Fostering resiliency ensures well-being of health care workforce
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Resiliency — the ability to bounce back or recover quickly from difficulties — has never been more important for health care workers.
COVID-19 has added unprecedented stress, uncertainty and fear to their lives.
Although physicians, nurses and medics who work in combat face these perils every day, until now they were not as common in noncombat situations. Today, the foe is an unseen virus — not artillery fire or an explosive device — and its impact on the health care workforce is significant.
Given that, how do you build resiliency in a health care organization’s workforce?
Let’s start at the beginning and look at the situation and how it developed.
Cracks in an already fractured system
The health care system in the United States was broken prior to COVID-19.
A system built on Medicare, Medicaid and third-party payers that was shifting from a fee-for-service model to a value-based care model was faced with too many patients, and not enough resources or trained staff to care for them.
When the COVID-19 pandemic began, many health care professionals became concerned about their own safety, as well as whether they would be able to provide adequate care to an overwhelming number of patients with a new, unfamiliar virus.
Some became distressed, believing patients were not receiving the level of care they required or deserved. Personal stressors related to COVID-19 compounded the problem.
If staff are overworked, or if they feel unsafe in the work environment or undervalued by the organization, they will burn out and leave the institution and potentially the profession.
Consequently, resiliency has become a major issue health care organizations will need to address — and foster — to retain their workforce and ensure their staff members’ well-being.
Fostering resiliency
How can organizations foster resiliency?
A good first step is to acknowledge the stress that staff members are feeling. Be open to hearing nurses’ views and engaging them in the search for innovative ways to address the issues they face.
Organizations may want to engage in flexible staffing to meet the needs of patients as well as staff.
Flexible scheduling is crucial because many caregivers are struggling to find care for their children or other loved ones due to pandemic-related closures of schools, day care centers and other facilities. Implementing shared positions or shortened shifts — from 12 hours to 8 hours or less — also can help.
Visibility is key. It is important for leaders to be seen on the units during the day and night.
Frequent rounds allow leaders to assess emotional and moral distress levels, keeping in mind nurses who feel their patients are not receiving the quality of care they deserve are at risk.
Leaders must be open to discussing the situation so nurses can voice their opinions, feel heard and have their concerns addressed. If ethical issues are identified, call upon the ethics committee to address them.
Emotional intelligence can help leaders recognize when staff are in jeopardy and at risk for leaving the organization or profession. It is important to observe staff for moral distress, anxiety and depression, understanding the catalyst may be issues within the work environment, personal environment or both. Employee assistance programs that provide support, as well as the creation of relaxation or reflection spaces in the work environment, may help these staff members.
Leaders should empathize with the extra emotional burden COVID-19 presents for nurses and other health care workers. The numbers of patients who need care often preclude debriefings after deaths — a challenge compounded by the additional emotional support nurses have provided to patients whose family members cannot be at their sides.
Development of a multispecialty workforce that increases staff agility also can build resiliency.
Many staff were furloughed because they lacked the proper skills and training to manage patients with severe COVID-19. If furloughed workers are cross-trained, they can have an opportunity to work with some regularity and be available if patient volume surges again, adding to scheduling flexibility.
Another consideration is to place additional personnel — such as physical therapists and respiratory therapists — on teams in units where patients are on mechanical ventilation and must be proned. Many hospitals implemented proning teams, and this improved the quality of care delivered to these patients.
This approach to the multidisciplinary team facilitates a deeper understanding of overall patient care among team members.
Additional strategies
Resiliency starts with safety.
It is imperative to provide as safe a work environment as possible and ensure adequate availability of personal protective equipment.
The workforce must be alerted immediately to changes in care protocols and standards.
Updates on evidence-based care should be shared through face-to-face interaction with professional development staff and through email. Some health care systems offer a handout with summarized changes to staff upon entrance to the facility.
It also is essential to ensure staff members have access to clinical decision support and reference materials on which to base care decisions. Because information about COVID-19 continues to evolve, staff members will need to be flexible and open to continual learning about this virus.
Institutions can consider other nonclinical steps to foster resiliency.
Child care during the pandemic can be an overwhelming concern for some staff. Health care institutions can consider offering child care alternatives for those who don’t have access to their regular facilities, or working with education systems to devise child care alternatives for staff.
Starting a small grocery store where staff can pick up essentials such as bread or milk, or prepackaged meals they can consume at work or take home for their family, can make life a bit less stressful for staff.
Institutions should provide easy access to healthy food and drinks and encourage staff to take breaks during their shifts to eat meals or recharge. A free coffee, tea, ice cream or bottle of water can go a long way.
Providing hand-sewn surgical caps to cover hair, devices to protect ears from the constant friction of wearing masks, or face cream to protect the skin under masks are other great options that demonstrate leaders understand issues nurses face.
‘The most valuable commodity’
The most valuable commodity in a health care system is the workforce that cares for patients.
COVID-19 has changed the care paradigm forever. Organizations must find ways to foster resiliency among their staff, or they will risk losing them.
Patient outcomes are optimized if the staff feel valued, have adequate resources, are properly trained and feel safe in the care environment.
People drive the success or failure of organizations, so leaders must take the time to listen to their staff, see the reality of the situation under their own roofs, and implement support systems that build well-being rather than hinder it.
References:
- Owens KM. Front Health Serv Manage. 2020;doi:10.1097/HAP.0000000000000094.
- Shanafelt TD, et al. Creating a resilient organization. Available at: www.ama-assn.org/system/files/2020-05/caring-for-health-care-workers-covid-19.pdf. Accessed Oct. 6, 2020.
- West P and Gee PM. Front Health Serv Manage. 2018;doi:10.1097/HAP.0000000000000044.
- Wolters Kluwer. Nurse executives: Driving change in the era of COVID-19. 2020.
For more information:
Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, can be reached at anne.woods@wolterskluwer.com.
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