Did you build a committee? How do you map all this out? So for someone listening, how do they get started?

Yarisbell Collazo: So, one, as a leader, we have to find those informal leaders on your team. So, those people that are volunteering, those are the ones that the other ones follow.

Host: So, you kind of know who they are.

Yarisbell Collazo: Right. So, those informal leaders worked with me when I went to them and said, "Hey, I'm noticing this," the engagement of the team, you know, I see the morale, I feel something, like, "What can we do?" Those are your key people because they're going to bring others. Those are the ones that you're like, "Okay, let's empower you to empower the rest."

We did a survey, so we kind of measure statistically, because we want to prove senior leadership that this is something that we need and we want. We got a statistic before and after. How do they feel? It's a self-reported survey of anxiety, mental health, how adequate they are. How would they like to have a concept like this next to them. And then, once we started the project, we measure eight months later, and then we have post data.

Host: Okay.

Yarisbell Collazo: So, 85% of the nurses actually said that improved their mental health well-being, having these conversations every month.

Host: Wow. That's amazing. Well, thank you for sharing that. So, identify your leaders first. Then, ask the right questions, and then put plans in place to address those. And your program of talking and having support and check-ins and meetings really has been beneficial.

Yarisbell Collazo: Innovative. Right. And creative. It's like find your resources. So, different hospital systems can have different resources. I don't know, Partner it up with a psychologist, with the social worker and just empower your nurses.

Host: Yeah. Okay. So, tell us about the results. So, you've got this plan in place, this program. What has happened?

Yarisbell Collazo: So right now, we've been doing it for two years, and it is standing. So, I added two more. So, we have now a total of six mental health resource nurses. And like I said, every month, they continue discussing this. We continue having great outcomes, great engagement. That also can be measured by Press Ganey Engagement Surveys. And we also continue doing kind of like a post-survey from time to time. And it is ongoing for us. It's part of our culture at this point.

Host: So, I like how you call them mental health resource nurses. So, that's your team that you've tasked with executing this program.

Yarisbell Collazo: Correct.

Host: So throughout this, did you find anything unusual-- I mean, not unusual-- or any unanticipated benefits or something like, "Wow, I didn't know I'd learned this."

Yarisbell Collazo: So, I didn't anticipate that a lot of people were interested, so people were floating to the unit and then they will see all these newsletters and the posters. And they will say, "Hey, are you a mental health resource?" And my nurses will be, "Yes. Do you need help in anything? This is what we are discussing this month. But I'm able to help in here." We have magazines in the break room related to Breathe, this is one of the magazines, and different exercises. So then, they start the voice out like, "Hey, we don't have something like this?" So, we do have data because we like evidence-based practice, but I never thought it would be something that a lot of people will like to have.

Host: Yeah. Yeah. So, I think this speaks to everybody wants to work in a healthy work environment and be seen and heard and recognized and supported. And if you have people around you that are actively trying to do that for you, that makes a huge difference. And it sounds like with your mental health resource nurse leaders, the newsletter, the programs, the check-ins, they feel that. Would that be right?

Yarisbell Collazo: Yes. I think that's the key. They feel that we take care, they feel like in a safe environment so they can share how they feel regardless it is a patient situation or themselves. And knowing that we will accept everybody who they are, you know? So, they have that open kind of like floor where they can talk. So, it's been great and a lot of people like it. And I get a lot of attention of actually recruitment, because then the new nurses coming out of school are like, "Hey, I heard this program started here." And I'm very interested because I can see myself doing something like that in the future.

Host: Right. That is really important. And I bet that also helps with nurse retention too.

Yarisbell Collazo: It does help with nurse retention as well. Yeah.

Host: Absolutely. Well, Bell, this has really been fascinating.

Yarisbell Collazo: Thank you.

Host: Thank you so much for your time. Anything else you want to add?

Yarisbell Collazo: I just want to say to nurse leaders, we are great also taking care of people, but this applies ourselves as well. I learned a lot from my nurses. And in the development of this project, I had to do some self check-ins as well. And I noticed that the anxiety and burnout doesn't only apply to caregivers, it applies to leaders as well. So, they have helped me as much as I have helped them. And it's an ongoing thing. It's like you have to work on yourself to be able to work with the team. So, definitely, it started like, "Oh, let me help my staff," but at the end, it helped me as well to grow as a nurse leader. So, my advice is don't be afraid, be innovative. And just make sure that if we are the captain and we are not taking care of our ourselves, we are not going to direct a good ship. So, let's just do it.

Host: When you said you have to work on yourself to help others.

Yarisbell Collazo: Yes, you do.

Host: Yeah. That's really, really well said. Well, Bell, thank you so much for stopping by today. We appreciate it.

Yarisbell Collazo: Thank you for having me.

Host: Of course, of course. Are you kidding me? Thank you again. Once again, that is Bell Collazo, her real name, Yarisbell, but she said I could call her Bell and I'm honored by that. For more information, please visit aonl.org. And if you found this podcast helpful and how could you not? Bell is so good. Come on. 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.

Yarisbell Collazo: Thank you.