CNOs should consider looking to unexpected sources for strategies to improve nurse wellbeing — including dogs.
CNOs everywhere have come up with innovative solutions for nurse wellbeing and retention.
But none quite like the one Beth Steinberg has implemented.
In her 43 years as a nurse, Steinberg, who serves as the associate director of research at the OSU Center for Integrative Health, noticed that stress and burnout were reaching all-time highs, especially after the COVID-19 pandemic. Lower work engagement and burnout were causing more turnover and nurses were rapidly leaving the bedside to follow different career paths.
"We lost a lot of our healthcare staff during the COVID pandemic," Steinberg said, "and then afterwards, people found that they just weren't able to come back to the bedside…[or] the hospital environment."
The healthcare exodus has since slowed, but stress and burnout continue to be top concerns for CNOs and healthcare providers in many inpatient and ambulatory settings, Steinberg explained.
One the biggest hurdles with previous wellness programs for staff that Steinberg implemented was that nurses are too busy during their shifts to access the provided resources.
"They had to register, they had to schedule, maybe take some time off," Steinberg said. "It's not easy to step away when you're taking care of patients."
Inspiration struck Steinberg when she and her colleague in the nursing department both got new puppies and began training them to be therapy dogs. The goal for the Buckeye Paws program, which was launched in 2020, is to bring a wellness program to the nurses and to meet them where they're at.
"As we were training our dogs to become therapy dogs, we talked about how we might bring a program into the hospital, not for patients, but for staff," Steinberg said. "We wanted to make it a program that was so accessible that we would go to where staff were working."
According to Steinberg, the program is run with stringent policies and procedures. At first, they thought they would only need eight to 10 dogs for the academic medical center, but they realized quickly during the program's pilot that they would need many more.
"We had a lot of excitement about the program," Steinberg said. "There are a lot of therapy dog programs out there, but the American Kennel Club has recognized Buckeye Paws as singular in the nation as a therapy dog program because it is a peer support program."
Currently, there are about 30 handlers, who are all medical center or university employees who volunteer their time to be part of the handler team. The handlers are trained in trauma informed care and mental health first aid before they are allowed to provide support.
"We have physicians, nurse practitioners, nurses, administrative staff, physical therapists, [just] a wide variety of handlers with varying amounts of time," Steinberg said. "They might do it on the weekends [or] the holidays when they're not in the office."
There are 20 more dogs set to join the program, which will bring the total to about 50 dogs, which is how many are needed to meet the needs of the organization, Steinberg explained.
"We have a canine master trainer that has oversight of our program that puts dogs through all the testing," Steinberg said. "We also have temperament testing and canine good citizen requirements as well as their health requirements and things like that."
A paws-itive impact
According to Steinberg, the Buckeye Paws dogs have a massive positive impact on the staff. They get called in for traumatic events, and they are available for staff to speak to with a nonjudgemental attitude.
"Dogs are nonjudgemental," Steinberg said, "so the staff readily talk to the dogs about what's going on with their day [and] what's going on with their personal lives."
Nurses and other staff members tend to be more honest with the dogs about how they are actually doing, Steinberg explained.
"There's a dynamic that changes things with the presence of a dog that provides that nonjudgemental support for people to feel comfortable and to be vulnerable," Steinberg said. "It doesn't always happen with humans."
The nurses' reaction has also been incredible, according to Steinberg.
"So many times we'll see people down the hall, and you'll see their face change," Steinberg said. "They start to light up, [and] they start running down the hall towards the dogs."
However, the handlers are also trained to recognize when people are afraid of dogs or don't want to interact with them. Those who don't want to interact with the dogs can still get the benefits of seeing their coworkers' moods lifted, Steinberg explained.
"There are people that are fearful, there are people that have allergies, and there are also people [who] culturally don't believe in dogs as pets," Steinberg said. "We recognize that and we're very aware of the behaviors and reactions of people when we come to the unit, whether they welcome that dog or not."
Tips for CNOs
For CNOs and other nurse leaders who might want to try this approach in their organizations, Steinberg emphasized that innovation is key.
"Hospitals have had therapy dog programs for [many] years, but usually they're for patients and families," Steinberg said. "Having something just specific to our staff, they've been so grateful and appreciative that when they see Buckeye Paws on the unit, they know we're not there to see a patient, we are there for them."
There is also research being done through the program that aims to measure the impact of the program on staff, the handlers, and the dogs. While this kind of program is not a fix for system-wide issues, Steinberg explained that the program has value as something that can help nurses get through their day.
"There are big picture things that still need to be worked on," Steinberg said, "but when you introduce something that can just for a few minutes offer support and maybe help improve mood, there are some downstream effects to that, [such as peer support], collaboration, patient care, and things like that."
Steinberg says Buckeye Paws can provide support to other health systems by helping them develop similar programs and working with them on policy, recruiting, and finding a canine master trainer.
"Not every hospital is suited or accepting of this kind of program," Steinberg said, "but if you can pull it off, it's so beneficial for the staff."
The nurse leaders at AONL 2025 are looking to revolutionize nursing education and promote nursing advocacy.
The 2025 AONL Conference wrapped up on Wednesday this week in Boston after four days of learning, idea sharing, high wind chill, and clam chowder.
This year, technology was the main superstar as leaders brainstormed the pros and cons of AI and the best use cases for virtual nursing. However, there was an undercurrent of tension and worry regarding the future of healthcare policy, the ethics surrounding AI, and other new nursing practices.
Despite these concerns, the nurse leaders in attendance are looking to push past boundaries and step into the future with highly effective strategies to keep nursing sustainable. Here are two of those innovative ideas.
Revolutionizing nursing education
With the nursing shortage in full swing, it's been difficult for nurse leaders everywhere to find new nurses and create pipelines into the industry. To help bring more nurses into the profession, the nursing leadership at WVU Medicine and Beebe Healthcare created hospital-based RN diploma programs.
According to Tanya Rogers, AVP of nursing education at WVU Medicine, and Karen Pickard, director of the Margaret H. Rollins School of Nursing and Clinical Professional Development at Beebe Healthcare, the goal of those diploma programs is to address staffing issues while having a program that can scale and change with the workforce.
According to Rogers and Pickard, this program is scalable for other health systems, and if CNOs want to try this program at their own health systems, they should customize it to fit their organizations.
At WVU, the students receive one credit for every five clinical hours, and their NCLEX pass rates are comparable to more traditional degree programs. They also receive free tuition as long as they commit to working in the health system for three years following the completion of the program. WVU partnered with Beebe to focus on outcomes, and there are four ROI metrics that the program focuses on: GME reimbursement, traveler savings, bed closure mitigation, and student tuition assistance.
Promoting nursing advocacy
Despite the wave of anti-DEI executive orders from the Trump administration, the nurse leaders at AONL came to discuss policy and how to get involved in the decision-making process at the local, state, and federal level.
Torrey Trzcienski, Jennifer Boutelle, and Kelly Haeckel from Middlesex Health created a policy advocacy coalition called the Healthcare Policy Awareness and Advocacy Coalition (HPAAC) to help get nurses more involved in policy. They collected data through a cross-sectional research study to see how knowledgeable and involved the nurses and nurse leaders are in political spheres.
For CNOs who want to attempt a program like this, Trzcienski, Boutelle, and Haeckel recommend starting locally to effect change that one can see in their community. Nurses can advocate in one of four different areas:
Public health
Patient care
Nursing practice
Fiscal sustainability
They also recommended gathering data to know where nurses are now, and then trying to prioritize policy and participating in the legislative process through voting and/or public comment. They also recommended inviting legislators to come into a health system to get a sense of what the industry is really like. That way, the nurse or nurse leader can build relationships with those legislators, and give them a person to call when they have questions about nursing.
There are major quantitative and qualitative benefits to CNOs and other nurse leaders focusing on nurse wellbeing.
HealthLeaders spoke to Diane Sieg, RN, CYT, CSP, registered nurse, author, coach, and creator of the Well-Being Coaching Initiative, about how CNOs can make the financial case for nurse wellbeing and prioritize wellbeing in their organizations. Tune in to hear her insights.
AONL 2025 is well underway as nurse leaders discuss AI, wellbeing, and DEI strategies.
After the first day of AONL 2025 in Boston, it's clear that CNOs and other nurse leaders have a few key concerns and focuses for nurse wellbeing, diversity, equity and inclusion (DEI), and tackling AI implementation.
Hesitations about AI
To no one’s surprise, AI is top of mind at the conference this year, and nurse leaders are feeling apprehensive. As the technology progresses, CNOs have to decide how and when to embrace it and incorporate it into workflows.
The nurse leaders participating in the discussion were concerned about documentation errors, transparency, and deskilling among the workforce. There were also ethical concerns about patient confusion when talking to a chatbot.
A new kind of mental health support
Nurse mental health continues to be a top priority for CNOs, as burnout and turnover rates remain high in many organizations. Yarisbell Collazo, DNP, RN, MLD-C, MEDSURG-BC, nurse manager at UF Health, helped implement a new program for mental health resource nurses (MHRNs), who can help staff deal with stress and mental health concerns at work.
Each MHRN specializes in a different skill, ranging from organization to de-escalation, confidence, anxiety, depression, and coping mechanisms. The nurses are certified in mental health first aid, and they provide monthly materials to staff related to mental health issues and themes. The goal is to make their roles official, so that they can dedicate more time to mental health education, which they are now taking on in addition to seeing patients.
Withstanding attacks on DEI
Under the waves of executive orders from the Trump administration, many organizations are hesitant to move forward with diversity, equity and inclusion (DEI) initiatives out of fear of noncompliance.
They also advocated for an inclusive excellence strategy based on Maslow’s hierarchy of needs, which begins with equality and results in human flourishing and self-actualization. The goal is to achieve equal opportunity for nurses while also prioritizing equitable patient care.
Having a virtual nurse available during discharges eliminates distractions, says this CNE.
On this episode of HL Shorts, we hear from Catherine Hughes, senior vice president and chief nurse executive of Virtua Health, about the concrete benefits that Virtua Health has seen from their virtual nursing program. Tune in to hear her insights.
Nurse leaders are gathering in Boston this year to strategize best practices for AI, virtual nursing, and how to streamline care models with technology.
As technology continues to embed itself into every industry, healthcare is bracing for the impact that AI will have on everything.
From the C-suite down to the bedside, AI and other new technologies will soon become care staples that nurses and patients alike will need to become familiar with. However, there is a right way and a wrong way for leaders to implement these changes.
That's why thousands of nurse leaders are coming together in Boston from March 30 to April 2 to brainstorm at the AONL 2025 Aspiring Leaders conference.
What to watch
The conference consists of daily sessions where various nurse leaders will highlight industry trends and provide their high-level insights to their peers. Generative AI and its pros and cons will be a hot button issue, as well as digital transformation strategies and the role of virtual nursing in care delivery.
Leadership development, specifically for nurse managers, is also top of mind as CNOs and CNEs engage in succession planning. In the fall 2024 Trends and Innovations Nurse Manager Retention report published by AONL and Laudio, nurse managers had four priorities that they want CNOs and other nurse leaders to focus on: ensuring a healthy work environment, promoting leadership development, identifying new leaders early, and addressing role complexity. These priorities and more will be central to the discussions in Boston.
Last but not least, workplace violence continues to be a large trend as incidents continue to rise and nurses keep bringing the issue to light. CNOs and other nurse leaders must keep working on prevention efforts while also streamlining the processes for reporting and following up on incidents when they occur.
As this year's AONL attendees come up with strategies for these issues, HealthLeaders will be there to take note of what is and isn't working.
Other sessions will cover policy and advocacy, transition to practice, and how to create a more diverse, stable workforce that values mental health and wellness. Attendees will have the opportunity to attend these sessions as well as walk through the exhibit hall.
Here are three tools that nurses and nurse leaders can use to prioritize their wellbeing.
Focusing on wellbeing is critical for nurse leaders who want to combat burnout and lower nurse turnover rates.
For CNOs who want to prioritize wellbeing and self-leadership for their workforces, Diane Sieg, a registered nurse, author, and the creator of the Well-Being Coaching Initiative, suggested "CPR," but not in the traditional sense of the term.
"CPR stands for compassion, presence, and recovery," Sieg said. "It's not the CPR that nurses are familiar with, but [it's] just as lifesaving because it infuses more energy, more engagement, [and] more connection into your work and life."
CNOs must look at metrics that will help them leverage virtual nursing through the future and continue to improve the experience for nurses and patients.
On this episode of HL Shorts, we hear from Jennie Van Antwerp, director of digital acute care at OSF OnCall, about the ROI metrics CNOs can use to make a financial case for virtual nursing. Tune in to hear her insights.
CNOs must look at metrics that will help them leverage virtual nursing through the future and continue to improve the experience for nurses and patients.
On this episode of HL Shorts, we hear from Jennie Van Antwerp, director of digital acute care at OSF OnCall, about the ROI metrics CNOs can use to make a financial case for virtual nursing. Tune in to hear her insights.
Prioritizing wellbeing requires leadership and individual commitment, says this nurse well-being thought leader.
The term "well-being" is a broad term defined in many ways today, depending on the person and their environment.
For CNOs, well-being programs and initiatives can focus on employee mental health, physical wellness, finding solutions to combat burnout, and creating healthy work environments.
For Diane Sieg, RN, CYT, CSP, the definition is simple.
"Well-being is how you feel about yourself and what you do every day," Sieg said. "Self-leadership is making the best decisions for yourself that supports your well-being."
Sieg, who is a registered nurse, author, coach, and creator of the Well-Being Coaching Initiative, explained to HealthLeaders that nurses traditionally don't always prioritize their own wellbeing, since they are so focused on patients, families, and their communities. Nurses know what to do to take care of themselves, they just don’t often do it.
However, there are major quantitative and qualitative benefits to CNOs and other nurse leaders focusing on nurse wellbeing.
"When nurses that feel good about themselves and what they do every day, they are less stressed and more connected, engaged, and energized in their work and in their life, which is what wellbeing can do for us," Sieg said.
The ROI of wellbeing
According to Sieg, the quantitative benefits of well-being can be found in improving retention and the bottom line. Through a pilot of the Well-Being Coaching Initiative started during the COVID-19 pandemic, Atrium Health reported a 30% improvement in stress, burnout, and engagement that correlated to a 30% reduction in turnover and $3 million in savings in one year.
There is also qualitative value in wellbeing.
"I have witnessed these nurses transform in their careers and lives," Sieg said. "They get promoted, create new positions, go back to school, and engage in and lead projects, because when you prioritize yourself, you have more to give, period."
To measure the ROI for well-being, Sieg recommended using standard validated assessments to measure burnout, engagement, stress and self-compassion. As with any new initiative, it's important to track metrics before, during, and after implementation.
"We measured self-compassion," Sieg said, "and then lastly was self-leadership, because we want to understand where [the nurses] start and where they are immediately after [intervention], in our case it was the coaching."
Prioritizing well-being requires leadership and individual commitment. Well-being initiatives must be supported by leadership as a benefit to recognize, acknowledge and value their nurses and the vital role they play in patient experience and outcomes, Sieg explained. Nurses need to commit to making changes by practicing self-leadership with the skills, structure and support provided.
The CPR method
For CNOs who want to prioritize wellbeing and self-leadership for their workforces, Sieg suggested "CPR," but not in the traditional sense of the term.
"This CPR stands for compassion, presence, and recovery," Sieg said. "It's not the CPR that nurses are familiar with, but [it's] just as lifesaving because it infuses more energy, purpose and meaning in your work and life."
The practice of compassion, according to Sieg, specifically refers to compassion for yourself. Nurses can have very high expectations of what they can accomplish in a shift, and when they don't meet those unrealistic expectations, are critical of themselves, Sieg explained. explained.
"Nurses have plenty of compassion for others, but what we don't have is compassion for ourselves," Sieg said. "Being kind to yourself is giving yourself a break, literally and figuratively, because you are human and require it."
The second practice is presence, which, to Sieg, is slowing down to experience the present moment fully. When nurses are focused on all their unfinished tasks, they can't engage with themselves or their patients as effectively, and this leads to more stress, exhaustion, and feeling overwhelmed.
"To be present to yourself is to realizing when you're overwhelmed, hungry, or grumpy, and then asking for help," Sieg says. "This focusing on yourself first, supports you to give your best to everyone and everything else."
The third practice is recovery, which to Sieg means finding ways to re-energize yourself, not just on vacation, or days off, but every day.
"[It's the] idea of filling yourself back up, doing things that help you feel good about yourself, that bring you joy," Sieg said, "not for hours, but even a few minutes of listening to your favorite music, creating some quiet space, moving, or getting outside to help you reset and renew yourself."
Incorporating these practices into nursing must begin with leadership.
"It's very important for nurse leaders to role model and support these practices for themselves and their staff" Sieg said. "Leaders need to treat themselves with kindness and not run themselves ragged, slow down to engage with staff, and prioritize their own recovery to support their staff to do the same."
For CNOs who are just starting a new wellbeing program, Sieg emphasized the importance of fully committing to it.
"Whatever you start and initiate, I encourage the nurse leaders to continue, so it is not a one-and-done program," Sieg said. "Well-being is about culture change and it takes time, consistency, and commitment, but it is so worth the investment to empower our nurses."
To learn more about the Well-Being Coaching Initiative, you can contact Diane here: diane@dianesieg.com.
