HARDEN: We're committed to a culture of safety with patients, but we also need to be committed to each other.

NARRATOR: In this episode, you’ll hear Jen, an ambulatory nurse manager, and Ken, a nurse in hematology; discuss how they listened to their staff and made small changes to address burnout in their work unit.

HARDEN: In Hematology, the nursing staff have always experienced some amount of burnout throughout the years. Prior to 2017, according to our Sirota surveys, we were at a high percentage of about 90% to 100% burnout in the staff of Hematology. Back in October 2017, we were asked to be part of a pilot called the SPHERE project — Strategies to Promote Healing Engagement and Reduce Enervation project. It focused on how to help staff become less burnt out with an overall focus on wellness. Right before the Epic rollout in May 2018, there was a listening session with staff to engage with them, listen to what the concerns were, why they were feeling so burnt out, and get a pulse on the work unit itself. What are those pebbles in their shoes? From there, we formed our wellness group.

AGGEN: Nurses go into nursing to care for others. We were giving and giving, but no one was giving to each other. So as a Wellness Committee, different groups in Hematology got together and said, "What can we do about this?" and started to do some planning around that. Because that's what we do — we treat, we help others take care of themselves. We wanted to take care of ourselves.

HARDEN: The goal was, over 90 days, how to get staff to really start thinking about their wellness and how to care better for themselves.

AGGEN: It's important for nurses to do this. I'm sure a lot of people have heard about "compassion fatigue."With compassion fatigue, you can't give very well. You have to address it to care for our patients better. We started very simple. We looked at what is causing this compassion fatigue. We looked into the Well-Being intranet site. They have a good breakdown of different ways of looking at well-being. We started slowly with our physical challenges. A break challenge: Take a break. We weren't doing that. Other little pieces — drink water. Everybody knows water is the best thing for you, but nurses were becoming dehydrated. Other things such as "deskercise." We challenged each other to focus on a fruit of the month. All these suggestions were from the well-being site. We started to interact with each other better with these simple little tasks to challenge each other.

HARDEN: We had surveyed the staff prior to even doing any of these interventions. We were at about 54% burnout. After implementing some of these simple interventions, we decreased our burnout to 30%. So even just with some small steps and small interventions, we were able to make a difference in this group.

We also created a wellness board on our floor so that we could inspire others to do good things and to eat healthily. We also added inspirational quotes that we have found to be helpful to keep people grounded in such an unprecedented time. We also created some kindness jars to recognize something great that happened within each day. We gave out little slips of paper and everyone decorated their jar and then put something in someone else's jar for that day like, "You did a great job talking with that patient or getting through a difficult situation," or, "Thanks for your smile today." We had staff bring those jars with them to a few meetings and pull something out of their jars. Just the magnitude of that helped morale overall with the team.

AGGEN: Those things became contagious. It snowballed to you. If you received an anonymous affirmation, you may then pass it on to two other people. Those small bits in your day make a huge difference. We looked deeper into what was bothering people. We also went into a more spiritual domain and had some bereavement sessions. Many of our patients do not live forever, and we had no outlet for those kinds of things. One of the more popular things was our weekly blogs so members of the wellness committee each took turns highlighting what they thought about a certain wellness activity, why water is important for you, why exercise is important.

HARDEN: Reflecting on all of these different things that we've done helped staff get through the COVID-19 pandemic. As you start to make small amounts of change within your team — especially where you have some staff on-site and you have some living in more of a virtual world — how do you make those connections with people off-site? We used to have a Friday field trip that actually was in person. We'd all make sure to step away from our desks at around 3:15 p.m. on Fridays, and we would take a walk. Friday was our day to reconnect. We took that and just did it virtually instead. We did some Zoom calls with staff and the chaplain from our inpatient unit joined us for a few of those calls to boost our spirituality as well. It's more personal and focused on the employee. Some other things we've done to set us up for success during COVID are personal reflections. Ken brought the group back to the basics questions of, "Why did you go into nursing? Why do you show up at your job every day?" Similar to, "Why do you log in and work from home every day?" Some of those self-reflections leads us to thinking back to why we became nurses in the first place. It obviously is to care for patients. Then how do we also care for ourselves and our team members? During this time, it has been really challenging — so even a funny Skype message every morning helps. We have one nurse who sends out some jokes in the morning to get everybody grounded for the day and reflect on why we're here and the good work nurses do all day, every day.

AGGEN: But we also are continuing to look at ourselves critically. How can we communicate better and especially in these COVID-19 times? We're reshaping how we communicate and do things. It's a real good opportunity for us to shine. We're looking forward to those challenges.

HARDEN: We did a lot of stress resilience training with staff on some of our team days as well. The Dan Abraham Healthy Living Center staff have helped us with some quick S.M.A.R.T. (Specific, Measurable, Achievable, Relevant, Time-Based) sessions. We're looking forward to doing another wellness consult to reinvigorate that as well. But we're mostly just focusing on the good and the meaning and purpose behind what we're doing.

AGGEN: Having these challenges of burnout and stress and just all that sadness, we're better prepared to understand how patients are going through the COVID-19 process too. They're so unsure of what the future will bring. So we can help them process that as well because of our experience.

HARDEN: The SPHERE project helped us kickstart our group, looking at the stress of the work and what's going on in the workplace, and how that affects everybody's lives a little bit differently. A recommendation to address burnout is to take little bits and pieces of things that you can. It's the low-hanging fruit. Then, get into the heavy stuff. How do you support the team in taking care of themselves and understanding that we care about each other?

AGGEN: That is well said. Remember that others may feel exactly the way you do or similar to it, and get together as a team. Understand that everyone has the problem, and it's not just one person. There's a cause that we can usually address. Do it together as a team. Be creative and have fun with it.

NARRATOR: Consider using one or two of these initiatives with your colleagues in your work unit to increase staff satisfaction and engagement.