Trisha Williams (Host 1): Hi, guys. Welcome to the Advanced Practice Perspectives. I'm Trisha Williams.

Tobie O'Brien (Host 2): And I'm Tobie O'Brien. This is a podcast created by advanced practice providers for advanced practice providers. Our goal is to provide you with education and inspiration. We will be chatting with pediatric experts on timely key topics and giving you an inside look of the various advanced practice role at Children's Mercy.

Host 1: We are so glad that you're joining us. Before we introduce our guest, we wanted to share with you a very exciting opportunity. We are finally offering nursing contact hours. Participants who meet the successful completion requirements will receive 0.5 nursing contact hours. To receive the contact hours, you must listen to the entire podcast episode and complete the evaluation associated with the episode. You can visit childrensmercy.org/appeval. That's childrensmercy.org/A-P-P-E-V-A-L. Children's Mercy Kansas City is approved as a provider for nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Now that we have the housekeeping tasks out of the way, it's time to sit back, tune in, and get started. Today, we are pleased to have Kristin Ray. She is a nursing director for the Center of Wellbeing at Children's Mercy Kansas City. Welcome to the podcast, Kristin.

Kristin Ray: Thank you so much.

Host 1: We are super excited to have you share your expertise with us today. Can you please tell us a little bit about yourself before we get started?

Kristin Ray: Absolutely. So, I have been very fortunate to spend my entire nursing career here at Children's Mercy. I started as a new grad nurse here on a Med-Surg unit, 6 Henson about 18 years ago and worked through many nursing roles from staff nurse to charge nurse, even went on to be a unit educator, and then really found my passion in nursing leadership. So, I spent almost a decade in nursing leadership in Perioperative Services where I oversaw a few different areas in that department, and then went on to really find my place in the Center for Wellbeing about two years ago. Super passionate about the work we're doing to address workforce wellbeing in healthcare. As we now know, it is just plagued with burnout, compassion fatigue, moral distress, and so many more challenges than there are solutions lately. And so, I have a great team where we're really working to address short-term solutions and also long-term solutions to help reinvigorate the nursing workforce and, you know, also call out the fact that it's okay to not be okay and how can we build programs and resources to help employees find joy in what they do, to help nurses, nurse practitioners, and providers really reconnect to their purpose and their passion for the work.

Host 2: Well, we are so excited to have you on to talk about all of that, Kristin. We love doing this podcast and one of our passions is just trying to make sure people are loving what they do. And so, we thought this would be a great way to kick off our fifth season. So, let's start off by having you define what burnout is for us just to make sure we're all on the same page.

Kristin Ray: Yes. So, that's a great question because, I mean, many of us carry our own thoughts and personal definitions of what we think burnout is, but it's really important to level set. So, I'll use the US Surgeon General's recent publication in 2022. There was a document called Building a Thriving Workforce to Address Healthcare Worker Burnout. And they use that definition for burnout as an occupational condition characterized by a high degree of emotional exhaustion, depersonalization, which is also known as cynicism, and reduced feelings of self-efficacy or personal accomplishment. So really, a combination of a few things and everyone will have their own different burnout profile, and what speaks to them most within that definition.

I think it's also important to note that if we're talking about burnout as a definition, a lot of times it gets interchanged with stress. And people think, well, if they're stressed, they're burned out. And I think it's important to note that stress in a work environment is natural and expected. And it will peak and valley at different times and in different environments, but burnout happens when chronic stress is not managed or it's mismanaged over a long period of time, and there's no improvement or resolutions or meaningful interventions in place. So, burnout can be a long-term result of chronic stress, but having episodic feelings of being stressed doesn't necessarily indicate burnout.

Host 1: That's a really great description, Kristin, about the difference between stress and burnout. We all do experience stress, especially as providers within the healthcare force, just on our day to day decision-making and patient advocacy and things for that nature. And I like what you said about not being able to handle the stress could lead to burnout. So, what are the current statistics regarding provider burnout in the healthcare field?

Kristin Ray: So, there's a wide range of burnout statistics, and I'll go over a few high-level ones. National studies are indicating that 50% of providers are burned out, most specifically highest in fields like Emergency Medicine, Urology, Anesthesia, Surgery, and Internal Medicine.

The National Academy of Medicine reports ranges of 35% to 55% across nursing and physician providers since 2022. Some studies show that outpatient providers are actually reporting more emotional exhaustion than inpatient providers, surely based on volume and how quickly they are turning over patients and providers in the area. More specific to nurse practitioners, 66% of nurse practitioners are reporting exhaustion, with key contributing factors being feelings of overwhelm and difficulty sleeping.

Now, let's talk about these key drivers for a second, because as people are reporting feelings of burnout in these surveys, it's because of a variety of reasons. So, let's talk about the long hours. When we talk about staffing challenges, we are all feeling that in healthcare, and it's not a Children's Mercy issue, it's not a regional issue, it's a national and worldwide issue, right? So, we look at those staffing challenges really plaguing burnout. We look at the acuity. Patients are getting sicker. Patients are sicker now than they were 10 years ago, and the level of care they're needing has increased, okay? There's a big focus across the country on high productivity goals, and we continue to struggle as healthcare providers with work-life integration. If anybody's found the secret to that, please let us know, right? But it's contributing to burnout.

We can talk about technology. We can talk about the electronic health record. As many great things as there are associated with having an electronic health record, there are certainly barriers to getting our work done in a reasonable amount of time and how much duplication efforts there is when we're charting. So, we look at factors in the work environment, but really focusing on these drivers of burnout being workforce shortages, practice autonomy and things associated with that.

Host 1: When you talk about those things, I often wonder too, you had mentioned technology and with that, I think about social media and surveys that come from parents and I place a great value on my own practice regarding those surveys and regarding the feedback on social media and things to that nature. Do you feel like you can either give a professional or a personal opinion about-- do you feel that that also leads to stress, emotional fatigue, those types of things for providers?

Kristin Ray: Personal opinion, absolutely. We as a healthcare workforce have a tendency to be extremely critical of our own efforts and meticulous and the attention to detail and the pressure we place on ourselves is often higher than others are placing on us or than our organization is placing on us. So, when we look for those surveys and we look for the validation that we're giving patients and families what we need, it absolutely has the impact to raise our stress levels, to make us more anxious in the process of doing good work and what defines that good work. And sometimes we find ourselves chasing a ghost.

Host 1: Yeah, exactly right. Do you feel like burnout is higher now since the pandemic of COVID-19? Or do you feel like it was present way before and then this just kind of built upon each other?

Kristin Ray: Yeah. So, definitely both. I think it's higher now, but it was absolutely in existence long before the COVID-19 pandemic. The statistics I found around that is burnout has increased in specifically the APRN role from the 38.5% pre-pandemic in 2019 to 54% in 2022, which is just a couple years ago. So, some people, especially younger generations in the workforce, think that burnout's this new phenomenon, it's post-COVID, they burned us to the ground, we're overworked, and we're trying to recuperate from the pandemic and sink into this new normal, but that's in fact not true. The fact of the matter, it was always there. And now, it's just been brought to a larger scale on the surface. And so, the seeds were always there, but the pandemic really served as an accelerant, which brought it right up to the surface and ready to boil over.

There was a great article in Harvard Business Review that spoke to this, and I'll quote an excerpt from that article that says, "The healthcare industry has a long-standing problem with burnout that's been encoded in the culture of what we do, and for a myriad of reasons, including excessive workload, stigma, posttraumatic stress, and learned helplessness, we see a major threat that has only gotten worse from the pandemic.

Host 2: So as you mentioned, there are so many things that can seem to increase burnout, or make it worse. Like you said, technology or the amount of patients that are needing to be seen and such. And that seems to have also accelerated. I wonder if that's getting even higher as post-COVID.

Kristin Ray: I think if we look at technology, I mean, again, it can be a blessing and a curse. There are so many good things with the growth we've seen with technology, whether it's EHR-related or not. A real big benefit that's coming out of the COVID pandemic is some of the virtual nursing work and virtual provider opportunities that are existing in today's day and age, that wasn't a thing 10 years ago.

But on the flip side of that, you know, as we start to get into the AI world and we look at the implications of advancing in technology, we have to be very aware as to the impact it's going to have on us as providers and how we can continue to stay connected to what we do and enjoy what we do.

Host 2: Absolutely. So, there's obvious signs of burnout that we see. Maybe we feel not excited about work or maybe we don't feel connected to our purpose anymore. So, there's those obvious signs of burnout that I think we all have been able to notice, but are there some more subtle signs that you've seen or that you've had people share with you that you think are worth noting?

Kristin Ray: So again, if we look back at that definition and we consider kind of the big three components that make that up, we talk about disengagement with cynicism, we talk about feelings of decreased value and self-efficacy, and we talk about that emotional exhaustion. So, what that looks like is different for different individuals. Some people have routine and swirling negative thoughts. Now, some people share those negative thoughts or the cynical remarks. Some people keep them inside. But if you're telling them to yourself, every time you're getting ready to start a shift, that's impactful. Some people have that unproductive venting tendencies. And when you start seeing burnout in an employee, they're routinely in the break room, swirling on different things that they want to complain about, and they want to say everything that's wrong with their job and get it out. For other people, it's a little more subtle. It's just some self-doubt. It's maybe a little bit lower self-worth. And again, in episodes of that, you know, that's maybe to be expected. But over time and continually feeling those feelings is something to definitely watch out for.

Host 2: So, there's so many things that we won't be able to control with our jobs that are going to be happening and like nothing's going to change that we get to control. So, we can control the things within ourselves. So, what do you think are great strategies to remedy some of the burnout that we may be having?

Kristin Ray: Yeah. So, I think there's obviously a lot of things that we can talk about that burnout doesn't have to be all gloom and doom. There are actually things we can do personally to help improve our situation. Many people want to talk about how, "Okay, I'm burned out, I'm burned out, I'm burned out," and I'm waiting for my place of work to lift me out of it. And I'm here to say that it takes both sides of that puzzle. It takes the individual side, and it also will take organizational level solutions to help this burnout issue that we're facing.

So, let's talk about some of those individual practices. With burnout, early detection and intervention is linked with best outcomes. So, consider building these wellness and resiliency tactics into your daily life.

And please know when I talk about resiliency, because I know that that's a word that some people love to hate, I'm not talking about pushing through. I'm not talking about resiliency equaling through just getting through the rough times. I'm actually talking about healthy stress coping abilities, okay? So, these tactics and approaches can really help boost you out of a burnout path. So, let's talk about mindfulness practices, okay? This is evidence-based and grounded in research. The outcomes speak for themselves, but practicing mindfulness allows for a reset and reframe of our minds. It's about focusing on the present, the here and now, versus thinking about the past. What happened yesterday? What happened all last week? Oh my God, we had all these issues in clinic last week. No, no, no, no. Mindfulness is about being present. It's also not thinking about the future. Well, what if the organization does this? What if I can't figure out this with my block time and my schedule? And what if I can't do this? And what if, what if, what if, okay? And what we talk a lot in the Center for Wellbeing is if we can focus on the present, we can be much more effective and connected to the work we need to do right now. And not getting lost in the what happened and the what ifs, okay? It's about creating that space of calmness and peace in the moment so we can function as our best self.

Host 1: I had a person tell me once because I would, I was in a path of spiral myself, heading towards burnout. And I had received some coaching through that situation. And I had a really hard time grounding myself and pulling myself out of that kind of downward spiral. And so, the thing that she had taught me is I needed something tactile to grasp to. So, she told me to rub my fingers together so hard until I could feel basically my fingerprints rubbing against each other until I was at a space where I could feel like I could bring myself back to my body. And that really helped me. Like I needed something tactile to hold on to, to bring me back to the moment and to that mindful space. And so, I thought that that was really helpful.

Kristin Ray: Yeah. I mean, sometimes people get, and what I've even heard from my work in the center, is people get a little intimidated by mindfulness, or they associate it with meditation and some practice where you need to sit cross legged on the ground in this perfectly silent environment, and somehow, you know, all the stress is lifted. And that has certainly not been my experience. But this can look different for a lot of different people. And I would really encourage people to think outside the box with this kind of thing. So, don't be afraid to explore practices that are different than what you've been accustomed to in the past.

Host 1: What's your favorite, Kristin?

Kristin Ray: Mine is definitely when I'm driving in the car. Because I am alone at that time, usually, like, I'm either at work with other people or with my kids at home. But if I'm driving in the car, even if I have music on in the background, I can intentionally tell myself, "Okay. Don't think about all the what ifs of what I'm going to get into when, like, let's say I'm on my way home, and I start thinking, "Oh my gosh, what if Allie has issues with her math homework? And what if I can't get Evan to his soccer practice in time? And what if I can't do this? What if, what if, what if?" And then, I have trained my brain to then stop those automatic thoughts and tell myself, "Okay. If I ask myself all those what-ifs, the next what-if I have to ask is what if it all works out?" And I have to answer it. And that will quickly halt some of those spinning thoughts that a lot of people have, and it's a practice that I found at least very effective for me, because I could give you 35 what ifs because that's just who I am. I'd like to say that I majored in Nursing, but I also major in worrying, and if there was a master's degree, I would have it. So, what if it all works out is my favorite mindfulness practice question.

Host 1: I love it.

Host 2: Yeah, I love that. Okay. I have a thought. So, there are so many of us listening that we want to try to be in the moment. But within our work, because of the technology, there's constantly things dinging at us that need our attention. We're trying to stay focused at the task at hand, but then there's like all this input constantly. And I think for me, that's challenging to stay present, but also putting out fires that are constantly coming at you. So, I don't know if you have any thoughts or suggestions around that.

Kristin Ray: So I'm going to talk about routine because I talked a lot of it about being preventative. We can't wait to the point where we're like, "Shoot, we've got too much going on, and I can't find a way to take care of ourselves."

So, I do want to highlight the importance of a self-care routine. And I know that there's probably listeners out there right now that want to give me an instant eye roll when I say the word self-care, and I'm totally fine with that. But what I hope to achieve today in this podcast is I want to give you a little bit of a different look. I'm not talking about, okay, run out and get a massage once a week and go get your manicure and then your self-care is done. I'm not talking about that. So, it's important, it's actually vital to prioritize your own well-being so that we can take great care of these kids and families, but it's not only spa days, yoga sessions, and those kind of luxury self-cares. It's really about healthy boundaries. It's about taking care of your mind and your body, not just at work, okay? Not just on your walk-in or not just when you get home at the end of the day. It's also self-care is about surrounding yourself with good company. The people that build you up, not the people that swirl and want to take you down, right? The people that boost your spirits, that don't drown you with negative and toxic thoughts and feelings. Sometimes a self-care routine is about taking those three deep breaths before you're ready to walk into a room or have a really tough conversation, and that can help you instantly get back into that present moment.

So, I would challenge everyone to take a look at self-care a little bit different with a higher level light, and it can be done in such small doses. It doesn't have to be like, "Okay, I've got that week-long vacation to the beach next month, and I'm hanging on to that self-care plan." No, that's not a self-care plan. Small intentional practices, boundary setting, healthy thoughts, taking care of your body, okay? All that stuff makes it so we can function in our role at our optimal self.

The other thing that's important to note is we have to be willing to increase our reflective and self-awareness practices, okay? We need to be able, as healthcare providers, to accurately and with full vulnerability know where we are and what we need, okay? So, I would encourage people to, at times, take a personal inventory, okay? What am I seeing in myself? What are my trusted colleagues seeing in me? How am I showing up at work? Am I proud of the way I'm showing up? Am I like, "Dang, I wouldn't want me taking care of me today"? Or am I masking it and hiding it from someone? Should I find a coach, a mentor, or a counselor to talk through some of these things,

and I'll close with one more thing that I think is super important that is something that even me in the Center for Well-being and as the Nursing Director continues to struggle with, but again, something I'm committed to working on. And we touched on this a little bit earlier, but again, as healthcare employees, we have a tendency to be super hard on ourselves. And a big well-being practice that often gets left on the side is how do we show ourselves self-compassion? Because if we do that, it creates a culture of well-being for not only ourself but our teams, it creates a culture of belonging, it creates a culture of connection. And maybe you take that self-compassion, and then you use it to recognize and share it with a co-worker, or you practice daily gratitude. Great things are happening around our hospital and hospitals all over the country, but sometimes they're getting lost because people are so internally focused on everything that's wrong. And if we take that self-compassion, we practice some recognition, we practice some gratitude, and we give ourselves grace and credit for the great work that's being done, we can really shift the script on burnout.

Host 1: Yeah, I completely agree. I think I look at it as, I suffer from a big case of imposter syndrome. Like, "Oh, I can't be good enough to do that," "Oh, did I really do that?" "Oh, no, maybe I didn't do that." You know, and I have had some big accomplishments in my career, and I still suffer from imposter syndrome. And so, I try to lead my mind with saying, "If I would not say that to my adult, young baby, adult daughter, or to my best friend, I'm not going to say it to myself." So, I try really hard to practice that, but that imposter syndrome is sitting on my left shoulder pretty strongly. So, sometimes I have to remember just to flick him off. But then, they come back, but I keep flicking.

Kristin Ray: Keep doing it.

Host 2: I agree, Trisha. I think too, it's just like you mentioned, Kristin, so many times we focus on those minute negatives that there's so many awesome positive things happening. We're doing so many things right, but we get one teeny tiny thing wrong, and it's like a loop constantly. And it's like how to figure out how to say, "I have many people that would say let it go. And like, Trisha, you taught me to have a dumping point. So like on my way home, I have a spot where I just try to say, "I'm going to let all that go." And I'm going to get home and be present with my kids. I mean, we had a lot of things go really well today, this didn't, but I'm going to try to let it go because I can't do anything about it now and, you know, I just need to move on, and that's hard, but it's definitely practicing it.

Host 1: it's a game changer. And I love the work that our Center for Wellbeing is doing. Because 25 years ago, or when I started back at Mercy in 1999, I'm dating myself, but 1999, right? Hey! We didn't look at it, you know, at that way. It was, you did your work, you got over it. You came back to work the next day, you got over it. You maybe went out and had a Happy Hour with colleagues. Got up the next day, did it again. And so, I love the recognition that it's all coming to light and really looking into how we can take care of ourselves so we can give our best selves to our patients and our families. And that's what it's really all about, right? Like I want to show up the best I am and the best that I can be for my patients and my families, and then show up back at home for my family, the best that I can. And now, that's all anybody really wants. And people say it's work-life balance. I like to say life-work, because I have my life first and work is part of my life. So, that's kind of how I like to look at it.

Kristin Ray: Absolutely

Host 1: Yeah. Kristin, we talked about a lot of things to kind of incorporate within ourselves, right? Do you have any innovative ideas regarding supporting each other? Like, if Tobie shows up to work one day and I think that she's spiraling out of control, normally, I just kind of give her the old, "What for, Tobie? Don't say that." But what can we do, you know, in an innovative way to help support our colleagues, you know, somebody who that I can see as kind of spiraling out of control, what are some things that we can do?

Kristin Ray: Yeah. So, I think that's important to talk about, because we can talk about personalized resilience all day long and very individualized approaches that are isolated to us, but there are also some things we can do as teams. And I have a couple that I'd love to share, and the first one centers around well-being improvement. If you look at the Institute of healthcare Improvement and several publications out there, there is a major system opportunity that we have to fix some of the barriers we face in our daily practice. And you'll see these barriers called pebbles in your shoes. It's just these nagging things that get in the way of us having really good, productive, smooth days, or really finding joy in what we do. And so, taking a look as a team at saying, you might come in and say all right, "Hey, what's getting in the way of having a great day? Or what does great look like?" And you start to identify, you know, I wish we didn't have to fill out this form every time we see this patient, because this is very similar to the form that someone else is filling out because of this. And then, one gets transferred into the record and one doesn't. I could go on and on. But why don't we take a look at some of those processes that are like, do we need to do this? Or is this an administrative burden that's not adding value to the patient or to our processes? And so, if over time we can help reduce some of these system barriers and process barriers that aren't necessarily necessary, then all of a sudden our job engagement is improved. Our team satisfaction is improved. People aren't as annoyed with these little things being like, "Man, by removing that step, that saved me 10 minutes. That's 10 minutes I get back at the bedside," or "That's 10 minutes I get back to get my charting done so I'm not leaving late," okay? So, a lot of these well-being improvements might be quality improvements, but that have a well-being outcome improvement associated with it. If we can decrease cognitive load, if we can decrease that administrative burden and it allows us to practice at the top of our scope, that's what people want to do.

So, I would implore people to practice some mini PDSA cycles. "Hey, this thing doesn't seem to fit in our daily process of this." if we took that out or if we changed it, how can we make it better? And then, look at what that outcome is. If it boosts your team morale, great, keep it. If it doesn't, retry something else. It's a continual process that can pay huge dividends in boosting well-being and decreasing burnout.

The other thing we really could do is improving, like you mentioned, our collegiality at work. And that can be done in a couple ways, because so many people that work in healthcare are team people. They not only want to thrive themselves, but they want their teammates to thrive, okay? They love the connection. And so if you want to improve this, there is some great research around commensality groups. And Stanford is really a leader in this space, but these groups are an evidence-based innovation that increases the sense of connection among providers and builds camaraderie and meaning in work. And by providing protected time to do some of these group meetings and maybe group meals, you can have a small discussion You know, share some food, get in there, build that connection, talk about well-being, and link it back to empowerment and engagement in work, and then that can help reduce some of the distress that we feel. So, those commensality groups are a great way to do it.

And the other thing to consider is peer support. And there's a lot of peer support programs at various organizations and we're working on a current pilot group here at Children's Mercy. But peer support is a type of support that involves connecting people with similar experiences to acknowledge the hard work we're doing and the emotional toll it can take. So with those similar experiences, peers can help each other from having knowledge sharing and providing that emotional support and offering practical help, okay? That can look a lot of different ways, including peer mentoring, reflective listening, but it's something that we're deeply committed to here at Children's Mercy to make sure we can establish, you know, a variety of forms of support.

Host 1: I love that. At Children's Mercy, I know that we have a lot of those things in place. And I was taking notes as you were talking, because we have our STP processes in place that something bothers you. Those are the pebbles that we can fix and put an STP in place. For our APP groups, we have happy hours, you know, on a quarterly basis attend those happy hours, attend those things with our APP leaderships and talk to them on a non-stressful manner, kind of in a fun environment, go to conferences, have lunch, involve yourself in the peer mentor program. There's so many things that are available to us that we need to be able to take advantage of these. And I'm sure, if you are one of our wonderful listeners that are outside of our Children's Mercy Network, look into your own institution. Look and see what they have available, and really get involved with those things in your institution, because I'm a firm believer of what Kristin said, it really improves your well-being.

Kristin Ray: Well, and Trisha, as you mentioned, I mean, when you mention all those things, and many people, whether you're inside Children's Mercy or external, those are the first things to go when things get tight. It's like, "Well, I know I could go to that conference, and I know I could submit an abstract to this, but I'm just not going to because I'm too busy," and "I know this happy hours coming up with a networking group at my hospital. But, man, I'm just too busy and I'm too tired." And so, there is a mixture of setting healthy boundaries with that, but there's also consideration to, okay, what can I put effort into that will feed my purpose, that will feed my joy in work and my engagement that will help me reconnect so that I find joy in what I do, and that I find joy in the teammates I'm around. And how do I get to know the new employees better? And so, I think there are ways to find a healthy balance, but the answer to just getting rid of those first to free up time or space in our day isn't maybe necessarily the answer.

Host 1: Maybe that's the self-care that you need

Kristin Ray: Maybe

Host 1: up something else, you know.

Kristin Ray: Maybe so, Trisha. Maybe so.

Host 1: I know it's all like self-care boundaries, get involved. And then, you know, on top of it, most of our advanced practice people, we're all type A personalities and we want perfection in every aspect of our lives. And it really is just taking a moment, centering yourself and really looking at what's important. So, you've given a lot of grateful information today, Kristin. Thank you for that.

Host 2: Absolutely. Well, Kristin, we really appreciate everything that you shared with us today. You are quite an expert in this and, I mean, we could talk a lot longer. But one final thing we always like to do, we end each season with a different question. So for season five, we are going to ask you this question, and it actually relates to this whole topic of kind of well-being. So, we want to know for you, like, what is filling your cup right now in this season of your life?

Kristin Ray: That's a great question. A couple things. What's filling my cup? Personally, is the age of my kids right now, they are 13 and 11. And while I have enjoyed every phase of their life and what ages they've been, as they grow up, this is a really exciting time. And actually, what I find so much satisfaction, is going to their different activities, sporting events, concerts. And as their mind grows and they continue to develop into these tweens, I guess you call them, they're so impressionable and I love seeing them work towards things and it paying off. I am a huge sports fanatic, so watching them do competitive sports and helping them grow is really, really filling my cup.

What also fills my cup is the Kansas City Chiefs. And that's right, I am a massive fan. My family has had season tickets for a long time, and I liked them when they were horrible and I love them when they're awesome.

Besides those, personally, professionally, I love my team. I love the work that we're doing. I love that the organization supports the mission of this work, because it can't be an afterthought anymore. Well-being at work is not going to fix itself, and I am very honored to work for a place that sees the value in that and is willing to support our programs and resources to help move us forward.

Host 1: I love all of those cup fillers. That's amazing. Thank you. I have two kids myself and I love every part of their lives. And I call them baby adults now. So, they're almost 20 and 18. So, it just gets better. They'll keep filling your cups regardless of their age. So, but you know, Kristin, we really appreciate your time today and thank you so much for joining us on our podcast.

Kristin Ray: Thanks for having me.

Host 2: Thanks, Kristin. If you have a topic that you would like to hear about or you are interested in being a guest, you can email us at tdobrian@cmh.edu or twilliams@cmh.edu. As a reminder, to complete your evaluation and ensure that you get the credit for listening, visit childrensmercy.org/appeval. That's childrensmercy.org/appeval. Once again, thanks so much for listening to the Advanced Practice Perspectives podcast.