Two reports find that RNs are both personally and professionally affected by natural disasters
That includes nurses.
“When both personal life and professional life are impacted by an adverse event, as occurred in Superstorm Sandy, stress can exponentially increase,” said Victoria H. Raveis, PhD, director of the Psychosocial Research Unit on Health, Aging, and the Community at NYU College of Dentistry. “The responsibilities associated with the profession of nursing add additional demands that increase the risk for role conflict when a disaster occurs.”
She, along with colleagues at NYU Rory Meyers College of Nursing and NYU Dentistry, recently published two reports in the Journal of Nursing Scholarship that offer insights on emergency preparedness, recovery, and resilience. The studies were centered on nurses working at NYU Langone Health’s main hospital during Superstorm Sandy in 2012. Key themes that emerged were communication — both improving channels and the importance of connecting nurses with others during a crisis — and social support.
Preparedness Training Needed¹
To understand how nurses at NYU Langone were impacted before, during, and after the storm, the researchers conducted interviews and surveys with 16 nurses who participated in the mid-storm evacuation of more than 300 patients at the institution’s 725-bed Tisch Hospital due to high water levels.
Raveis and her team explored nurses’ experiences in disasters, assessed the nurses’ challenges and resources for carrying out responsibilities, and uncovered some lessons.
After the interviews, an online survey was sent to all RNs assigned to inpatient units at NYU Langone on the day of the storm. The researchers received 528 anonymous responses, including responses from 173 nurses who were part of the evacuation.
While some nurses had previous disaster training and experience, and a few of them reported feeling prepared during the storm and the resulting evacuation, many working the night of the storm lacked prior hands-on experience or deep knowledge of emergency preparedness.
This lack of comfort with emergency preparedness is not uncommon, noted Eric Alberts, corporate manager for emergency preparedness at Orlando Health in Florida.
“I’ve been going across the United States speaking about the PULSE [nightclub mass shooting] incident, and, unfortunately, we’re finding that a lot of hospitals don’t have an emergency plan,” he said.
“Or if they do, they don’t practice it. And if they do practice it, they’re not really practicing it — they’re just doing a flu shot campaign and calling it an exercise.”
Alberts recommended that hospital and health system leaders do a thorough evaluation of their disaster readiness: “Really look at your processes and your people and see what is available during emergencies. Emergency preparedness and healthcare looks and feels different everywhere you go. And then from that, look at what resources and people are able to help those individuals have a good, efficient, and effective plan.”
The researchers also called for more education and planning for future disasters and they recommend FEMA’s all hazards approach to disaster planning.
Personal Concerns Present
Communication was a challenge during Superstorm Sandy when access to electronic medical records, email, and phone communication was unavailable because of power loss.
RNs reported unlocking medication carts in anticipation of the power outage and handwriting medical summaries for patients being evacuated to other hospitals. Of the nurses surveyed, 72% reported that their primary mode of communication was talking face-to-face and 24% used personal cell phones.
The researchers also found that nurses had their own personal concerns during the storm, worrying about their families’ welfare and personal loss. And while many arranged for extended stays at the hospital before the storm, they reported feeling uncertain about leaving their families and later had trouble contacting loved ones.
The survey found that 25% of nurses suffered property damage or loss, and 22% needed to relocate after the storm. Some respondents reported psychological problems after the storm, including having disturbing thoughts (5%) and difficulty sleeping (4%).
Social support from co-workers, hospital leadership, and loved ones was cited as an important resource in helping nurses cope with the stress of the disaster.
“Our research also shows that maintaining good communication with peers and hospital leaders after the hurricane helped the nursing staff feel more connected and less stressed,” said another of the study coauthors, Christine T. Kovner, RN, PhD, professor of geriatric nursing at NYU Meyers.
This story was originally shared on MedPage Today.
Stress manifests among nurses in various forms and can affect patient outcomes
Being a nurse can be fulfilling and rewarding. We get the privilege of helping new lives enter the world, comforting those who are exiting this world, and everything in between. Yet nursing is also taxing and draining at times. Off-shifts (nights and weekends), hectic workloads, violence from patients and families, and incivility among staff members can all cause physical and emotional wear and tear among nurses.
Unfortunately, issues like depression, burnout, and fatigue are extremely prevalent among nurses. As Alexandra Wilson Pecci writes in a recent article, one 2016 study found that nurses experience depression at twice the rate of those in other professions.
This is bad not just for nurses but also for patients. Another study Pecci highlights found a link between nurses reporting poor health, particularly depression, and higher rates of reported medical errors.
That’s a serious issue and one that certainly needs to be addressed.
Some recent HealthLeaders articles offer solutions to address stress among RNs.
Beating Clinician Burnout
There’s a common belief that burnout is a personal failing and that resolving dimensions of burnout — emotional exhaustion, cynicism, inefficacy — are that individual’s responsibility. Eat a salad, go for a walk, take a yoga class, and you’ll be fine. In reality, however, burnout is a sign that something is amiss within an organization, and healthcare leaders need to uncover both the prevalence of burnout at their organizations as well as its root causes.
“There needs be a framework to understand where the pain points are, and then how an organization can do something about that,” said Karen Weiner, MD, MMM, CPE, chief medical officer and CEO at Oregon Medical Group (OMG), a physician-owned, primary care–based multispecialty group of about 140 healthcare providers, with offices in the Eugene and Springfield area.
Weiner advises that leaders implement system-wide changes to address the factors contributing to burnout. After administering the Maslach Burnout Inventory at OMG, the organization made multiple changes including creating a physician-organization compact, developing new compensation practices, and redistributing workloads.
Creating Culture of Caregiver Support
A 2015 Gallup survey found that more than half of all healthcare workers report thriving in none or only one element (purpose, social, financial, community, physical) on the Gallup-Healthways Well-Being Index.
To better help employees cope with the emotional demands of caring for others, some organizations are implementing programs to prevent problems like burnout, suicide, and substance abuse.
“Strategies that could support employees include reducing the stigma about mental health concerns, providing resilience training and care for the caregiver support programs, and providing health and wellness benefits, including policies that allow for time off for mental health concerns as well as for physical health concerns,” said Celeste Johnson, DNP, APRN, PMH CNS, a member of the board of directors of the American Psychiatric Nurses Association and director of nursing, psychiatric services at Parkland at Green Oaks Hospital in Dallas.
For example, the University of Missouri Health System’s forYOU program provides support to healthcare workers experiencing symptoms of “second victim syndrome.”
Parkland provides universal screening for suicide risk, including for those employees seen in the employee clinic.
How to Handle Cyberbullying in the Nursing Unit
Another source of stress among nurses is workplace violence, and cyberbullying meets that definition. Thanks to technology, bullying behaviors can now occur in digital form via means such as instant messaging, email, text messaging, social networking sites, or blogs.
According to the National Council for the State Board of Nursing’s policy on social media, any online comments posted about a co-worker may constitute lateral violence — even if the post is from home during non-work hours.
To confront cyberbullying, the policy states, individual nurses should save evidence of bullying comments. Then, during a private conversation, present the evidence to the person who made the comments. Document the conversation and its outcome and if there is a second instance of cyberbullying, report it to the nurse manager. If the behavior continues, alert the chief nursing officer.
Nurse managers should verbalize to their staff that there is a zero-tolerance policy for bullying of any kind, including comments made online. Managers should also educate staff on standards and polices regarding cyberbullying and should take derogatory remarks seriously.
Creating a work environment that addresses issues that contribute to nurse stress and burnout is more than something that’s just nice to do; it’s also a way to improve patient care. There are plenty of reasons to improve. Research by Linda H. Aiken, RN, PhD, at the University of Pennsylvania in Philadelphia, has found that patients who had surgery at hospitals with better nursing environments and above-average staffing levels have better outcomes at the same or lower costs than other hospitals.
Need any more proof?
This story was originally posted on MedPage Today.
Linsey Steege, PhD, a professor in the University of Wisconsin-Madison (UW-Madison) School of Nursing, has announced a new study on nurse stress and fatigue, which will ultimately improve nurses’ health. Steege will use Fitbits to track the activities of selected nurses throughout the day, gathering data on their steps, heart rate, and sleep to identify factors that cause fatigue and stress in this vital care provider population.
Steege tells mhealthintelligence.com, “I became interested in focusing on how to improve how we support nurses so that they in turn can be safe and provide the highest quality patient care. But when I looked around, there was a lot of research on physical fatigue and sleep deprivation for medical residents, but much less on how nursing work is contributing to fatigue and how fatigue is contributing to stress, burnout, and worst of all, medical error.”
Data can positively impact how we care for ourselves and Steege wants to use data to help nurses understand what contributes to their fatigue. She also wants to collect data on the nurse’s work environment, including noise levels, pages and calls, time spent navigating the hospital’s electronic health record platform, nurse movement patterns, shift staffing reports, and more.
Steege has found that hospitals tend to focus on patient safety while not considering nurse safety and wellbeing at the same time. If health systems don’t account for the burden of fatigue on their nurses, medical errors, turnover, and costs increase. Hospitals have used data to improve workflow in the past, but now they can also look at individual health data and look for specific triggers that cause provider fatigue and stress.
To learn more about new research from Linsey Steege, a nursing professor at UW-Madison who is using Fitbit data to identify factors that cause nurse fatigue and stress, visit here.
Nurses know that caring for patients and others before yourself can lead to nurse fatigue. An essential first step to taking good care of yourself is finding a healthy outlet for stress. How can you do that? Some of the simple ways that nurses report for dealing with tension include: hiking, biking, crafting, taking a sauna, or spending time with family and friends.
But one of the most powerful (though not effortless) ways to find a positive perspective is through meditation. Meditation may seem off-putting to many people who aren’t familiar with the practice, but it doesn’t have to be. You don’t have to sit on a floor cushion and fold yourself up like a pretzel to meditate. You don’t have to hum or chant, either. But you certainly can and it’s an amazing way to relieve stress, clarify your mind, and improve your life. What nurse couldn’t do with a bit more calm and focus and balance?
If you’d like to give meditation a try, you can start by sitting in your favorite comfy armchair. You could also lie on a bed or floor—but then you might fall asleep. Some nurses struggle to get restful, restorative sleep, what with 10-hour shifts and rotating schedules, so sleep may be what you need for health. But it wouldn’t help you develop a meditation practice.
Next, close your eyes and take a few slow and deep breaths. That will help clear your mind of everyday thoughts and concerns. Then, give your mind something else to think about (that’s what minds do best—think!), such as a soothing word. You may want to silently repeat that word or phrase, sometimes referred to as a “mantra,” if you think that may be calming. Depending on your religious faith or cultural tradition, you could choose “shalom” or “om” or simply “home.” Other popular options include “peace,” “love,” or “calm” or favorite prayers and sacred passages.
One of the first researchers in the area of meditation-based stress reduction, Dr. Herbert Benson, suggests the word “one” silently as you breath out. He offers that as a secular mantra because it doesn’t have strong associations that may distract some meditators. (Also, when he’d originally asked subjects to count up to 10 with each breath, they’d get so relaxed that they’d lose track of where they were in the number sequence.)
Benson wrote the best-seller The Relaxation Response forty years ago while a professor at Harvard Medical School. His work is still the subject of studies on how it can be used to increase the health and well-being of patients and health care providers. He has proven that meditation really does reduce stress as well as improving medical symptoms and promoting wellness.
Start gently with five minutes of meditation and work your way up to 10 minutes, and then preferably 20 minutes, a day. Making this a daily event is how it becomes a transformative practice in the life of a stressed-out nurse.