Caring for the Caregiver: Taking Care of You (first) and Your Staff (second) Judith S. Gooding VP Signature Programs March of Dimes NICU Leadership Forum: April 30, 2014 Nothing to disclose Neither I nor the planners for this activity have any financial, professional or personal relationships that could potentially bias the content of this presentation. Learning Objectives Following the seminar, participants will be able to: Identify three symptoms of health care provider fatigue and burn out. Explain the difference between secondary trauma and burn out. Discuss and incorporate three techniques to maintain a healthy, professional quality of life. Develop plan to apply at least three strategies that can improve work place environment for NICU staff. 1
A shortage of 400,000 registered nurses is expected by 2020. The healthcare work environment as a source of stress and overwork has been implicated in the shortage of nurses. Shirey, M. May, 2006. American Journal of Critical Care March of Dimes & NANN: Survey of NICU Nurse Stress & Coping 1,100 respondents, 700+ Level III NICU RN 61% report higher levels of stress Stress managed by: 86% seek support from peers 74% seek support from friends and family 47% reduce stress through exercise 18% seek support through counseling Workplace interruptions Prolonged work place stress Increasing demands and complexity of problems Lower work place performance 2
Compassion satisfaction Dr. Beth Hudnall Stamm, Ph.D., Idaho State University www.proqol.org Burn out Compassion Fatigue Syndrome Vicarious Traumatization Secondary Traumatization Secondary Traumatic Stress Compassion fatigue Dr. Beth Hudnall Stamm, Ph.D., Idaho State University www.proqol.org 3
Burnout Emotional Exhaustion Depleted emotional resources Depersonalization Indifferent or negative, callous, cynical attitudes toward work Gradual onset Feelings that your work doesn t make a difference Associated with a high workload Dr. Beth Hudnall Stamm, Ph.D., Idaho State University www.proqol.org Maslach C, Jackson SE & Leiter M (1966) Secondary Trauma Work-related, secondary exposure to extremely stressful events Rapid onset Feeling afraid Difficulty sleeping Images of the upsetting event pop into your mind Avoiding things that remind you of the event Dr. Beth Hudnall Stamm, Ph.D., Idaho State University www.proqol.org Compassion Fatigue Syndrome Depleted, exhausted, numb Symptoms include: Withdrawal Inappropriate anger or irritability Rigidity Sense of one s work as routine Headaches, GI symptoms, neck/back pain Inability to enjoy life Figley CR (ed.) (2002) 4
Secret Keeping The inability to express thoughts and feelings about stressful situations and events When you DO NOT express thoughts or feelings about a traumatic event More likely to obsess over it increased risk of experiencing long-term health consequences decreased job satisfaction When you DO express thoughts or feelings about a traumatic event More Likely to come to terms with the event Higher Confidence Better overall health better job satisfaction Pennebaker, J.W. (1985) Decision Making Organizational norms and culture influence Nurse Manager decision-making. Nurse Manager favored decision-making that was consistent with hospital culture and norms If there was an ethical dilemma, Nurse Manager pursued doing what they thought was right and generally did NOT stay silent Shirey (ed.) (2013) A healthy work environment is a work setting in which policies, procedures, and systems are designed so that employees are able to meet organizational objectives and achieve personal satisfaction in their work. Dirsch J. Creating healthy work environments. Creat. Nurs. 2002) 5
Strategy #1: Back to the basics Rest Relaxation Vacation Therapy Don t take stress out on your body Take your time off Strategy #2: Control the Interruptions Thank you for asking, but not now. I wish I could commit to this, but I have other priorities right now. When your door is closed, its closed. No. I can t. Strategy #3: Nurture your personal relationships What would your friends or family members tell you about your work? How does your work load and job impact their life and how you spend your time together? 6
Strategy #4: Create and sustain a healthy work environment for your staff. 1. Balance the tension between production and efficiency Make a short list of tasks to accomplish 2. Create and Sustain trust at all levels 3. Actively manage the process of change 4. Involve staff in decision-making (design and work flow) 5. Create a environment of learning Institute for Medicine, National Academies Press (2004) Optimal Patient Outcomes Skilled Communication Clinical Excellence Healthy Work Environment Leadership Meaningful Recognition True Collaboration Effective Decision making Adapted from Shirey (ed.) (2006) Strategy #5: Utilize debriefing successfully Debrief with peers, co-workers, boss Appropriate, using respectful terminology Removing gossip from the conversation Professional, Therapist Carefully with your family or friends Who initiates the conversation? Be mindful of body language or lack of responses Bottled-up emotions will eventually come out 7
Strategy #6: Use the buddy system 1. Co-managing leadership positions 2. Your inner circle 3. Your availability to your peers References Braithwaite M. (2008). Nurse burnout and stress in the NICU. Advances in Neonatal Care, 8(6), 343 347. Dirsch J. (2002) Creating healthy work environments. Creat. Nurs. 8 (2):3 4 Figley CR (ed.) (2002). Treating Compassion Fatigue. New York, NY: Routledge Institute for Medicine, National Academies Press (2004) Lazarus (1966) Psychological Stress and the Coping Process. New York, NY. Maslach C, Jackson SE & Leiter M. (1966.) Maslach Burout Inventory. Manual, 3rd ed. National Association of Neonatal Nurses and NANN Board of Directors, NANNP Council. (2007). Neonatal advanced practice nurses shift length, fatigue and impact on patient safety. Position Statement #3043. Pennebaker, J.W. (1985). Traumatic experience and psychosomatic disease: exploring the roles of behavioral inhibition, obsession and confiding. Canadian Psychology, 26, 82 95. References Porter, Porter & Lower. (1989). Enhancing the image of nursing. Journal of Nursing Administration, 19(2), 36 40. Roesler R, Ward D and M Short. (2009). Supporting staff recovery and reintegration after a critical incident resulting in infant death. Advances in Neonatal Care, 9(4), 163 171. Schaef AW (2004). Meditations for women who do too much. New York, NY: HarperOne. Shirey M. et al, (2013) Nurse manager cognitive decision making amidst stress and work complexity. Journal of Nursing Management, 21, 17 30. Shirey M. (2006) Authentic Leaders Creating Healthy Work Environments for Nursing Practice. American journal of Critical Care. American Journal of Critical Care. 15, V3. 8