May 27, 2021

How to go beyond 'thank you' and help nurses heal

Daily Briefing

    How can health care leaders support and celebrate their nurses, many of whom have faced a particularly challenging year amid Covid-19? Advisory Board's nursing experts Karl Whitemarsh and Maddie Langr sit down with Radio Advisory's Rachel Woods to talk about what health care leaders can do to go beyond "thank you"—and make sure nurses feel valued and supported.

    Read a lightly edited excerpt from the interview below and download the episode for the full conversation.

    Our take: Three strategies for hospitals to build baseline emotional support

    Rachel Woods: Creating a safe and a flexible environment feels like the bare minimum that we can do to support nurses this year. But I have to believe, in this moment, where there are very practical needs for nurses, that there has to be something more that we can be doing. What do you two think?

    Karl Whitemarsh: We need to do everything that we can to make sure that our nurses can heal and recover from the rigorous 12 months that have left many of them stressed, at a minimum, and traumatized on the other end of the spectrum.

    Maddie Langr: I think, too, doing everything we can means making strategic trade-offs for organizations to invest the money and the time that is needed to really allow that to happen.

    Woods: Let's talk about those trade-offs. Practically speaking, how do we help nurses heal? How do we give them recovery?

    Whitemarsh: We can think about recovery in two kind of overarching buckets. We need to do what we can to help them physically recover, but then especially emotionally recover as well.

    Woods: We are going to be devoting a whole episode to be talking about that physical side of recovery. But I don't want to ignore it here because it is so important. When it comes to the physical aspect of recovery, what's one of the big takeaways that you want to make sure you leave our listeners with?

    Langr: I would say that for physical recovery, I know that anybody who's involved in nursing, who's listening to this, knows that we can't just give all of our nurses a six-month sabbatical and unlimited PTO to take time away from work. But at a minimum, I think we can think about places to create flexibility in workflows and schedules. So thinking back to that, that broader category of flexibility to allow some of that physical recovery to occur.

    Woods: So what you're saying is, even though we don't have enough supply to, like you said, give nurses a sabbatical, we can still use the same principles of flexibility that we had to use during the worst moments of the surges, and we're continuing to use to meet very real nursing needs, as a way to move towards physical recovery.

    Langr: Yes. I think that's a really good point, too, that we're at a point where organizations are going to be thinking about, how do we staff coming out of crisis mode? I implore all nursing leaders who have implemented these pockets of flexibility to think long and hard about which ones will continue to serve us, but maybe for different reasons outside of Covid surges.

    Woods: Let's move to that other side of recovery, which is the emotional recovery. Karl actually used the word trauma earlier as a way to describe what nurses have gone through. In fact, even going so far as to point out that trauma isn't necessarily new in the nursing space. But tell me about the concept of providing emotional support. Is that new for clinical leaders?

    Whitemarsh: I would say it is and it isn't. I would say pre-pandemic, many leaders were increasingly prioritizing emotional wellbeing, but the burdens of the pandemic made those alarm bells into a three-alarm fire.

    So if we consider pre-pandemic, there was an interesting phenomenon where nurses were actually the most engaged member of the care team. While burnout had been on our radar, it had mostly been in the background.

    I actually want to attach some hard numbers to this by way of a study that came out on May 1st. A group of researchers from the Ohio State University published in the American Journal of Critical Care, a survey of over 700 critical care nurses.

    The period of the survey is interesting, because it's August 2018 to August 2019—squarely pre-pandemic. And despite the data being from the "before times," the results are still really concerning. And even more concerning when we consider how these figures may have very likely shifted for the worse during the last several months.

    So just to top line some of the results from the study, a clear majority of critical care nurses were rating their physical and mental health as very low on the scale provided by the study. And again, this was pre-pandemic.

    I actually want to call out a quote that the lead author provided, which is solutions-oriented. It's that, "If nurses believe they work for an institution that is supportive of their well-being, they actually have better health outcomes." So again, speaking to the power of perception here.

    And to quote what they wrote in the article, it's, "Critical care nurses who perceived high levels of wellness support from their organizations were twice as likely to have better health." So speaking to the importance of embedding not just a culture, but an infrastructure of wellness support, especially emotional wellness, for your critical care nurses and nurses in general, and pointing to how this will pay dividends for you.

    Woods: How does an organization do that? If I understand just how important this is, especially in this moment, how does an organization actually provide emotional support, wellness support, to the most overburdened workforce we've probably had?

    Whitemarsh: I think it's about really going beyond the Employee Assistance Program. Advisory Board's recommendation is that at a minimum, organizations need to provide at least one formal emotional support resource for each of the following:

    1. Major events that could lead to emotional distress, trauma, grief, PTSD. Of course, a pandemic would rise to that level;
    2. Moral distress. So again, moral distress is the feeling that you know the right course of action, but cannot take it due to some type of constraint; and
    3. Routine stress related to the rigors of health care. For instance, delivering frontline care routinely can, over time, contribute to compassion fatigue.

    So again, that's major events, moral distress, and the routine stress related to a job in providing direct patient care.

    Langr: I'd add to that, to go even more granular, and say there are specific experiences or emotions that clinicians have had across the last year that leaders need to consider how to address within those broader categories. The five that we've been talking about here at Advisory Board are: fear, exhaustion, isolation, distress, and trauma. These are some of the many responses that clinicians have had across the last year. Some may experience all of them.

    It's been a rough year. Many people have all or some of these emotions. Health care organizations need to think about, how will we help our staff address these emotions moving forward?

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