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.