Brennan Lewis (Host): Welcome to Nurses Connect, a podcast from Children's Health dedicated to exploring critical issues and dynamic topics that shape the nursing profession today. I'm Brennan Lewis, Senior Vice President of Nursing Excellence, Innovation, and Patient Experience.

Christi Welter (Host): And I'm Christi Welter, Program Manager of Nursing Communications.

We are your co-hosts for Nurses Connect, and we're so happy you've joined us today. On this episode, we're discussing the power of wellbeing and gratitude in nursing practice and practical strategies to gear up for the busy season, prioritize wellness, and recognize the invaluable contributions of nursing colleagues.

Brennan Lewis (Host): We have two guests today, our Program Director of Resilience, Dr. Elaine Beardsley, and our Program Director for Magnet and Nursing recognition, Alison Kell. Welcome to Nurses Connect Elaine and Alison.

Alison Kell, MSN, RN, CCRN, NPD-BC, NEA-BC: Thank you. We're happy to be here.

Elaine Beardsley, PhD, MN, ACCNS-P: Thank you. Such an honor to be here.

Christi Welter (Host): All right. Well, to get us started, can each of you tell us a little bit about your role?I know that you both kind of have unique positions here, so we'd love to hear more about what you do.

Alison Kell, MSN, RN, CCRN, NPD-BC, NEA-BC: Thanks, Christie. Yeah, so I, Alison am the Program Director for Magnet and Nursing Recognition here at Children's on our Dallas campus. And I've been in that role for about a year. But prior to that, for about two years, I was our Program Manager for nursing recognition, which is a really unique role to Children's Health in that I had never heard of an organization having a Program Manager for nursing recognition before coming here and was very excited to get to go on that journey. And it became really an intensive in really trying to understand the evidence behind meaningful recognition, building healthy work environments through gratitude. And it's been an opportunity that I've been very grateful to have.

Christi Welter (Host): Thank you.

Elaine Beardsley, PhD, MN, ACCNS-P: And my name's Elaine Beardsley and I am the Program Director of the Resilience Program, which is part of a larger program called RISE within Children's Health, and that constitutes resilience, integrated ethics, staff support and engagement. And my background is I am a clinical nurse specialist, by background.

And now, have a PhD in organizational psychology. And what my role really focuses on is learning the science behind resilience, specifically within healthcare to promote individual resilience factors and team resilience factors that help us connect to who we are, what makes a difference, a sense of belonging, and really enables the reason that we went into healthcare, and that is to make a difference through our gifts and our strength.

Brennan Lewis (Host): I love that. All right, so we know that stress is on the rise in healthcare globally. What do you think some of the factors are that are influencing this?

Elaine Beardsley, PhD, MN, ACCNS-P: I love that question, Brennan, because you said some of the many factors and there are, there's a multitude of factors that are coinciding, really synonymously, and that includes, rising acuity, demographic changes, rising population differences in that there's a move to move to more urban areas. The technological advances, although those are incredible, those play out not only in the technologies that are available for treatments for patients, but it also means electronic medical record documentation, changes in the payer mix, and all of those combined. Healthcare has changed more rapidly in the last 20 years than it has in hundreds of years prior, and although that is an incredible thing, how all of the evidence and change processes can happen; can influence the stress level at an individual level, and it absolutely can influence it at a team level.

Brennan Lewis (Host): I love that you highlighted the acuity of the patients changing because, the kids that are coming into our health system are much more complex than they've ever been before. And as technology continues to advance and we're able to do more and more things, it's a really great thing for the care that we're delivering to our patients, but also adds complexity to the care that we're doing and adds that stress. So, that's a good highlight.

Christi Welter (Host): Yeah. And kind of piggybacking off of that, I know that keeping nurses wellbeing high and building their resilience is really important for cultivating a healthy work environment and impacting patient care.

Can you speak a little bit to that?

Elaine Beardsley, PhD, MN, ACCNS-P: Yeah. So, if you were to look even back 25 years in nursing medical curriculum, that absolutely the, the goal to even further back was to be empathetic to your patients and to put kind of yourself forward to be empathetic to the patients. And while that is absolutely true 25, 30 years ago, there was no mention, there was no curriculum about how do you manage all that you see, all the different priorities, the expectations, the secondary traumatic kind of exposure. None of that was really taught. So what is now really kind of emerging as a new science, with all different kind of schools of thought and different scientific kind of backgrounds coming together; is the concept of uncontrolled cumulative stress that is really meaningful and psychological.

So meaning that healthcare, especially nursing, are so mission driven, are so driven to do the best for their patients, their families, and their coworkers. But how do we support those resilience factors to enable them, to support them and into relationships in the team to navigate all of those stressors so it doesn't just get suppressed and become uncontrolled cumulative stress.

When that happens, that's when the networks not only in our brain can become dysregulated, that's when maladaptive patterns can start happening maybe in cultures or teams to maybe in the short run help, but in the long run can actually interfere with meaning, purpose, belonging, all of which make up a healthy work environment.

Brennan Lewis (Host): That's good. Allison, what role does gratitude play in creating a healthy work environment?

Alison Kell, MSN, RN, CCRN, NPD-BC, NEA-BC: Absolutely. So listening to everything that Elaine was saying and talking about the potential for compassion fatigue that arises in our nurses; one of the things that we know when we dive into the literature on this subject is that when nurses receive meaningful recognition, it actually mitigates that risk of compassion fatigue and increases their compassion satisfaction. And so one of the things that I emphasize is really, I think one of the things that we hear from our leaders frequently is that question about, on the Gallup survey about meaningful recognition occurring at a weekly frequency, and is that too frequent?

And my response is kind of when you dive back into the literature and you can see that we can mitigate all of these things by just implementing saying, thank you for being here and for making a valuable contribution. Why wouldn't we do it more frequently, essentially? And so I think that is the reason that we want to dive into making sure that it occurs frequently.

But also when we talk about it, we want to make sure that we are really emphasizing the what that they did. Because oftentimes we'll just say thank you. Like I'll just say thank you, Brennan, but I don't say like. Thank you for making sure that I have all of the resources, that I was able to accomplish the tasks that I needed to today, and how that really made a meaningful impact.

We're thanking our nurses for showing up. Oftentimes, we just take for granted that they're going to be here. But I think one of the things that we do at every single Daisy Award presentation that we do at this organization that I think is extremely meaningful is that we read an excerpt from a letter by Mark Barnes, who is the father of Patrick Barnes, who was the individual that they formed the Daisy Foundation after his passing. And one of the things that we do is we read this letter and it's titled, Just Doing My Job. And I think it's so important for us as leaders to realize that yes, while we may have the expectation that our nurses are going to show up and they're going to be here, what I often say is, if you ever want to feel grateful, pause and reflect on what would happen if those people weren't here today.

If your nurses didn't show up today, what would your unit look like? And when you do that, instantaneously you feel grateful. And gratitude just has this amazing power to be able to pull into all of different pieces of our neuroscience and behavioral science to really emphasize experiencing greater than oneself.

And I think that is so important when we talk about empathy and the ability that we have as nurses to make a meaningful impact. It's saying thank you for that impact and what it is. Because oftentimes as nurses, we often forget what we were doing really did make an impact. And so when someone is able to say to us, thank you for doing this, you really made a difference to that patient or to that family, and really made a difference in their lives, it really pulls us back to that purpose and is able to help us to feel a million times better in some of the situations that we're in.

Brennan Lewis (Host): I love that every time I hear that letter being read at the Daisy Awards, it's just a reminder that it, it's more than just doing our job, and for people to take the time out and provide that meaningful recognition. It does reconnect us to our purpose.

Christi Welter (Host): Yeah. Allison, I think you have such a cool job. And I'm just curious, in your role, how are you preparing leaders to foster that culture of gratitude?

Alison Kell, MSN, RN, CCRN, NPD-BC, NEA-BC: Absolutely. So one of the things we've been doing recently is really emphasizing the professional development of our nurses to really our nurse leaders, really to be able to say thank you well.

And to really understand that recognition is so different to every person across this organization. So oftentimes I think people want me be able to come in and say, if you just start sending out thank you's every Friday, your nurses are going to feel so much better. The morale in your unit is going to improve.

But what we did recently was we analyzed our employee engagement results and really looked at a thematic analysis of what recognition means to our nurses. And we did this based off of the five languages of appreciation in the workplace and not surprisingly, what we found is that nurses want to be recognized in different ways.

And if you really self-reflect and think about yourself, there may be even times where what is recognition to you might mean something different. A good example that I like to use with our leaders is asking if anyone's ever been overwhelmed before. And of course everyone's been overwhelmed before. And then asking them, did you know in that moment exactly what you needed to delegate or how you could have made, how you could have been better served? And of course the answer is no. All of the same people who have been overwhelmed before know that they did not have the cognitive capacity to delegate effectively in that moment. So understanding as leaders, that acts of service can be knowing that, oh, she hasn't had lunch and she's about to get this DKA admission, can I step in and assist with admitting that patient so that she can eat, so that she can fuel her body and be able to provide for her patient. That's an act of service.

And when I'm in a moment of overwhelm, that's really meaningful to me. And understanding that there's more power in verbally saying thank you because it really does tie in this release of oxytocin that you don't get when you read a letter or a note from someone. You really get a dopamine hit from it.

And that oxytocin release is really what we get when we have that transcendent experience. So it helps us to build more meaningful and connective teams, and we know that connective teams perform better and have better outcomes. And so those are the strategies of understanding that it's multiple things in your toolbox. You can't just have one go-to that you're going to be able to use for everyone.

Christi Welter (Host): Yeah, that's amazing.

Brennan Lewis (Host): Elaine, I know that you were the PI for a wellbeing study for leaders. Tell us a little bit about what you learned through that research about the wellbeing of leaders.

Elaine Beardsley, PhD, MN, ACCNS-P: Thank you for that question, Brennan. What we learned in the study is that nurse leaders kind of foundational, have to support themselves to develop not only their mindset, but a collective mindset with looking towards what is fulfilling for the team, what is fulfilling for the system, but equally including what does nurse fulfillment look like for me as a nurse leader.

And then exactly as Alison said, that recognition can look like being valued, being listened to, being in those moments and observing. And that is a skill that takes a level of self-awareness, stress reduction, and then that metacognition to create meaning. But then the last step is what does replenishment look like? Definitely gratitude is part of replenishment, but what does replenishment also look like for the nurse leader?

Brennan Lewis (Host): Okay. All right. Before we wrap up, is there anything else you'd like for our listeners to hear?

Alison Kell, MSN, RN, CCRN, NPD-BC, NEA-BC: I think the most important thing that I would say to take away when we're talking about gratitude and meaningful recognition and really trying to understand what that means, I always tell people to reflect back on, I see it as saying, I see you. I see you for what you brought. I see you for your contributions, and how you've come to be a part of this team today. And I always go back to the movie Avatar and in that movie, the way that they say, like they greet each other or they say, I love you to one another, is to say, I see you.

And I think that's what we really can take away from this, is it's that ability to be like, I see you and who you are and where you're coming from and what you're bringing to this environment that we're in.

Brennan Lewis (Host): Oh, I love that. Elaine, anything more?

Elaine Beardsley, PhD, MN, ACCNS-P: I think just, I love what you just said and I see you and, and I think that is that mindset of just like washing hands and all the moments of hand hygiene are absolutely essential, and now they're normalized in our behavior.

Along with that is that self-awareness to build in every day. It sounds like it's easy. It's not. When we get stressed of where am I? And then where am I in relation to my team? Like I see you, and how do we do that? Through those micro breaks throughout the day, what's going to happen is we're going to start shifting our mindset.

Not only to a mindset of care and compassion for ourself, but a mindset for care and compassion for our team. And, and that's where healthcare has shown it has absolutely abundant capacity and has done that many times, I think more so than ever that is needed now.

Brennan Lewis (Host): That's awesome. Okay, it's time to wrap up this episode of Nurses Connect.

Thank you both for joining us today.

Elaine Beardsley, PhD, MN, ACCNS-P: Thank you so much. It's been such an honor.

Alison Kell, MSN, RN, CCRN, NPD-BC, NEA-BC: Thank you so much. Really appreciate you being here today.

Christi Welter (Host): If you wanna know more about nursing at Children's Health, we encourage you to visit children's.com/nursingannualreport. Here you'll find information that summarizes a variety of our nursing initiatives.

Thank you to our listeners for joining us today, and we'll talk to you next time on Nurses Connect.