Transcription:
Professional Well-being: A Crucial Topic for APPs

Trisha Williams (Host): Hi guys. Welcome to the Advanced Practice Perspectives. I'm Trisha Williams.

Tobie O'Brien (Host): And I'm Tobie O'Brien. This is a podcast created by Advanced Practice Providers for Advanced Practice Providers. We will be highlighting our amazing APPs here at Children's Mercy and do some education along the way.

Trisha: Today, we are stepping out of our norm and we're taking a different direction with our podcast. It's a very special episode that we are so excited to bring to you. So sit back, tune in and let's get started.

Tobie: As healthcare providers, we tend to forego our own wellbeing for our patients. Now we do this really willingly because we love our work, but if we aren't careful and take care of ourselves, we may not love our work as much. So, today, as Trisha mentioned, this is special, because we are interviewing Dr. Bickel, from the Center for Professional Wellbeing. We are going to get some insight on taking care of ourselves as well as really understanding what professional wellbeing means.

Dr. Bickel serves as the Medical Director for Professional Wellbeing at Children's Mercy Hospital in Kansas City. Dr. Bickel is also nationally recognized for her work in headache medicine, leadership development, professional wellbeing, and patient advocacy. She is a leader in the American Academy of Neurology, where she serves in many roles, including Chair of the Wellness Subcommittee, as an Editorial Board member for Neurology Today and as the Physician Liaison for the Transforming Leadership Program.

Trisha: Dr. Bickel, welcome to the Advanced Practice Perspectives podcast. Thank you so much for joining us today. And I have to give you also another shout out for thank you for being a huge advocate for Tobie and I, when we started out on our adventure with this podcast, you were one of our huge supporters. So, we truly appreciate that. And we're so excited to have you on today.

Jennifer Bickel, MD, FAAN FAHS (Guest): Nope. Thank you. I love how it all comes full circle. It's my pleasure to be here.

Tobie: Tell our listeners, which are mostly APPs, but could you tell them a little bit about your background?

Dr. Bickel: Sure. I am a Neurologist. It's actually kind of funny. I'm an Adult Neurologist, but I've worked at Children's Mercy gosh, since 2006 full-time, since 2010, building the Headache Program there in which APPs were crucial part of it. So, I've been working side by side with APPs since 2010 and really building a comprehensive headache program. And then a couple of years ago, I moved into the role as Medical Director for the Center for Professional Wellbeing, which is really all about how can we improve the system and improve the support for our people to be able to take better our care of our patients. And I'm also a mom of four boys. So, I like to stay busy.

Trisha: I know you like to stay busy. I bet just with those four boys, you stay busy. And then I know that you're involved in large amount of things within our institution. So, can you tell us a little bit about how you found yourself in your current role the Professional Wellbeing Center?

Dr. Bickel: Yeah. You know, it's really interesting because I certainly never saw that I would be going into hospital administration. Right? I cared so much about patient care. But really seeing through the years about how much our doctors, our nurses, our APPs, and beyond, really they give all they can to be able to take care of our patients and to have the opportunity to be able to improve the way it's done, was frankly almost like a calling for me. And it was really hard for me to go through the fact that I was decreasing my clinical time. I frankly shed plenty of tears over that, but I don't regret my decision whatsoever. Because I think about all the patients that I can help by helping the people who are taking care of them. And also me, frankly, too, I love new fields. I love the fact that this is not something that was really prioritized 20 years ago or even 10 years ago. But I think it's going to be as important as quality and safety in the coming years. And I'm happy to be on the, the edge of that.

Tobie: I know we all love what we do, but like you just said, I mean, we love what we do, but if we aren't careful, we can begin to not love what we do and then our patients suffer. So, thank you for kind of sacrificing what you love to do to help all of us be able to do what we do better by remembering how important it is to take care of ourselves as well. So, would you help us though define what professional wellbeing means to you?

Dr. Bickel: I mean, that's a great question. Right? And sometimes my family members still ask me what they're like now, what do you do again, Jen? So, I mean, it can be hard. So, professional wellbeing doesn't mean walking around happy all day long and never having any trouble. What it's really about is being able to find meaning in your work, removing those barriers, removing the administrative burden so that you can find more meaning in your work as well as our work brings with it very challenging situations that we have to face with our patients.

And how do we better recover from those challenging situations? How do we take care of ourselves? So, professional wellbeing is all ultimately about being able to connect with the meaning in our work and get that satisfaction and that deeper sense of purpose that we're all really wanting when we decided to go into this field in the first place.

Trisha: That's a very good definition. I love how you said in your prior statement that, you know, you had to step away from taking care of patients, but you actually found that by stepping away and taking care of the providers and making sure that we're meeting that professional wellbeing, how many patients you are actually helping and Dr. Bickel, it's huge because you're making us better and us more aware of professional fulfillment and things like that, to be able to better take care of our patients, and we have over, I think we're almost at a hundred or 450 Advanced Practice Providers within our institution now that we took on some anesthesia assistance and some CRNAs.

And so we have a huge group of Advanced Practice Providers. And so, when we think about that, what do you think that we're doing right to prevent burnout? Because that's a huge retention, right? So, like what are we doing right to prevent burnout and how can we improve it? And can you help shed some light on that?

Dr. Bickel: So, you know, one of the things is the fact that I think some of the things that we do really well is that we do have a lot of support services available either through the Center for Professional Wellbeing and our HR with the EAP has many ribose services. We also typically treat each other the right way. Right? The vast majority of people at Children's Mercy really do find purpose in their work. And they really do enjoy the teams that they work with. The other thing that we're doing is, I mean, you know, we may burn out the organizational metrics of it, that the highest level of the organization, it is up to or right up with patient experience, right up with stewardship.

It is up there in order to keep our people engaged and well. So, I think that those things are incredibly important. I think that from the APPs perspective that there are challenges in the fact that the APP role is relatively new, right? Speaking, you know, in very relative terms there. And I think that there's often a lot of confusion about what APPs can do, how they are best used, how they're best brought into the team, how they are best retained and how their skills are communicated to patients. And those are frequent points of dissatisfaction for those who are in the APP role, which is a unique and not the same as what you would see for maybe as much in physicians or nurses.

Trisha: You hit the nail on the head, I'm going, amen. That you're, you're so right. And I think that we're on the front lines of it all and but we're also, I think, on the forefront of a change, like of having referring physicians understand who we are, to having families understand how to utilize Advanced Practice Providers, but we have to establish that within our institution and before we can get it out into the community and we're doing a very good job of, with that. And we have a lot of great collaborating attendings and our collaboration of practice that really sheds light on that. So, thank you for pointing that out.

Dr. Bickel: Yeah, absolutely. I mean, at the heart of it, it's all the collaboration of practice, it's how we work together as a team to best serve the needs of our patients. And I think that team approach often gets mistaken when people are just so focused on their own individual roles and titles and et cetera. So yes.

Tobie: It sure does. I know probably most clinics and at least in the ambulatory setting, since COVID, we sort of don't get to work in our same teams that we always had. So, I know our section specifically is sort of missing that team aspect. So, I was sort of wondering as far as communication and team building and sort of sense of community and peer support, what do you think we could do within our you know, maybe even just our APP group, but even APP, you know, doctor, nurse sort of team. How do you think we can improve that to create better job satisfaction for all of those involved?

Dr. Bickel: You know, I think that's a great question. Right? So, loneliness was already an issue in healthcare workers, even before COVID hit right, because of so much time spending the computer working at different locations. And so it was already an issue. And so, now that those teams have been fractured in a lot more ways, one of the things that we have to do is actually become more intentional about adding back in social time, because in the past it occurred just by walking by each other in the halls, just by sitting in the same room. And so now we have to. So does that mean that if we end up having a meeting together that we intentionally use 10 minutes of it just to be able to check in and see how people are doing? You know, one of the things that we did at one of my meetings a couple months ago was everybody went around and shared one good thing that had happened to them that past week. And it really kind of gave, all the fields for the people in the room. So, we really have to intentionally build in that the fun, quite frankly.

Trisha: I'm making notes. I love it. I love fun.

Dr. Bickel: It is, and we underestimate it. We think the fun is just, you know, a little bit of the icing on the cake, but that's really what helps to get us through these very rough time, is the fun, the sense of belonging, the teamwork. And so when those pieces are there, our safety nets are more likely to fail us.

Tobie: When there is that comradery and team approach, it is amazing how much better patients get taken care of when you feel like you can communicate with people openly because you kind of already have that great rapport with them. I do think that really helps to take care of those kids the way we all want to take care of them.

Dr. Bickel: No. And you're absolutely right. So, if it's a perfect example about how who we are as people and who we are as teams is directly related to patient care. And the truth is, is that, you know, and what you're referring to is that sense of teamwork and that when we're able to say, hey, this might be a safety issue, or hey, something might be wrong. We have to have psychological safety. We have to have a culture of safety in order to be able to communicate effectively with each other and a foundation of safety is necessary for any wellbeing effort, honestly, a foundation of safety and a foundation of equity, diversity inclusion is crucial for any wellbeing efforts.

Trisha: Yeah, and it starts with open communication. So, I love it. It all comes full circle back to I mean, excellent patient care. It comes full circle with good teamwork and open communication. I know, I miss my physician colleagues, you know, we used to have clinics together and now we're independent and we see each other in the hall and we're like, we miss each other. It's like, hey and but we talk via email and text messages, but it's not that face to face contact. So, I'm ready to get back to that.

Dr. Bickel: Absolutely. You know, I think that over the past year, we've all realized that even those of us who are you know, kind of on the mix of an introvert and extrovert, but how much we really need each other just in little ways that we didn't quite understand before.

Trisha: Yeah, absolutely. Absolutely. You know, and I think a lot of people are practicing self-care, which kind of leads us into our next question about what do you do for self-care? What's your favorite self-care thing that you participate in? And if you have to do it yourself,

Dr. Bickel: Yeah. You know, it's interesting. I do like using apps on my phone, like Breathe and really just little meditations. During the workday, we have a yoga mat in my office and if the camera's not on, I'll try to get up and stretch for about five minutes every meeting at least so that I can move around. But honestly, probably one of the best things I do is I have a lot of different hobbies, but I love camping with the kids. We have a travel trailer and when we go camping many weekends a year. And so it's really nice just to be able to get away.

Trisha: I love that you find time for that. Yeah. And I think we could all stretch.

Dr. Bickel: Oh yeah. No, and that's the thing that, I mean, but my house is a mess and my yard doesn't look well. Right? So, I sacrifice other things in order to find time for that. That's for sure.

Trisha: Yeah. I tell people to outsource those things, right. You know, you can't get the time back with your kid. You can't get that five minutes of stretching in your office, but you can outsource, you know, the house cleaning and the yard and the car washing, you know, you can outsource that.

Tobie: Or you can ignore it, which is what I do.

Dr. Bickel: Right. I think that I find a fine balance of the two of those.

Tobie: Yeah. Yeah, for sure. Oh, well, thank you so much for your time. We would like to end this episode though, with a question for you. So, we ask each of our guests the same question, at least in this 2021 year. And we want to know for you too what advice would you give your younger self. So, picture yourself just one year after you finished your Fellowship in Neurology, what advice would you give your younger self that maybe we could all benefit from hearing?

Dr. Bickel: No, I really love that question. I really love it. And I love that you ask everybody that. What a great idea. I would like to tell myself to have trusted in my skills and my ability more. Right? To understand that I was able to contribute in ways that maybe the people around me were not even completely aware of. But that I had more to offer than I thought that I did. And so it's been really great over the years to develop that person, but I think that there was some unnecessary suffering with the imposter syndrome and all that kind of stuff that could've been better.

Tobie: Sure. And that's kind of been a theme, is grace for yourself, you know.

Trisha: I love that. That is, that's great. Great piece of advice, Dr. Bickel. We truly appreciate you joining us today and listeners, thank you so much for tuning into our very special episode. It's been a privilege to talk with Dr. Bickel. So, up next our episode will feature Stephanie Kronberg. She is an APRN in Dermatology and she'll be sharing her expertise with us.

Tobie: If you have a topic that you would like to hear more about, or you're even interested in being a guest, please email us at tdobrien@cmh.edu or triciatwilliams@cmh.edu. Once again, thanks so much to Dr. Bickel. And thanks for listening to the Advanced Practice Perspectives podcast.