{"id":11882,"date":"2017-09-06T09:53:09","date_gmt":"2017-09-06T15:53:09","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=11882"},"modified":"2023-06-23T12:02:41","modified_gmt":"2023-06-23T18:02:41","slug":"uchealth-looks-to-strengthen-providers-emotional-reserves","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/uchealth-looks-to-strengthen-providers-emotional-reserves\/","title":{"rendered":"UCHealth looks to strengthen providers\u2019 emotional reserves"},"content":{"rendered":"
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When a health care provider at UCHealth University of Colorado Hospital gets an accidental needle stick, there is no confusion about what to do. He or she follows a protocol that includes a clinic trip and incident report. The obvious goal: protect the provider.<\/p>\n

The process has been much less clear for nurses, physicians and other providers confronted with verbal and physical abuse from angry patients and distraught caregivers. Ditto the emotional burden providers carry when a patient dies unexpectedly or endures physical and emotional pain that can\u2019t be easily assuaged. Individuals trained to deal with a wide variety of clinical problems may founder in these waters. The difficulties worsen when they treat patients with illnesses, diseases and injuries complicated by behavioral and mental health issues.<\/p>\n

At UCH and hospitals around the country, providers facing these kinds of challenges too often have had to rely on their own resources to cope. But that approach often has diminishing returns. Even the strongest individuals\u2019 emotional tanks can run dry, said Jamie Nordhagen, RN, nurse manager of the Oncology Unit at UCH.<\/p>\n

\u201cWe need ways to support staff and to acknowledge the effects that accumulated stressful situations have on them,\u201d Nordhagen said. Failing to do so, she added, can have long-term consequences for nurses. They risk succumbing to \u201cdecreasing feelings of joy and purpose\u201d and may \u201cstruggle to connect\u201d with colleagues and patients.<\/p>\n

Time to REST<\/strong><\/p>\n

The hospital is addressing the challenge with the recently formed Resiliency Education and Support Team (REST), six staffers (see box)<\/em> trained to help tamp down emotional stress. They serve the hospital\u2019s Emergency Department and inpatient and intensive care units. The initiative, which officially launched July 1, aims to establish a process for nurses to report stressful situations and get professional support from REST.<\/p>\n

The effort, which has the support of the hospital\u2019s executive leadership, also includes providing education, such as Crisis Prevention Institute<\/a> training, and raising staff awareness of emotional support resources like HeartMath<\/a> and free counseling services through UCHealth\u2019s Employee Assistance Program.<\/p>\n

\"Two
Katie Donovan (left) and Jamie Nordhagen of the Oncology Unit at UCHealth University of Colorado Hospital are leaders of the REST initiative, which encourages nurses and other providers to report incidents of emotional distress and verbal and physical abuse by patients and caregivers.<\/figcaption><\/figure>\n

The core of the REST strat\u00adegy is encouraging staff to report \u201ccritical incidents,\u201d such as violent or abusive behavior from patients, draining emotional distress of family members, or unexpected patient deaths. The bedside nurse or CNA involved, together with the charge nurse, completes and submits a form that describes the incident. The most serious require that the REST team be paged and the unit manager notified. Otherwise, the report is emailed to the REST team, which is to respond to the staff member within 24 hours. The team solicits and logs information about the incident and offers support and additional resources.<\/p>\n

Speaking up, speaking out<\/strong><\/p>\n

It\u2019s important to initiate and respond to the report promptly, said Sara Stowell, MSW, LSW, manager of UCH\u2019s Behavioral Health Program and a REST leader. She noted, for example, that critical incident debriefing is routine in the military \u2013 and for good reason.<\/p>\n

\u201cThe sooner you debrief, the better you are about processing what occurred,\u201d Stowell said. \u201cIt\u2019s more productive for the team and the individual and helps to prevent the incident from manifesting itself in a negative way.\u201d<\/p>\n

The tell-tale signs of an individual\u2019s accumulated stress \u2013 frequently referred to as \u201cburnout\u201d or \u201ccompassion fatigue\u201d \u2013 include frequently calling in sick, requesting not to care for a patient, or crying unexpectedly, Stowell said. These and other signs of mounting pressure, in turn, take a toll on units and the entire hospital. Left unaddressed, they can drive an individual to change careers, she added.<\/p>\n

\u201cWe are trying to improve staff\u2019s ability to handle the pace of the hospital and changes in our patient population,\u201d Stowell said. \u201cTo do that, we have to give them the tools and resources they need to manage the challenges.\u201d<\/p>\n

The REST initiative follows a \u201crapid improvement event<\/a>\u201d and pilot earlier this year in the BMT\/Oncology and Medicine Specialties units. The pilot also emphasized the importance of emotional support for staff caring for a growing population of patients with behavioral and mental health issues faced with dwindling community resources for treating the problems.<\/p>\n

\u201cThere are fewer options for these patients,\u201d Nordhagen said. \u201cWhen it is unsafe for us to discharge them, they stay on inpatient floors for psychiatric issues.\u201d That, in turn, heightens the challenges for a unit like Nordhagen\u2019s, which cares for patients struggling with varieties of cancer and arduous recoveries from bone marrow transplants.<\/p>\n

Protecting emotional reserves<\/strong><\/p>\n

As a charge nurse on the Oncology Unit, Katie Donovan, RN, recognized that reality and the growing emotional burden it imposes on nurses and other providers. She developed the REST protocol as her credentialing project for UEXCEL, the hospital\u2019s professional development ladder for nurses.<\/p>\n

Donovan said her undergraduate studies in psychology as well as her observations and experiences as a nurse the past four-and-a-half years, all at UCH, spurred her work on the REST initiative. She has seen her colleagues struggle with recurring anxiety, emotional stress, and digestive issues, often linked to experiences with emotionally demanding patients, such as those who refuse care, or caregivers whose own stress makes them abusive to hospital providers.<\/p>\n

\u201cI see the wear on staff. I don\u2019t like feeling helpless,\u201d Donovan said.<\/p>\n

The array of resources REST offers is vital, she added, but the program\u2019s success relies on staff moving away from a go-it-alone mentality when they experience abusive behavior or the loss of patients with whom they have formed bonds.<\/p>\n

\u201cThe act of acknowledging that something happened that isn\u2019t okay is therapeutic in and of itself,\u201d Donovan said. \u201cThe experience is validated.\u201d<\/p>\n

That acknowledgement can be a difficult step for some nurses to take. \u201cIt will be a long haul,\u201d Nordhagen said. \u201cWe have a tough-it-out mentality.\u201d<\/p>\n

It also requires providers thinking differently about how they provide care, Donovan noted.<\/p>\n

\u201cNurses, by virtue of the care we provide patients, are interested in emotional well-being. It\u2019s part of our vocabulary,\u201d she said. When patient behavior crosses acceptable boundaries, however, the equation must change, she added. \u201cAt that point, it\u2019s not about the patient. The question is, \u2018How are you [as a nurse] processing it?\u2019\u201d<\/p>\n

Changing the culture<\/strong><\/p>\n

It\u2019s too early to assess the effects of REST, but the measuring tools are in place. On a broad scale, the National Database of Nursing Quality Indicators (NDNQI) in July began tracking assaults on nurses as part of an effort to assess and ultimately improve workplace safety.<\/p>\n

\u201cWe\u2019ll be able to go into the NDNQI database and see how we match with other hospitals,\u201d Stowell said.<\/p>\n

The strength of that comparison will rest on the data the hospital collects. Donovan points to staff learning to regularly report incidents and, when appropriate, request debriefings. With solid information in hand, she hopes to see individual units and the hospital as a whole respond with operational changes and additional resources to decrease the incidences of physical and emotional aggression and strengthen staff\u2019s sense that their work environment is safe. That, in turn, could help to decrease turnover, a key concern for any hospital in a competitive environment.<\/p>\n

Success hinges on providers accepting that reporting incidents that affect their emotional health is just as important as reporting accidents like needle sticks that endanger their physical health, Stowell said. That will require an \u201congoing resiliency strategy\u201d that includes regular training and education that highlights available resources like HeartMath, she said, adding that managers will be asked to encourage staff to develop plans for managing their emotional health as part of their yearly goal setting.<\/p>\n

Donovan too looks for the day that emotional resiliency training is routine for all new clinical providers at UCH.<\/p>\n

\u201cI want to see when people come to the hospital and are precepted that we tell them, \u2018This is how we handle these incidents,\u2019\u201d she said. \u201cIt should be part of our culture and our expectations.\u201d<\/p>\n

Nordhagen called on her colleagues to drive that change. \u201cPeople need to own their self-care,\u201d she said. \u201cWe owe it to ourselves and we have a professional obligation to make sure that we are okay to take care of others.\u201d<\/p>\n

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REST Responders at UCH<\/strong><\/p>\n