Wellbeing 101: How CNOs Can Provide Support and Build Resiliency

Nurse wellbeing is critical to positive patient outcomes and the overall success of a health system.

Being a nurse is difficult.

The job entails long hours, substantial workloads, and the heavy emotional burden of guiding patients through some of the toughest moments of their lives.

Nurse wellbeing is essential to the success of a health system, and it is the CNO's job to make sure they are providing programs and support to help keep their staff safe and well.

According to April Prunty, director of nursing professional development at Allina Health, more than half of the healthcare workforce is made up of nurses or nurse-related positions, so the wellbeing and success of nurses affects everyone. If nurses are not in top shape, Prunty explained, that causes a decline in patient outcomes.

"If our nurses and our nursing team members aren't doing well, they are not in a good position to provide that excellent patient care," Prunty said. "There is also some evidence to suggest that if nurses are doing well, the rest of the healthcare team is doing well."

Understanding wellbeing

Wellbeing looks different for each nurse. Some might prioritize flexible scheduling and better work-life balance, while others might want more opportunities to connect with others or time to process events.

" One of the key tenets of nurse wellbeing is really understanding what wellbeing means for the individual nurse," Prunty said. " It does look different for everybody, but there's some key principles that can be woven throughout to support wellbeing."

CNOs need to show their support and learn about their staff to understand what those needs are.

"One of the things that we often hear from nursing staff is that they really appreciate visibility," Prunty said. 

Nurse leaders should take time to informally round on units and connect with staff, Prunty recommended. CNOs can take that opportunity to listen to what the nurses are telling them, so they can provide the correct support and continue to advocate for them.

"Continuing to advocate for staff [at] whatever table they're sitting at to make sure that staff have the resources that they need to continue providing excellent patient care is always important," Prunty said.

Changing the environment

The next step is to make the work environment healthier and safer. Prunty referenced the uptick in workplace violence as one of the key challenges in the healthcare industry, as well as the increased levels of care required by patients.

"We're seeing a lot of changes in some of our healthcare settings," Prunty said, "and we need to make sure that our staff feel safe coming to work, and that they're adequately prepared to care for the complexity of patients that we're seeing."

Prunty recommends that CNOs allow for adequate breaks throughout the day so that nurses can take a breather, while feeling empowered to do so.

Prunty said there are a few different phases to supporting staff who have experienced a traumatic event or high-stress situation.

The first is to provide support in the moment allow the nurse to take a step back, and reassure them that a colleague or a nurse manager has their back. The second is to make sure that the nurse has time to process what happened.

Prunty said Allina Health implemented both employee assistance programs and a spiritual care team that can support staff in real time.

"We need to be attuned to the impact of the experiences that our nurses are feeling," Prunty said. "I think the importance is having the support and resources in the right place at the right time."

Leaders also need to ensure that nurses feel like their tasks are a value add, and that they are giving nurses back time at the bedside.

"It's really important for executive nursing leaders to think about what [our workflows are] and what [our processes are], and how [we can] improve efficiency," Prunty said, "so that we are maximizing the time that we have with our patientsand making sure that we're promoting a healthy work environment."

Supplying resources

Prunty suggested that CNOs try something creative when providing resources to support nurse wellbeing. In addition to the standard employee assistance programs, a few of the sites across the Allina Health system have calming rooms, where nurses can go to take a break.

"It's a space [where] you can listen to calming music [or] meditate and take a deep breath," Prunty said. "A space where you can physically close the door and sort of separate yourself from what's happening on your unity during your clinic."

Allina Health also has robust employee well-being programs through the Penny George Institute for Health and Healing. The programs allow staff to receive coaching on a variety of different topics through online asynchronous learning.

"I think this is really our opportunity to say OK, what's working, [and] what's not working," Prunty said, "and it's OK, we can try something else."

It's critical that CNOs communicate the existence of resources as well, so that nurses can find and use them. Prunty emphasized the difficulty of communicating with nurses, since nurses do not have time to frequently check their e-mails.

Allina Health has tiered huddles that are focused on safety issues, and a communications team that disseminates all the necessary information on a weekly basis to staff. Prunty said they are also looking at ways to integrate resources into the EHR, including a button that can be pressed if nurses need resources during the documentation process.

Prunty also explained that they are leveraging social media and signage to provide even more avenues of communication.

"As our health system continues to grow in complexity and expand in geographic areas," Prunty said, "we really need to think about how [we can] reach all of our staff, because that's part of feeling included . Knowing what’s going on and not feeling left out of messaging."

Preparing new nurses

CNOs need to find innovative ways to build resiliency among new nurses. According to Prunty, the disruption to academic programming by the COVID-19 pandemic caused many new nurses to enter the industry with less clinical experience.

"I think it really is an opportunity for us to think differently about how we bring people in and help them through that transition," Prunty said.

Allina Health has implemented a strong nurse residency program that Prunty says is addressing the needs of the new generation of nurses. The program gives nurses the opportunity to build community with those going through similar experiences.

"We're talking a lot about moral distress, moral injury, processing grief and loss, [and] having crucial conversations," Prunty said. " Things that are really challenging for folks as they enter the nursing workforce."

There is also an opportunity to revamp academic programs and partnerships sto support nurses in their transition to the workforce.

Prunty emphasized the need for leaders to stay flexible.

"I would say the agility and curiosity in approaching the new needs of this workforce are going to be critical," Prunty said, "to make sure that they have what they need to take care of patients."

Leading by example

There are a few things CNOs can do to positively influence the work environment and keep spirits high, and visibility is a key component.

"I think rounding and making sure people see you as a person," Prunty said, "and you [making] that connection with your teams is critically important."

CNOs need to keep advocating for nurses in as many spaces as possible, and to help people outside the nursing realm understand the role of a nurse.

It's difficult to explain to others the invisible labor that is associated with providing excellent patient care, Prunty stated, and it's important that that's recognized and acknowledged as a critical part of providing care.

"I think any opportunity to just be curious and help people understand," Prunty said, "and tell our story as nurses, I think is really important."