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Creating and Sustaining Healthy Workplace Environments

Creating and Sustaining Healthy Workplace Environments. University of Maryland All Alumni Reunion April 28, 2018 Dorrie Fontaine RN, PhD, FAAN Cheryl Cioffi DNP, RN, ANP-BC, NEA-BC, FACHE. Objectives.

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Creating and Sustaining Healthy Workplace Environments

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  1. Creating and Sustaining Healthy Workplace Environments University of Maryland All Alumni Reunion April 28, 2018 Dorrie Fontaine RN, PhD, FAAN Cheryl Cioffi DNP, RN, ANP-BC, NEA-BC, FACHE

  2. Objectives Define why a healthy work environment is important to patient care and resilience in care providers Describe the current state of burnout and methods to restore joy in nursing

  3. Key Questions • Why is a healthy work environment(HWE) important to patient care and resilience in care providers? • What is the current state of burnout and methods to reduce stress? • What are a few clinical examples of a HWE ? • What does it mean to create resiliency through Compassionate Care?

  4. “The urgency of slowing down …”- Pico Iyer ……………………………………………

  5. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence

  6. Essential Elements of a Healthy Work Environment (AACN 2016 2nd ed) Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  7. “Our lives begin to end the day we become silent about things that matter.” Martin Luther King, Jr.

  8. Being present …fully present

  9. Healthy work environments? • Workforce shortages • Moral distress • Lateral and vertical violence such as bullying • Quality & safety issues • Working wounded • BURNOUT

  10. Common in nurses & physicians • Burnout • PTSD • Moral distress • Mealer et al 2009; Bruce et al 2014

  11. Nurseswhoexperienceburnout… • Higher number of sick days; miss work due to injury, illness, depression or fatigue • More likely to have workplace errors • More likely to be impatient and reactive to fellow colleagues and patients and families • More likely to change jobs

  12. Healthy work environments: How arewe doing? One example Meaningful recognition scores (1-4, 4 = highest) 2006 (2.73) 2008 (2.77) 2013 (2.62) Ulrich, B. et al (2014) Critical care nurse work environments 2013: A status report Critical Care Nurse;34:64-79

  13. Association between Burnout and Patient Outcomes 30% decrease over 6,000 fewer infections and cost savings of $69M Hospitals with more stressed nurses had higher infection rates When burnout reduced, quality of care and cost improved …. Cimiotti et al., 2012, U of Pennsylvania

  14. The cost of bad behavior Pearson, C. & Porath, C. (2009) The cost of bad behavior: How incivility is damaging your business and what to do about it. New York: Penguin Group

  15. “Why do doctors commit suicide?” Pranay Sinha MD (Medicine, `14) Yale-New Haven Hospital resident New York Times op-ed September 4, 2014

  16. No Time to be Nice in the Intensive Care Unit D Fontaine, J Haizlip, & R Lavandero (2018) American Journal of Critical Care

  17. Solutions/Opportunities A call to action Clinical Stories

  18. Examples of a healthy work environment from the clinical setting Cheryl Cioffi, Senior Vice President, COO/CNO Frederick Regional Health System, Frederick, MD

  19. AACN Healthy Work Environment Elements: • Skilled communication • True collaboration • Effective decision making • Appropriate staffing • Meaningful recognition • Authentic leadership

  20. Skilled Communication & True Collaboration • Team STEPPS – Feel free to CUS • Bring Your Heart to Work program • Medical Review Oversight Committee (Physician Peer Review) AACN HWE Elements:Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  21. Meaningful Recognition • Celebrations • Certified Nurses Day, Preceptor of the Year, Nurse of the Year, etc. • PEP Program (People – Excellence – Performance) • Patient Safety Hero • Patient-Family Centered Care Award Satisfaction Avoidance Disengaged Illness Turnover Scared Safety at Risk Harm Dissatisfied Mortality AACN HWE Elements:Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  22. Appropriate Staffing • RN Pipeline Program • Twice Daily Staffing Huddles • Proactive Staffing Incentive Plan • Flexible Staffing Options / Robust Internal Float Pool • Root Cause Analysis AACN HWE Elements:Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  23. Authentic Leadership • Pet Therapy focused on staff • Senior Leader Rounds • Director/VP/CNO presence every weekend • Supporting what matters • Remove Barriers- “Quality Waste” • ClinTech Nursing Council- streamlining documentation AACN HWE Elements:Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  24. Critical Event Support Team • Available to all staff, Volunteers, and Physicians to provide emotional support following an unusually stressful scenario in the workplace • The Critical Event Support Team members are trained in providing a brief assessment and support, and determining if further intervention may be needed AACN HWE Elements:Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  25. Impact to Outcomes • Great Place to Work • Distinguished Hospital for Clinical Excellence • CMS 5-Star Rating • Highest rating for “Satisfied with Nurse Manager” • Increased Patient Satisfaction scores AACN HWE Elements:Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership

  26. “Taking Care of the People who Take Care of Our Patients”

  27. At UVA School of Nursing … Creating compassionate nurses and leadersfor the 21st century

  28. Our goal …………………………………………… Reducing human suffering by cultivating compassionate people and systems

  29. Compassion …experiencing a trembling or quivering of the heart in response to another’s pain Sharon Salzburg

  30. Empathy Putting yourself in the shoes of another A necessary precondition for compassion

  31. Can empathy and compassion be learned? Fontaine, D. K. (January 6, 2013) Editorial, Daily Progress

  32. What do people see when they see you? …………………………………………… “We live in a time when science is validating what humans have known throughout the ages: that compassion is not a luxury; it is a necessity for our well-being, resilience, and survival.” - Roshi Joan Halifax Nursing

  33. Compassion as a Global Remedy His Holiness the Dalai Lama, October 2012

  34. UVA Nursing’sResiliency Initiative

  35. The Architecture of Resilience “…resilient practices -- things like meditation, yoga, reflective writing, deep breathing, even physical exercise -- make for happier, stronger, more centered clinicians.” D. Fontaine, S. Bauer-Wu, & D. Germano (2014) http://www.huffingtonpost.com/dorrie-k-fontaine/the-architecture-of-resil_b_4560762.html

  36. Compassionate Care Initiative Jonathan Bartels RN, BSN The Pause Bartels, J. (2014). The pause. Critical Care Nurse, 30:74-75.

  37. Compassion, and the need for kindness

  38. Kindness “is not just about being nice, it’s about recognizing another human being who deserves care and respect”

  39. Compassionate Care Contemplative Practices Awareness—Presence—Resilience

  40. “Mindfulness is a way of being and relating to ourselves, our circumstances, one another, and the world around us … It invites an attitude of openness and curiosity.” - Susan Bauer-Wu (2011)

  41. “… It is being awake to the fullness of our lives right now, through engaging the five senses and noticing the changing landscapes of our minds without holding on or pushing away any of it.” -Susan Bauer-Wu (2011)

  42. Mindful clinicians associated with better patient care • Multi-center, observational study (MD, NP, PA) • Measures: • Patient ratings of quality of care (n=437) • Clinician (n=45) encounters recorded and coded into high and low mindfulness • High mindfulness clinicians associated with: • Patient-centered communication • Positive emotional tone (Beach et al., 2013)

  43. CCI’s growing vision To have safe, high-functioning healthcare environments with healthy and happy nurses, physicians and other health care workers where heart and humanness are valued and embodied

  44. Nursing

  45. What are we doing at UVA? …………………………………………… Nursing

  46. Nursing

  47. Nursing

  48. Our CCI ‘ambassadors’

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