3What we will look atHealth care providers care for others…do they look after their own needsEat = physical needs, energy balancePray = emotional needsLove = relationships (linked to well-being)Goals:evaluate physical, emotional role risksexplore how relationships (professional and personal) impact overall well being
5Health impact of your role Think of a time that your role has impacted your health….IllnessInjuryRest/sleepDemands, deadlinesIrritable clientsAdministrative
6Risks for health care providers Physical demandsEmotional demandsAcute & chronic needs of othersDeathThe unexpectedPersonal trials (what is happening in own life)Lateral violenceAdministrative changesGovernmental policyHow do we handle it all?
7Workplace hazards 1. Biological: viral hepatitis, TB, HIV 2. Chemical: cytotoxic, anesthetic3. Physical: radiation, needle stick, patient handling4. Psychosocial: stress, shift workOutcomes of exposureCancer, injuries, infectious diseases2011 Nursing World: Health & safety top concerns:Acute/chronic effects of stress & overwork (74%)Musculoskeletal injury (62%)Aiken et al 2002 ; Peipins, et al 1997
8Odor, noise, stress Work: When controlled environmental factors: improvedSatisfactionRetentionStressOutcome measurement of job stress: moodFull time & strains & sprains linked to turnover intentBrewer et al 2011Applebaum, Fowler, Fiedler 2010
9Inpatient nurses Nursing shortage Increased work load Decreased supportRetention/turnover issuesChallenging work environment: are new grads ready for the demandsPolled nursing schools…New grad comments…Family bathes, trays passed by non nurses: Introduce Gloria...IV, meds, monitoringPolled nursing schools: post graduate surveys asked about how school prepared the student. None asked about lateral violence, nor how they are doing emotionally.New grad comments: working night shift, 0200 call to mom in GB RE did not feel qualified, unit full, no back up help. Overwhelmed with the acuity, inexperience, feeling of overload.Introduce Gloria. Friend, teacher, mother to Renee who I had the pleasure of caring for (CF). She was a nurse at same hospital. Taught me much about caring, being a mom, nurse. Now retired-ran into nurse still employed RE “You are lucky you are retired” and elaborated about the change in climate, family doing bathes, trays passed by dietetic staff (how do we get those secondary assessments). Nurse role more technical, monitoring, less time at the bedside. Nurse satisfaction greatly improved by “hands on” care---this part seems to be eroding away. Gloria reminded me of the waiver we had to sign that we were aware that handling “chemo” and body excrements are dangerous to our health. Recently treated at a smaller hospital. Noted “family, kind” interaction of all the staff.Job satisfaction mattersTime with patient & ability to care impacts satisfactionDavey, et al 2009Spence, et al 2009
10Rate of illness for nurses Working age nurse: Younger nurseTB death smallNo excess death r/t HIVCA: breast & colon CA slightly higherChronic lympho-leukemia slightly higherOlder nurse:Chronic myeloid leukemiaMalignant neoplasmSlight increased kidney cancerSlight increase brain & CNS CA—compared to totalNurse health study
11Injuries in the line of duty Work injury influenced by psychosocial & physical exposures (Australia)^ stress 5% probability of injuryAs # of health conditions increased, (3 & >6) chance of injury increased (5% & 15%)Programs targeting modifiable factors (psychosocial & physical health) improved health & work productivityVecchio et al, 2010Low back pain compared to personal/work characteristicsKorea: mean age 27High prevalence of back pain in ICU nursesNurse w/2-4 years experience had greatest probability of back pain and treatment90.3 % had back pain/monthly18.3% received treatmentIf perceived staffing as inadequate (64%) and working >6 night shifts/month (48%) = increase in back painJa June & Cho 2010
12Mortality of nurses Mortality due to diabetes = white collar workers Mortality due to heart disease: fewer compared to allWorking age nurse (vs retired): increased accidental poisoning: drugs/medsFallsSlight increased risk: suicideNo homicide or alcohol related increasesBaer et al 2010What does working age nurse mean?Last nurse study: 2012White rice activity
13Interest of safety… Infection control, universal precautions Protective needlesRemember finger cots?Safety is improvedMasksGlovesGownsAttention toNoiseLightingShift limitsProtective gear mattersHockey “cup” invented in 1874Head helmet in 1974??
16Self determination Theory Basics CompetenceRecognitionAbilityStrengthsGiftsAutonomy:ChoicesVoiceMake decisionsFeel supportedLongevity,Power, less hostilityRelatednessBelongingConnected to others that are supportiveSupportProfessionalPersonalTeambuildingNo title?Self determination Theory, Mental Fitness
17Purpose of surveyExamine job related autonomy, relatedness and competence in a group of health care providers (AADE members attending AADE12 invited to participate)Assess if there is a correlation between overall quality of life and perceived autonomy, relatedness and competence.Hypothesis: improved job satisfaction and overall perception of health positively impacts quality of life and perception of well being.
21Summary Lower competence <11 years in role Relatedness increased if >33 hours per week:<33 hrs. per week less relatedness (p=0.041)Lower competence <11 years in role(p= 0.027)Greater competence:Age >47 (p = 0.015)>25 years in profession (p= 0.015)Increased autonomy :>25 years in profession
22The aging process Sense of smell & taste decline over time Decreased muscle massAfter age 35 we lose ½ # muscle / year= a shift in type of cells even if the scale doesn’t changeEnergy: 3500 calories = # 1SittingChild calories/hourAdult 80 calories/hourMuscle burns calories/pound;Fat burns 2 calories per poundIs this writing going to be too small?
23What is the plan? How do we? Combat aging Deal with gravity Stop muscle lossDeal with work demandsWhat about you and your work environment…How about activity?Do you have play time?
241. The leading cause of preventable death? a. Smokingb. Obesity2. When sleep deprived, what type of food do persons grab the most?a. fruitsb. veggiesc. cookie, candy, soda & donut like stuff.
25Heart Association guidelines Get active30-60 min. most daysMore intense 45 min 2x/weekMonitor intake—journalEat breakfastFruit/veggie intake, fiber, portion sizes, reduce fatCalcium, vitamin D, iron, etc.Maintain a healthy weightNo/reduce smokingControl health concerns:CholesterolBP, weight, blood sugarIf you have a minute, use it wisely.Zapka et al 2009
26Eat = energy balance Quality, quantity of energy intake Food = socializationLiquid calories?Activitymiracle grow for the brainstress managementKaiser: healthy weight less likely to develop dementiaAmen clinics: dinosaur theory: smaller brainWhat about your work team…..Lemon bars need lemon
28Life journey Nursing Self & growth Maker of meaning Public self Member of technologyEach a mysteryPeople are messyGallion & StampLink between patient safety & nurse safetyFoley 2004Self & growthPublic selfPrivate selfPersonal self
29Impact on our emotions. Think of a time when emotions were impacted ElatedOn fireDulled/numbHurtingStress of diagnosisLoss of the knownHow was your life journey impacted?The 5 minute call…HappyProudSurpriseExcitedCalm/relaxedFrustratedAngerIrritatedKeeping the poker face when stressed…I spoke to the mom of a 5 month old. Complicated care, awaiting heart surgery, on tube feeding, Down’s syndrome, hypothyroidism, live far from specialists. Called lab results (continue same dose). Mom concerned about lack of wanting to nipple…. Reviewed lose what don’t use—especially when too much car time. The comment “It would have been easier to adopt a child with special needs than feel so responsible…. The pieces of this life, conversation stayed with me. How do you handle all the emotions of the lives you touch every day….Erickson & Grove 2011
30Emotions MatterDoes management of the emotion or the emotion itself cause burnout?Burnout related to:Older nurse: if low level of + emotions<30 yr old: if experience agitationCovering up true feelings lead to increased burnout than nurse who does not cover up true feelingsFor practice:Positive emotions may insulate usMentoring needs an emotional, supportive partErickson & GroveReviewed emotions & burnoutKnowing emotional demand is critical; how work stress translates to burnout & turnoverInfluenced by organizational practices governing work place more than the challenge of careHow emotions are managed on the outside: surface acting Vs deep acting (how one feels on the inside)Younger nurse experience more stress & burnoutIncreased burnout if more surface acting & more masking of emotions
31Job satisfaction All this helps weather health care’s economic storm Commitment of management in nursing:Increasedquality careprofessional developmentpatient safety+ clinical experienceretentionSammer & James 2011All this helps weather health care’s economic storm2/3 say job satisfaction same or slightly less than in the pastListed professional development & recognition as motivatorsAdministrators goal:job satisfaction,decreased turnoverless nurse shortageMa, Samuels & Alexander 2003
32Satisfaction, cont. Structural & emotional empowerment matter Job satisfactionIncreased retentionImproved patient satisfactionPersonality traits do NOT matterIf more satisfiedRaise to challenge of organizational restructure, needAccess to informationSupportOpportunityResources to do the workCertification and magnetism mattersPursuit of higher educationNo title? Wording is different on this slide.Erickson & Grove 2011
33Nurse meta-analysis Job satisfaction Job stress: leads to work burnout emotional exhaustionwork frustrationAutonomy—improved work environment, more control+ relationship to job satisfactionWeston 2010; Zangaro & Soeken 2007
36Oppressed group behavior Systemic problemDisenfranchisementMarginalizationOppressed group created by powerlessness of nurse health care systemMcPhaul & Lipscomb 2004; Gates et al 2011; Jones & Argentino 2010
37Nurse to nurse hostility Emotionally challenged impactsperformance,satisfaction,retention,health,patient satisfactionDoes improved Emotional Intelligence (EI) impact group emotional competenceConstructive & appropriate behaviors : decrease anxiety & nurse to nurse hostilityFeather 2009; Fuimano 2004; Zeidner, Matthews & Roberts 2004
38Emotional Intelligence (EI) Self aware: emotional feelings and reactionsEmotion = energyEmotional resilienceMotivationInterpersonal sensitivityConscious of energy behind the words and interactionsInfluenceIntuitivenessConscientiousnessBody receives/understands informationWickipedia accessed 8/15/2011Mayer, Roberts & Barsade 2008
39Will enhancing EI matter? LearnedEmpowermentIncrease autonomy, locus of control,Intrinsic & extrinsic motivators (individual)Recognitionachievementsdesire to care (intrinsic)receive appreciation for care given (extrinsic)Hyrkas & Dende 2009
40EI as a groupIncreased behaviors & habits that work vs. do not work for the groupProactive skills speak up if out of line100% valued– experience desired teamworkBuild EI in the individual it buildsthe groupteam trusteffectivenessnetworkingZeidner, Matthews & Roberts 2004; Feather 2009;
41What can we do? Have space to experience own emotions Empower each other: ^ trust, caring, safety, EIEnergizeEncourage, respectEmpathy: center to nursing roleImproves outcomes, increases satisfaction with careIt can be learned through in-service educationWard, et al (2012) assessed empathy in undergrad programs:found decline in empathy over the school yearstudents with more clinical exposure had less empathyhistorically younger nurse, with less experience more empatheticDecline may be related to: time constraints, anxiety, lack of support, intimidating educational environmentexpanded roles increase in technical skills
42Empowerment Increase trust, care, safety Increase EI & Group Emotional Quotient (GEQ)Modify, redirect actions (based on assessment for the moment)Increase constructive outcomesImproved group member awareness, regulation, & interactionEncourage behaviors that seek awareness (+)Regulate emotions through personal growth increases group competenceFuimano 2004; Mayer, Roberts & Barsade 2008, Laschinger et al 2009
43Since 1960’s: Nurses eat their young How are we doing?Nursing 93-95% womenWhat about women?EmotionsHormonesMulti-taskCompetitiveInternalize stress health consequencesStress eatLapse B/W knowledge and ownership of behaviorWomen in survey CVD prevention: assessed knowledge, intake, if smoked, exerciseHad knowledge, didn’t implementSenior nurse down hill flowUnderstanding the new nurse isn’t easyCommunity vs. I approachProper orientationMentoringBuddy systemTeambuildingConflict resolution skillsCommonwealthHold each other accountableHippeli 2009; Mills & Mullins 2008; Zangaro & Soeken 2007
44Emotions Belief in something greater than one-self Offers renewal Soul nurturingConnect with natureWhere do you find balance in your life?Floating down the Menominee River VS rafting class 4 rapids
45Other factors Stay or go? Personal factors In business Marital status Childcare needsGreater chance at part time employmentHigher educationMales: enroll in non nurse roleAdvanced practice: decreased attritionNooney, Unruh & Yore 2010In businessEstrogen to profit ratio is well knownWomen leaders mentor underlingsNursing is flooded with “estrogen”, yet we struggleNo title?
46Resilience Handling the curves in life Past experience Current perspective (choices)Rested vs. fatiguedBeing vs. livingThink of a time you were tossed an unexpected curve ball—how was this handledStaffing changed unexpectedly
47Hope, faith, air Hope = #1 predictor in goal achievement Faith = belief in futureAir = deep breathingOxygenCalmingRX: nature-play prescriptionAcorns, water, sun, quietDr. Nan Strand and the amazing race
48What about music? Singing improves: Immunity Well being Energy Posture LongevityDecreases pain
49Of interest… Muscles to smile = 22 Muscles to frown = 37-72 Smiling = anti gravitySmiling = contagiousMay 2 = world laugh dayLaugh for nothing: it’s heart friendlyLaugh at self—shift the perspectiveNo humor: emotional apathy disease
50Hobbies and free timeDoes how you spend your free time impact your emotions?What impacts your well being?
51Summing up emotions…. What keeps you grounded? How do you keep your creativity alive?What about work stress, how do you handle this?How do you feed your inner child?Is use of your hands important to you?
53Who’s in your circle Think of your relations Family Work Friends NeighborsCommunitiesWho makes up the strands that help hold it all together for you?Do you want to use bullet points like you have on all the rest? Hold what all together?Who’s in your circleWellcoaches, 2010
55Love = relationships Life engagement Connections: Help with personal developmentHelp us achieve our potentialLife bands: link or connect usWatch for negativity
56Does the age of your peers matter? Veterans born: pre (>64)Baby boomers: (47-64)Generation X: (30-64)Generation Y: after (26-30)Millennium Era??
57What about generation gaps? Veteran nurseHard workRespect authorityDuty before playSacrificeFollow rulesWork is obligationExperience respectedNo news is good newsSatisfied with job well doneWork & family kept separateBaby boomersValue familyJob completionDo as toldCommit to experienceAccomplishments matterRoles overlapHuge #; nursing is 2nd careerFocus on the big pictureWorkaholicsLess appreciate rewards, feedbackLess balance
58Generation Y Generation X Less value on authorityPersonal touch mattersNeeds reinforcementInterested in work/life balanceValue flexibility, fun, quality of life, & creativityTechnology abounds: look at monitor; forget the patientExpect to be appreciated for their intellectLike recognitionMutual supportTrust in systemEmbrace newMulti-task?BothCommitted to the team Longevity less embraced Authority less valued Manager: people focused: motivator, communicatorDo you want to make the 2 generation slides the samebottom?
59How we see each other X & Y see baby boomers as self indulgent RuthlessUncaringBaby boomers see X, Y as slacker, want a free ride
60RelationshipsQuality of relationships is reflected by the energy brought to the relationshipIncreased purposeMeaning to lifeRespect & joy in each otherI am lucky to have so many siblings…..I am lucky to have_____on my team
61Research shows…..Relationships: Key to survival Impact overall well- being In the DNA of well being: relationships are the strands that hold everything (us) together
62Love Adult life 1st part: mind & heart (doing) 2nd part: body & soul (being)Increase mindfulness = attention to the momentStory: shopping for furs in Chicago
63Love shows in your being… Heart energy is vitalRandom acts of kindness: filling the bucketForgivenessFriendshipOptimismAt the beginning of the day, what do I look forward to?Look for reasons to say thank you…List 3 things grateful for daily…
64Love helpful in managing stress Stress impactFoot on gasFoot on brakeFoot on bothAntidote for stressLaughterJoyHumorFuture focusConnectednessConfidence
65Sharing a story Sharing a relationship or personal challenge………. Even short term***How did you overcome?How did it make you feel at the time? Later?Was there someone or something that helped?How were you impacted long term?In my early 40s my mother developed lung cancer after 50+ years of smoking. She had a right lower lobectomy. Went home on O2, had therapies., etc. Thursday 3 weeks after discharge she had her first outing to the annual chili supper. That Friday I brought her fish, Saturday did laundry and visited, Sunday brought ribs. She was in good spirits and getting better. On Monday I was to pick her up for her post op appt. with the lung surgeon. When I arrived, her physical therapist was there waiting for me. She had called the doctor as mom wasn’t feeling well. We were to bring her in for the appt. When I approached the bedside feelings were non-specific, but she thought she would be ok. I totally went into daughter mode as she told me to go to city hall and get the wheel chair from Sue to help get her to the car. I left the room, but decided I should call to make sure the chair was ready. I couldn’t find the phone book, so returned to her bedside asking where the phone book was…but stopped, as she had that look. I reached down and cradled her as I guided her head to the pillow. At that time I was CPR trained for over 20 years, and never used it, not once. I called to the therapist, called 911—started CPR. was grateful, for the 6 minutes it took for the ambulance to arrive to not be alone. When the AED was applied, we knew what the outcome would be. During this very difficult moment in my life, this very short term relationship had a lasting, forever impact. I am so glad I was not alone.
66Support Increases longevity Connections in your circle Rejuvenate soul Busy hands/mindIncrease humorFriendshipsMind stimulating— never stop learningObstaclesLife is busyConvenience foodsSupersized?Stress eating?Impact on activityStress:DeadlinesPerfectionistOther contributor’s timelineHealth concerns
67Life balance positives negatives Stress Time management strains Dead linesSleep deprivation, shift workLifestyle choices (over- commitment, sedentary, dietary habits)Stuff accumulationThe unexpected…Cutbacks..How well can you juggle?Friendship/relationshipsHelping professionLike to spend timeLike to make a differenceSatisfaction in task completionHappiness factorsStress antidotesBrain cell activationGoal settingpositivesnegatives
68Prioritize the positive GratefulnessIncreased awarenessSatisfactionMemories+ mindset,appreciative+ emotions = life satisfaction, less depression
69Never stop playing Brain socially connected The potential to change, to learn, and to grow is in relationshipsHave a sense of humor (must be mutually shared)Are the persons in your circle nurturing for you?
70Making a differenceThe Tipping PointBy: Malcolm GladwellIdeas are spread like epidemicsLittle things make a big difference3 rules of epidemics (agents of change)Law of the few (80/20 rule)Connectors =gift for bringing togethernessMavens = information specialistSalesmen = persuaders, charismatic, negotiatorsStickiness factorRetention of content & entertainment valueContext: sensitive to condition and circumstance at the timeWe are inundated with messages: back to word of mouth: personal connections matter
71Summary Links to longevity Think about: Hobby Humor Happiness PositivitySleepThink about:Eat (energy balance),Pray (emotions),Love (life engagement through relationships)My first 30 years….Back to my friend GloriaI introduced you to Gloria a nurse I worked with. She had a daughter Renee that I had the joy of caring for and being part of her life through my role as a RN. Over the years, we shared many joys and trials. Renee’s lung function got progressively worse. Her family brought her to USC for a living donor lung transplant. This is where they take the right lower lobe out of 2 separate donors, and transplant them to Renee. Think of how complicated the surgery would be, reconnecting all the vasculature, etc. When Renee survived the surgery, I channeled my joy into a poem called The Butterfly Lady—where her web was released, and she could breathe once again. The poem was even published in the hospital paper. Renee’s lungs allowed new life, for a while. Eventually the lungs failed. As the helecopter transported her to Madison, then back to USC for another transplant, I once again channeled my thoughts and fears into poetry and My Broken Butterfly was written. This is what I read at the funeral, as there were complications with the second surgery. Fast forward 15 years. On the day of the funeral Renee’s sister did a home pregnancy test that was positive. Rebecca is now a freshman in HS, and in forensics. Although she never met Renee, Renee is in her heart through stories, photos, etc. It is 2012 and I get a call from Gloria, as Rebecca will be reading the 2 poems for forensics competition. She reminds me that Frosh usually do not place. Imagine the excitement when I got the call that she took first and was going to state!! And 3 weeks later when the call came in that she “aced” it at state, as a freshman this is rare. Imagine the joy we all felt. As I prepared this talk I thought how wonderful that my joy and grief continue to life in the poems, and how lucky I have been to have relationships like the one with Gloria, the nurse, mother, mentor, friend to guide and care for me as a nurse, mother, mentor, friend. I truly feel blessed and amazed. Rebecca is a very talented orator, but in my heart I believe Renee’s angelic presence may have helped a little.
72Look at Be the tipping point Maven Salesperson Connector Use positivity to fuel your life journeyCreate a future that empowersFind/post an image to help maintain your goalsWhat can we do to be part of the tipping point that transforms health care in a positive way?
73Setting goals Pick 1 thing (personal or professional) Where are you now(on a scale of 1 to 10)?Where would you like to be?What does your goal look like: visualize the dream…What is the first step?**If we are emotionally attached = increased likely to follow through & success
74Thank you!! Shari Liesch APNP, CDE CHW Fox Valley 130 2nd Street Neenah, WIThank you!!
75A Butterfly’s Birthday Daybreak calls.She gently takes flight; wings alive and aglow.Kissing each flower good morning,Bidding them to rise—decorating her world;Painting my world; with colors so magnificent.She tickles each blossom, soon they are singing;An enchanting choir fills the air. Our world is alive!With all petals at attention, sweet sounds echo about.Contented, she drifts down to her favorite rock,Peaking over the peaceful ripples of the bay.She rests, soaking up energy from the sun’s rays,Until gentle breezes call her, to come and play.Today as I rested on the sandy shore,Peaceful breezes sang.The butterfly sat down beside me. My heart swelled.I tried to reach out to her,But she flew away…eluding my touch.I was saddened she left me so alone,Yet, I thought I heard her whisper,“Today I celebrate, come and play!”By Shari Liesch RN, August 1996
76ReferencesAiken L., Clarke S., Sloane, D., Sochalski, J., & Silber, J. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288(16),Applebaum, D., Fowler, S., & Fiedler, N. (2010). The impact of environmental factors on nursing stress, job satisfaction, and turnover intention. JONA 40(7/8),Endicott, J. and Nee, J. (1997). Assessment letters for clinical studies. Psychopharmacology Bulletin 31(1),Endicott, J., Nee, J., Harrison, W., & Blumenthal, R. (1993). Quality of life enjoyment and satisfaction questionnaire: A new measure. Psychopharmacology Bulletin 29(2),Feather, R. (2008). Emotional intelligence in relation to nursing leadership: Does it matter? with lifetime history of mental illness. Psychiatry Research 152, Journal of Nursing Management Issue,
77References, cont.Gates, D., Gillespie, G., and Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nurse Economics 29(2),Gladwell, Malcolm. The tipping point.Hippeli, F. (2009). Nursing: Does it still eat its young, of have we progressed beyond this? Nursing Forum 44(3),Jones, T. and Argentino, D. (2010). Nurse to nurse hostility, confrontational anxiety andemotional intelligence: An integral, descriptive pilot study. Journal of Peri-Anesthesia Nurses 25(4),Kimball, B. (2004). Health care’s human crisis-Rx for an evolving profession. The Online Journal of Issues in Nursing 9(2), Manuscript 1. pagesMa, C. C., Samuels, M., and Alexander, J. (2003). Factors that influence nurses’ job satisfaction. JONA 33(5),Manojlovich, M. and Spence Laschinger, H. (2002). The relationship of empowerment and selected personality characteristics to nursing job satisfaction. JONA 32(11),Mills, J. and Mullins, A. (2008). The California nurse mentor project: Every nurse deserves a mentor. Nursing Economics 26(5),
78referencesNooney, J., Unruh, L., and Yore, M. (2010). Should I stay or should I go? Career change and labor force separation among registered nurses in the US. Social Science & Medicine 70,Peipins, L., Burnett, C., Alterman, T., & Lalich, N. (1997). Mortality patterns among female nurses: A 27 state study, through American Journal of Public Health 87(9),Schechter, D., Endicott, J., and Nee, J. (2007). Quality of life of “normal” controls: Association selfdetermination.org. (2010).Perceived autonomy support: The climate questionnaires: The work climate questionnaire (WCQ). Retrieved February 18, 2010, from Venhaus Stein, J. and Reeder, F. (2009). Laughing at myself: beginning nursing students’ insightfor a professional career. Nursing Forum 44(4),
79referencesWatts, M. (2010). Certification and clinical ladder as the impetus for professional development. Critical Care Nurse Quarterly 33(1),Zangaro, G. and Soeken, K. (2007). A meta- analysis of studies of nurses’ job satisfaction. Research in Nursing & Health 30,