Days can go fast and furious amid our COVID-19 changed lifestyles and habits. Take a quick 3-minute pause to listen to this uplifting micro-interview between Dr. Bonnie Clipper & Joyce Ryan DNP FNP-BC RN, talking about gratitude, inspiration, and leadership.
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Dr. Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE
There is much uncertainty for all of us. Our emotions wax and wane daily and we are all likely taking time alternating between being the support and needing support. These difficult times call for all of us to work together for the greater good and help each other through the challenges of the upcoming weeks. Doing this is going to require focus, discipline, compassion and a great deal of gratitude.
Gratitude is not simply for others; it is also about being kind and grateful to ourselves. There is a saying along the lines of “how we treat ourselves is a reflection of how we treat others”. While that makes sense, it doesn’t completely resonate because as healthcare professionals we tend to treat others better than we treat ourselves. As highly empathetic caregivers, we generally put others first and ourselves last.
Have you put much thought into how you treat yourself? Are you kind to yourself (self-kindness)? Are you compassionate to yourself (self-compassion)? Are you grateful to yourself (self-gratitude)? As I continue to sharpen my focus on kindness, compassion, and gratitude, there are many times that in hindsight, I think I am overly hard on myself. I can even think of the times that I haven’t shown myself the compassion, kindness, and gratitude that I deserved. This makes me think that I am not at all unique and makes me wonder how many of us don’t practice self-kindness, self-compassion, and self-gratitude.
Part of our practice of showing gratitude to those around us for their efforts and to recognize their hard work requires that we show ourselves the same gratitude. Yet so often we fall short on creating gratitude for ourselves. In a conversation on this topic with Vicki Hess, MS, RN, Employee Engagement Expert, she shared that “We always hear about how important it is to slow down and take care of ourselves so we can support others. Yet many are so overwhelmed with everything that they have to do each day that it’s tough to come up for air and be grateful.”
Hess goes on to say that “one thing that works well is to create Gratitude TriggersTM which reminds you to stop and be grateful. These can be at work or at home (or anywhere in-between). I frequently ask nurses to share what routines they use to pause and bring gratitude into their lives. Their examples include sitting down to a meal, walking the dog, pulling into a parking spot at work, washing their hands…and the list goes on.” Now, even the smallest opportunities present themselves for gratitude. Hess suggests considering this best practice for yourself, “Develop one Gratitude TriggerTM that you could utilize to remind yourself to stop and think about what you are grateful for because implementing this process can literally change the way you think, work and play.”
Another option may be to use a gratitude journal which is one of the most popular ways to practice gratitude and allows for reflection for not only self-gratitude but also self-compassion (Vetter, 2018). Now, is a good time to think about your own practice and start a gratitude journal. Lately, I find myself grateful on a more frequent basis. It’s a good reminder for me to write it down and reflect on it. Otherwise, I find myself taking things for granted.
Practice gratitude at least once a day and like most behaviors, over the course of time, it will become hardwired. Show yourself some gratitude and self-compassion, you deserve it. Much gratitude for all of those who are on the front lines of the pandemic and ensuring our safety and caring for those who are sick.
Be kind and be well.
Vetter, A. (2018). How Gratitude Can Make You a Better Person in Business and Life. Inc.com. Accessed on March 10, 2020. Accessed at https://www.inc.com/amy-vetter/why-celebrating-your-wins-no-matter-how-small-is-good-for-you-your-business.html.
A special thank you to Vicki Hess, RN, MS. Top 5 Healthcare Speaker, and author, guides healthcare professionals who want to create an environment where employees are engaged, customers are happy, and goals are achieved. Ms. Hess works with organizations and associations to positively impact employee engagement through consulting, workshops, retreats and keynote presentations. Her unique views on employee engagement are evidence-based, relatable and real-world www.VickiHess.com.
Dr. Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE
There has never been a more important time to thank people for their kindness and recognize people for who they are and what they do. At times like this, no act is “too small”. Understandably our minds are running in a million directions, however, anchoring to the positive is important in difficult times. Here are a few tips:
- 1. Show gratitude for anything and everything. In a crisis, our perspective changes and reminds us that nothing should be taken for granted.
- 2. Close your eyes for 15-30 seconds and clear your mind. Focus on what is going well. Tune out the news and limit social media. Think of what is important in your life.
- 3. Send a thank you text. Send a text to share your gratitude to colleagues, friends, and family. Especially now, a simple note of recognition for coming into work, for picking up a shift, taking on a project, volunteering, working from a bedroom, dropping off groceries, etc. Find something to show that you are “thinking” of someone.
Take just a few minutes each day to contemplate your gratitude and share it with others.
#nurses #physicians #healthcare
David Shulkin, M.D. FACP
Ninth Secretary, US Department of Veteran Affairs
With the coronavirus (COVID-19) actively spreading, and so many uncertainties about its course, it may seem like we are in unchartered territory. The declaration of a national emergency at both state and federal levels has clearly focused attention on the readiness of our medical infrastructure and workforce. While the COVID-19 virus is novel, there is still much we can learn from prior infectious outbreaks.
It is crucial to note that the spread of viral illness depends on a number of factors such as the virulence of the pathogen, adherence to public health precautions and measures, and the readiness of the healthcare system to address these outbreaks, to name a few. The resilience of healthcare professionals is a critical element of the system’s ability to respond.
In the 1918 influenza pandemic, hospitals were overflowing with patients. Many had to double or triple their usual bed capacity and used hallways to accommodate the demand. Already experiencing a severe nursing shortage from military demands of World War I, civilian hospitals were left with minimal staff. As a result, nurses and other healthcare workers were often on duty from early morning to the late hours of the night. Workloads were dramatically expanded, and staff often worked without proper supplies, equipment or medications. Even worse, large numbers of healthcare workers themselves got sick, and many died.
The stress on nurses, physicians and others dealing with the 1918 pandemic was considerable. Yet few voluntarily left their assignments, instead caring for patients even when it meant a risk to their own health. There may have been many reasons for this, but it is my opinion that the response from organized professional societies and the public at large played an important role.
In support of nurses and others during the 1918 pandemic, the Red Cross organized motor brigades for transportation to help get healthcare professionals to work and home. Community groups organized food pantries and other staples to support staff who did not have time to go to markets and attend to ordinary household chores. Supervisors in hospitals, even those not clinically trained, helped gather supplies for nurses and would assist on rounds. Volunteers came to help with staffing shortages. Professional societies worked on education and communication campaigns. But maybe most important, government officials and community leaders publicly offered their gratitude and support for what the healthcare professionals were doing to try to lessen the catastrophic nature of the pandemic.
Since 1918, our healthcare system has responded to many other challenges and we’ve been able to quantify the impact of infectious outbreaks on healthcare workers. In the A/H1N1 pandemic in 2009, 56% of healthcare workers expressed worry for their own safety and that of their families. Absentee rates of up to 35% were observed during this outbreak due to healthcare workers’ concerns, their own illness, or needing to care for sick family members.
Staffing shortages only add to the stress of those that continue to work, often at times of high patient demand. Those that remain face additional stress in the workplace. During times of crisis, healthcare workers often report a sense of ethical duty and many put their responsibility to help others above their concerns for their own health or that of their family. This professionalism must both be admired, but at the same time, must be supported with meaningful responses from health system leaders and the community at large.
As we’ve learned from past infectious outbreaks, how our staff are treated and supported during a pandemic can have a big impact on our workforce and ultimately on our patients. With the most challenging times for dealing with coronavirus likely still ahead of us, thinking through how we lessen the stress on our staff and address their concerns will be of critical importance.
Ensuring that staff know that leaders are concerned about their safety and health is vital. This can be done by explicitly stating that this is an institutional priority. Before a pandemic occurs, staff must have the time to prepare for situations like this and ensure they have the skills to respond accordingly. In the face of a pandemic, staff must have the right protective equipment and supplies for them to feel safe and to deliver safe, quality care. Training and education about the infectious agent, and the epidemiology of the disease, is essential for staff members to feel well-informed and supported to do their jobs well. Additionally, emergency preparedness trainings and resilience trainings are useful in preparing staff for these often-unpredictable situations.
Recognizing staff for the courageous way they respond to the challenges faced, and professionalism in which they meet these demands, is impactful. Far too often, staff are not recognized for the work they do and the differences they make. Recognition from leaders, co-workers, and patients and their families are all essential for reinforcing the reason why healthcare professionals step up in times of crisis. Real-time feedback is the best possible way to tap into the reason why people remain committed and dedicated to their work.
Systems that demonstrate the impact of recognition, where patients and families can leave real-time recognition and feedback for their care team, are showing very real increases in staff morale. It is important for staff to be recognized for their valiant efforts during times of crisis, such as responding to this current pandemic. Amid staff feeling concerned and fearful of the many unknowns surrounding COVID-19, this approach makes staff feel like their work doesn’t go unnoticed, but is instead valued and appreciated.
Regular updates and communications about the current situation facing a community or an organization are helpful in allowing staff to feel more control of their situation. The use of technology and social media platforms to share information can be an effective form of communication. Moreover, forming committees, or other organized forums, to get input from staff and others on how best to address the situation and the environment is a good way to ensure feedback from those often being affected the most. Providing forums to have exchanges of information is a vital part of addressing these needs.
Providing transportation, telephone or device access, and food is often effective in reducing some of the stress that can be seen with increasing job demands. In times of pandemics, options such as public transportation may be limited, making getting to and from work for some more challenging. Being able to stay in communication with family and friends is often a concern as well with more hours being spent at work.
Stress and burnout of healthcare workers has been growing for years, but during times of crisis, we must be especially vigilant in addressing the needs of our staff. Addressing these issues is an essential part of a healthcare organizations’ emergency preparedness. Even more than 100 years since the last great pandemic, let’s hope that we can learn from that experience and do an even better job in supporting those that are doing such important work.
Dr. Bonnie Clipper, DNP, MA, MBA, RN, CENP, FACHE
Today, our health care professionals are on the front lines of a new kind of “war”. This isn’t a war of guns, bombs or bullets, but rather one of a silent killer- a highly transmittable and potentially lethal virus. The Coronavirus is an equal opportunity opportunist. It matters not your race, gender, class, religion or status, but only if you would make a good host. This is a war, where those on the front lines didn’t sign up or enlist, by default they were all drafted. While well trained, our millions of health care professionals, as well as housekeeping, food service and support staff, are in fact on the front lines and have not had the opportunity to drill, synchronize and perfect their efforts -like a professional military.
According to the Bureau of Labor Statistics (2019) there are over 4 million nurses, 1 million physicians, 800,000 pharmacists, approximately 130,000 respiratory therapists along with hundreds of thousands of therapists and others who are on our front lines today. These are our new “troops”, those who we must support in order to defend our communities. As the country is closing schools, reducing travel, canceling major league sports and regional events and contemplating further closures to reduce transmissibility of the virus, our health care professionals and support staff are showing up to work. They didn’t ask to be put into these potentially high-risk roles like a Special Ops or Seal Team soldier, yet there they are. I am not demeaning the importance of military roles, just trying to show that the comparison at this time is similar.
Consider how you can support our new “troops”. Our health care professionals have older parents, children and friends, and many of them are concerned about what they are bringing home to their families. Additionally, they worry for themselves and their colleagues, partially about getting COVID but also, as a close ED nurse family member said to me yesterday “if I get sick, I can’t work and help in the ED and they are already getting swamped”. This is what health care professionals do. Yes, they worry about themselves, but really, they are concerned about others. This is what makes them such unique and special people. It is no surprise that for 18 years nurses have been the most trusted profession. They, along with their interdisciplinary colleagues work tirelessly and continue to show up no matter the personal expense.
Today, I am reflecting on what I can impact and focusing on the task at hand which is supporting those on the front line of this new “war”. I have had many people reach out to me to ask how they too can help. Here are some ideas; prepare and drop off meals, offer to watch pets or walk a dog, consider watching their kids or having a sleepover for a night or two to help relieve some of the stress and obligation that our caregivers and providers feel on a daily basis, pick up groceries, etc. In digging back into how our country has responded to crises in previous decades, I stumbled upon the significance of the Yellow Ribbon during wartime. While not intended to take anything away from the significance of this gesture to honor our courageous military, I think it applies in this recent “war” on the Coronavirus as well.
As Winston Churchill said, “never waste a good crisis” (realbusiness, 2020). Let use the COVID crisis as an opportunity to learn and improve, when we get to the point of serious debriefing on the outcomes and the toll that this crisis has taken on our country. We will have some serious questions to face. How do we learn from this and be prepared for the next pandemic? We will also need to face endemic burnout issues head-on to ensure that we can truly recruit and retain the best and the brightest in our health professions. This means that ongoing pay, resource, and staffing needs to change to be sure that we have an adequate supply of nurses, physicians and respiratory therapists going forward. Our healthcare disciplines all face looming shortages only projected to increase in the coming years. The documentation burden needs to be addressed once and for all, how many years of redundant documentation need to continue to show what a problem it is. How can we ensure that we aren’t again caught flat-footed on medical equipment and PPE inventory? And most importantly, how we can fund public health, community health, and school nurses to an effective and acceptable level again.
Hunker down and support our health care professionals in any way that you can. As for me, I am resorting to the age-old tradition of showing support for the new “troops”, and I have started tying yellow ribbons to trees in my community as a sign of my support for our health care professionals and support staff that are on the front line. Please join me by tying or wearing a yellow ribbon to support our front line heroes.
Be smart. Be kind. Be safe.
Realbusiness. (2020). Accessed on March 15, 2020. Accessed at https://realbusiness.co.uk.com/as-said-by-winston-chirchill-never-waste-a-good-crisis/.
Ashley Eddings, MBA, SSGB
When reading the 2019 HR Healthcare Report, there was a statistic that stopped me in my tracks: “91% of respondents believe the quality and care with which their company leaders engage employees influences aspects of the care those employees provide” (HR Healthcare and WBR insights, 2019, p. 3). If there was any gray area that employee engagement has a profound impact on patient care provided, this statistic alone could dispel it. Keeping employees engaged on the job is not only difficult, but it is one of the most important facets of retention. Furthermore, employees who are engaged often feel valued and are connected to their sense of purpose. They know their why and seek it each day on the job. This can undoubtedly translate to better patient care. Knowing the importance of engaged employees and their impact on patient care, how do we get and keep them engaged? A couple key insights from the 2019 HR Healthcare Report are shared below.
Consider this: “Communication and transparency within the organization improves employee engagement which, in turn, improves the quality of care employees provide to their patients. Organizations will invest more in communication and performance measurement technologies to catalyze this progress” (HR Healthcare and WBR insights, 2019, p. 17). Given the tumultuous burnout landscape, communication and transparency are incredibly important to ensure that employees feel seen and heard. Employees want to know that the organization and its leaders are approachable and have the time and desire to communicate with them in a transparent, thorough manner. Employees who know what is going on and are apprised of pertinent information as it pertains to their roles and the organization, will often go above and beyond for their leaders, organization, and more importantly, for their patients. Communication and transparency in a busy workplace are not always easy, and it takes intentionality, but the return is fruitful in the quality of care being provided by engaged employees.
Additionally, while there are many nuances and causes of disengagement and burnout, it is widely studied and accepted that the effects of burnout can be reduced, and employees become more engaged, with meaningful recognition. In fact, HR Healthcare and WBR insights (2019) explains that “peer-to-peer employee recognition is a tried and tested method through which employee engagement and quality of work improve consistently” (p. 14). Think about it – when colleagues recognize your contributions and hard work, how does this make you feel? For many, it gives them the encouragement needed to continue through a rough day, or perhaps the gentle nudge to keep up the great work. Being recognized and acknowledged has a lasting impact and often pushes employees to maintain the high-quality level of care they are providing because it is seen and valued. When employees are celebrated for their work and appreciated for what they do, employee engagement increases. Meaningful recognition is a simple yet highly effective way to keep employees engaged in their work, and in turn, providing quality care to patients.
The report explains that leaders should provide their employees with new scenarios and approaches for them to consider and implement. Employees who can weigh in on a new process, situation, or approach often come up with innovative and thoughtful solutions and ideas. These ideas frequently translate into change in practice, research studies and evidence-based practice projects, to name a few. This keeps employees engaged on the job and in their role as they work to improve patient care. Leaders should consider giving employees the ability to influence their practice and elevate their footprint in patient care. Owning and implementing new approaches and scenarios is an effective way to engage employees.
It is vital to remember that “…although satisfaction and commitment are related to performance, engagement appears overall to be a better predictor of employee performance” (HR Healthcare and WBR insights, 2019, p. 6). Gone are the days of “band-aid” approaches to keep employees engaged and performing at their peak. Instead, seek ways to empower employees to operate at their best on the job. Give them opportunities to share fresh and new ideas, allow for transparency and open communication, and continue to show that you care for and value them. Recognize them continually and show in action and words that you want to see them connected to their work and purpose. When you go above and beyond for your employees, they will often do the same in return. It matters for the employee, the team, the leader, the organization, and ultimately, the patient.
HR Healthcare and WBR Insights. (2019). A 2019 HR Healthcare report: Aligning employee engagement and satisfaction with the quality of patient care.
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