A series celebrating nurse leaders who go above and beyond.
Nurses busy with patient care generally don't take time for their own self-care and nurse executive Mary Sullivan Smith, DNP, RN, NEA-BC, wanted to change that.
Around that same time, she was pursuing her Doctor of Nursing Practice degree, so Sullivan Smith, senior vice president, chief operating officer, and chief nursing officer of New England Baptist Hospital, chose as her capstone project, "Mindfulness training for acute care nurses to promote a healthy workplace."
Smith Sullivan received her DNP in 2020, and research from that project has resulted in wellness programs at New England Baptist.
Smith Sullivan spoke with HealthLeaders about how mindfulness training can benefit nurse and help create a healthy workplace.
This transcript has been lightly edited for length and clarity.
HealthLeaders: How did you become interested in helping nurses adopt mindfulness?
Mary Sullivan Smith: I was always interested in how oneself—a nurse—takes good care of themselves in the course of a very dynamic and busy day. At this organization, we do so much surgery and the turnover of patients is very rapid that nurses could care for and discharge four patients in the same day, so it's very busy throughput. The average age of our patients is 64, and along with that we have all the comorbidities of caring for people as they have other system involvement during the aging process.
I don't think there's a better profession than that of a registered nurse in terms of the depth and breadth in which one can make a contribution throughout their career, but it's a job that takes a lot also from people—from their heart, their soul, their spirit, and physically—and I got curious about that for my DNP project.
I started to do research on my own and came upon a study by the American Nurses Association that studied the health of about 11,000 nurses over the course of a period of time, and it illustrated that in this fast-paced, dynamic, 24/7 environment that there was definitely opportunity for nurse health to be increased and improved.
I thought there must be ways to incorporate some of the some more healthy habits into the organization … and that's when I started looking into opportunities. Establishing a mindfulness practice is beneficial in so many ways, but it certainly hits that those areas that I was concerned about—caring for others more than oneself and not taking enough time to hydrate and get good nutrition.
I partnered with a colleague who is a certified mindfulness instructor and one of the inpatient care units agreed to work on my project. We carved up the time for them to do these mindfulness meditations and some were very short. And this colleague of mine really taught people how to do short meditations and give resources for all kinds of things that could help one center oneself and get a break.
Not only did the nurses take advantage of it, but other disciplines as well because we put them on Zoom and invited people to participate. Once I finished with the pilot project, I introduced this into our nurse residency program, so one of the aspects of our curriculum is on wellness and self-care and they learn the benefit of meditation.
I'm also opening that up again with the mindfulness instructor to do Zoom meditation training again. It's designed to meet people's needs while they're at work, to free up their minds for a bit to center themselves and to take some deep breaths. I'm trying to establish a body of mindfulness work and practitioners—those who have learned it and been certified with it—and continue to advance that.
HL: How, specifically, can mindfulness training benefit a nurse and, therefore, promote a healthy workplace?
Sullivan Smith: It teaches a nurse that in a very short period of time, you can clear yourself with some deep breathing, stretching, sitting, and meditating, and you don't have to do it for long. You can do it for a few minutes. It provides a respite and helps people feel better.
[A colleague] was saying how in our busy preoperative unit they stop every so often and they all walk away from their computers, they stretch, and they'll have a moment of quiet, which helps them reframe and reset. So, it's very small work, but it has great outcomes, or consequences. And the literature is replete with the benefits of mindfulness.
It has come into its own again from the 1960s and '70s, and now it's a well-understood opportunity to incorporate mindfulness practices to manage stress in a time that is beyond some of the worst stressors that healthcare professionals have to deal with.
HL: A recent study said that most nurses experienced moral distress, especially in the early days of the pandemic. How does a nurse leader build a healthy workplace considering so much emotional damage?
Sullivan Smith: Yes, it was incredible moral distress that nurses experienced. What many have done is to take advantage of employee resources that exist at organizations. Other nurse leaders have done a lot of rounding and talking with nurses individually, making sure that there was debriefing after really difficult situations. A lot of it has been hands-on, face-to-face work to make sure that what someone has been through is acknowledged.
Many nurses in this country have gone through other bleak periods of time. The AIDS epidemic is different in terms of the amounts of people that were affected, but that's probably the closest thing to what anyone could imagine this COVID-19 pandemic to be like in terms of the devastation, loss, and youthfulness and everything that happens to the patient. And nurses were at the center of that, so there is nothing more important than acknowledging what a nurse has been through.
HL: What would you advise for nurse leaders who are working to create a healthy work environment for nurses?
Sullivan Smith: Whether it's the chief nurse or other members of the nursing leadership, it's important to pay attention to nurse resilience and promote a workforce that can be sustained into the future. It's also important to pay attention to how people respond to small tests of change, because that's what this was and it's had very good response, and to try different modalities of stress reduction.
It's all important. It's critical for us to make sure that we're creating an environment that is good and healthy in which to work every day.
But as he's sought and received guidance, particularly in the last decade, Bailey has become a champion of mentorship. Not only does he have several mentors, but he mentors multiple nurses and healthcare employees, as well.
Bailey spoke to HealthLeaders about how mentorships can provide benefits all around.
This transcript has been edited for length and clarity.
HealthLeaders: How was one of your best mentors so effective?
David Bailey: I have several mentors for different specialties that I'm involved with, but the one that stands out to me the most is the one I gained after going through to a conference that is called the CNO Academy. My relationship with that mentor started in 2015 and continues to this day. She can help me walk through situations. Especially when I was a novice chief nurse, she really helped me think differently and more broadly. And then if I hit a roadblock, she could help me think about it differently and from different people's vantage points, which was huge for me. It helped open my thinking from multiple levels—strategic planning, operational management—that helped me to be a better and broader leader.
HL: What are the benefits of mentorship, generally, both for the mentor and the mentee?
Bailey: It really is a dual benefit. For the mentee, the benefit is having that safe space for anything to be discussed. There's no sacred cows that can't be discussed there.
For the mentor, you can use the wisdom that you have earned and learned across your career, and you can provide (mentees) them insights without telling them the way they need to do it. You just provide space for them to learn so they can bounce ideas off you.
What I do is ask questions to help them to move toward the answer they need and help them think through that. On the flip side of that, it keeps me engaged and energized to make sure that I stay on top of my game to be able to support them to help them grow.
HL: What can mentorship do for underrepresented groups in healthcare, such as women or people of color?
Bailey: It's the exact same thing. We all need it regardless of the differences that we each are, and that we have. Everyone should receive mentorship.
For one of my leaders' developmental process, we sent her to a program external to the organization, and she came back to me [afterward] and said, "There were people at the conference for the first time that looked like me." And I had to take a deep breath because I would have never thought like that.
She also said, "And they added a faculty member there who looks like me." Well, I happened to see those faculty members [recently] at the American Organization of Nursing Leadership conference and I told everyone of them that story and I said, "You've made a difference for one and I'm sure you've made a difference for many because now there's a different connection there because there is someone who looks like them."
I consider myself having a diverse leadership group, but when I'm helping them be developed and sending them to things, this made me more conscious and aware to make sure I'm finding the right environment for them to learn it.
HL: What are some attributes that it takes to be a good mentor?
Bailey: You have some basics, and to me these are like Maslow's hierarchy of needs—if you don't make the foundation, it's not going to work. You have to have trust and you have to be able to have open and honest communication, whether things are going well, or especially if they're not.
You have to listen; you just can't do all the talking. You have to listen and see where the person is coming from so you can help redirect and reinforce whatever angle it's coming from.
The other thing is presence. There's some emerging literature coming out about the importance of nursing leadership presence, which is more recognized since the pandemic. But having presence demonstrates that you are walking the talk and that you really are following through—that you're just not giving advice and not following it. It really illustrates to your mentee and to others that you're authentic and that you are supporting them but you're also living by what you're talking about.
HL: How long should an effective mentorship last?
Bailey: It can last as short you need it to or as long as you want it to. Some mentors will be transient for individuals, whereas others will be very long term. As an example, I was asked to write an article for a journal and I had never done that, so I reached out internally to a school of nursing faculty member for help and a few months later it was published. That was a transient situation because I didn't know where I was going, and she helped with that situation.
Then there's the people from the CNO Academy faculty that I mentioned earlier, who continue to be in my life today. I know at any moment, I can pick a phone up, text, email, and I’m going to get a response really quickly, regardless of the subject, and to me, those are lifelong [mentors]. That has been such a professional gift. My goal is that I am that to others.
HL: What have you gained from being a mentor?
Bailey: Being comfortable knowing that an individual is going to grow may not always stay with you. I've never been of the belief that everybody that's ever worked for me has to stay with me forever. I want them to grow and to prosper and I'm willing to help them do that.
It's literally an investment of your time and your resources in that person, and you hope that will pay off for the organization, but the broader thing is that it pays off for the nursing profession. That's really the broadest gift that we can give someone by being a mentor.
A series celebrating nurse leaders who go above and beyond.
Practically every one of Winnie Mele's waking hours is spent taking care of someone. And she wouldn't have it any other way.
As director of perioperative services at Northwell Health's Plainview Hospital, Mele, RN, makes sure her nurses are taken care of. At home, she is a caregiver to her husband, John, who is being treated for cancer caused by the events of September 11, and a nephew who has Huntington's disease.
Mele also took care of her sister, who battled Huntington's, and her father before they both died.
"I believe caretaking is in my DNA," she says. "I do it at work and I do it at home."
Mele spoke to HealthLeaders about how nurse leaders can help guide their nurses toward good mental health, and what gives her joy (Hint: it involves singing before a worldwide audience).
This transcript has been lightly edited for length and clarity.
HealthLeaders: How did you manage emotionally during the most difficult days of the pandemic?
Winnie Mele: The staff looked to leadership to drive this, and I found that it gave me a ministry and a mission during COVID to keep the place going. It kept me busy and then when I came home, I had my ministry at home, so I didn't really think about it. It's kind of what I do.
I found that the biggest thing for help for me during the pandemic for self-care was to go outside. It was cold, but I put on my sweater on my husband would light the back heater, and I would bring out blankets—it didn't matter how cold it was—just to get outside and to breathe fresh air. That was the first thing that brought me comfort: just to sit and do nothing.
HL: What are ways that you've taken care of your nursing teams?
Mele: One thing my leadership team is good at is connecting with the person, so we know our people, and we try to be flexible with our schedules. As hard as it is when someone says, "I need to take my mother for a CT scan," or "My daughter has a dance recital," we try to connect with the person and give them what they need.
We've always been good at it, and one of the reasons why our employee engagement in perioperative services so high is that we really do care about people. I'm from a big family and it's always about the other guy, so when I was putting together the leadership team over the last 10 years, my mission was to hire people that have that same vision. We would [say], "If you don't tell us, we can't help you, so don't hold it in. Whatever you need." We can't always give them everything they want, but we certainly can try to help them navigate these tough times.
The other thing we do is "Heartburn Tuesday," which is an opportunity for them to tell us whatever is getting in their way of providing spectacular care. Whether it's a surgeon that's giving them a hard time or something that's happening at home, or they need a piece of equipment, they have the opportunity to say it … or they knock on my door and tell me. But right now, the climate is good and very often on Heartburn Tuesday, nobody comes up with anything.
We also talk about what brings joy. If you like to knit, if you like to sing, if you like to run or ride a bike, you really need to do it, because during the pandemic, we put a lot of that away because we had no time. Now, we're encouraging them to get back to whatever it is that they'd like to do.
If your cup is empty, you can't really help anybody else. You need to fill your cup to be effective and do the best work that you can.
HL: You are part of the Northwell Health Nurse Choir, which appeared in season 16 of America's Got Talent and made it all the way into the Top 10. Was that a way to fill your cup?
Mele: I always want the people that work with me and for me to understand how much they are appreciated, and that was one of the things we tried to do with America's Got Talent. It was about the singing, too, but it was really about saying, "We need you. We love you. You're important."
So many of the emails and Instagram messages we got were from people who were losing hope, and as crazy as it sounds, some of our journey really helped a lot of people. We did live Instagrams where people were sending in messages saying, "I really was in a dark place, and I look forward to every Tuesday to hear all you singing nurses. It just makes me feel better. It makes me feel good."
HL: So how do you fill your cup?
Mele: I love music. I always have music on, and I love to sing. I have a tremendous family. I have a lot of siblings, a lot of nieces and nephews, and I have three sons that I adore and they're very connected to me. I love to walk on the treadmill, and I love to golf—I went golfing with two of my boys last Sunday—so I try to do things that make me feel good and I'm trying to stay healthy. I'm also a woman of faith; I find that's very comforting to me.
I try to live in the world of gratitude because I think when you're grateful, a lot of stress and things go away. I feel like I'm in a very good place. I struggle but I love going to work too because it gives me a mission. And the nice thing is all of a sudden, I get on a plane to go sing with the Northwell Health Nurse Choir. So, I really have a lot of things in my life to keep me positive and keep me on my mission.
Toolkit identifies six priority areas that need urgent action, with recommendations, actions, and measurable outcomes.
Actionable and immediate strategies for staffing in acute and critical care practice have been unveiled by a specially formed think tank to address the nurse staffing crisis.
The Nurse Staffing Think Tank, a diverse group of nursing leaders, frontline nurses, CEOs, chief financial officers, human resources executives, and patient safety representatives, identified six priority areas that need urgent action.
It has published a set of priorities and recommendations that provide immediate strategies for those six priority areas that can be feasibly implemented in the short term (12-18 months) to help address the nurse staffing crisis.
The six priority areas are:
Healthy work environment
Diversity, equity, and inclusion
Work schedule flexibility
Stress injury continuum
Innovative care delivery models
Total compensation
The recommendations, actions, and measurable outcomes for implementing each priority are now available on the Nurse Staffing Think Tank web page for healthcare leaders to access.
Appropriate nurse staffing has been a challenge for decades. Nurses, healthcare leaders, and policymakers have attempted varied approaches, but consistent, effective solutions have remained elusive, and indeed made more challenging by the COVID-19.
"The COVID-19 pandemic has placed a spotlight on the value of nurses, and the nursing workforce," said Katie Boston-Leary, PhD, MBA, MHA, RN, NEA-BC, director of nursing programs for ANA. "At the same time, it has accelerated a persistent staffing shortage that has plagued the profession for decades toward a crisis. Without swift and sufficient action, the nation’s nurses, patients, and communities will continue to suffer."
Creating the plan
The Nurse Staffing Think Tank convened six times between January and March 2022 to tackle a wide range of issues related to the nurse staffing crisis.
Major topics included the impact of the COVID-19 pandemic on nursing, the importance of trust and transparency to build healthy work environments, the connection between nurses’ well-being and staff retention, the best ways to use scheduling flexibility, compensation, delivery models, and other related issues.
Insights from the Nurse Staffing Think Tank will guide the efforts of the Nurse Staffing Task Force, which launched this month and will drive dialogue on a national scale and bring together a wide range of healthcare leaders and advocates to develop mid-range to long-term sustainable solutions to the nurse staffing crisis.
"Addressing workforce challenges is the top priority in healthcare. We can’t provide healthcare and services to our communities without our workforce," said AONL CEO Robyn Begley, DNP, RN, NEA-BC.
"Bringing together those who deliver care and those who ensure sustainability of care delivery is critical to developing outcomes-based staffing models, improving value, and fostering a healthy practice environment to engage nurses and support resilience and well-being," Begley said.
As demand for health services continues to rise, addressing nurse staffing is critical. An established body of evidence shows that appropriate nurse staffing is correlated with improved patient outcomes and greater satisfaction for both patients and staff.
"Healthcare is a human business, " said Beth Wathen, MSN, RN, CCRN-K, president of AACN. "Hospitals can add all the rooms, beds and equipment they want, but none of that matters without nurses there to take care of sick patients."
"For years, usual and accepted staffing models have viewed nursing as an expense, not an investment," Wathen said, "And yet, there is ample evidence that links appropriate nurse staffing with optimized nursing care and improved patient outcomes."
Identifying sustainable solutions is a major step to addressing the problem of nurse staffing shortages, said Joseph J. Fifer, FHFMA, CPA, president and CEO of HFMA.
"This group is well equipped to drive actionable solutions, which are urgently needed," he said.
Practice-ready program is designed to fill significant shortages and stave off first-year nursing turnover by helping nursing students find their niche.
A new, innovative approach to fill a critical need for operating room nurses, along with reducing first-year nurse turnover, relies on a triad of academic, service, and a specialty association to attract and prepare nursing students to perioperative practice.
After nearly a year of planning, Practice Ready, Specialty Focused™ debuted in January at Chamberlain University to help prepare perioperative nurses upon graduation meet a significant demand, says Dr. Karen Cox, PhD, RN, FACHE, FAAN, Chamberlain's president.
Cox spoke with HealthLeaders about the unique program and how it may counteract the dreadfully high first-year 30% turnover rate by helping student nurses choose areas of practice that interest them most.
This transcript has been lightly edited for length and clarity.
HealthLeaders: Nurses are specializing like never before. Why is that?
Dr. Karen Cox: Healthcare itself has become more specialized. I worked at Children's Mercy Hospital here in Kansas City for many years, and we had general pediatricians who would send what we used to call minor or office-treatable [health conditions} to specialists. If somebody had a gut ache, they would send them to a pediatric GI specialist. That's happened in medicine.
There are so many different things that nurses can do and are qualified to do because of our background: You can work in informatics at an informatics company, you can work in quality in a hospital, you can work in the government. So as healthcare has gotten more specialized, the need for nursing to be more specialized has been the same.
HL: How often do Chamberlain's students enter nursing school with a specific specialty in mind?
Cox: Many of them aren't aware. They know they want to be a nurse, and a few of them come in because they saw how well a nurse took care of somebody close to them when they were younger. We have one nurse who just graduated from the Atlanta campus who had cancer as a child 10 years ago, and she's now going back as a nurse to that unit where she was cared for.
But a lot of time, students have perceptions that don't match reality and part of it is their clinicals are based on being a generalist, so they don't really focus in on an individual specialty interest. That goes into why this program is so important, because the first-year turnover rate is so high.
HL: Practice Ready, Specialty Focused is the first educational initiative of its kind being offered in partnership with AORN. How and when did this idea develop and why was perioperative nursing chosen as the first initiative?
Cox: With the first-year turnover rate being at 30%, that's not acceptable and it's a huge burden on the service side—on hospitals, health systems, and others who employ new nurses. A lot of time goes into orienting and onboarding and then they all of a sudden at six or eight or 12 months, they quit. It's a resource issue, and in my mind, at least one of the factors is this idea of how they're choosing where to go.
Back when there wasn't that big of a shortage, new grads would take whatever they could get at the hospital they wanted, knowing they could transfer after a year-and-a-half or so. But now there's so many options. Why not make sure that somebody knows what they're getting into? If I like structure, I'm probably not going to like the emergency department. On the other hand, structure in the OR and periop is what keeps patients safe; it's a big piece of it.
So, that was our theory. The reason we picked periop is because that's probably the largest shortage area and students don't get exposed to it. It's not a rotation.
So, we joined up with AORN and [AORN CEO/executive director] Linda Groah and I met and talked about it. Chamberlain has scale, and because of our size, number of campuses, and our BSN program, we can try some different, innovative things that don't disrupt their program of study that keep the generalist front and center, but that allow them to begin the thoughts. That's why we say, "specialty focused." We are not looking to pigeonhole them into anything; we're trying to help them.
Education has to take part of the responsibility for this, because by the time they get to their first job, it's too late. Residency programs in hospitals are trying to get at that, but there's only so much they can do.
HL: Describe what the program looks like from a student's perspective.
Cox: The Atlanta campus for us is one of our largest, with 1,200 students. And if you are a student in good standing, toward the end of your program of study you can choose to take what's called Intro to Periop Nursing that AORN developed and is free to the students so there's no additional dollars. There are no credits, but they get a badge if they complete it successfully.
It's 15 modules, so it's pretty comprehensive. If you get your badge, then you have the option to go to Emory and spend a significant amount of time in your last year doing clinicals in periop. Our research hypothesis is a couple of things: one is we think that probably a high percentage will stay and work at Emory in periop. But a smaller percentage will say, "Get me out of here fast. I never want to be here again. It's just not for me."
It may be a little lofty, but my vision is that this is a way to maintain the generalist experience and preparation, but to have badge opportunities that are student choice. We're not there yet; the first thing we have to do is prove this works and the intended outcomes are occurring.
HL: What are you seeing so far?
Cox: We've had 90 students already in those three cities pass the Intro to Periop Nursing, and that's significant because last year, only four out of 100 new graduates selected periop.
HL: Do you see the program expanding into other specialties?
Cox: Yes, post-acute and homecare. It's another area where students don't get any exposure. For the longest time people said to work in home care you need a year of general med surg experience. Well, why? If you send them away when they want to start there, they're most likely not coming back. And home health is exploding [especially with] the concept hospital at home.
The claims are 'inaccurate, misleading, and counterproductive,' hospital administration responds.
Nurses with SSM Health Saint Louis University (SLU) Hospital have overwhelmingly passed a vote of "no confidence" in the leadership of their chief nursing officer (CNO) and human resources director because of staffing shortages, low morale, and safety concerns.
With most of the hospital's eligible nurses voting, 93% of voters voted "no confidence" in the leadership of Rita Fowler, CNO, and Chris Greenley, human resources director. Voting was conducted April 20-24 by National Nurses Organizing Committee/National Nurses United (NNOC/NNU).
Nurses called the vote because decisions made by SLU Hospital administration have been "detrimental to staff recruitment and retention, and therefore patient care," according to a press release from NNOC/NNU.
The union's claims are "inaccurate, misleading, and counterproductive," the hospital responded in a statement provided to HealthLeaders.
The hospital has a more than 30% vacancy rate for nursing positions, up from less than 10% in the summer of 2021, and despite a growing number of vacancies—more than 235—SLU Hospital has onboarded only 14 staff nurses in the last three months, according to NNOC/NNU.
Most of the current RNs were hired at SLU Hospital before the COVID-19 pandemic began, the union says.
"These numbers aren't just about moral distress and exhaustion from working during the pandemic or nurses leaving for traveler gigs," said Earline Shephard, RN.
"We know why people leave. It’s the little things that could be fixed but aren’t. We are waiting weeks for a response when a piece of equipment is broken or a payroll error occurs," she said. "It feels like a slap in the face when nurses aren’t supported and valued after being expected to be superheroes for the last two years.”
The union charges that Greenley and Fowler have repeatedly rejected suggestions made by RNs to improve retention, morale, and safety.
"Overall staffing numbers continue to worsen, yet SSM recently cut extra shift incentives and overtime pay. In late 2021, Greenley announced that the hospital intended to offer retention bonuses and increase hiring bonuses, and then failed to follow through on those promises," according to the union.
The nurses union also charges that, despite nurses raising numerous staffing and safety concerns in advance, SLU Hospital opened an additional 15 beds in the former main hospital building last month, and has announced plans to open an additional 25 beds in July.
"We are opening our doors to more and more patients when we don’t have the staff to care for the ones we already have," said Meghan Boresi, RN. "We’re relying on temporary staff and nurses working overtime, but that’s not a recipe for quality care. Nurses don’t want to go home wondering if we missed something because we were exhausted or were the only nurse on that shift who really knew the hospital policy and protocol."
SSM Health SLU Hospital is facing the same COVID-related burdens as other acute-care facilities, the hospital's statement said.
"Hospitals and healthcare systems across the country continue to face significant challenges due to the COVID-19 pandemic, including the nation’s critical shortage of nurses and health care professionals. Now, more than ever, we must work together to meet the needs of those who depend on us for care," according to the statement. "We are disappointed the NNOC has chosen to make inaccurate, misleading and counterproductive claims that paint a negative image of our hospital and the life-saving care our team provides."
"SSM Health remains committed to fostering a positive, supportive workplace where team members can thrive," according to the hospital, "and we’ve made significant investments in our recruitment efforts, including competitive compensation, opportunities for career development and growth, and programs to support employee physical, emotional, social, and spiritual well-being."
The study's purpose was to qualitatively describe the emotions experienced by U.S. nurses during the initial pandemic response, so researchers interviewed a diverse group 100 nurses—the first large-scale study of its kind, according to the study.
"Study participants resoundingly articulated a chasm between how they would have liked to have performed according to their professional duty and obligations as nurses versus the reality of providing patient care during the first wave of the pandemic," researchers said.
Within the main theme moral distress, four specific subthemes articulating the emotions felt by nurses experiencing moral distress emerged: fear, frustration, powerlessness, and guilt around letting others down, the study said.
1. Fear
Study participants resoundingly reported "fear of the unknown" in providing patient care during the pandemic's first wave.
Providing nursing care to COVID patients was perceived to be "scary" and "dangerous" by study participants.
"This virus made a lot of older nurses and nurses with preexisting conditions retire," one nurse responded. "It did instill a lot of fear to the point of the nurses quit[ting] their jobs … It just shook everything."
2. Frustration
Nurses experienced frustration because of unmet needs and feeling unacknowledged, the study said.
Study participants described various sources of frustration, ranging from dissatisfaction with leadership to irritation during patient interactions.
"It does make me frustrated that there's no medical people in management," one study participant said. "People are making decisions [who] aren't necessarily aware of how it works … why are we not having more power and more say in things?"
3. Powerlessness
Nurses felt an inability to influence an outcome and/or voice their concerns, leading to feelings of powerlessness, according to the study.
Many were dismayed that their institution didn't involve nurses in helping develop safety plans.
"Even when I was there prior to COVID, we were not really involved in … decision making, and it's really unfortunate because the people who govern … nurses are not people who have health backgrounds," one nurse told researchers. "So if we make a suggestion, it sort of falls on deaf ears because they’re not health professionals.
4. Guilt around letting others down
Many nurses expressed regret surrounding care and decision-making as it related to themselves, their colleagues, and the treatment of their patients and family units.
"The hardest part … for me, was the separation of the families [from] the patient and the suffering that [it] caused," one nurse expressed to researchers.
"Their spouses would be sobbing on the phone saying, 'Is there any way you can get me into that room? … I've been at his side for 65 years …. Now at this important time, I can't be with him.' And it broke my heart," the nurse continued. "That, for me, was the hardest thing."
Listening to nurses
Hearing the voices of nurses from this unparalleled moment in history could help inform policies and laws to improve retention and reduce burnout among nurses in the U.S., study researchers said.
"People need to listen to nurses more, and nurses need to feel empowered to share their experiences at every level of leadership," said principal investigator Shannon Simonovich, PhD, RN, assistant professor of nursing.
Simonovich recruited a diverse group of DePaul nurse researchers to conduct the study, which in turn helped recruit a diverse group of nurses to be interviewed, according to assistant professor and coauthor Kashica Webber-Ritchey, PhD, RN.
"We captured the voices of diverse nurses caring for a diverse patient population that was being disproportionately impacted by COVID-19," Webber-Ritchey said.
In the DePaul sample, 65% of the nurses identified as a member of a racial, ethnic, or gender minority group.
Call to action
The narratives in this study should be a call to action, says Kim Amer, PhD, RN, an associate professor with 40 years of nursing experience.
"Nurses need to come together as a profession and make our standards and our demands clear," Amer said. "We are a largely female profession, and we don't complain enough when things are tough. As a faculty member, we teach students that it’s OK to refuse an assignment if it’s not safe. We need to stand by that."
The DePaul research team is calling for clear, safe standards for nurses that will be legally binding and hold hospitals accountable.
“We go into nursing with the intention of saving lives and helping people to be healthy,” Simonovich said. “Ultimately, nurses want to feel good about the work they do for individuals, families, and communities.”
The research is published and available online from the journal SAGE Open Nursing.
The new residency program develops critical-thinking, problem-solving, and communication skills of a new graduate nurse or a new-to-the-ED nurse before they practice independently, according to ENA.
It supplies dedicated time with nurse educators and clinical preceptors to create an immersive experience to prepare a nurse to provide care to ED patients.
ENA, which piloted the 18-week program at 10 hospitals in 2021, has reached agreements with several hospitals to bring the program into their EDs.
"The first few months in the ED are crucial for any nurse, but too often staffing demands mean a new nurse is thrown into the mix without all the tools and support they need to be successful," said Jennifer Schmitz, MSN, EMT-P, CEN, CPEN, CNML, FNP-C, NE-BC, president of ENA.
The new residency program is a "holistic approach to preparing ED nurses from day one, putting them on a path to be empowered clinicians who trust their skills and confidently deliver high-quality care," she said.
With newly licensed RN turnover rates ranging between 17% and 30% their first year, and 30% to 57% by their second year, according to different studies, a properly implemented nurse residency program can increase retention of new graduate nurses by reducing burnout and acclimating them to the sociocultural environment.
"Staff turnover has clear financial costs, and there is a significant time investment required to fill vacant positions," Schmitz said. "ENA's new residency program represents an opportunity for hospitals to invest in their future by giving new nurses a robust and comprehensive integration into the ED."
Kansas becomes the 26th state to grant patients full and direct access to care by NPs.
Kansas lawmakers' adoption of Full Practice Authority (FPA)—making it the 26th state to enact FPA legislation—means that more U.S. states than not have granted patients full and direct access to care by nurse practitioners (NPs.)
When Gov. Laura Kelly signed House Bill 2279 into law on Friday, Kansas became the second state in 2022 and the 26th state in the nation, along with the District of Columbia and two U.S. territories, to adopt FPA.
"We celebrate as Kansas becomes the 26th state to grant patients full and direct access to nurse practitioners’ care. The majority of states have now adopted this legislative model," she said. "We thank Gov. Kelly and the legislature for prioritizing patients and taking action to improve healthcare in the Sunflower State."
The move had strong bipartisan support. A Kansas poll showed broad bipartisan and key demographic support across the state. Furthermore, most voters said they would be more likely to vote for a legislator who agreed with granting FPA.
FPA is the authorization of NPs to evaluate patients, diagnose, order, and interpret diagnostic tests, and initiate and manage treatments under the exclusive licensure authority of the state board of nursing.
This regulatory framework eliminates requirements for NPs to hold a state-mandated contract with a physician as a condition of state licensure and to provide patient care.
The National Academy of Medicine's The Future of Nursing 2020-2030 report recommends that nurses be allowed to "practice to the full extent of their education and training by removing barriers that prevent them from more fully addressing social needs and social determinants of health and improving healthcare access, quality, and value."
Nearly 781,000 Kansans live in a federally designated primary care health professional shortage area where only about 52% of the need for primary care services is met, according to the U.S. Health Resources and Services Administration. Even more alarming, mental health professional shortages affect more than 1.3 million Kansans, with just 32.74% of the need being met.
"This law is a necessary step toward eliminating healthcare disparities, managing costs, and building the healthcare workforce for Kansas,” said Jon Fanning, AANP's CEO.
"States that have adopted Full Practice Authority are better positioned to address these critical issues. Today, patients in most states have full and direct access to NPs and these benefits," he said. "We call on the remaining states to follow suit and modernize their licensure laws to ensure patients have full and direct access to high-quality, nurse practitioner-delivered care.”
Learn about the hot topics coming out of the annual American Organization for Nursing Leadership conference.
Hundreds of nurse leaders gathering this week for AONL 22, the annual conference of the American Organization for Nursing Leadership (AONL), are picking up ideas on mentoring, well-being, and how to move forward after a difficult two years.
With more than 50 breakout sessions and a handful of plenary gatherings at the weeklong conference, which wraps up this afternoon in San Antonio, Texas, the nurse leaders are hearing an abundance of helpful messages.
Here are three of them:
1. Diversity by itself is not enough. You must have an inclusive culture.
Diversity, equity, and inclusion (DEI) is not just an initiative; it must be part of an organization's culture, said Jakki Opollo, PhD, RN, MSN, MPH, NEA-BC, vice president talent initiatives and regional chief diversity officer for Atrium Health, Wake Forest Baptist.
Atrium's senior leadership "paid attention" to the killings of George Floyd and Breonna Taylor and the resulting focus on the Black Lives Matter movement and prioritized DEI, she said in the breakout session, "Nursing Leading the Way: Advancing Diversity, Equity, and Inclusion."
"Prior to George Floyd, the organization was doing DEI, but that situation created momentum," she said.
They started with a survey sent to 1,200 leaders within Atrium's clinical care, pharmacy, and pastoral care, received feedback, and built an action plan, she said.
For that, and any other DEI culture to flourish, a healthcare organization must:
Evaluate the needs of workforce related to DEI.
Set up governance structures to empower those leading DEI.
Embed and align DEI across programs, processes, and policies to make it everyone's responsibility.
Drive a culture of psychological safety ad inclusion.
Build accountability throughout the process.
2. For nurse well-being, accessibility and ease of use determine how likely people are to take advantage of resources.
When Crystal Morales, director of nurse well-being at MedStar Health, pulls her wellness wagon around the health system's facilities, she brings gifts, games, and fun—along with resources for nurses' well-being.
"My goal is to build a rapport," said Morales. "When I have their attention, I give them resources."
Each fun-filled goody bag includes an important QR code, which nurses are strongly encouraged to immediately scan with their phone, which is a "one-stop shop" to wellness tools and aides, said Morales, who presented the "Prioritizing Nurse Well-Being," breakout session.
Morales and MedStar have also paved the way for stress relief and better mental health by:
Allowing employees' families to use EAP resources.
It is difficult for employees to focus on work when they're concerned about their home situation, so MedStar allows families to use EAP services, Morales said.
Encouraging regular mental health appointments.
Eyes and teeth get regular check-ups, so "why not the brain?" Morales said. And when she learned that the wait time to see a mental health provider was three months, she stepped in and hired a professional who could see MedStar employees almost immediately until they could get appointments with their regular provider.
"It's been a game-changer," she said. "It's been used so much, we had to bring on another provider."
3. Microlearning in short, bite-sized bits, is extraordinarily effective.
"What does your learning management system look like? Hurry up, get through it, click, and we're done," notes Amelia Waldrup, MSN, NEA-BC, senior director of patient services at Children's Hospital New Orleans. "That is not way we want to give education."
Instead, Children's Hospital nurses get web-based small, step-by-step lesson modules when they need it, said Waldrup, a presenter for the breakout session, " Empowering Nurses with the Cloud to Improve Engagement, Onboarding, and Cost."
"If you give people small, bite-sized information, they learn it," she said. "There is research that microlearning is effective … We know from research that people like it, particularly in healthcare."
Research shows that microlearning boosts confidence, encourages collaborative learning, and helps retain information, she said.
Using cloud-based software, Children's began building web-based microlearning modules that nurses could access on their smart phones.
"We built exactly what YouTube videos do, except it was our folks [in the videos]," she said.
The program has resulted in improved quality outcomes, higher nurse engagement, and cost savings, Waldrup said.
