Regulator s Approach to Ensuring Registrants Ginny Hanrahan and Jenny Bulbulia, CORU Ireland Resilience The world breaks everyone, and afterward, some are stronger at the broken places. Hemmingway, A Farewell to Arms The oak fought the wind and was broken, the willow bent when it must and survived. and Regulation 1
Regulators Responsibilities To protect the public by promoting high standards of professional conduct, education, training and competence for registrants Continuing Professional Development but how about life getting in the way Normal Distribution Curve Unacceptable Acceptable Good/Very Good Excellent Right Touch Regulation Professional Standards Authority UK Identify the problem before the solution Quantify the risks Get as close to the problem as possible Focus on the outcome Use regulation only when necessary Keep it simple Check for unintended consequences Review and respond to change and Regulation 2
Identify and Quantify the Problem Caring for others skilfully involves a high degree of self-giving. Whilst the self can certainly grow and flourish in this altruistic experience, it can also suffer. (McAllister et al, 2009) The Cost of Caring (Figley, 1995) The Hazards of the Healing Professions (Zeidner, 2013) What is Resilience? A dynamic process wherein individuals display positive adaptation despite experiences of significant adversity or trauma (Luthar and Cicchetti 2000) A display of manifested competence (Masten and Coatsworth 1998) A two dimensional construct including the experience of adverse conditions and the presence of positive skills in coping with these conditions ( Beddoe,Davys Adamson 2013) and Regulation 3
Or rather than attempting to achieve conceptual clarity or a consensus of meaning, resilience should be considered a rubric or umbrella term. (Grant & Kinman, 2013) Is Resilience always a good thing? Resigned Resilience? (Strategic Review of the Nursing and Midwifery Council 2012) Resilience in Adolescence I only have myself to rely on. (Hunter & Chandler, 1999) Get as Close to The Problem as Possible Evidenced Based Research and Regulation 4
Research Fostering Resilience at a personal, professional and organisational level: an international study of registered social workers Jenny Bulbulia & Michael S Gordon Trinity College, Dublin, Ireland A strengths based approach If 1 in 5 physicians are affected by burnout, what are the other 4 doing right? (Zwack & Schweitzer, 2013) As yet, little is known about fundamental issues such as what resilience means to social workers and how it can be supported effectively in training and practice. Grant & Kinman, 2013 and Regulation 5
Research Questions 1. What is the Professional Quality of Life of this cohort? 2. What are the personal, professional and organisational factors that impact professional quality of life? 3. What is the nature of resilience in this context? 4. What is the role of the Regulator in fostering resilience? Methods RQ.1 PROQOL (Stamm, 2010) RQ.2 RS14 (Wagnild, 2009) Brief Cope (Carver, 1997), DSQ40 (Andrews et al., 1993), SPOS (Eisenberger, 1984), UWES (Schaufeli & Baker 2003) Questionnaire RQ. 3 What is your understanding of resilience as it relates to your profession? RQ. 4 Online Focus Groups and Interviews and Regulation 6
As of 31 st July, 2013 129 participants Countries: Ireland, England, Wales, Scotland and Northern Ireland, Canadian Province of Saskatchewan Work Country Canada Uk and Ireland 42 58 Gender Male Female 15 85 and Regulation 7
Age 30.2 27.9 20.9 14.0 4.7 2.3 25 or less 26-34 35-44 45-54 55-64 over 65 Educational Level 50.4 37.2 6.2 0.8 4.7 0.8 Diploma Assoc Degree Cert/NQSW Bachelor Masters Doctorate Years Employed 20.9 22.5 15.5 17.1 12.4 11.6 5 or less 5-9 10-14 15-19 20-24 25 or more and Regulation 8
Bulbulia & Gordon, 2014 Trinity College, Dublin Ireland Preliminary Analysis Personal, Professional and Organisational Emerging Trends.. ProQOl Total Scores 75.2 Low Average High 66.7 52.7 47.3 24.8 33.3 0.0 0.0 0.0 Compassion Satisfaction Burnout Secondary Trauma Resilience 34.9 15.5 23.3 19.4 1.6 5.4 Very Low Low On the Low End Moderate Moderate to High High and Regulation 9
WHY? PERSONAL FACTORS Relationships- Psychological Factors Scale Resilience Self Compassion Compassion Satisfaction.64**.43** Burnout -.35** -.20* Secondary Trauma -.33** -.34** Resilience.53** **Correlation is significant at the 0.01 level (two tailed) * Correlation is significant at the 0.05 level (two tailed) Predicting Compassion Satisfaction.356 These two predictor variables account for 41 of the variability (R²=0.406).136 However, Resilience is our only significant predictor (p<0.001) and Regulation 10
Predicting Burnout -.209 These two predictor variables account for 12 of the variability (R²=0.120) -.026 However, Resilience is our only significant predictor (p<0.001) Predicting Secondary Traumatic Stress -.116 These two predictor variables account for 15 of the variability (R²=0.120) -.085 However, Self- Compassion is our only significant predictor (p<0.05) Other Personal Factors Defence Mechanisms and Coping Styles A Neurotic or Immature Defence Style is a predictor of Burnout and Secondary Traumatic Stress A Negative Coping Style is a predictor of Burnout and Secondary Traumatic Stress and Regulation 11
Work Life Balance - Factors 92.2 79.1 72.1 56.6 46.5 31.8 22.5 Work Life Balance Significant positive relationships were found between Compassion satisfaction and family time Resilience and family time and group activities Significant negative relationships were found between Burnout and family time, socialising and group recreation Secondary trauma and sport, cultural activities, family time, socialising and group recreation It is difficult to detach myself from my job High Low 60 48.1 40.7 33.3 11.1 6.6 Never/almost never Rarely/sometimes Often/very often HIGH - For participants who are high in compassion satisfaction and moderately high/high in resilience LOW - For participants who are average/low in compassion satisfaction and Low/very low in resilience and Regulation 12
WHY? ORGANISATIONAL FACTORS Utrecht Work Engagement Scale 82.2 0 7.8 9.3 0.8 Very Low Low Average High Very High Perceived Organisational Support 79.1 25.6 3.5 Low Medium High and Regulation 13
Relationships Organisational Factors Scale Compassion Satisfaction Utrecht Work Engagement Perceived Organisational Support.71**.43** Burnout -.25** -.46** Secondary Trauma -.18* -.37** Resilience.61**.39** **Correlation is significant at the 0.01 level (two tailed) * Correlation is significant at the 0.05 level (two tailed) Predicting Compassion Satisfaction.349 These two predictor variables account for 50 of the variability (R²=0.501).104 Work Engagement is our only significant predictor (p<0.001) Predicting Burnout -.082 These two predictor variables account for 21 of the variability (R²=0.201) -.288 POS is our only significant predictor (p<0.001) and Regulation 14
Predicting Secondary Traumatic Stress -.049 These two predictor variables account for 13 of the variability (R²=0.133) -.212 POS is the only significant predictor (p<0.001) Resigned Resilience?.524 These two predictor variables account for 37 of the variability (R²=0.370).185 Work Engagement is the significant predictor (p<0.001) Qualitative Question Define Resilience Answer 12 No Answer 88 and Regulation 15
WHY? PROFESSIONAL FACTORS Professional Areas 60 50 40 30 20 10 0 Key Areas Identified Supervision Training and Regulation 16
Frequency of Supervision 38 45.7 6.2 2.3 7.8 Never Irregular Monthly Fortnightly Weekly Quality of Supervision 45.3 32.8 18.8 3.1 Negative Inadequate Adequate Effective Purpose of Supervision Admin/case management No Yes 26 74 and Regulation 17
A qualitative enquiry The question of what constitutes good or effective supervision is thoroughly canvassed in the supervision literature with little consensus as to a definitive statement. (Beddoe et al, 2014) Training Received 39.5 45 Resilience 56.6 51.9 Burnout 3.9 3.1 Yes No Don't know Quality of Training Resilience Burnout 65.3 68.4 22.8 16.3 18.4 8.8 Poor Average Good and Regulation 18
Training Preliminary analysis indicates that lack of training negatively impacts on: Resilience Work Engagement Compassion Satisfaction Perceived Organisational Support Self Compassion Training needed 69 7 0.8 5.4 17.8 Strongly Disagree Disagree Uncertain Agree Strongly Agree Who should provide training? agreement Educator/CPD 81.4 Regulator 45.7 Employer Practitioner/Regi strant 89.1 89.1 and Regulation 19
Professional Quality of Life Multiple Pathways that are complex, dynamic and interacting The Person The Organisation The Profession Focus on the Outcome What are the desired outcomes of a Resilient registrant? What does having a good Professional Quality of Life actually mean? To consider together How should regulators implement this information Through review of approved training programmes? Continuing Professional Development/Competence Assurance? and Regulation 20
Speaker Contact Information Ginny Hanrahan CEO/Registrar, CORU regulating Health and Social Care professions in Ireland Tel +3531 2934751 (office) +353860405850 Jenny Bulbulia, Council Member of CORU/Barrister/ PhD student, Trinity College Dublin, Ireland bulbulij@tcd.ie Dr. Michael S Gordon, Trinity College Dublin, Ireland gordonms@tcd.ie and Regulation 21