WEBVTT 00:00:14.000 --> 00:00:16.500 position:50% align:middle - [Dr. Alexander] Well, welcome back everyone. 00:00:16.500 --> 00:00:21.133 position:50% align:middle We're going to turn our attention now to mental health issues 00:00:21.133 --> 00:00:24.497 position:50% align:middle and wellness of the nursing workforce. 00:00:24.497 --> 00:00:27.784 position:50% align:middle So, I'd like to begin by introducing our panel. 00:00:27.784 --> 00:00:29.580 position:50% align:middle I'll let them introduce themselves. 00:00:29.580 --> 00:00:33.000 position:50% align:middle Let me begin at my far left. 00:00:33.000 --> 00:00:35.053 position:50% align:middle - [Dr. Priola] My name is Victoria Priola. 00:00:35.053 --> 00:00:36.778 position:50% align:middle I'm a clinical psychologist. 00:00:36.778 --> 00:00:43.220 position:50% align:middle And I work primarily with individuals in the healthcare community, providing individual 00:00:43.220 --> 00:00:44.450 position:50% align:middle and group psychotherapy. 00:00:46.113 --> 00:00:47.880 position:50% align:middle - [Eve] Hi, I'm Eve Poczatek. 00:00:47.880 --> 00:00:53.690 position:50% align:middle I'm the Director of the wellness program at Rush University System for Health in Chicago, Illinois. 00:00:53.690 --> 00:00:59.402 position:50% align:middle Our program serves over 17,000 employees and students. 00:00:59.402 --> 00:01:01.530 position:50% align:middle - [Dr. Hatmaker] I'm Debbie Hatmaker. 00:01:01.530 --> 00:01:07.096 position:50% align:middle I'm the Chief Nursing Officer for the A&A Enterprise, where I oversee the programs 00:01:07.096 --> 00:01:11.060 position:50% align:middle for the American Nurses Association and the American Nurses Credentialing Center. 00:01:12.572 --> 00:01:13.935 position:50% align:middle - [Dr. Esquibel] I'm Kim Esquibel. 00:01:13.935 --> 00:01:18.430 position:50% align:middle I'm the Executive Director of the Maine State Board of Nursing. 00:01:18.430 --> 00:01:26.463 position:50% align:middle As an appointee of the board, my goal is to carry out the programs of the board. 00:01:26.463 --> 00:01:29.080 position:50% align:middle - Well, thank you all and welcome. 00:01:29.080 --> 00:01:32.390 position:50% align:middle And I appreciate your being here. 00:01:32.390 --> 00:01:36.070 position:50% align:middle Victoria, our first question is for you. 00:01:36.070 --> 00:01:44.490 position:50% align:middle Our data show that 45% to 56% of nurses that participated in the National Nursing Workforce 00:01:44.490 --> 00:01:51.100 position:50% align:middle Study felt emotionally drained, used up, fatigued, or burnt out. 00:01:51.100 --> 00:01:55.600 position:50% align:middle Twenty nine percent of them said they were at the end of their rope. 00:01:55.600 --> 00:02:01.870 position:50% align:middle What is burnout, how serious is it, and what contributes to it? 00:02:01.870 --> 00:02:05.900 position:50% align:middle - I'm so glad you asked, and I'm so glad to be here today to provide some 00:02:05.900 --> 00:02:08.690 position:50% align:middle clarification from the clinical perspective. 00:02:08.690 --> 00:02:13.955 position:50% align:middle I think "burnout" happens to be one of those words that's made its way into the vernacular 00:02:13.955 --> 00:02:17.880 position:50% align:middle that is largely misunderstood. 00:02:17.880 --> 00:02:23.790 position:50% align:middle Burnout is the cumulative experience of stressors. 00:02:23.790 --> 00:02:28.650 position:50% align:middle So, the idea is that a person can be stressed without being burnt out. 00:02:28.650 --> 00:02:35.248 position:50% align:middle But if they are burnt out, it's very likely, in fact I would say guaranteed, that they've had 00:02:35.248 --> 00:02:40.920 position:50% align:middle multiple experiences of high levels of stress that have gone unmanaged and unaddressed. 00:02:40.920 --> 00:02:44.960 position:50% align:middle So, I think it's really important that we appreciate, you know, sort of the 00:02:44.960 --> 00:02:47.880 position:50% align:middle cumulative effect of this condition. 00:02:47.880 --> 00:02:52.738 position:50% align:middle And that if a person is burnt out, it's likely that they are involved in an 00:02:52.738 --> 00:02:59.840 position:50% align:middle environment, because only certain environments allow and foster burnout. 00:02:59.840 --> 00:03:02.610 position:50% align:middle So, we have to think about this contextually, as well. 00:03:02.610 --> 00:03:07.660 position:50% align:middle It's not just about the individual, it's about the environment that the person is trying 00:03:07.660 --> 00:03:10.041 position:50% align:middle to work in. 00:03:10.041 --> 00:03:13.550 position:50% align:middle - How widespread is this? 00:03:13.550 --> 00:03:18.930 position:50% align:middle Debbie, you're Chief Nursing Officer of the American Nurses Association. 00:03:18.930 --> 00:03:20.800 position:50% align:middle I know you know a lot about this. 00:03:20.800 --> 00:03:21.920 position:50% align:middle How widespread is it? 00:03:21.920 --> 00:03:28.480 position:50% align:middle - Well, our foundation has just released its latest survey they did in conjunction with McKinsey. 00:03:28.480 --> 00:03:35.860 position:50% align:middle And unfortunately, the numbers are still high, similar to what NCSBN found last year. 00:03:35.860 --> 00:03:42.390 position:50% align:middle So, the stress on the workforce and on nurses continues to be high. 00:03:42.390 --> 00:03:50.050 position:50% align:middle It continues to be high, especially for those with the less numbers of experience. 00:03:50.050 --> 00:03:56.190 position:50% align:middle So, we're very much worried about those who are still new in the workforce. 00:03:56.190 --> 00:04:04.552 position:50% align:middle And while we see a lot of wellness programs and interventions being created, we also know 00:04:04.552 --> 00:04:08.020 position:50% align:middle that we're not going to solve the problem. 00:04:08.020 --> 00:04:13.737 position:50% align:middle The programs are not going to be successful until we address the underlying issues that are 00:04:13.737 --> 00:04:16.270 position:50% align:middle driving stress and burnout. 00:04:16.270 --> 00:04:23.530 position:50% align:middle And nurses tell us that it's inadequate staffing, workplace violence, mandatory overtime, 00:04:23.530 --> 00:04:25.360 position:50% align:middle and documentation burden. 00:04:25.360 --> 00:04:32.693 position:50% align:middle So, we have to work on issues in the work environment, as well as then create prevention 00:04:32.693 --> 00:04:37.100 position:50% align:middle programs, and programs and resources that address the issues. 00:04:37.100 --> 00:04:41.360 position:50% align:middle - And we're going to get into those issues in just a minute. 00:04:41.360 --> 00:04:45.590 position:50% align:middle Eve, any further comments about this and what you're seeing in clinical practice? 00:04:45.590 --> 00:04:46.840 position:50% align:middle - Certainly. 00:04:46.840 --> 00:04:51.580 position:50% align:middle So, this is something we certainly see at Rush and I hear from colleagues across the country 00:04:51.580 --> 00:04:53.990 position:50% align:middle is very present within the workday. 00:04:53.990 --> 00:04:55.260 position:50% align:middle Our folks are tired. 00:04:55.260 --> 00:04:58.270 position:50% align:middle We've been in an emergent state for years now. 00:04:58.270 --> 00:05:01.990 position:50% align:middle And at some point, we need to start thinking about our future. 00:05:01.990 --> 00:05:03.330 position:50% align:middle We can't just be reactive. 00:05:03.330 --> 00:05:07.035 position:50% align:middle We need to respond to what's going on and take constructive steps forward, 00:05:07.035 --> 00:05:09.467 position:50% align:middle ownership of what's next. 00:05:09.467 --> 00:05:11.849 position:50% align:middle - So, Kim. 00:05:11.849 --> 00:05:12.680 position:50% align:middle - Yes. 00:05:12.680 --> 00:05:17.730 position:50% align:middle - There are studies that show this affects patient safety. 00:05:17.730 --> 00:05:21.480 position:50% align:middle Tell us about this from a public protection standpoint. 00:05:21.480 --> 00:05:31.520 position:50% align:middle - So, in Maine, over the last three years, we've seen a steady increase in the number of nurses 00:05:31.520 --> 00:05:40.150 position:50% align:middle that have either been referred or self-referred to the Medical Professionals Health Program. 00:05:40.150 --> 00:05:44.552 position:50% align:middle This is actually a program under the Maine Medical Association, 00:05:44.552 --> 00:05:56.600 position:50% align:middle but it's funded by licensing boards, professional associations, malpractice carriers, and hospitals. 00:05:56.600 --> 00:06:06.989 position:50% align:middle The program, the mission is really to actually safeguard the public and help professionals 00:06:06.989 --> 00:06:11.210 position:50% align:middle be able to practice at their highest level. 00:06:11.210 --> 00:06:20.360 position:50% align:middle I think the pandemic has brought to issue public safety. 00:06:20.360 --> 00:06:28.460 position:50% align:middle And we really need to have programs that support nurses, because they're human. 00:06:28.460 --> 00:06:29.430 position:50% align:middle - Yeah. 00:06:29.430 --> 00:06:36.030 position:50% align:middle Our data and other data, as well, show that nurses who are burnt out and under a lot 00:06:36.030 --> 00:06:39.140 position:50% align:middle of stress tend to make more errors. 00:06:39.140 --> 00:06:44.830 position:50% align:middle And so from a patient safety and a regulatory standpoint, we certainly need to be very 00:06:44.830 --> 00:06:46.530 position:50% align:middle focused on this. 00:06:46.530 --> 00:06:50.898 position:50% align:middle So, you've kind of opened the door to some of the solutions 00:06:50.898 --> 00:06:53.762 position:50% align:middle and prevention programs that are out there. 00:06:53.762 --> 00:06:57.100 position:50% align:middle Tell us a little bit more about the Maine program. 00:06:57.100 --> 00:07:03.030 position:50% align:middle Who's eligible for it, who's signing up for it, and what really does it do? 00:07:03.030 --> 00:07:07.367 position:50% align:middle - So, the Medical Professionals Health Program is... 00:07:07.367 --> 00:07:13.160 position:50% align:middle It actually provides resources to healthcare professionals. 00:07:13.160 --> 00:07:20.260 position:50% align:middle There are several licensing boards that are...they fund the program. 00:07:20.260 --> 00:07:23.340 position:50% align:middle We work with professional associations. 00:07:23.340 --> 00:07:26.450 position:50% align:middle We get the word out to hospitals. 00:07:26.450 --> 00:07:32.150 position:50% align:middle So, employers can actually refer nurses to this program. 00:07:32.150 --> 00:07:36.380 position:50% align:middle And the regulatory board doesn't need to know about it. 00:07:36.380 --> 00:07:40.440 position:50% align:middle It's not a disciplinary action. 00:07:40.440 --> 00:07:49.258 position:50% align:middle It's so that they can get the help they need before something happens to patients or 00:07:49.258 --> 00:07:52.550 position:50% align:middle they get terminated from the hospital. 00:07:52.550 --> 00:07:59.290 position:50% align:middle And then it becomes more of a board order to go into this monitoring program. 00:07:59.290 --> 00:08:04.380 position:50% align:middle Nurses can self-refer to the program. 00:08:04.380 --> 00:08:07.340 position:50% align:middle It's really to give them support. 00:08:07.340 --> 00:08:09.918 position:50% align:middle It includes substance use. 00:08:09.918 --> 00:08:12.112 position:50% align:middle That's one avenue. 00:08:12.112 --> 00:08:16.991 position:50% align:middle But it's unique because it also addresses 00:08:16.991 --> 00:08:21.058 position:50% align:middle mental health, burnout, stress... 00:08:21.058 --> 00:08:24.915 position:50% align:middle It's available to nursing students, 00:08:24.915 --> 00:08:30.264 position:50% align:middle just any nurse in Maine. 00:08:30.264 --> 00:08:40.010 position:50% align:middle I think that the goal is to keep getting the word out so that nurses will seek out that help before it 00:08:40.010 --> 00:08:45.950 position:50% align:middle becomes a patient safety issue or a board issue. 00:08:45.950 --> 00:08:50.190 position:50% align:middle - And that's a great, great solution at the state level. 00:08:50.190 --> 00:08:50.760 position:50% align:middle - Yes. 00:08:50.760 --> 00:08:52.430 position:50% align:middle - Let's look a little bit more local. 00:08:52.430 --> 00:08:57.710 position:50% align:middle What does Rush have going on that helps the nurses that may need some assistance? 00:08:57.710 --> 00:09:02.310 position:50% align:middle - So, Rush has a real commitment to well-being. 00:09:02.310 --> 00:09:04.180 position:50% align:middle It has become an organizational priority. 00:09:04.180 --> 00:09:09.010 position:50% align:middle And so I lead a wellness department that serves all Rush employees and students. 00:09:09.010 --> 00:09:12.443 position:50% align:middle We provide free, unlimited therapy to our employees and students, 00:09:12.443 --> 00:09:16.338 position:50% align:middle 24% of whom are nurses in our annual volume. 00:09:16.338 --> 00:09:22.930 position:50% align:middle In addition to that, we have a number of programs, trainings, resources, and events around well-being, 00:09:22.930 --> 00:09:28.230 position:50% align:middle really normalizing the conversation that our work is hard and that it's okay to not be okay. 00:09:28.230 --> 00:09:32.990 position:50% align:middle A program that I'm particularly proud of is the Nursing Wellness Awards. 00:09:32.990 --> 00:09:38.330 position:50% align:middle It's a grant program for nurse well-being where nurses can apply with a wellness 00:09:38.330 --> 00:09:41.980 position:50% align:middle project that would improve well-being in their local units. 00:09:41.980 --> 00:09:43.690 position:50% align:middle One project... 00:09:43.690 --> 00:09:47.160 position:50% align:middle And be awarded monies to implement that project over a year. 00:09:47.160 --> 00:09:51.600 position:50% align:middle One project that was really successful over the last year was art breaks. 00:09:51.600 --> 00:09:58.360 position:50% align:middle This was a dedicated creative space in break rooms where nurses could decompress, build community, 00:09:58.360 --> 00:10:00.960 position:50% align:middle and increase their overall wellness during the day. 00:10:00.960 --> 00:10:03.440 position:50% align:middle And I want to get my facts right here, so looking down at my notes. 00:10:03.440 --> 00:10:10.080 position:50% align:middle But 20% of nurses who came into those art breaks reported feeling not stressed going in. 00:10:10.080 --> 00:10:16.810 position:50% align:middle But by the end of the session, 62% reported that they felt better. 00:10:16.810 --> 00:10:21.330 position:50% align:middle One workshop participant remarked, "This is a great way to be a human, 00:10:21.330 --> 00:10:24.100 position:50% align:middle not just a nurse doing tasks." 00:10:24.100 --> 00:10:28.660 position:50% align:middle For their effort, that project team was awarded the Cam Busch NOAH Arts in Health Award 00:10:28.660 --> 00:10:30.110 position:50% align:middle Arts Building Resilience. 00:10:30.110 --> 00:10:34.920 position:50% align:middle And I think programs like these are exemplary because what we've done is we ask our nurses, 00:10:34.920 --> 00:10:36.570 position:50% align:middle "What would help you? 00:10:36.570 --> 00:10:40.554 position:50% align:middle Let us empower you to make your workplace better." 00:10:40.554 --> 00:10:41.520 position:50% align:middle - Thank you. 00:10:41.520 --> 00:10:47.730 position:50% align:middle So, Debbie, I know A&A has a national program. 00:10:47.730 --> 00:10:49.700 position:50% align:middle Can you tell us a little bit about that? 00:10:49.700 --> 00:10:56.830 position:50% align:middle - Well, we've invested for a number of years in health programs and wellness programs for nurses. 00:10:56.830 --> 00:11:01.350 position:50% align:middle That certainly increased during the pandemic with some generous funding. 00:11:01.350 --> 00:11:06.968 position:50% align:middle Our Healthy Nurse, Healthy Nation program is a program we've had for a number of years that 00:11:06.968 --> 00:11:12.330 position:50% align:middle focuses on health across the continuum, but mental health is an aspect of that. 00:11:12.330 --> 00:11:15.930 position:50% align:middle So, we certainly want to engage nurses and individuals. 00:11:15.930 --> 00:11:22.378 position:50% align:middle And we partner with a number of, really over 600, healthcare organizations to be engaged 00:11:22.378 --> 00:11:26.910 position:50% align:middle and to bring forward and to prioritize health and wellness. 00:11:26.910 --> 00:11:33.360 position:50% align:middle Our foundation, through UnitedHealth, has just funded a pilot project on stress 00:11:33.360 --> 00:11:35.350 position:50% align:middle and burnout prevention. 00:11:35.350 --> 00:11:39.380 position:50% align:middle It's in four different states for large health systems, 00:11:39.380 --> 00:11:46.110 position:50% align:middle urban, rural, multiple settings, both acute as well as ambulatory. 00:11:46.110 --> 00:11:51.456 position:50% align:middle So, we're very excited to see the outcome of that pilot program and to see if we can 00:11:51.456 --> 00:11:53.899 position:50% align:middle scale that even further. 00:11:53.899 --> 00:12:01.120 position:50% align:middle And, as well, for A&A members, we've been able to partner with SC Healthcare 00:12:01.120 --> 00:12:08.460 position:50% align:middle on healthcare prevention, a stress and wellness burnout prevention program. 00:12:08.460 --> 00:12:15.860 position:50% align:middle And we've had over 10,000 nurses register for that program and collect over 20,000 00:12:15.860 --> 00:12:18.530 position:50% align:middle continuing education hours. 00:12:18.530 --> 00:12:26.150 position:50% align:middle We've gotten great feedback that that's a program that has helped prevent burnout, 00:12:26.150 --> 00:12:29.820 position:50% align:middle or to assist them if they feel that they're moving in that direction. 00:12:29.820 --> 00:12:34.950 position:50% align:middle So, I think burnout and prevention is an underlying aspect there, as well. 00:12:34.950 --> 00:12:36.830 position:50% align:middle - Absolutely. 00:12:36.830 --> 00:12:41.320 position:50% align:middle But let me ask you, what are some specific components of that program? 00:12:41.320 --> 00:12:48.287 position:50% align:middle - Well, the SC Healthcare program is self-directed videos, a lot of educational 00:12:48.287 --> 00:12:55.405 position:50% align:middle efforts to really help nurses assist with skills and resources to identify 00:12:55.405 --> 00:13:02.170 position:50% align:middle issues around stress and look at strategies to try to alleviate that stress. 00:13:02.170 --> 00:13:08.241 position:50% align:middle We partner, and hopefully partner, with a number of employers to bring programs 00:13:08.241 --> 00:13:11.570 position:50% align:middle like that into their systems. 00:13:11.570 --> 00:13:14.805 position:50% align:middle Again, I think prevention is a key here. 00:13:14.805 --> 00:13:19.900 position:50% align:middle While we want to address it certainly for nurses who are experiencing stress and burnout, 00:13:19.900 --> 00:13:26.630 position:50% align:middle if we can identify what we need to do on the front end and build in the resources and a great 00:13:26.630 --> 00:13:33.244 position:50% align:middle work environment, hopefully we cannot have so many nurses in that situation. 00:13:33.244 --> 00:13:41.840 position:50% align:middle - So, Victoria, a lot of times, people take care of everyone but themselves. 00:13:41.840 --> 00:13:47.100 position:50% align:middle And it's hard sometimes to identify, "I should be in that program," or, 00:13:47.100 --> 00:13:54.150 position:50% align:middle "I need to get involved in that," or, you know, call the Board of Nursing to find out more 00:13:54.150 --> 00:13:56.260 position:50% align:middle about that program. 00:13:56.260 --> 00:13:57.480 position:50% align:middle What are you seeing? 00:13:57.480 --> 00:13:59.850 position:50% align:middle Are nurses reaching out and doing that? 00:13:59.850 --> 00:14:04.220 position:50% align:middle And what can we do to encourage them to do so? 00:14:04.220 --> 00:14:08.990 position:50% align:middle - This might be an unpopular opinion, but I'm going to go ahead and throw it out there. 00:14:08.990 --> 00:14:14.420 position:50% align:middle I think we need to stop referring to nurses as heroes. 00:14:14.420 --> 00:14:16.580 position:50% align:middle I think that would be the first step. 00:14:16.580 --> 00:14:21.874 position:50% align:middle And the reason I'm saying that is because a superhero, for those of you that are Greek 00:14:21.874 --> 00:14:28.500 position:50% align:middle mythology geeks, you know that they're defined as superhuman. 00:14:28.500 --> 00:14:32.820 position:50% align:middle And I think that that's a precedent that is unrealistic, and I'm going to argue 00:14:32.820 --> 00:14:34.350 position:50% align:middle that it's dangerous. 00:14:34.350 --> 00:14:37.455 position:50% align:middle And I think in large part, even though it was a well-meaning 00:14:37.455 --> 00:14:42.190 position:50% align:middle and well-intentioned acknowledgement, I think what's happened is that it's created 00:14:42.190 --> 00:14:46.960 position:50% align:middle an environment in which people are going into work with the assumption that they're 00:14:46.960 --> 00:14:52.392 position:50% align:middle going to have to be self-sacrificing to a level... excuse me, to a level that 00:14:52.392 --> 00:14:55.760 position:50% align:middle compromises their own health and well-being. 00:14:55.760 --> 00:15:02.020 position:50% align:middle And I see that this core is exceptionally problematic for obvious reasons, but also 00:15:02.020 --> 00:15:06.890 position:50% align:middle because it creates a wall and a barrier between their willingness to then go out 00:15:06.890 --> 00:15:08.760 position:50% align:middle and reach out for help. 00:15:08.760 --> 00:15:16.130 position:50% align:middle And so I find that in my clinical work with nurses, often a large portion of at least the initial stages 00:15:16.130 --> 00:15:23.700 position:50% align:middle of our work together is about deprogramming them, telling them that they're not superheroes. 00:15:23.700 --> 00:15:29.480 position:50% align:middle They're regular folks going to work and being asked to do extraordinary things. 00:15:29.480 --> 00:15:36.530 position:50% align:middle And that the essence of that is what creates a large conflict internally for them because they evaluate 00:15:36.530 --> 00:15:40.190 position:50% align:middle their performance through that extreme lens. 00:15:40.190 --> 00:15:41.980 position:50% align:middle And that's an issue. 00:15:41.980 --> 00:15:49.060 position:50% align:middle I think it's also important for us to appreciate that when we ask people to do extraordinary things 00:15:49.060 --> 00:15:53.530 position:50% align:middle every day, all the time, that they're going to feel inadequate about that. 00:15:53.530 --> 00:15:57.810 position:50% align:middle And when a nurse is burned out, meaning she's been under these 00:15:57.810 --> 00:16:01.670 position:50% align:middle high-stress environments, or he has been under these high-stress environments, 00:16:01.670 --> 00:16:06.116 position:50% align:middle and expectations for a long period of time, I'd like to suggest that those individuals 00:16:06.116 --> 00:16:10.430 position:50% align:middle are at risk, and the patients that they're trying to take care of are also at risk. 00:16:10.430 --> 00:16:16.125 position:50% align:middle Because we understand burnout to be exceptionally extreme exhaustion 00:16:16.125 --> 00:16:22.840 position:50% align:middle in every aspect of yourself, emotionally, physically, cognitively. 00:16:22.840 --> 00:16:28.080 position:50% align:middle And so what that ends up looking like is that you have people trying to make high-level decisions, 00:16:28.080 --> 00:16:32.979 position:50% align:middle life and death decisions, when they're not cognitively, emotionally, and physically 00:16:32.979 --> 00:16:34.311 position:50% align:middle capable of doing that. 00:16:34.311 --> 00:16:40.965 position:50% align:middle And this is why we need to care about this issue and feel like each of us has a responsibility to 00:16:40.965 --> 00:16:44.500 position:50% align:middle encourage nurses to get care. 00:16:44.500 --> 00:16:48.560 position:50% align:middle If you have to drag them in to see me kicking and screaming, I'm okay with that. 00:16:48.560 --> 00:16:50.330 position:50% align:middle Just get them to me. 00:16:50.330 --> 00:16:54.507 position:50% align:middle And I think the rest of the mental health profession recognizes the level of crisis 00:16:54.507 --> 00:16:57.005 position:50% align:middle that we're in. 00:16:57.005 --> 00:17:01.208 position:50% align:middle And they understand the assignment, and they're ready and willing to provide 00:17:01.208 --> 00:17:07.405 position:50% align:middle the support to our brothers and sisters in the healthcare environment to help them feel better, 00:17:07.405 --> 00:17:11.690 position:50% align:middle and to do better, and ultimately to be safe. 00:17:11.690 --> 00:17:17.030 position:50% align:middle - So, Eve, Rush has a 24-hour call-in line, correct? 00:17:17.030 --> 00:17:17.690 position:50% align:middle - That's right. 00:17:17.690 --> 00:17:21.110 position:50% align:middle - A nurse that's under a lot of stress can call in. 00:17:21.110 --> 00:17:22.930 position:50% align:middle Could you tell us a little more about that? 00:17:22.930 --> 00:17:24.260 position:50% align:middle - Certainly. 00:17:24.260 --> 00:17:29.340 position:50% align:middle So, like many health systems, Rush, for a long time, had an employee assistance program, 00:17:29.340 --> 00:17:31.490 position:50% align:middle but we found that it wasn't being well utilized. 00:17:31.490 --> 00:17:35.315 position:50% align:middle And so my team was thinking critically about what are the reasons we're hearing 00:17:35.315 --> 00:17:36.467 position:50% align:middle why people aren't using it? 00:17:36.467 --> 00:17:37.378 position:50% align:middle It feels unsafe. 00:17:37.378 --> 00:17:38.561 position:50% align:middle It feels unfamiliar. 00:17:38.561 --> 00:17:42.940 position:50% align:middle And the session limit was a barrier. 00:17:42.940 --> 00:17:47.350 position:50% align:middle But with our outpatient clinic, you know, we're open 7:00 to 7:00, Monday through Friday. 00:17:47.350 --> 00:17:49.270 position:50% align:middle That's not 24/7 like a hospital is. 00:17:49.270 --> 00:17:56.170 position:50% align:middle So, what do we do about all the times outside of those hours that staff need support? 00:17:56.170 --> 00:18:01.320 position:50% align:middle So, in August 2021, we stood up what we call the Wellness Triage Pager. 00:18:01.320 --> 00:18:08.610 position:50% align:middle And this is a paging system where an on-call social worker responds 24/7, within 60 minutes, 00:18:08.610 --> 00:18:11.528 position:50% align:middle to the feelings of, "I feel overwhelmed," 00:18:11.528 --> 00:18:13.462 position:50% align:middle "I feel concerned." 00:18:13.462 --> 00:18:18.671 position:50% align:middle So, we really tried to be careful and strategic in our phrasing because we certainly want 00:18:18.671 --> 00:18:22.070 position:50% align:middle emergent issues to go the appropriate routes. 00:18:22.070 --> 00:18:26.030 position:50% align:middle But for all those spaces of gray in between, we want folks to call us. 00:18:26.030 --> 00:18:32.050 position:50% align:middle And in fact, we also encouraged our nurses, our employees to call on behalf of people they know. 00:18:32.050 --> 00:18:36.160 position:50% align:middle So, if you're worried about a colleague, you see someone crying in a hall, call us. 00:18:36.160 --> 00:18:39.840 position:50% align:middle We can provide you with language, coach you through that difficult moment. 00:18:39.840 --> 00:18:44.960 position:50% align:middle And with the permission of the individual who is in distress, we're happy to speak with them directly. 00:18:44.960 --> 00:18:48.180 position:50% align:middle And so we've really seen this volume take off. 00:18:48.180 --> 00:18:53.920 position:50% align:middle So, in our first year, volume was really slow, only about 20 pages over the full year. 00:18:53.920 --> 00:18:57.870 position:50% align:middle We had 20 pages in two months this year. 00:18:57.870 --> 00:18:59.916 position:50% align:middle So, really picking up quickly. 00:18:59.916 --> 00:19:01.504 position:50% align:middle It's system-wide. 00:19:01.504 --> 00:19:05.230 position:50% align:middle And I think most importantly, it's really helped our nurses, 00:19:05.230 --> 00:19:10.446 position:50% align:middle our employees understand that there really is someone here at Rush that you know you can 00:19:10.446 --> 00:19:13.440 position:50% align:middle find their email, 24/7 available for you. 00:19:13.440 --> 00:19:14.830 position:50% align:middle That's how much Rush cares about you. 00:19:14.830 --> 00:19:22.950 position:50% align:middle - So, there is a certain stigma, you know, that is often attached to saying, 00:19:22.950 --> 00:19:27.620 position:50% align:middle "I'm not well. I have some mental health issues." 00:19:27.620 --> 00:19:29.100 position:50% align:middle How do we overcome that? 00:19:29.100 --> 00:19:30.480 position:50% align:middle And I... 00:19:30.480 --> 00:19:30.870 position:50% align:middle Eve. 00:19:30.870 --> 00:19:35.240 position:50% align:middle - And I think that it's difficult, but I think we need to talk about it. 00:19:35.240 --> 00:19:38.210 position:50% align:middle And I feel so passionately about this. 00:19:38.210 --> 00:19:41.670 position:50% align:middle Because I think the more we talk about it, bring it into our vernacular, 00:19:41.670 --> 00:19:46.660 position:50% align:middle encourage our leaders to talk about what they're struggling with, that will help our staff to feel 00:19:46.660 --> 00:19:51.050 position:50% align:middle comfortable and confident coming forward when they have an issue, a crisis that they're 00:19:51.050 --> 00:19:52.470 position:50% align:middle dealing with personally. 00:19:52.470 --> 00:19:57.236 position:50% align:middle So, you know, I tell leaders at Rush you don't need to tell folks the intimate details 00:19:57.236 --> 00:20:01.710 position:50% align:middle of what might be going on with you, but you can tell your staff, "I'm not okay today. 00:20:01.710 --> 00:20:03.800 position:50% align:middle I might need a little help today. 00:20:03.800 --> 00:20:08.440 position:50% align:middle I'm going to take a day of rest because I have some stuff going on at home." 00:20:08.440 --> 00:20:14.670 position:50% align:middle That kind of vulnerability builds such sincere trust and really helps the team to rely on each other. 00:20:14.670 --> 00:20:18.390 position:50% align:middle And I think particularly within nursing culture, we want to care for each other. 00:20:18.390 --> 00:20:19.130 position:50% align:middle Right? 00:20:19.130 --> 00:20:25.020 position:50% align:middle And so, you know, relying on each other, not just as colleagues, but as caregivers, as friends, 00:20:25.020 --> 00:20:28.850 position:50% align:middle as, you know, folks who care, I think that's how we can really start 00:20:28.850 --> 00:20:29.650 position:50% align:middle to change the culture. 00:20:29.650 --> 00:20:30.120 position:50% align:middle - Yeah. 00:20:30.120 --> 00:20:30.650 position:50% align:middle - Deb. 00:20:30.650 --> 00:20:36.191 position:50% align:middle - I absolutely agree about leaders being able to speak to their own 00:20:36.191 --> 00:20:38.965 position:50% align:middle distress or their own experiences. 00:20:38.965 --> 00:20:45.200 position:50% align:middle We found early in the pandemic, we were putting forward a lot with a lot 00:20:45.200 --> 00:20:52.543 position:50% align:middle of partnerships, digital apps and other kind of quick solutions that we could stand up during 00:20:52.543 --> 00:20:54.890 position:50% align:middle the worst of the pandemic. 00:20:54.890 --> 00:20:59.880 position:50% align:middle And initially, the use was very low and we were very concerned. 00:20:59.880 --> 00:21:02.160 position:50% align:middle We increased our communication. 00:21:02.160 --> 00:21:04.458 position:50% align:middle We reached out in multiple ways. 00:21:04.458 --> 00:21:10.443 position:50% align:middle And as we were talking to individuals, it was this issue of being a superhuman, 00:21:10.443 --> 00:21:17.530 position:50% align:middle being superheroes, and feeling like maybe their leaders were saying, "Oh, we can do this. 00:21:17.530 --> 00:21:18.829 position:50% align:middle We can push through. 00:21:18.829 --> 00:21:19.739 position:50% align:middle We can do this. 00:21:19.739 --> 00:21:21.530 position:50% align:middle Nurses can always do this." 00:21:21.530 --> 00:21:28.190 position:50% align:middle So, the ability to admit vulnerability and the need for help is so important. 00:21:28.190 --> 00:21:30.669 position:50% align:middle And we just saw that absolutely. 00:21:30.669 --> 00:21:36.650 position:50% align:middle And as we heard more and more leaders understanding and being able to say that, 00:21:36.650 --> 00:21:41.970 position:50% align:middle we saw more willing to come forward and use resources and to say they needed help. 00:21:41.970 --> 00:21:44.450 position:50% align:middle - Great. 00:21:44.450 --> 00:21:45.530 position:50% align:middle Victoria, please. 00:21:45.530 --> 00:21:53.038 position:50% align:middle - I would just like to add that I think there's a really valid reason why healthcare workers 00:21:53.038 --> 00:21:58.230 position:50% align:middle and nurses don't use services available at the hospital. 00:21:58.230 --> 00:22:00.098 position:50% align:middle A lot of that is confidentiality. 00:22:00.098 --> 00:22:06.940 position:50% align:middle A lot of that is fear about what it will mean for their careers. 00:22:06.940 --> 00:22:12.720 position:50% align:middle And so one of the things that I'd like to suggest that we can do, especially those that are in a position 00:22:12.720 --> 00:22:17.466 position:50% align:middle of choosing healthcare plans for healthcare organizations, is to make sure you have 00:22:17.466 --> 00:22:24.140 position:50% align:middle robust mental healthcare for your employees and make sure they understand how to access it. 00:22:24.140 --> 00:22:28.837 position:50% align:middle I can't tell you the number of healthcare workers and nurses that come to my office with absolutely 00:22:28.837 --> 00:22:32.430 position:50% align:middle no idea about the benefits that they have. 00:22:32.430 --> 00:22:37.010 position:50% align:middle And to be quite honest, some of them are really lousy benefits. 00:22:37.010 --> 00:22:42.083 position:50% align:middle So, I think on a larger scale and contextually what we can think about is when we have 00:22:42.083 --> 00:22:45.802 position:50% align:middle access to benefit plans and when we're choosing what those look like for our 00:22:45.802 --> 00:22:52.359 position:50% align:middle employees and for ourselves, that we make sure that we understand and provide them 00:22:52.359 --> 00:22:54.878 position:50% align:middle an opportunity to use the best of the best. 00:22:54.878 --> 00:22:56.360 position:50% align:middle We owe them that. 00:22:56.360 --> 00:23:05.970 position:50% align:middle - Is there anything regulators can do to help avoid that stigma of mental health services? 00:23:05.970 --> 00:23:10.260 position:50% align:middle - I think it's... 00:23:10.260 --> 00:23:20.200 position:50% align:middle So, I actually go out to the nursing schools and speak with them about board processes, 00:23:20.200 --> 00:23:26.260 position:50% align:middle resources that are available, the MPHP program. 00:23:26.260 --> 00:23:30.480 position:50% align:middle And there is... 00:23:30.480 --> 00:23:38.670 position:50% align:middle You know, embed in them that there is not a stigma in reaching out for help before 00:23:38.670 --> 00:23:49.030 position:50% align:middle their patients are at risk or it becomes an accountability problem for them. 00:23:49.030 --> 00:23:59.400 position:50% align:middle I think employers need to be committed to changing the culture in the hospital systems. 00:23:59.400 --> 00:24:06.950 position:50% align:middle I think nurses, they need to ask each other every day, "What have you done for self-care today?" 00:24:06.950 --> 00:24:10.350 position:50% align:middle They need to feel like they can be open to that. 00:24:11.890 --> 00:24:15.010 position:50% align:middle - So, how does an employer... 00:24:15.010 --> 00:24:20.230 position:50% align:middle Again, thinking about solutions, you can have these programs. 00:24:20.230 --> 00:24:27.870 position:50% align:middle But how does the employer get the word out to their nursing staff, "Use our programs. 00:24:27.870 --> 00:24:34.790 position:50% align:middle This is what it is," other than just sending out some brochures or email messages? 00:24:34.790 --> 00:24:39.380 position:50% align:middle - You know, what's really worked well for us is going in person. 00:24:39.380 --> 00:24:46.130 position:50% align:middle And that sounds like it's a lot of resources, but it is me and a part-time person. 00:24:46.130 --> 00:24:47.230 position:50% align:middle It's not... 00:24:47.230 --> 00:24:50.830 position:50% align:middle I think that human connection just can't be substituted for anything else. 00:24:50.830 --> 00:24:55.890 position:50% align:middle We all are bombarded with emails, social media, brochures, what have it, 00:24:55.890 --> 00:25:01.860 position:50% align:middle that just seeing a person and being able to associate them as, "Hey, that person looks okay. 00:25:01.860 --> 00:25:03.640 position:50% align:middle Maybe it's okay for me to seek help. 00:25:03.640 --> 00:25:05.860 position:50% align:middle They're telling me it is." 00:25:05.860 --> 00:25:06.960 position:50% align:middle We found over time... 00:25:06.960 --> 00:25:08.608 position:50% align:middle Our program is relatively new. 00:25:08.608 --> 00:25:10.611 position:50% align:middle We opened in July 2020. 00:25:10.611 --> 00:25:12.870 position:50% align:middle Nothing going on then. 00:25:12.870 --> 00:25:18.510 position:50% align:middle We found that over time, folks would start volunteering in these presentations 00:25:18.510 --> 00:25:20.490 position:50% align:middle to say, "I go to the wellness center. 00:25:20.490 --> 00:25:22.340 position:50% align:middle I love my therapist there." 00:25:22.340 --> 00:25:25.164 position:50% align:middle And, you know, more and more of that would happen, to the point where, 00:25:25.164 --> 00:25:29.400 position:50% align:middle you know, we have entire units that love a single therapist in my clinic. 00:25:29.400 --> 00:25:32.470 position:50% align:middle You know, "L&D all sees, you know, this person." 00:25:32.470 --> 00:25:36.140 position:50% align:middle And I think that's really exciting that they're talking about it with each other, 00:25:36.140 --> 00:25:38.565 position:50% align:middle but it took that first in-person conversation 00:25:38.565 --> 00:25:39.994 position:50% align:middle to really make a difference. 00:25:39.994 --> 00:25:44.707 position:50% align:middle And I think it is both that person, whoever represents the wellness 00:25:44.707 --> 00:25:48.477 position:50% align:middle resources or whatever resources you want to share with your nurses, but also the leader 00:25:48.477 --> 00:25:51.700 position:50% align:middle condoning it saying, "This is important for you. 00:25:51.700 --> 00:25:53.260 position:50% align:middle Your job is hard. 00:25:53.260 --> 00:25:55.429 position:50% align:middle It is okay to ask for help." 00:25:55.429 --> 00:26:02.110 position:50% align:middle - Do you ever bring in anybody or have any of your therapists talk to the unit as a group? 00:26:02.110 --> 00:26:03.130 position:50% align:middle - I do. 00:26:03.130 --> 00:26:09.010 position:50% align:middle And so we both bring in our therapists for those resource presentations. 00:26:09.010 --> 00:26:12.970 position:50% align:middle I think it's important that people can kind of see behind, you know, the mask, 00:26:12.970 --> 00:26:15.240 position:50% align:middle that they know who they're talking to. 00:26:15.240 --> 00:26:20.850 position:50% align:middle So, I try to get our therapists in front of staff frequently, as they're comfortable with. 00:26:20.850 --> 00:26:26.370 position:50% align:middle And then in addition to that, after difficult events, we hold processing sessions. 00:26:26.370 --> 00:26:32.047 position:50% align:middle And so it's important to normalize that, you know, whether it's an upsetting patient death 00:26:32.047 --> 00:26:38.360 position:50% align:middle or something going on in our greater world, work is a place that can be safe. 00:26:38.360 --> 00:26:43.120 position:50% align:middle It doesn't always feel safe, but we want you to feel safe with your colleagues and 00:26:43.120 --> 00:26:46.245 position:50% align:middle that you can talk about your big feelings here at work. 00:26:46.245 --> 00:26:47.510 position:50% align:middle - That's great. 00:26:47.510 --> 00:26:48.952 position:50% align:middle So, there are... 00:26:48.952 --> 00:26:56.376 position:50% align:middle Rush is a big medical center with many resources, but there are many small rural 00:26:56.376 --> 00:27:00.840 position:50% align:middle hospitals that don't have that capability. 00:27:00.840 --> 00:27:02.030 position:50% align:middle Deb, what can be done? 00:27:02.030 --> 00:27:03.340 position:50% align:middle I mean, you have a program. 00:27:03.340 --> 00:27:10.580 position:50% align:middle How do you get the word out to them that there is some availability at your level? 00:27:10.580 --> 00:27:11.140 position:50% align:middle - Right. 00:27:11.140 --> 00:27:15.890 position:50% align:middle Well, we do a great...we attempt to do a great deal of communication, 00:27:15.890 --> 00:27:21.556 position:50% align:middle certainly both into our members when it's a member benefit, but we have a great many 00:27:21.556 --> 00:27:23.860 position:50% align:middle resources that are open to anyone. 00:27:23.860 --> 00:27:31.940 position:50% align:middle So, all of the apps and programs that are foundation-funded, especially during COVID, 00:27:31.940 --> 00:27:38.230 position:50% align:middle and we've continued those, are open to all nurses and they can access those. 00:27:38.230 --> 00:27:45.778 position:50% align:middle We work with our state nurses associations in all the states to push that out and make sure that as 00:27:45.778 --> 00:27:50.730 position:50% align:middle much communication as possible, especially for those...as you say, 00:27:50.730 --> 00:27:56.540 position:50% align:middle those smaller hospitals or those hospitals that don't have the resources to create programs. 00:27:56.540 --> 00:28:05.680 position:50% align:middle At the same time, we continue to communicate and work on issues related to work environment. 00:28:05.680 --> 00:28:11.220 position:50% align:middle I'm so excited about the Rush program, some great examples that you have. 00:28:11.220 --> 00:28:15.970 position:50% align:middle And I'm sure that Rush equally you know, focuses its time on 00:28:15.970 --> 00:28:17.740 position:50% align:middle an improved work environment. 00:28:17.740 --> 00:28:25.500 position:50% align:middle But we still hear from nurses who feel that, you know, during the pandemic, 00:28:25.500 --> 00:28:32.650 position:50% align:middle maybe well-intentioned leaders set up wellness rooms or brought in spa chairs and nurses felt like, 00:28:32.650 --> 00:28:35.150 position:50% align:middle "I can't even leave the unit to use those." 00:28:35.150 --> 00:28:40.080 position:50% align:middle So, you know, "They don't mean anything if I can't use them." 00:28:40.080 --> 00:28:46.170 position:50% align:middle Or, you know, "You're doing that, but you're expecting me to staff 00:28:46.170 --> 00:28:48.120 position:50% align:middle this unit inappropriately." 00:28:48.120 --> 00:28:55.330 position:50% align:middle Or, "The burden of care that I'm giving is my real stressor here, it's not being addressed." 00:28:55.330 --> 00:28:59.994 position:50% align:middle So, we attempt to be very comprehensive, while at the same time we want to make sure 00:28:59.994 --> 00:29:03.282 position:50% align:middle we have resources for those who need them. 00:29:03.282 --> 00:29:15.860 position:50% align:middle - So, Victoria, what are some of the main ways that people that have a healthcare facility that is 00:29:15.860 --> 00:29:21.245 position:50% align:middle maybe smaller, that doesn't have a lot of resources can let their nurses know 00:29:21.245 --> 00:29:23.995 position:50% align:middle and help them get help? 00:29:23.995 --> 00:29:31.759 position:50% align:middle - I think it's really important that people are aware of all of the online and virtual resources 00:29:31.990 --> 00:29:33.750 position:50% align:middle that are available now. 00:29:33.750 --> 00:29:37.790 position:50% align:middle And, you know, this is one of the best outcomes of the pandemic. 00:29:37.790 --> 00:29:42.150 position:50% align:middle Because the literature is clear, the experience of clinicians is clear, 00:29:42.150 --> 00:29:48.440 position:50% align:middle that this is a very useful and effective form of treatment for those who can't access it 00:29:48.440 --> 00:29:50.110 position:50% align:middle in some other way. 00:29:50.110 --> 00:29:54.411 position:50% align:middle And it's not the "something is better than nothing," that the quality of care 00:29:54.411 --> 00:29:57.800 position:50% align:middle that's being provided virtually is on par. 00:29:57.800 --> 00:30:00.000 position:50% align:middle And it's about the skill of the clinician, 00:30:00.000 --> 00:30:03.891 position:50% align:middle but it's also about, you know, the motivation of the patient. 00:30:03.891 --> 00:30:07.740 position:50% align:middle And that's not anything new, but I think what we're finding is that it is 00:30:07.740 --> 00:30:13.299 position:50% align:middle bearing out, and that it is a reasonable and appropriate way for people who don't have 00:30:13.299 --> 00:30:18.150 position:50% align:middle access to the kinds of services available in large cities but they can do that. 00:30:18.150 --> 00:30:25.311 position:50% align:middle So, I think that coupled with, you know, organizations that communicate that and 00:30:25.311 --> 00:30:32.660 position:50% align:middle let people know, send out newsletters, "Hey, if you don't have time or you can't access or drive 00:30:32.660 --> 00:30:38.660 position:50% align:middle wherever to go get care, there are lots of online opportunities to do that." 00:30:38.660 --> 00:30:43.640 position:50% align:middle And maybe that will be enough for them, and maybe it will be a bridge to something else. 00:30:43.640 --> 00:30:48.504 position:50% align:middle But the idea there is that you continually communicate that maybe there are services 00:30:48.504 --> 00:30:50.910 position:50% align:middle available in the hospital or in the organization. 00:30:50.910 --> 00:30:56.450 position:50% align:middle But if there isn't, there are other ways that you can access that care clinically and see 00:30:56.450 --> 00:30:58.010 position:50% align:middle a virtual therapist. 00:30:58.010 --> 00:31:03.110 position:50% align:middle Or if you just want to be part of a mental health community specifically for nurses or for your 00:31:03.110 --> 00:31:08.751 position:50% align:middle particular discipline, there are tons of really great organizations and 00:31:08.751 --> 00:31:13.694 position:50% align:middle communities online that get it and that can be resources for you to figure out 00:31:13.694 --> 00:31:16.360 position:50% align:middle what you need and how to get access to it. 00:31:16.360 --> 00:31:17.810 position:50% align:middle - Great, thank you. 00:31:17.810 --> 00:31:18.410 position:50% align:middle Eve? 00:31:18.410 --> 00:31:24.110 position:50% align:middle - I think, too, something any organization can do is encourage their nurses to take breaks. 00:31:24.110 --> 00:31:27.580 position:50% align:middle And I would be the first to say that Rush has work to do here. 00:31:27.580 --> 00:31:33.713 position:50% align:middle It's really hard to change a long-standing culture around nurses being heroes or 00:31:33.713 --> 00:31:37.490 position:50% align:middle heroines and giving their all to the patient. 00:31:37.490 --> 00:31:42.160 position:50% align:middle I've heard from a lot of nurses a sense of guilt stepping away from their patients, 00:31:42.160 --> 00:31:45.990 position:50% align:middle that they're taking a 15-minute break, let alone a lunch break, 00:31:45.990 --> 00:31:48.897 position:50% align:middle means that they're not as committed as their colleagues may be, that they're 00:31:48.897 --> 00:31:51.140 position:50% align:middle putting their work onto someone else. 00:31:51.140 --> 00:31:54.600 position:50% align:middle But as you mentioned earlier, we know that a burned-out nurse affects our 00:31:54.600 --> 00:31:57.130 position:50% align:middle patient care, affects patient experience. 00:31:57.130 --> 00:32:02.141 position:50% align:middle And so unless we can start to change the narrative there, I think there really won't be 00:32:02.141 --> 00:32:05.250 position:50% align:middle improvement in nurse well-being. 00:32:05.250 --> 00:32:09.110 position:50% align:middle I think mental health and therapy can do a lot. 00:32:09.110 --> 00:32:13.780 position:50% align:middle But if you're not even just taking time to rest and recharge, how can you be your best self at work? 00:32:13.780 --> 00:32:15.170 position:50% align:middle - Right. 00:32:15.170 --> 00:32:18.170 position:50% align:middle So, let me then ask. 00:32:18.170 --> 00:32:20.770 position:50% align:middle Rush has a lot of students. 00:32:20.770 --> 00:32:27.204 position:50% align:middle Are there any programs geared towards them and preparing them to enter the environment 00:32:27.204 --> 00:32:29.520 position:50% align:middle that can be rather stressful? 00:32:29.520 --> 00:32:31.060 position:50% align:middle - Yes. 00:32:31.060 --> 00:32:36.268 position:50% align:middle So, in November 2021, two Rush clinical nurse specialists developed 00:32:36.268 --> 00:32:40.000 position:50% align:middle a new graduate residency program for the ICUs. 00:32:40.000 --> 00:32:44.223 position:50% align:middle They recognized that there was a lot of attrition from especially younger nurses 00:32:44.223 --> 00:32:45.756 position:50% align:middle as they entered the unit. 00:32:45.756 --> 00:32:50.840 position:50% align:middle And they cited issues that we've already heard about today around bullying, around overwork, 00:32:50.840 --> 00:32:52.990 position:50% align:middle and just feeling overwhelmed in their new space. 00:32:52.990 --> 00:33:00.342 position:50% align:middle And so what this program did was provide nurses with a structured program over 00:33:00.342 --> 00:33:06.240 position:50% align:middle 12 months where they received skills training, mentorship, and instruction in self-care. 00:33:06.240 --> 00:33:11.530 position:50% align:middle And what that means is that weekly, there were dedicated 60 to 90-minute sessions 00:33:11.530 --> 00:33:15.400 position:50% align:middle on mindfulness, processing, or yoga. 00:33:15.400 --> 00:33:20.140 position:50% align:middle So, what's really neat is that, you know, again, since its inception in November 2021, 00:33:20.140 --> 00:33:23.190 position:50% align:middle the program has graduated 71 nurses. 00:33:23.190 --> 00:33:26.740 position:50% align:middle And 96% of those nurses are still at Rush. 00:33:26.740 --> 00:33:30.715 position:50% align:middle We are really optimistic for the future and we're starting to emulate this program in 00:33:30.715 --> 00:33:32.494 position:50% align:middle other areas of the hospital. 00:33:32.494 --> 00:33:34.500 position:50% align:middle - That sounds terrific. 00:33:34.500 --> 00:33:42.481 position:50% align:middle Well, I'd like to now open this up to the audience for any questions that you have. 00:33:50.090 --> 00:33:52.650 position:50% align:middle - [Michelle] First of all, thank you very much, panelists. 00:33:52.650 --> 00:33:54.010 position:50% align:middle This has been really interesting. 00:33:54.010 --> 00:33:55.039 position:50% align:middle I'm Michelle Buck. 00:33:55.039 --> 00:33:59.743 position:50% align:middle I'm the APRN Senior Policy Advisor for National Council of State Boards of Nursing. 00:33:59.743 --> 00:34:04.270 position:50% align:middle And my question, I guess I'd like to start with you, Victoria. 00:34:04.270 --> 00:34:10.330 position:50% align:middle We know that nurses' suicide rate is higher than that of the general population. 00:34:10.330 --> 00:34:15.544 position:50% align:middle And I'm wondering if you can speak to that and maybe the other panelists could comment on, 00:34:15.544 --> 00:34:23.402 position:50% align:middle you know, what can we do to engage and empower our nurses to seek resources 00:34:23.402 --> 00:34:28.420 position:50% align:middle so that we can address this issue of suicide in the nursing profession. 00:34:28.420 --> 00:34:28.780 position:50% align:middle Thank you. 00:34:28.780 --> 00:34:30.680 position:50% align:middle - Yeah, I'm so glad you asked. 00:34:30.680 --> 00:34:39.658 position:50% align:middle We can all appreciate how someone who's suffering and doesn't feel as though they have 00:34:39.658 --> 00:34:45.720 position:50% align:middle adequate support or access would feel incredibly isolated and alone. 00:34:45.720 --> 00:34:50.039 position:50% align:middle I think when you couple that with a system that sort of 00:34:50.039 --> 00:34:52.606 position:50% align:middle perpetuates that idea... 00:34:52.606 --> 00:34:53.662 position:50% align:middle You know, let's face it. 00:34:53.662 --> 00:34:56.110 position:50% align:middle Healthcare is a culture of silence. 00:34:56.110 --> 00:35:03.343 position:50% align:middle And when a culture of silence is coupled with high stress, high demand, unrealistic 00:35:03.343 --> 00:35:07.040 position:50% align:middle expectations, people, they're going to break down. 00:35:07.040 --> 00:35:12.330 position:50% align:middle I think the most recent and poignant example of that, for those of you maybe who didn't catch it 00:35:12.330 --> 00:35:17.670 position:50% align:middle on social media, was a young nurse by the name of Tristin Kate Smith. 00:35:17.670 --> 00:35:18.800 position:50% align:middle Did anyone see her? 00:35:18.800 --> 00:35:19.770 position:50% align:middle - Yeah. 00:35:19.770 --> 00:35:24.710 position:50% align:middle - The title of her letter was A Letter to My Abuser. 00:35:24.710 --> 00:35:29.080 position:50% align:middle And she was referring to her abuser as the healthcare system. 00:35:29.080 --> 00:35:34.590 position:50% align:middle And so I think I invite all of you to read that. 00:35:34.590 --> 00:35:38.359 position:50% align:middle It's widely available on social media, Tristin Kate Smith. 00:35:38.359 --> 00:35:45.701 position:50% align:middle And read her story, and feel a personal responsibility to maybe cross what we 00:35:45.701 --> 00:35:50.287 position:50% align:middle are now calling professional boundaries and show acts of care and concern for 00:35:50.287 --> 00:35:51.839 position:50% align:middle our fellow humans. 00:35:51.839 --> 00:35:57.520 position:50% align:middle And I think that's the root of this issue, the grassroot, puts a lot of responsibility on us 00:35:57.520 --> 00:36:01.080 position:50% align:middle as individuals to care for each other. 00:36:01.080 --> 00:36:04.565 position:50% align:middle So, if we have a conversation like this and we acknowledge that there's a problem, 00:36:04.565 --> 00:36:06.273 position:50% align:middle it's not enough. 00:36:06.273 --> 00:36:08.131 position:50% align:middle You have to do something about it. 00:36:08.131 --> 00:36:12.531 position:50% align:middle So, that means when you walk out of here and you see a nurse or a healthcare worker 00:36:12.531 --> 00:36:16.996 position:50% align:middle and they look a little rattled and disheveled, you say, "You all right?" 00:36:16.996 --> 00:36:20.580 position:50% align:middle You know, "You want to grab coffee after work?" 00:36:20.580 --> 00:36:26.420 position:50% align:middle You know, let's get back to the humanity of all of this and, you know, care for each other on that level. 00:36:26.420 --> 00:36:33.450 position:50% align:middle And I think when we do that, and the data is clear that when we do do that, 00:36:33.450 --> 00:36:35.250 position:50% align:middle that we save lives. 00:36:36.378 --> 00:36:37.310 position:50% align:middle - Deb. 00:36:37.310 --> 00:36:40.706 position:50% align:middle - I'll just mention, you know, advocacy is a big part of what 00:36:40.706 --> 00:36:42.630 position:50% align:middle we do in a professional association. 00:36:42.630 --> 00:36:47.730 position:50% align:middle We were very pleased to work with a number of organizations to pass the Lorna Breen Act, 00:36:47.730 --> 00:36:51.780 position:50% align:middle but the issue around nurse suicide has been long-standing. 00:36:51.780 --> 00:36:55.650 position:50% align:middle And even early in our Healthy Nurse, Healthy Nation program, 00:36:55.650 --> 00:37:01.958 position:50% align:middle we pulled together a number of nurses who have skills and expertise, and have done 00:37:01.958 --> 00:37:07.553 position:50% align:middle research in the area of suicide, and developed a number of resources 00:37:07.553 --> 00:37:10.876 position:50% align:middle that we have online open to anyone. 00:37:10.876 --> 00:37:19.046 position:50% align:middle The issue, I think, is about those of us who work with individuals tapping into that early enough 00:37:19.046 --> 00:37:23.640 position:50% align:middle that we can identify that, get the resources to them they need. 00:37:23.640 --> 00:37:30.137 position:50% align:middle But we do have those available and we do want to make sure that we, you know, 00:37:30.137 --> 00:37:34.950 position:50% align:middle prevent it before it happens, try to identify it early on. 00:37:34.950 --> 00:37:37.720 position:50% align:middle So, certainly, it's an issue for us that we've identified. 00:37:37.720 --> 00:37:39.510 position:50% align:middle - Absolutely. 00:37:39.510 --> 00:37:39.950 position:50% align:middle Eve? 00:37:39.950 --> 00:37:45.632 position:50% align:middle - Something we recently did at Rush that I think many other health systems 00:37:45.632 --> 00:37:50.520 position:50% align:middle could do also, is we established a protocol for a threat of self-harm. 00:37:50.520 --> 00:37:55.730 position:50% align:middle So, what to do when someone does express suicidal ideation. 00:37:55.730 --> 00:38:03.570 position:50% align:middle And we will put steps in place as well as a supportive online training, just 10 minutes. 00:38:03.570 --> 00:38:08.170 position:50% align:middle Because I think in those moments, you know, it's so easy to be a bystander. 00:38:08.170 --> 00:38:11.890 position:50% align:middle It's so easy to say, "Ooh, I feel uncomfortable. 00:38:11.890 --> 00:38:16.116 position:50% align:middle I'll step away," when someone's saying something like, "I'm not sure I want to 00:38:16.116 --> 00:38:17.514 position:50% align:middle be here anymore." 00:38:17.514 --> 00:38:25.350 position:50% align:middle So, really, not just setting a standard of what we should do when someone expresses suicidality, 00:38:25.350 --> 00:38:31.215 position:50% align:middle but also equipping them with the training and words to interact well in that situation. 00:38:31.215 --> 00:38:33.050 position:50% align:middle - Right, thank you. 00:38:33.050 --> 00:38:35.160 position:50% align:middle Any more questions? 00:38:35.160 --> 00:38:35.550 position:50% align:middle Jason. 00:38:35.550 --> 00:38:37.170 position:50% align:middle - [Jason] Yeah, definitely. 00:38:37.170 --> 00:38:39.740 position:50% align:middle Jason Schwartz, Director of Outreach in the marketing group. 00:38:39.740 --> 00:38:43.380 position:50% align:middle So, like Michelle, I just appreciate all of you being here so much. 00:38:43.380 --> 00:38:46.040 position:50% align:middle My question, I think, is mostly for Victoria. 00:38:46.040 --> 00:38:51.960 position:50% align:middle So, Victoria, you had, at the very beginning, defined "burnout" as really an accumulation 00:38:51.960 --> 00:38:54.260 position:50% align:middle of unresolved stressors. 00:38:54.260 --> 00:38:59.174 position:50% align:middle And what I wanted to ask you is are there outward signs when somebody's 10% of 00:38:59.174 --> 00:39:02.180 position:50% align:middle the way there that you can notice and respond to? 00:39:02.180 --> 00:39:05.370 position:50% align:middle Because I think a lot of times, by the time people get help, 00:39:05.370 --> 00:39:06.867 position:50% align:middle there's too much to unpack. 00:39:06.867 --> 00:39:08.830 position:50% align:middle - Yeah. 00:39:08.830 --> 00:39:14.020 position:50% align:middle In clinical settings, we use two tools to help measure burnout. 00:39:14.020 --> 00:39:20.200 position:50% align:middle Both are peer-reviewed and standardized, and I recommend that organizations actually 00:39:20.200 --> 00:39:21.600 position:50% align:middle adopt these two. 00:39:21.600 --> 00:39:24.410 position:50% align:middle One was designed specifically for nurses. 00:39:24.410 --> 00:39:26.625 position:50% align:middle I'm hoping some of you have heard of this one. 00:39:26.625 --> 00:39:27.882 position:50% align:middle It's the BOSAS. 00:39:27.882 --> 00:39:29.280 position:50% align:middle Has anyone heard of the BOSAS? 00:39:29.280 --> 00:39:31.640 position:50% align:middle And the other is the MBI. 00:39:31.640 --> 00:39:35.620 position:50% align:middle But these are tools that we use to assess a person's level of burnout. 00:39:35.620 --> 00:39:38.060 position:50% align:middle We understand from those assessments... 00:39:38.060 --> 00:39:42.740 position:50% align:middle And they are widely used to study burnout. 00:39:42.740 --> 00:39:48.840 position:50% align:middle But we understand that when a person starts to disengage and starts to get cynical, 00:39:48.840 --> 00:39:52.870 position:50% align:middle that those are the two early signs of burnout that we try to catch. 00:39:52.870 --> 00:39:58.700 position:50% align:middle It means that the demands of the environment are exceeding the person's sense of their own 00:39:58.700 --> 00:40:00.710 position:50% align:middle capacity to meet them. 00:40:00.710 --> 00:40:07.792 position:50% align:middle And so when they start to get crabby and irritable and maybe their work performance 00:40:07.792 --> 00:40:13.700 position:50% align:middle starts to fail, those are the early signs that something is about to go terribly wrong. 00:40:13.700 --> 00:40:15.590 position:50% align:middle - Bev, did you have an... 00:40:15.590 --> 00:40:16.250 position:50% align:middle - Yes. 00:40:16.250 --> 00:40:18.660 position:50% align:middle - [Bev] Bev Malone, National League for Nursing. 00:40:18.660 --> 00:40:23.980 position:50% align:middle I was thinking of equity, diversity, and inclusion in terms of mental health. 00:40:23.980 --> 00:40:28.880 position:50% align:middle And I know that this is an issue that gets pulled into that, appropriately so. 00:40:28.880 --> 00:40:31.960 position:50% align:middle And I was thinking about the Black tax. 00:40:31.960 --> 00:40:35.602 position:50% align:middle You know, just being Black in America, there's an additional 00:40:35.602 --> 00:40:39.425 position:50% align:middle tax that we are assigned. 00:40:39.425 --> 00:40:46.533 position:50% align:middle And I was wondering in terms of how does that get integrated into your caregiving and 00:40:46.533 --> 00:40:52.200 position:50% align:middle your thinking, your framing of mental health. 00:40:52.200 --> 00:40:56.610 position:50% align:middle - For us, it's something that we're actively working on. 00:40:56.610 --> 00:40:58.420 position:50% align:middle We partner closely. 00:40:58.420 --> 00:41:02.550 position:50% align:middle We have a health equity initiative at Rush, as well as the DEI office. 00:41:02.550 --> 00:41:06.888 position:50% align:middle And so I wouldn't say we've solved it, but we're... 00:41:06.888 --> 00:41:10.990 position:50% align:middle I think first it's acknowledging that there is an issue, right? 00:41:10.990 --> 00:41:16.886 position:50% align:middle And, you know, we're really trying to think creatively around how do we support 00:41:16.886 --> 00:41:22.513 position:50% align:middle individuals who maybe are experiencing generational trauma, maybe are, you know, 00:41:22.513 --> 00:41:27.434 position:50% align:middle experiencing microaggressions every day or don't receive microaffirmations 00:41:27.434 --> 00:41:29.102 position:50% align:middle like their colleagues do. 00:41:29.102 --> 00:41:35.204 position:50% align:middle How do we help to create an inclusive environment instead of unintentionally 00:41:35.204 --> 00:41:37.980 position:50% align:middle or intentionally creating an other? 00:41:37.980 --> 00:41:41.860 position:50% align:middle And so I think for Rush, you know, there are a lot of neat initiatives going on. 00:41:41.860 --> 00:41:46.550 position:50% align:middle One of my colleagues, Aaron Franklin, is working on Black men in nursing. 00:41:46.550 --> 00:41:51.543 position:50% align:middle We're really trying to encourage a diverse workforce, so a lot of what you were talking 00:41:51.543 --> 00:41:52.559 position:50% align:middle about earlier. 00:41:52.559 --> 00:41:58.960 position:50% align:middle But I think from a mental health lens, so much of a first step is validating those feelings 00:41:58.960 --> 00:42:03.865 position:50% align:middle and acknowledging they're there, and acknowledging that it's not okay. 00:42:03.865 --> 00:42:06.990 position:50% align:middle - So, we have one minute left. 00:42:06.990 --> 00:42:11.821 position:50% align:middle I'd like to go around and, once again, ask you most important take-home 00:42:11.821 --> 00:42:14.560 position:50% align:middle message you want the audience to remember? 00:42:14.560 --> 00:42:15.270 position:50% align:middle Victoria. 00:42:15.270 --> 00:42:24.120 position:50% align:middle - I am on a personal and professional mission to make it weird to not have a therapist. 00:42:24.120 --> 00:42:25.438 position:50% align:middle Join me. 00:42:28.104 --> 00:42:36.140 position:50% align:middle - Mine would be, if you know a nurse, respect their time away, especially if you're a leader. 00:42:36.140 --> 00:42:43.220 position:50% align:middle It's so easy to send a text, an email, you know, and get that quick question answered. 00:42:43.220 --> 00:42:45.370 position:50% align:middle Maybe wait until the morning. 00:42:45.370 --> 00:42:51.160 position:50% align:middle I think so many nurses feel like they can't even enjoy dinner with their family, let alone take PTO. 00:42:51.160 --> 00:42:54.423 position:50% align:middle We really need to start creating boundaries ourselves so that the 00:42:54.423 --> 00:42:56.706 position:50% align:middle staff don't have to create it for us. 00:42:56.706 --> 00:42:57.400 position:50% align:middle - Deb. 00:42:57.400 --> 00:43:04.880 position:50% align:middle - I would say from the professional association and credentialing association model is we have 00:43:04.880 --> 00:43:08.470 position:50% align:middle to look at how we've built this into our work. 00:43:08.470 --> 00:43:12.390 position:50% align:middle Our Pathway to Excellence Program, which focuses on positive work environments, 00:43:12.390 --> 00:43:14.780 position:50% align:middle has well-being as a standard. 00:43:14.780 --> 00:43:20.685 position:50% align:middle It is an expectation for those who want to create a positive practice environment 00:43:20.685 --> 00:43:22.552 position:50% align:middle to focus on well-being. 00:43:22.552 --> 00:43:29.970 position:50% align:middle Our Practice Transition Accreditation Program is working with other accreditors to build well-being 00:43:29.970 --> 00:43:31.570 position:50% align:middle into the standards. 00:43:31.570 --> 00:43:36.640 position:50% align:middle So, it has to be a part of the way we do our work, and it has to be visible, 00:43:36.640 --> 00:43:40.495 position:50% align:middle and we have to show a real commitment to it. 00:43:40.495 --> 00:43:41.640 position:50% align:middle - Absolutely. 00:43:41.640 --> 00:43:42.410 position:50% align:middle Kim. 00:43:42.410 --> 00:43:52.899 position:50% align:middle - As a regulator, I think that we do have a commitment to working with professional 00:43:52.899 --> 00:44:06.520 position:50% align:middle associations, organizations to change that culture of stigma, and to educate and provide outreach 00:44:06.520 --> 00:44:08.270 position:50% align:middle for wellness programs. 00:44:08.270 --> 00:44:09.850 position:50% align:middle - Well said. 00:44:09.850 --> 00:44:11.780 position:50% align:middle Thank you all very much. 00:44:11.780 --> 00:44:16.868 position:50% align:middle We're going to take a quick break now, and we will be back and be talking about 00:44:16.868 --> 00:44:19.090 position:50% align:middle violence in the workplace.