Episode 79: New data on the state of nurse mental health
Episode 79: New data on the state of nurse mental health
Dan:
Dani, welcome back to the show.
Dani:
Thanks, Dan. My pleasure.
Dan:
So today we have sort of a special episode. We're going to be talking about a mental health study that Trusted conducted with some interesting findings. I don't think anything's groundbreaking that we didn't already know, but it adds some numbers and some context to some of the things we're feeling, which is always good. It's that evidence behind our assumptions. And this is a repeat survey as well. We've done this a number of years now. We worked with Ohio State on actually some formal published studies around nurses' mental health. And it's a little disheartening to see some of these results, but I think it gives us a starting point to start fixing it. So Dani, tell me. Why did we do this again? Why did Trusted sponsor another mental health study? What was one of the top findings that you thought was really interesting?
Dani:
Sure. Yeah. And I would agree with you, Dan. I think disheartening is the right word to use when we think about our profession and what they've been experiencing and feeling. This is the third year that Trusted has really set out to gauge mental health and the wellbeing of our nursing workforce as a part of our overall mission to support the four million nurses who make up the backbone of our health system. We're extremely proud that we've been very early into the conversation around mental health and have been actively trying to call attention to the issues to drive the conversation about change.
Dani:
This year, we expanded our focus to better understand the relationship between the nurses, their employers, and the healthcare industry at large when it comes to helping nurses manage their mental health. The data is helpful for also understanding the state of nursing, as you mentioned, at a high level, as well as what it takes to make nursing a sustainable, long-term career from a mental health perspective. Now we have a lot of findings. I'll start to go through those, and feel free to jump in. But I think one of the most surprising findings from this survey this year is that nurses' mental health has not rebounded to its pre pandemic levels.
Dani:
On a scale of one to 10, nurses rated their current mental health and wellbeing at an average of 5.8, compared to an average of 7.8 prior to the COVID-19 crisis, representing a decline of 26%. This finding indicates a very modest improvement over previous years' studies, which found decreases of 28% and 29% respectively. However, the nurses' mental health and wellbeing have not come close to reaching their pre pandemic levels, even though the most acute phase has subsided. Again, this isn't surprising, and it is disheartening. And it aligns with Dr. Linda Aiken's study, Chronic Hospital Nurse Under-Staffing Meets COVID-19, which indicated that nurses were already emotionally depleted and experienced burnout prior to COVID-19. Frontline nurses were working from a deficit, the surge hit for a sustained period of time, and the ability of the nurse to recover is often much harder when the workforce is not operating from a surplus of wellbeing, often associated with a healthy work environment and safe staffing.
Dan:
Yeah. So not surprising that mental health went down during the pandemic, not surprising that it's still down. We have staffing issues. There's culture issues. There's hospitals laying people off. There's just a lot of sort of chaos within the system, which as an innovator, I think chaos is good. It allows for new structures to emerge, which is awesome because I think we sort of knew where this study was going to go. Why would Trusted try and highlight these things? What's the goal of Trusted doing another mental health survey?
Dani:
Well, a healthy work environment is essential to a healthy patient. Right? So to care for our patients in their most vulnerable times, they're sick, they need the support, they need their resources, and so when we have a workforce that is also maybe not at their best, I think that implications and ramifications can be very severe. And so Trusted is very committed to ensuring that our patients get the best care and ensuring that those who deliver the care, our nurses, are getting supported, and that we're talking about this, and that we're making it aware, and that we're pushing and seeking health systems to really embrace this and start to make some changes around mental health awareness and support for the wellbeing of our workforce, who is doing really life changing work. It's heroic in nature and often can take a toll because of the things they face.
Dani:
And so they need that additional support, and we believe in it fundamentally. And that is why we continue to engage our workforce, understand where they're at, and then seek to bring the conversation and change to our health system.
Dan:
So I should back up a little bit, because since the last time we chatted, you've joined Trusted officially, and are a PhD prepared nurse in a very nice leadership position in a staffing company, which I think is amazing. We need more nurses in leadership position. We need people that understand the clinical workforce and can support it. So before we dive into the rest of some of the findings of the study, tell us about your new role within Trusted and how it relates to supporting the workforce.
Dani:
Absolutely. Yeah. So I joined trusted, I am the vice president of clinical strategy at Trusted. When I first joined, I was focused on learning the ins and outs of how trusted operates. I've progressed, and as I've progressed into my day to day work, my focus and purpose is really to draw on my 15 years of nursing workforce experience, both from research and practice to help health systems use Trusted's proven strategies and new workforce technology work to transform their nursing workforce programs and operationalize workforce strategies to achieve greater efficiency, safe nurse staffing levels, and flexibility that empowers both the frontline nurse and a manager. It's really exciting to know my passion to solve nurse staffing and workforce challenges completely aligns with Trusted's vision to truly transform healthcare. And again, it speaks to, we want to create a healthy workforce from all angles, not only just ensuring we have the right staff and helping health systems secure them. But what is the health of our workforce?
Dan:
Yeah. One of the reasons I joined Trusted in the past was because we need clinicians in these spaces. But any technology company, any company that's impacting clinicians needs to have a clinician in the leadership position on it. I posed this on LinkedIn. I've got to find it again and repost it, but I said, "Any healthcare company needs a chief patient officer, a chief nursing officer, and then maybe a chief medical officer." We'll see. If they're impacting physician, maybe medical officer. But if you have a chief nursing officer, chief patient officer, you're pretty much set up for outpacing your competition, so it's exciting to have you in that role. And then your expertise, I mean, there's probably no one else in the world that has a PhD in nursing workforce and staffing, or very few I think. That's just a super special opportunity to bring your expertise there. It's really exciting.
Dan:
So let's get back to the study a little bit and draw on your expertise. So we talked about what's most surprising. What are some of the other findings that stood out from the study?
Dani:
Yeah. Some other findings that really stood out is that one in 10 nurses have experienced suicidal thoughts as a result of the patient and. Nurses reported a variety of negative outcomes to their physical and mental health as a result of the pandemic, which includes burnout at 75%, compassion fatigue at 66%, depression at 64%, declines in physical health at 64%, and extreme feelings of trauma, stress, or PTSD at 50%. But perhaps the most disturbing is that one in 10 nurses reported that they had suicidal thoughts since the start of the pandemic, more than twice the incidence of such thoughts among the adult population in the US as a whole. Additionally, nurses are unlikely to seek support at work for mental health issues that could negatively impact their ability to do their job.
Dani:
Nearly 60% of the respondents said that they were very unlikely or somewhat unlikely to share feelings of acute depression, suicidal thoughts, or mental health issues with their managers or another individual at the facility. When asked why, the leading reasons were concerns about confidentiality, job security, and lack of effort to address the issues. This finding is consistent with previous reports that have found a high degree of stigma around issues of mental health among our healthcare workers.
Dan:
The suicidal piece I think is what really is distressing. And a couple years ago when we did the last study, we found similar outcomes. And we worked with The Ohio State University College of Nursing to set up mental health crisis line staffed by nurse practitioners. We set up a health coaching program. And you're right, I think the finding around nurses not wanting to seek help at their employer, or not feeling safe to do so, we saw the same thing. In the height of the pandemic, we set up this nurse practitioner crisis line, where we had nurses calling our nurse advocates all the time. Hey, I don't know how to deal with seeing 15 bodies every single day dying in the ICU. And we're like, "Hey, we have this great resource." And then we had a handful of people maybe call that line out of hundreds of thousands we sent the opportunity to use the resource.
Dan:
And I think it's the coat of armor there that I think we have to figure out within the profession because we know people are experiencing these symptoms that are having legitimate depression and suicidal ideation. And the resources we have for them aren't being utilized or aren't working. I think that's just a crisis. I don't know if you have thoughts on what we can do to support that.
Dani:
I would agree. I think it is a crisis, just like we talk about nurse staffing. You can see and feel that crisis. I don't have enough staff. But the crisis that's going on inside of a nurse, sometimes you can't see or feel. And then the fear of not being able to just verbalize that in a safe environment is quite concerning and alarming. I do think that it's important for hospitals and health systems to really start to work towards de stigmatizing those mental health issues. The fact that only one in three nurses have sought care for mental health from a mental health professional, and 60% wouldn't disclose potential job impairing issues to their employers despite high levels of depression, trauma, and stress and suicidal thoughts is quite discouraging and concerning, and alludes to what you experienced through your study and the efforts that you put in place.
Dani:
And so hospitals and health systems need to create a culture in which a nurse feels comfortable being open and honest about the issues they're facing, particularly when those are a direct result of the demands of the job, like they described. It's a heroic job. It's an amazing job. We get such great opportunities to care for people. But there's a toll associated with it when time and time again, you see some sickness, death, it can make it really tough for our workforce. And we need to continue to find ways to support them as they care for our patients.
Dan:
Yeah. And I think to the health system leaders out there and the people that can create sort of these structures around the nurses providing direct care, we have to ingrain some of these resources into the workday because I think one of the issues that I've seen and we've talked to nurses about this and we've actually found it in the study that Ohio State did, was nurses are expected to come in, do their work, and then deal with whatever happened. And that happens in multiple ways, some have counselors, some have trusted family members or partners that they can debrief with. Others compartmentalize it. Others turn to substance abuse, other poor coping mechanisms or inadequate coping mechanisms because we don't allow it to happen in the day.
Dan:
What if you walked into your shift and there was some sort of resource at the middle of the shift? And if there was a bad outcome with one of your patients, you actually were pulled off for a little bit and were able to do that trauma informed care, that debrief, or see somebody to talk through the emotions, at least to debrief it and get some support in those sort of hard situations. And there are some systems doing that, but across the board it feels like we just sort of forget that part, that it's just like, "Buck up and move on," sort of thing.
Dani:
Yeah, absolutely. And that speaks to building it into our workflows, our day, being very intentional about that and that's also another area that our health systems need support or need focus in, is what we've found through our study is we want to encourage our health systems to move from transactional to transformational engagement. And the fact that compensation rather than a relationship with a manager or facility leader is what was keeping the vast majority of nurses on the job, from our recent study, points to a weak transactional relationship between the nurses and their employers, so this is very alarming. And we know that drivers of recruitment or retention are around flexibility, staff inadequacies, and then a good relationship with their manager.
Dani:
So as we think about [inaudible 00:13:37] of our frontline, I also think we need to think about our nurse managers. And my heart goes out to the frontline nurse manager because their work, when not supported adequately, can be very stressful and overwhelming. They too often need the support and resources to ensure that they are tending to their own wellbeing, and that they can lead from a place of transformation authenticity. Hospitals and executive leadership need to help support their frontline nurse managers and find ways to free them from that tedious task, like staffing and scheduling, which they often spend about 60% of their time doing, and invest in programs to help equip and train them to lead from a place of transformation rather than transaction.
Dan:
Yeah. The nurse managers get so much focus. Right? It's always their fault, no matter what it is. It's the staffing, if it's innovation, it's whatever. But there is evidence behind that, that frontline nurse manager is the pivotal connector point for most issue solving, most problem solving, but they're not incented to do it. They're incented to put warm bodies in and provide care and get the patients staffed and cared for in some way. They're not incented to disrupt the system, or innovate, or do anything other than sort of manage that day to day because of the way our structures are set up. And I think there's a real opportunity for us to understand that. That might be the biggest barrier in health systems for change, and it's not their fault. It's the way we set up the system.
Dan:
And so those things that can take the burden of some of these transactions like calling people to come in, or figuring out a skill mix, or name that transactional, payroll, the stuff that just doesn't need nurse brains to do, and free them up from that and actually allow them to build those relationships, provide resources, be a coach, be a mentor, deal with issues around nursing practice and the support of their staff, rather than these transaction. I think you're right on. That's the key to the future of our health systems.
Dani:
Yeah. Like you mentioned, the two prong approach, support our workforce with those strategies, as you mentioned, crisis hotlines, one on one counseling, therapy, they were critical during the peak pandemic, so that our nurses can continue to work through what they just went through, and then also supporting the frontline manager in the same respect, that alleviating some of these tasks that take up their time, so they can be transformational and build credible relationships with their team. Be transparent and honest. Have those conversations about a nurse's career aspirations, their wellbeing, and how they can contribute to the larger profession, versus focusing on those simple scheduling, day to day tasks, compensation, et cetera. So it's quite a transformation. I'm hopeful, and that's again why I'm really proud of Trusted and excited that we're calling these things to light so that we can continue to talk about them, but also put action behind our conversation.
Dan:
Yeah. I think there's an opportunity because there's nimbleness in the non legacy systems to be able to support this. And we know nurses are choosing to travel or choosing to do different flexible work styles, and so if there's organizations that support them in that work and can give them resources differently, I think that's a good thing, and hopefully will lead to others following suit as well. So what do you think some of the other things that hospitals and health systems should be doing to address the issues that were found in the report?
Dani:
I also think what we discovered in the report was, as we mentioned, the programs like crisis hotlines were really helpful. But also, this year's respondents have made it clear that they're also looking for benefits that support their physical and mental wellbeing over the long-term, so they want access to fitness facilities and/or classes. Wellness stipends are a are big deal, as well as again, my passion, flexible scheduling. How can we continue to support the frontline and give that flexibility and autonomy over their schedule, over their work life balance, to really create the sense of control and engagement?
Dan:
Yeah. No, I think wellness piece is awesome, and access to that, interesting challenge from a staffing organization perspective to see. How do you provide those resources across all 50 states, thousands of nurses, moving around the country? It's a unique challenge, but I think that opportunity to reward that flexibility with resources like that is going to be key. What is your message to the chief nurses? We talked a lot about the managers, maybe some of those frontline leaders. But what do you think chief nurses should be thinking about as they embark on rethinking their workforce and supporting them differently?
Dani:
I think our chief nurses, again, they're also working really hard and may be caught up in the day to day as well. So being able to give themselves time to reflect and really think strategically in the days ahead, who we are today is definitely not who we need to be in the future, and so being open to the new ways of maybe scheduling staffing. What technology do we need to empower and automate some of our processes that are manual? And how can they truly build a supportive environment for their frontline leaders and their frontline nurses? And really digging deep, explore resources that are out there. I know a good resource to help hospitals to start to think about this and build healthy work environments is a recent report, The Nurse Staffing Think Tank and Priority Topics and Recommendations Report that was recently published by the AACN, ANA, AONL, HFMA, and IHI, actually give actionable steps and some concrete framework to start with to build the foundations and move more into some innovative thinking.
Dan:
Yeah. I think that think tank report is really important. It's supported by all our professional organizations in some way and has some great insights for leaders to take away and figure out. I think we need to continue to bring it up. I just gave a talk yesterday to actually the National Centers of Nursing Workforce, so every state, most states have a Center of Nurse Workforce. They all have a conference. They were in Vegas this week and I got to chat with them. And one of my slides says, "You'll never, ever, ever be fully staffed ever again, so stop thinking like that."
Dan:
And so what that means is that you may not necessarily be down individuals to provide the care, but the way we think about it, it needs to be different. And this recruit and retain without any flexibility to schedule up and schedule down based on different things is not going to work anymore. And so we have to think of it as sort of this flexible model that we'll have some core staff, you'll have some flexible staff, we support all of them. They're all part of our team in some way. They're not like us versus them, sort of thing. We've got to get rid of all those kind of traditional transactional pieces because we're in a very complex messed up system, and we're in a paradigm shift. And so those old solutions aren't going to work anymore. The think tank, the trusted resources, and the Linda Aiken study all provide, it's screaming in our face that we've got to rethink all of this stuff. And we can't go back, and so it's exciting to see some shifts in resources to make that happen.
Dan:
So we talked a lot about some of the negative that's coming out of the nursing workforce. But what's exciting for you in your role to help address some of these things? What are some of the initiatives you're working on?
Dani:
Yeah, as I mentioned, really, it's pairing strategy through automation and technology. And as I alluded to before, managers are spending 60% of their time doing this work. And oftentimes what the research shows is that they're not given the right tools, the right support, or motivation just do to this well. And so Trusted is really committed to developing strategies that will really help aid health systems in thinking differently around their staffing and scheduling, and that works, our new technology can power it and operationalize it and create that automation, so you're not having to build a big operational team to make this a reality. It's kind of the tip of the iceberg in my belief, Dan. We're peeling back the layers of: What does it mean to really take on staffing and do it differently, and create that flexibility of different shifts the way that we're able to fill those shifts? And who fills them? And you're right, we're all on the same team.
Dani:
So whatever layer of workforce you are, whether you're a core or you're a flexible, you are all on the same team to care for that patient and provide best patient care. And I think that is an imperative mindset shift that you called out for CNOs in the days ahead to think differently about their workforce and what they may look like. And in fact, what does loyalty and engagement look like in the days ahead? It may not be tenure of time, but rather engagement from their team to solve what is happening, and engagement in shared decision making, or redesigning policies. That is true engagement that we're pushing for and trying to free up our managers and our nurses to have time to do.
Dan:
Yeah. I think that's great. Push the policy piece. Think differently. You're positioned to be able to be disruptive outside of some of the legacy systems. I think all of that together can figure out and at least test out some of these ways to support a workforce because ultimately, if we don't support the workforce and they continue to leave, or we continue to have shortages, eventually people will stop looking to nurses to provide the care, and our profession could go away in the worst case scenario. And so I think we have to refocus our efforts, not on getting warm bodies into placements and shifts, but to really think of it holistically as a workforce that needs support, or the care that we're going to need in a few years is going to be really stressful without nurses. So I think this is what I call the blockbuster moment. We can double down on the past, or we can think like Netflix and others, and build the future we want. And I think we better default towards that building the future.
Dani:
Absolutely.
Dan:
So Dani, we talked about a lot. But on the handoff, we like to distill it down into what's that one nugget of information that we want them to walk away with, so we can create some change through this media. Dani, what would you like to hand off to our audience?
Dani:
I would like to hand off to our audience to first off, read the report and start to really dig into this issue that I think is coming to life over the last couple of years, but is actually another crisis that we're facing for our workforce, is their health, their wellbeing, and really dig into that and start to think about new ways of supporting our nurses and the work that they do, and how transformational that work is for our society and community at a large scale.
Dan:
Yeah. Awesome. Great points there. And like you said, look at the evidence. Let's create solutions around it. We have the information to show us what's broken, those fractures in the fault line, and it's time for us to repair those, so thanks, Dani, for that. These resources will be put in the show notes so you can link to the studies and the resources, the think tank documents that we talked about. I know Trusted's going to be promoting the findings of this study on social media and we'll have a website landing page we'll link to as well, so go and check those out because we have the evidence here, and it's time for us to stop talking about it and stop surveying and start making action to move forward. So Dani, thanks so much for being on the show. We really appreciate. Dani, we'll put your contact information and LinkedIn in the show notes as well, so that people can get ahold of you. And just really appreciate your insights on this important topic.
Dani:
Yeah, my pleasure. Thanks for having me.
Description
To close out season 5 of The Handoff we’re actually welcoming back a repeat visitor to the show. Dani Bowie joined us last season to talk about scheduling and staffing, and since that conversation, she’s actually joined the team at Trusted Health as their Vice President of Clinical Strategy & Transformation, where she’s helping health systems transform their nursing workforce programs.
We’re very happy to welcome her back to the show today to talk about a topic that is very close to both our hearts: nurse mental health. For the third year in a row, Trusted Health is releasing its annual survey on frontline nurse mental health and well-being and Dani and Dan talked about the findings, as well as her thoughts on what the nurse leaders, hospitals and the industry as a whole can do to address the issues raised.
Links to recommended reading:
Transcript
Dan:
Dani, welcome back to the show.
Dani:
Thanks, Dan. My pleasure.
Dan:
So today we have sort of a special episode. We're going to be talking about a mental health study that Trusted conducted with some interesting findings. I don't think anything's groundbreaking that we didn't already know, but it adds some numbers and some context to some of the things we're feeling, which is always good. It's that evidence behind our assumptions. And this is a repeat survey as well. We've done this a number of years now. We worked with Ohio State on actually some formal published studies around nurses' mental health. And it's a little disheartening to see some of these results, but I think it gives us a starting point to start fixing it. So Dani, tell me. Why did we do this again? Why did Trusted sponsor another mental health study? What was one of the top findings that you thought was really interesting?
Dani:
Sure. Yeah. And I would agree with you, Dan. I think disheartening is the right word to use when we think about our profession and what they've been experiencing and feeling. This is the third year that Trusted has really set out to gauge mental health and the wellbeing of our nursing workforce as a part of our overall mission to support the four million nurses who make up the backbone of our health system. We're extremely proud that we've been very early into the conversation around mental health and have been actively trying to call attention to the issues to drive the conversation about change.
Dani:
This year, we expanded our focus to better understand the relationship between the nurses, their employers, and the healthcare industry at large when it comes to helping nurses manage their mental health. The data is helpful for also understanding the state of nursing, as you mentioned, at a high level, as well as what it takes to make nursing a sustainable, long-term career from a mental health perspective. Now we have a lot of findings. I'll start to go through those, and feel free to jump in. But I think one of the most surprising findings from this survey this year is that nurses' mental health has not rebounded to its pre pandemic levels.
Dani:
On a scale of one to 10, nurses rated their current mental health and wellbeing at an average of 5.8, compared to an average of 7.8 prior to the COVID-19 crisis, representing a decline of 26%. This finding indicates a very modest improvement over previous years' studies, which found decreases of 28% and 29% respectively. However, the nurses' mental health and wellbeing have not come close to reaching their pre pandemic levels, even though the most acute phase has subsided. Again, this isn't surprising, and it is disheartening. And it aligns with Dr. Linda Aiken's study, Chronic Hospital Nurse Under-Staffing Meets COVID-19, which indicated that nurses were already emotionally depleted and experienced burnout prior to COVID-19. Frontline nurses were working from a deficit, the surge hit for a sustained period of time, and the ability of the nurse to recover is often much harder when the workforce is not operating from a surplus of wellbeing, often associated with a healthy work environment and safe staffing.
Dan:
Yeah. So not surprising that mental health went down during the pandemic, not surprising that it's still down. We have staffing issues. There's culture issues. There's hospitals laying people off. There's just a lot of sort of chaos within the system, which as an innovator, I think chaos is good. It allows for new structures to emerge, which is awesome because I think we sort of knew where this study was going to go. Why would Trusted try and highlight these things? What's the goal of Trusted doing another mental health survey?
Dani:
Well, a healthy work environment is essential to a healthy patient. Right? So to care for our patients in their most vulnerable times, they're sick, they need the support, they need their resources, and so when we have a workforce that is also maybe not at their best, I think that implications and ramifications can be very severe. And so Trusted is very committed to ensuring that our patients get the best care and ensuring that those who deliver the care, our nurses, are getting supported, and that we're talking about this, and that we're making it aware, and that we're pushing and seeking health systems to really embrace this and start to make some changes around mental health awareness and support for the wellbeing of our workforce, who is doing really life changing work. It's heroic in nature and often can take a toll because of the things they face.
Dani:
And so they need that additional support, and we believe in it fundamentally. And that is why we continue to engage our workforce, understand where they're at, and then seek to bring the conversation and change to our health system.
Dan:
So I should back up a little bit, because since the last time we chatted, you've joined Trusted officially, and are a PhD prepared nurse in a very nice leadership position in a staffing company, which I think is amazing. We need more nurses in leadership position. We need people that understand the clinical workforce and can support it. So before we dive into the rest of some of the findings of the study, tell us about your new role within Trusted and how it relates to supporting the workforce.
Dani:
Absolutely. Yeah. So I joined trusted, I am the vice president of clinical strategy at Trusted. When I first joined, I was focused on learning the ins and outs of how trusted operates. I've progressed, and as I've progressed into my day to day work, my focus and purpose is really to draw on my 15 years of nursing workforce experience, both from research and practice to help health systems use Trusted's proven strategies and new workforce technology work to transform their nursing workforce programs and operationalize workforce strategies to achieve greater efficiency, safe nurse staffing levels, and flexibility that empowers both the frontline nurse and a manager. It's really exciting to know my passion to solve nurse staffing and workforce challenges completely aligns with Trusted's vision to truly transform healthcare. And again, it speaks to, we want to create a healthy workforce from all angles, not only just ensuring we have the right staff and helping health systems secure them. But what is the health of our workforce?
Dan:
Yeah. One of the reasons I joined Trusted in the past was because we need clinicians in these spaces. But any technology company, any company that's impacting clinicians needs to have a clinician in the leadership position on it. I posed this on LinkedIn. I've got to find it again and repost it, but I said, "Any healthcare company needs a chief patient officer, a chief nursing officer, and then maybe a chief medical officer." We'll see. If they're impacting physician, maybe medical officer. But if you have a chief nursing officer, chief patient officer, you're pretty much set up for outpacing your competition, so it's exciting to have you in that role. And then your expertise, I mean, there's probably no one else in the world that has a PhD in nursing workforce and staffing, or very few I think. That's just a super special opportunity to bring your expertise there. It's really exciting.
Dan:
So let's get back to the study a little bit and draw on your expertise. So we talked about what's most surprising. What are some of the other findings that stood out from the study?
Dani:
Yeah. Some other findings that really stood out is that one in 10 nurses have experienced suicidal thoughts as a result of the patient and. Nurses reported a variety of negative outcomes to their physical and mental health as a result of the pandemic, which includes burnout at 75%, compassion fatigue at 66%, depression at 64%, declines in physical health at 64%, and extreme feelings of trauma, stress, or PTSD at 50%. But perhaps the most disturbing is that one in 10 nurses reported that they had suicidal thoughts since the start of the pandemic, more than twice the incidence of such thoughts among the adult population in the US as a whole. Additionally, nurses are unlikely to seek support at work for mental health issues that could negatively impact their ability to do their job.
Dani:
Nearly 60% of the respondents said that they were very unlikely or somewhat unlikely to share feelings of acute depression, suicidal thoughts, or mental health issues with their managers or another individual at the facility. When asked why, the leading reasons were concerns about confidentiality, job security, and lack of effort to address the issues. This finding is consistent with previous reports that have found a high degree of stigma around issues of mental health among our healthcare workers.
Dan:
The suicidal piece I think is what really is distressing. And a couple years ago when we did the last study, we found similar outcomes. And we worked with The Ohio State University College of Nursing to set up mental health crisis line staffed by nurse practitioners. We set up a health coaching program. And you're right, I think the finding around nurses not wanting to seek help at their employer, or not feeling safe to do so, we saw the same thing. In the height of the pandemic, we set up this nurse practitioner crisis line, where we had nurses calling our nurse advocates all the time. Hey, I don't know how to deal with seeing 15 bodies every single day dying in the ICU. And we're like, "Hey, we have this great resource." And then we had a handful of people maybe call that line out of hundreds of thousands we sent the opportunity to use the resource.
Dan:
And I think it's the coat of armor there that I think we have to figure out within the profession because we know people are experiencing these symptoms that are having legitimate depression and suicidal ideation. And the resources we have for them aren't being utilized or aren't working. I think that's just a crisis. I don't know if you have thoughts on what we can do to support that.
Dani:
I would agree. I think it is a crisis, just like we talk about nurse staffing. You can see and feel that crisis. I don't have enough staff. But the crisis that's going on inside of a nurse, sometimes you can't see or feel. And then the fear of not being able to just verbalize that in a safe environment is quite concerning and alarming. I do think that it's important for hospitals and health systems to really start to work towards de stigmatizing those mental health issues. The fact that only one in three nurses have sought care for mental health from a mental health professional, and 60% wouldn't disclose potential job impairing issues to their employers despite high levels of depression, trauma, and stress and suicidal thoughts is quite discouraging and concerning, and alludes to what you experienced through your study and the efforts that you put in place.
Dani:
And so hospitals and health systems need to create a culture in which a nurse feels comfortable being open and honest about the issues they're facing, particularly when those are a direct result of the demands of the job, like they described. It's a heroic job. It's an amazing job. We get such great opportunities to care for people. But there's a toll associated with it when time and time again, you see some sickness, death, it can make it really tough for our workforce. And we need to continue to find ways to support them as they care for our patients.
Dan:
Yeah. And I think to the health system leaders out there and the people that can create sort of these structures around the nurses providing direct care, we have to ingrain some of these resources into the workday because I think one of the issues that I've seen and we've talked to nurses about this and we've actually found it in the study that Ohio State did, was nurses are expected to come in, do their work, and then deal with whatever happened. And that happens in multiple ways, some have counselors, some have trusted family members or partners that they can debrief with. Others compartmentalize it. Others turn to substance abuse, other poor coping mechanisms or inadequate coping mechanisms because we don't allow it to happen in the day.
Dan:
What if you walked into your shift and there was some sort of resource at the middle of the shift? And if there was a bad outcome with one of your patients, you actually were pulled off for a little bit and were able to do that trauma informed care, that debrief, or see somebody to talk through the emotions, at least to debrief it and get some support in those sort of hard situations. And there are some systems doing that, but across the board it feels like we just sort of forget that part, that it's just like, "Buck up and move on," sort of thing.
Dani:
Yeah, absolutely. And that speaks to building it into our workflows, our day, being very intentional about that and that's also another area that our health systems need support or need focus in, is what we've found through our study is we want to encourage our health systems to move from transactional to transformational engagement. And the fact that compensation rather than a relationship with a manager or facility leader is what was keeping the vast majority of nurses on the job, from our recent study, points to a weak transactional relationship between the nurses and their employers, so this is very alarming. And we know that drivers of recruitment or retention are around flexibility, staff inadequacies, and then a good relationship with their manager.
Dani:
So as we think about [inaudible 00:13:37] of our frontline, I also think we need to think about our nurse managers. And my heart goes out to the frontline nurse manager because their work, when not supported adequately, can be very stressful and overwhelming. They too often need the support and resources to ensure that they are tending to their own wellbeing, and that they can lead from a place of transformation authenticity. Hospitals and executive leadership need to help support their frontline nurse managers and find ways to free them from that tedious task, like staffing and scheduling, which they often spend about 60% of their time doing, and invest in programs to help equip and train them to lead from a place of transformation rather than transaction.
Dan:
Yeah. The nurse managers get so much focus. Right? It's always their fault, no matter what it is. It's the staffing, if it's innovation, it's whatever. But there is evidence behind that, that frontline nurse manager is the pivotal connector point for most issue solving, most problem solving, but they're not incented to do it. They're incented to put warm bodies in and provide care and get the patients staffed and cared for in some way. They're not incented to disrupt the system, or innovate, or do anything other than sort of manage that day to day because of the way our structures are set up. And I think there's a real opportunity for us to understand that. That might be the biggest barrier in health systems for change, and it's not their fault. It's the way we set up the system.
Dan:
And so those things that can take the burden of some of these transactions like calling people to come in, or figuring out a skill mix, or name that transactional, payroll, the stuff that just doesn't need nurse brains to do, and free them up from that and actually allow them to build those relationships, provide resources, be a coach, be a mentor, deal with issues around nursing practice and the support of their staff, rather than these transaction. I think you're right on. That's the key to the future of our health systems.
Dani:
Yeah. Like you mentioned, the two prong approach, support our workforce with those strategies, as you mentioned, crisis hotlines, one on one counseling, therapy, they were critical during the peak pandemic, so that our nurses can continue to work through what they just went through, and then also supporting the frontline manager in the same respect, that alleviating some of these tasks that take up their time, so they can be transformational and build credible relationships with their team. Be transparent and honest. Have those conversations about a nurse's career aspirations, their wellbeing, and how they can contribute to the larger profession, versus focusing on those simple scheduling, day to day tasks, compensation, et cetera. So it's quite a transformation. I'm hopeful, and that's again why I'm really proud of Trusted and excited that we're calling these things to light so that we can continue to talk about them, but also put action behind our conversation.
Dan:
Yeah. I think there's an opportunity because there's nimbleness in the non legacy systems to be able to support this. And we know nurses are choosing to travel or choosing to do different flexible work styles, and so if there's organizations that support them in that work and can give them resources differently, I think that's a good thing, and hopefully will lead to others following suit as well. So what do you think some of the other things that hospitals and health systems should be doing to address the issues that were found in the report?
Dani:
I also think what we discovered in the report was, as we mentioned, the programs like crisis hotlines were really helpful. But also, this year's respondents have made it clear that they're also looking for benefits that support their physical and mental wellbeing over the long-term, so they want access to fitness facilities and/or classes. Wellness stipends are a are big deal, as well as again, my passion, flexible scheduling. How can we continue to support the frontline and give that flexibility and autonomy over their schedule, over their work life balance, to really create the sense of control and engagement?
Dan:
Yeah. No, I think wellness piece is awesome, and access to that, interesting challenge from a staffing organization perspective to see. How do you provide those resources across all 50 states, thousands of nurses, moving around the country? It's a unique challenge, but I think that opportunity to reward that flexibility with resources like that is going to be key. What is your message to the chief nurses? We talked a lot about the managers, maybe some of those frontline leaders. But what do you think chief nurses should be thinking about as they embark on rethinking their workforce and supporting them differently?
Dani:
I think our chief nurses, again, they're also working really hard and may be caught up in the day to day as well. So being able to give themselves time to reflect and really think strategically in the days ahead, who we are today is definitely not who we need to be in the future, and so being open to the new ways of maybe scheduling staffing. What technology do we need to empower and automate some of our processes that are manual? And how can they truly build a supportive environment for their frontline leaders and their frontline nurses? And really digging deep, explore resources that are out there. I know a good resource to help hospitals to start to think about this and build healthy work environments is a recent report, The Nurse Staffing Think Tank and Priority Topics and Recommendations Report that was recently published by the AACN, ANA, AONL, HFMA, and IHI, actually give actionable steps and some concrete framework to start with to build the foundations and move more into some innovative thinking.
Dan:
Yeah. I think that think tank report is really important. It's supported by all our professional organizations in some way and has some great insights for leaders to take away and figure out. I think we need to continue to bring it up. I just gave a talk yesterday to actually the National Centers of Nursing Workforce, so every state, most states have a Center of Nurse Workforce. They all have a conference. They were in Vegas this week and I got to chat with them. And one of my slides says, "You'll never, ever, ever be fully staffed ever again, so stop thinking like that."
Dan:
And so what that means is that you may not necessarily be down individuals to provide the care, but the way we think about it, it needs to be different. And this recruit and retain without any flexibility to schedule up and schedule down based on different things is not going to work anymore. And so we have to think of it as sort of this flexible model that we'll have some core staff, you'll have some flexible staff, we support all of them. They're all part of our team in some way. They're not like us versus them, sort of thing. We've got to get rid of all those kind of traditional transactional pieces because we're in a very complex messed up system, and we're in a paradigm shift. And so those old solutions aren't going to work anymore. The think tank, the trusted resources, and the Linda Aiken study all provide, it's screaming in our face that we've got to rethink all of this stuff. And we can't go back, and so it's exciting to see some shifts in resources to make that happen.
Dan:
So we talked a lot about some of the negative that's coming out of the nursing workforce. But what's exciting for you in your role to help address some of these things? What are some of the initiatives you're working on?
Dani:
Yeah, as I mentioned, really, it's pairing strategy through automation and technology. And as I alluded to before, managers are spending 60% of their time doing this work. And oftentimes what the research shows is that they're not given the right tools, the right support, or motivation just do to this well. And so Trusted is really committed to developing strategies that will really help aid health systems in thinking differently around their staffing and scheduling, and that works, our new technology can power it and operationalize it and create that automation, so you're not having to build a big operational team to make this a reality. It's kind of the tip of the iceberg in my belief, Dan. We're peeling back the layers of: What does it mean to really take on staffing and do it differently, and create that flexibility of different shifts the way that we're able to fill those shifts? And who fills them? And you're right, we're all on the same team.
Dani:
So whatever layer of workforce you are, whether you're a core or you're a flexible, you are all on the same team to care for that patient and provide best patient care. And I think that is an imperative mindset shift that you called out for CNOs in the days ahead to think differently about their workforce and what they may look like. And in fact, what does loyalty and engagement look like in the days ahead? It may not be tenure of time, but rather engagement from their team to solve what is happening, and engagement in shared decision making, or redesigning policies. That is true engagement that we're pushing for and trying to free up our managers and our nurses to have time to do.
Dan:
Yeah. I think that's great. Push the policy piece. Think differently. You're positioned to be able to be disruptive outside of some of the legacy systems. I think all of that together can figure out and at least test out some of these ways to support a workforce because ultimately, if we don't support the workforce and they continue to leave, or we continue to have shortages, eventually people will stop looking to nurses to provide the care, and our profession could go away in the worst case scenario. And so I think we have to refocus our efforts, not on getting warm bodies into placements and shifts, but to really think of it holistically as a workforce that needs support, or the care that we're going to need in a few years is going to be really stressful without nurses. So I think this is what I call the blockbuster moment. We can double down on the past, or we can think like Netflix and others, and build the future we want. And I think we better default towards that building the future.
Dani:
Absolutely.
Dan:
So Dani, we talked about a lot. But on the handoff, we like to distill it down into what's that one nugget of information that we want them to walk away with, so we can create some change through this media. Dani, what would you like to hand off to our audience?
Dani:
I would like to hand off to our audience to first off, read the report and start to really dig into this issue that I think is coming to life over the last couple of years, but is actually another crisis that we're facing for our workforce, is their health, their wellbeing, and really dig into that and start to think about new ways of supporting our nurses and the work that they do, and how transformational that work is for our society and community at a large scale.
Dan:
Yeah. Awesome. Great points there. And like you said, look at the evidence. Let's create solutions around it. We have the information to show us what's broken, those fractures in the fault line, and it's time for us to repair those, so thanks, Dani, for that. These resources will be put in the show notes so you can link to the studies and the resources, the think tank documents that we talked about. I know Trusted's going to be promoting the findings of this study on social media and we'll have a website landing page we'll link to as well, so go and check those out because we have the evidence here, and it's time for us to stop talking about it and stop surveying and start making action to move forward. So Dani, thanks so much for being on the show. We really appreciate. Dani, we'll put your contact information and LinkedIn in the show notes as well, so that people can get ahold of you. And just really appreciate your insights on this important topic.
Dani:
Yeah, my pleasure. Thanks for having me.
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