Hoping to counter stress and compassion fatigue, one hospital has created private spaces for its nurses to process their emotions before returning to their patients, refocused. At least one study links better nursing environments to better patient outcomes.
Crying at work is traditionally frowned upon, but I'm going to put myself out on a limb and admit I've done it. And, if you're being completely honest, you've done it, too.
After a code, a patient's death, a scolding from a physician, or a day when nothing seems to go right, many of us have sought solace in the nearest linen closet, locker room, or bathroom stall and let the tears flow.
In fact, just last week, this photo of an ED physician grieving the loss of a patient, popped-up in my Facebook feed, courtesy of an ED nurse friend. When someone who isn't a healthcare professional commented that it's unreasonable to expect healthcare workers to jump back into their shifts after a patient's death as if nothing happened, my friend replied, "We do it every day."
But, this 'rub some dirt on it and get back into the game' mentality might not be serving our profession well.
A study published in 2011 found that in a sample of 182 oncology nurses, one-third demonstrated emotional exhaustion and reported low rates of personal accomplishment, one-quarter reported depersonalization, and a 50% reported levels of emotional distress.
"Compassion fatigue is a huge issue for us all in bedside nursing, and we as leaders need to look into and address that," says Jacklynn Lesniak, RN, MS, BSN, senior vice president of patient care services and chief nursing officer at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, IL.
Jacklynn Lesniak, RN
One way CTCA Midwestern is tackling this issue is by giving RNs the time, tools, and space to process their feelings in the comfort of nurse-designed renewal rooms.
Disconnect to Reconnect
Jillianne Shriver, RN, BSN, HN-BC, team lead for the inpatient medical oncology unit at CTCA Midwestern, was inspired to develop the concept for the organization's renewal rooms after learning various types of relaxation techniques, during a three-week training on holistic nursing.
Those techniques included aromatherapy, journaling, and meditation. Though many of these interventions don't take very long—Shriver says benefits can be seen in as little as five minutes—finding the time and place to practice them during a busy shift can be challenging.
"I decided that I really wanted somewhere for the nurses to take that time to renew, rejuvenate, and recharge," she says. "To step out of whatever situation they may be in, whether that be a stressful or busy day, and have five to 15 minutes to themselves to be able to focus, ground themselves, take a deep breath, and then step back into practice."
Shriver began the project in May 2013 by reclaiming a storage space in which to she established the first renewal room. In it she placed a massage chair and tools for aromatherapy, music therapy, and journaling. There is also a sand garden, small waterfall, inspirational books, a Tibetan singing bowl, and a yoga mat.
"The environment I wanted to create is a private space," Shriver says. "We ask that they go in by themselves."
Before entering, nurses must let their charge nurse know they need to use the room and must turn over their phones, pagers, or other communications devices. The door is locked to ensure no one can interrupt them during their five to 15 minutes away.
"That way there's not any distractions, and they can really take that moment to focus on themselves," Shriver says. "In nursing, we have a wide variety of emotions, and they're able to go in there and express those emotions in a quiet, safe place."
A Much Needed Intervention
Aware of the aforementioned study on oncology nurses' experiences of burnout, Shriver wanted to make sure the room was serving its purpose. So she asked nurses to rate their anxiety levels on a Likert scale before and after using the room. After three months, it became clear it was a much-needed intervention.
Jillianne Shriver, RN
"We logged that the room was utilized over 422 times in three months," she says. "After reviewing the surveys, 96% of the nurses reported that they had a decreased level of anxiety and they felt much better after they left the room."
In addition, Shriver says there was often a line of nurses waiting to use the room and the nurses shared some of their personal experiences using the room.
"I had a nurse say that after a patient crisis, her heart was racing and she shouldn't catch her breath," Shriver says. "So she went to the renewal room to cry it out. After that she was able to be present for all of her patients at that time."
She presented her findings to nursing leadership, which in turn supported the addition of renewal rooms in the construction plans for the organization's new inpatient tower that opened in November 2015.
"As the chief nursing officer, I was able to advocate for the staff through the building process and say to the board of directors, 'We really need this space in the new building.'"
Lesniak says there are now five renewal rooms in the organization—one on each unit in the inpatient tower, one in the surgical department, and one in the outpatient care area.
Benefits of a Holistic Environment
The renewal rooms are part of CTCA Midwestern's larger commitment to providing a holistic environment for both staff and patients, says Lesniak.
"One of our goals is to be a premier provider of nursing care and to establish that in an environment of healing and hope," she says. "Normally you look at an environment of healing and hope as being very patient-centric, which at CTCA is foundational to our model. But we took it a step further and [looked] at how it affects our nursing staff."
This includes supporting nurses in obtaining specialty certification in holistic nursing. Lesniak says there are currently 36 nurses who have achieved the holistic nursing specialty certification.
Developing a holistic work environment is more than something that is just nice to do for the nurses. Lesniak says helping nurses stay connected to their mind, body, emotions, and spirit, can benefit organizations and patients as well.
"As CNOs, something we're facing is the recruitment and retention of great talent," she says. "Holistic nursing and things like the renewal room and other methodologies of ensuring our bedside staff can take care of themselves are a huge strategy to help with recruitment and retention of our bedside nurses in the country."
New research by Linda H. Aiken, RN, PhD, FAAN, FRCN, at the University of Pennsylvania supports the idea that happy nurses equal happy (and healthy) patients. The study found patients who had surgery at hospitals with better nursing environments, including Magnet designation (which CTCA Midwestern has achieved), and above-average staffing levels, have better outcomes at the same or lower costs than other hospitals.
And in healthcare, no matter how you get there, better patient outcomes is what it's all about.
"We really want our nurses to empower themselves by realizing the importance of their practice of self-care," Shiver says, "because when nurses take care of themselves, they can better serve their patients, the patients' families, and their communities."
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Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.