Creating and Sustaining Healthy
Workplace Environments
University of Maryland All Alumni Reunion
April 28, 2018
Dorrie Fontaine RN, PhD, FAAN
Cheryl Cioffi DNP, RN, ANP-BC, NEA-BC, FACHE
Objectives
Define why a healthy
work environment is
important to patient
care and resilience in
care providers
Describe the current
state of burnout and
methods to restore joy
in nursing
Key Questions
Why is a healthy work
environment(HWE)
important to patient care
and resilience in care
providers?
What is the current state
of burnout and methods
to reduce stress?
What are a few clinical
examples of a HWE ?
What does it mean to
create resiliency through
Compassionate Care?
“The ……………………………………………
urgency of slowing down …”
- Pico Iyer
AACN Standards for
Establishing and Sustaining
Healthy Work Environments:
A Journey to Excellence
Essential Elements of a
Healthy Work
Environment (AACN 2016 2
nd
ed)
Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership
“Our
lives begin to end the day we
become silent about things that
matter.”
Martin Luther King, Jr.
Being present …fully present
Healthy work environments?
•
•
•
•
•
•
Workforce shortages
Moral distress
Lateral and vertical violence such as bullying
Quality & safety issues
Working wounded
BURNOUT
Common in nurses
& physicians
• Burnout
• PTSD
• Moral distress
Mealer et al 2009; Bruce et al 2014
Nurses who experience
burnout…
• Higher number of sick days; miss work due to injury,
illness, depression or fatigue
• More likely to have workplace errors
• More likely to be impatient and reactive to fellow
colleagues and patients and families
• More likely to change jobs
Healthy work environments:
How are we doing?
One example
Meaningful recognition scores (1-4, 4 = highest)
2006 (2.73)
2008 (2.77)
2013 (2.62)
Ulrich, B. et al (2014) Critical care nurse work environments
2013: A status report Critical Care Nurse;34:64-79
Association between Burnout and
Patient Outcomes
Hospitals with more
stressed nurses had higher
infection rates
When burnout reduced,
quality of care and cost
improved ….
30% decrease
over 6,000 fewer
infections and cost
savings of $69M
Cimiotti et al., 2012, U of Pennsylvania
The cost of bad behavior
Pearson, C. & Porath, C.
(2009) The cost of bad
behavior: How incivility is
damaging your business
and what to do about it.
New York: Penguin Group
“Why do doctors
commit suicide?”
Pranay Sinha MD (Medicine, `14)
Yale-New Haven Hospital resident
New York Times op-ed
September 4, 2014
No Time to be
Nice in the
Intensive Care
Unit
D Fontaine, J Haizlip, &
R Lavandero (2018)
American Journal of
Critical Care
Solutions/Opportunities
A call to action
Clinical Stories
Examples of a
healthy work
environment
from the clinical
setting
Cheryl Cioffi, Senior Vice President, COO/CNO
Frederick Regional Health System, Frederick, MD
AACN Healthy Work Environment
Elements:
• Skilled communication
• True collaboration
• Effective decision making
• Appropriate staffing
• Meaningful recognition
• Authentic leadership
Skilled Communication &
True Collaboration
• Team STEPPS – Feel free to CUS
• Bring Your Heart to Work program
• Medical Review Oversight Committee
(Physician Peer Review)
AACN HWE Elements:
Skilled communication True collaboration Effective decision making
Appropriate staffing Meaningful recognition Authentic leadership
Meaningful Recognition
• Celebrations
Satisfaction
Scared
Avoidance
Safety at Risk
• Certified Nurses Day, Preceptor of the Year,
Nurse of the Year, etc.
• PEP Program (People – Excellence – Performance)
• Disengaged
Patient Safety Hero
Harm
• Patient-Family Centered Care Award
Illness
AACN HWE Elements:
Turnover
Skilled communication
Appropriate staffing
Dissatisfied
True collaboration Effective decision making
Meaningful recognition Authentic leadership
Mortality
Appropriate Staffing
• RN Pipeline Program
• Twice Daily Staffing Huddles
• Proactive Staffing Incentive Plan
• Flexible Staffing Options / Robust Internal Float Pool
• Root Cause Analysis
AACN HWE Elements:
Skilled communication True collaboration Effective decision making
Appropriate staffing Meaningful recognition Authentic leadership
Authentic Leadership
• Pet Therapy focused on staff
• Senior Leader Rounds
• Director/VP/CNO presence every weekend
• Supporting what matters
• Remove Barriers- “Quality Waste”
• ClinTech Nursing Council- streamlining documentation
AACN HWE Elements:
Skilled communication True collaboration Effective decision making
Appropriate staffing Meaningful recognition Authentic leadership
Critical Event Support Team
• Available to all staff, Volunteers, and Physicians to
provide emotional support following an unusually
stressful scenario in the workplace
• The Critical Event Support Team members are trained
in providing a brief assessment and support, and
determining if further intervention may be needed
AACN HWE Elements:
Skilled communication True collaboration Effective decision making
Appropriate staffing Meaningful recognition Authentic leadership
Impact to Outcomes
• Great Place to Work
• Distinguished Hospital for Clinical Excellence
• CMS 5-Star Rating
• Highest rating for “Satisfied with Nurse Manager”
• Increased Patient Satisfaction scores
AACN HWE Elements:
Skilled communication True collaboration Effective decision making
Appropriate staffing Meaningful recognition Authentic leadership
Good Place to Work
5
4,79
4,64
Mean Score
4,5
4,42
4,42
2013
2014
4
3,5
3
FMH
2015
State
National
2017
“Taking Care of the People
who Take Care of Our Patients”
At UVA School of
Nursing … Creating
compassionate
nurses and leaders
for the 21st century
Our
goal
……………………………………………
Reducing human
suffering by cultivating
compassionate people
and systems
Compassion
…experiencing a
trembling or
quivering of the
heart in response to
another’s pain
Sharon Salzburg
Empathy
Putting yourself in
the shoes of
another
A necessary
precondition for
compassion
Can empathy and compassion
be learned?
Fontaine, D. K. (January 6, 2013) Editorial,
Daily Progress
What ……………………………………………
do people see when they see
you?
“We live in a time when science is validating what
humans have known throughout the ages:
that compassion is not a luxury; it is a necessity for
our well-being, resilience, and survival.”
- Roshi Joan Halifax
Nursing
Compassion as a Global Remedy
His Holiness the Dalai
Lama, October 2012
UVA Nursing’s
Resiliency Initiative
The Architecture of
Resilience
“…resilient practices -- things like
meditation, yoga, reflective writing, deep
breathing, even physical exercise -- make
for happier, stronger, more centered
clinicians.”
D. Fontaine, S. Bauer-Wu, & D. Germano (2014)
http://www.huffingtonpost.com/dorrie-k-fontaine/thearchitecture-of-resil_b_4560762.html
Compassionate Care Initiative
Jonathan Bartels RN, BSN
The Pause
Bartels, J. (2014). The
pause. Critical Care
Nurse, 30:74-75.
Compassion, and
the need for
kindness
Kindness
“is not just about
being nice, it’s
about recognizing
another human
being who deserves
care and respect”
Compassionate Care
Contemplative Practices
Awareness—Presence—Resilience
“Mindfulness is a way of being and
relating to ourselves, our circumstances,
one another, and the world around us … It
invites an attitude of openness and
curiosity.”
- Susan Bauer-Wu (2011)
“… It is being awake to the fullness of
our lives right now, through engaging the
five senses and noticing the changing
landscapes of our minds without holding
on or pushing away any of it.”
-Susan Bauer-Wu (2011)
Mindful clinicians associated with
better patient care
• Multi-center, observational study
(MD, NP, PA)
• Measures:
– Patient ratings of quality of care (n=437)
– Clinician (n=45) encounters recorded and coded
into high and low mindfulness
• High mindfulness clinicians associated with:
– Patient-centered communication
– Positive emotional tone
(Beach et al., 2013)
CCI’s growing vision
To have safe, highfunctioning
healthcare
environments
with healthy and
happy nurses,
physicians and
other health
care workers
where heart and
humanness are
valued and
embodied
Nursing
What
are
we
doing
at
UVA?
……………………………………………
Nursing
Nursing
Nursing
Our CCI
‘ambassadors’
Creating a Resilience Room
CCI’s drop-in programs
•Mindfulness Meditation: Guided
meditations offered 3x a week
•Yoga: offered 3x every week
•T’ai Chi: Offered once each week
•Chair massage: offered weekly. 10
minute chair massages over 2 hours
•Other sessions offered monthly
–Mindful lunches, reflective/creative writing,
creativity/art workshops, chair yoga, Mindful
Music
•Aired on 78 NPR
stations and
SiriusXM and
downloaded more
than 11,000 times
•Episodes 1-4
available on
humanmedia.org
•Two additional
productions
available on
nursing.virginia.edu
Restoring Joy to Nursing:
An idea exchange to reduce caregiver burnout
Invited conference at Wingspread
(Johnson Foundation, Nov 2016)
10 health systems
CNOs, clinical nurses, AACN,
ANA, AONE, and industry
Preventing Burnout in 2017
Moss, M., et al. (2016). An
official critical care societies
collaborative statement:
Burnout syndrome in critical
care health professionals: A
call for action. Critical Care
Medicine, 44, 1414-1421.
Among Solutions:
Include
interprofessional
education/team
training for the next
generation
Our focus includes
Interprofessional Education
To create understanding
of each other’s roles by
training all 3rd year
nursing and medical
students together
Resources
American Association of Critical-Care Nurses. (2016). 2nd ed.
AACN standards for establishing and sustaining healthy work
environments. Available at: http://www.aacn.org/hwe
Bartels, J. (2014). The pause. Critical Care Nurse, 30:74-75.
Bauer-Wu, S., Fontaine, D. (2015). Prioritizing clinician
wellbeing: The University of Virginia’s Compassionate Care
Initiative. Global advances in health and medicine, 4(5):1622.
Fontaine, D. K., Rushton, C.H., & Sharma, M. (2014).
Cultivating compassion and empathy. In M. Plews-Ogan & E.
Beyt (Eds.). Wisdom leadership in academic health care
centers: Leading positive change. London: Radcliffe
Publishing, 92-110.
Resources
Fontaine, D. K. Can empathy and compassion be
learned? Editorial, Daily Progress, January 6, 2013.
Fontaine, D. K., Bauer-Wu, S. & Germano, D. (2014)
The architecture of resilience.
http://www.huffingtonpost.com/dorrie-k-fontaine/thearchitecture-of-resil_b_4560762.html
Marturano, J. (2014). Finding the space to lead: A
practical guide to mindful leadership. New York:
Bloomsbury Press.
Resources
Mealer, M., Jones, J., & Meek, P. (2017). Factors affecting
resilience and development of posttraumatic stress disorder in
critical care nurses. American Journal of Critical Care, 26,
184-192
Moss, M., Good, V.S., Gozal, D., Kleinpell, R., & Sessler, C.N.
(2016). An official critical care societies collaborative
statement: Burnout syndrome in critical care health
professionals: A call for action. Critical Care Medicine, 44,
1414-1421.
Worline, M. & Dutton, J. E. (2017). Awakening compassion at
work: The quiet power that elevates people and organizations.
Oakland, CA: Berrett-Koehler Publishers.