Rae Woods:
From Advisory Board, we are bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae. It's nurse's week. Which means that once again, leaders are trying to figure out how to actually support and celebrate those that have served on the front lines of the COVID-19 pandemic. To offer our own support, we've added a link to our show notes that covers some of the most important steps that leaders can take right now. It is more important than ever for leaders to go beyond simply thanking nurses. To talk about how to do that, I've brought two nursing experts to the pod, Karl Whitemarsh and Maddie Langr. Hey, Maddie. Hey, Karl.

Maddie Langr:
Hi, Rae.

Karl Whitemarsh:
Hey there, Rae. How are you?

Rae Woods:
I am good. I'm so happy to have two new voices on Radio Advisory.

Karl Whitemarsh:
Thanks for having us.

Maddie Langr:
Yeah, I'm so excited to join today.

Rae Woods:
I should start by saying happy Nurse's Week. It's hard to believe it's been a year since the last time we celebrated this.

Maddie Langr:
I'm personally very excited. Last year, when Nurse's Week kicked off, we were in a very different state. So this year I'm looking forward to celebrating all that nurses have accomplished across the last year.

Rae Woods:
Every year, there's actually a theme to Nurse's Week. You mentioned, Maddie, that 2020 was a little bit different, right?

Maddie Langr:
Yeah. Mm-hmm (affirmative).

Rae Woods:
And in 2020, the theme was the Year of the Nurse. Obviously nobody predicted that that would fall in the middle of the first surge of a pandemic. What did the American Nurses Association decide would be the theme for 2021?

Maddie Langr:
This year the theme is excel, lead, and innovate. They actually extended the Year of the Nurse into 2021 as well. So we're continuing to celebrate across the entire year.

Rae Woods:
So it's the Year of the Nurse, but then there are these three words that are meant to, I think, celebrate excellence in nursing, leadership in nursing, innovation.

Maddie Langr:
Mm-hmm (affirmative).

Rae Woods:
Gut check with me for a second. How do you feel about this theme?

Karl Whitemarsh:
Yeah. I'll start off by saying that I have no shred of doubt that the American Nurses Association has the industry's best interest at heart, and by extension that of frontline clinicians. So I think to start off by giving them credit, it's an appropriate theme, and that if we think about the last 12 plus months, nurses have certainly more than risen to the occasion. They have excelled for better or for worse in this moment, and they have led patient care during an incredibly difficult time. Nurses have been at the forefront of a lot of innovation at this time, too. But I also would say that in the spirit of candor and in the spirit of some collegial critique, I would just pose the open question, is this the right year for a message like excel, lead, innovate? We'll get into more about what we mean by that. But I question whether the message is right for this year in particular, coming on the heels of several months that have been nothing short of traumatic for the industry and for frontline clinicians.

Rae Woods:
I had the exact same reaction, Karl. In fact, it reminded me immediately of a previous episode that we've done on this podcast, where we talked about resilience. The key moment that I had in that episode was that too many leaders were focused on getting to the top of the pyramid. If we think back to Maslow, they were trying to figure out how to get their staff to this self-actualization moment, when first they had to address these cracks in the foundation. I cannot imagine another time in which the foundation is broken, or seems to be broken, for nurses than what they have been through in the last year. So my question is, if we want nurses to truly feel valued and celebrated, what are those foundational steps that we need to take first?

Maddie Langr:
There are three big things that we need to focus on right now. The first two we've been working on for some time, and that is making sure that we have a safe work environment for nurses, as well as flexible options to really meet their needs in the workplace. But the third one is a little bit newer in terms of our prioritization of it, and that is recovery. So how do we help our nurses recover after what has been an incredibly challenging year?

Rae Woods:
Well, let's go into each of those a little bit deeper. I want to start with safety. Because like you said, this has been a big topic for nursing for some time and certainly across this crisis. I do get a little bit nervous here that people might conflate safety with like basic PPE, with pandemic-based safety. The challenge with that is if that's the narrow view, people might say, "We're done. We've created a safe environment because we're no longer reusing masks, or where we were at this time last year." What do you mean when you're talking about safety?

Karl Whitemarsh:
I think pandemic safety is certainly part of the equation, but it is not the entire picture. When we think about the last several months, there's actually been a pretty perverse silver lining of the restrictive visitor policies, in that violence at the hands of patients and families has actually gone down quite a bit. It doesn't require any stretch of the imagination to think that those instances of situations that escalate into nurses getting hit and punched, those have been reduced because of restrictive visitor policies.

Rae Woods:
That was actually really common prior to the pandemic. I don't want people to just think about what they might see in the latest NBC drama. This was a very real concern for nurses every day.

Karl Whitemarsh:
Of course. Data in terms of the actual instances showed that those cases were on the rise. And of course, perception data also showed that this was top of mind, not just for clinicians, but for their leaders as well.

Rae Woods:
But, like you said, the unfortunate silver lining is that because family members weren't at the bedside, because folks were kind of forced to connect virtually, workplace violence actually went down. What does that mean now that things are starting to open back up?

Karl Whitemarsh:
Now that things are starting to open back up, well, first of all, thank goodness they are because those visitation policies were really difficult for patients and families. So thank goodness we are opening back up. But as we think about more people coming into healthcare settings, we need to kind of get back to basics when it comes to workplace safety issues. So making sure that your nursing staff and all clinicians, all members of the care team, have the basic deescalation skills in their back pocket that they can reach for, and that they have easy ways to call for help when they feel that they need it.

Karl Whitemarsh:
I want to actually think back to a conversation that I was having with a progressive nursing leader earlier this year. It was in January. So if we think back to January, there was a pretty clear instance of political violence. That was a local issue here in DC, of course, but with national implications. So it was in this context that I was having a conversation with this nursing leader around violence in healthcare settings. She predicted that as we started to open up that we would really see those violent situations spill over into healthcare settings at an increasing rate. Just as we saw pre pandemic. We think about political violence around the insurrection, the near daily mass shootings that we're seeing in this country, these are all top of mind for nurses when it comes to feeling safe at work. So I definitely would encourage healthcare leaders to revisit their workplace safety policies, and really make sure, do their due diligence to feel confident that staff not just are told that they're safe by their leadership, but that, perception is reality, that they really do feel safe at work as well.

Rae Woods:
Mm-hmm (affirmative). Absolutely. Absolutely.

Maddie Langr:
Karl, I completely agree with what you're saying there. I think that's such a good point, where nursing leaders need to plan now to make sure that these workplace violence policies aren't reactive to a potential increase in violence, but that we're ready to go. Behavioral emergency response teams are in place, security roundings, all those things we know hospitals were doing before COVID are in gear, ready to go, so that staff are safe.

Rae Woods:
This is such a good example of what we're talking about by the foundational things that need to be in place, so that we can create room for nurses to heal and ultimately to feel celebrated. The other foundational piece that, Maddie, you mentioned existed before the pandemic, but I think the dial definitely got turned up, is just the demand for flexibility. Now, I'm hearing that word get thrown around quite a bit. So what do we actually mean when we talk about creating more flexibility for nurses?

Maddie Langr:
Yeah, that's a good question. People use the term flexibility to describe many things, and it absolutely is a broad term. But I think that there are two big ways to consider what flexibility means. The first is from the hospital perspective, how do we make sure that we actually have enough nurses to cover shifts in the right parts of the hospital at the right times? And then on the other end, there is that staff perception. So, how do we create the flexibility that nurses need and are asking for in their lives?

Rae Woods:
When it comes to the flexibility that nurses are asking for, again, I want to make sure that we're speaking in the right definition. Because we did an episode a few months ago that specifically looked at one angle of flexibility, in the context of working parents. Huge and unfortunate impact that this pandemic has had on working parents, which of course makes up a majority of the nursing workforce. But I have to believe that flexibility is more than what we do for new moms and dads. So how does the kind of flexibility you're describing actually manifest for individuals?

Maddie Langr:
You're spot on there. That is absolutely an important part, but there is more to flexibility than just that. I like to think about it in terms of nurses schedules. So the hours they work, the types of roles that they take, and where they work within the organization. Because typically, we think about nurses working on one unit, specializing there, and typically working 12 hour shifts. A specific challenge that we face in healthcare is that we need nursing coverage 24 hours a day, 365 days a year. So that breeds more rigid schedules because of the vast coverage that we have to provide. So flexibility is really difficult to create, but has a lot of really important payback in terms of organization staffing and staff needs.

Rae Woods:
I think this might feel simple, but to your point, this is not something that has been traditionally done. We take that 24 hours, we cut it in half, that's our shift, and we just need to make sure that we have enough coverage. I wonder if you can give me an example of ... Again, let's take a non-parent example of how this kind of flexibility might manifest in a unit or in a hospital.

Maddie Langr:
One example that comes to mind is a really smart way to use your most experienced nurses who might be on the brink of retirement, bring them to different types of roles where they're able to mentor more novice nurses and play an elevated role in terms of delivering care. Because bedside nursing requires a lot of physical work and it can become challenging for older nurses who might be at the ends of their careers. So we've seen organizations think creatively about, what are the types of tasks that we can have these experienced nurses do that allows them to meet the physical needs that they have in their job, while also elevating the vast nursing knowledge that they have to provide safer care and to train new nurses?

Rae Woods:
So that might be example of that flexible role, because we don't want to lose that nurse, but we need to have him or her do different things during their shift.

Karl Whitemarsh:
I would just add to that, that the practical implications of embedding that flexibility means that for that older, more experienced nurse, it allows them to remain in the workforce. We're able to retain them, even if it's for a handful of additional years. Because we have to remember that 12 hour shifts, those are taxing even for the younger, spring chickens in our workforce, let alone an experienced nurse who would otherwise be on the cusp of retiring, and almost driven to retirement if they would be required to continue to work 12 hour shifts.

Maddie Langr:
Absolutely. Outside of that too, there are many more examples of what a flexible nursing role can look like. One that comes to mind is virtual nursing. So we can have nurses who are kind of the head of a care team, who sit at a computer and interact with nurses who are on the front lines providing care. So that's another example of a different type of role, but one that is still equally valuable.

Rae Woods:
Yeah. Absolutely. But you actually started somewhere else, when we talked about flexibility. You talked about the needs of the hospital. The actual needs of the organization. We have to kind of match the desires of the workforce with the practical realities of what it means to run a hospital. What advice do you have for how to bring those two things together?

Maddie Langr:
That is the big question here in terms of how do you actually make flexibility work? Because you're right, there are organization challenges such as being short-staffed or this growing experience complexity gap, where we have less experienced nurses as baby boomer nurses retire. This has been exacerbated by COVID. But then on the flip side, we have changing workforce needs. The Harvard Business Review did a study that indicated that 96% of U.S. professionals want flexibility in their role. So we know that this is where we're headed. So to meet the needs of those nurses who have similar needs and wants for flexibility, organizations need to find that sweet spot in between and find out, what are the strategies that can help them meet their staffing needs while also meeting their organization's needs?

Maddie Langr:
That is kind of where the rubber meets the road and we find organizations doing things like providing shorter shifts in non-traditional roles, or cross specializing nurses with similar technical skills to help meet pockets of shortages in different areas of the system. Or even scaling expertise using different staffing models. The last one that comes to mind, for me, there is enabling non-float nurses to really practice across multiple settings, to allow nurses to have a wider breadth of experience, if that's what they're interested in, while also making sure that you can staff without using extra agency, labor, or overtime.

Rae Woods:
We'll be right back with more Radio Advisory after this short break.

Rae Woods:
Creating a safe and a flexible environment feels like the bare minimum that we can do to support nurses this year, which is probably why the ANA reached for a loftier goal. But I have to believe, in this moment, where there are very practical needs for nurses, that there has to be something more that we can be doing. What do you two think?

Karl Whitemarsh:
We need to do everything that we can to make sure that our nurses can heal and recover from the rigorous 12 months that have left many of them stressed, at a minimum, and traumatized on the other end of the spectrum.

Maddie Langr:
I think, too, doing everything we can means making strategic trade-offs for organizations to invest the money and the time that is needed to really allow that to happen.

Rae Woods:
Let's talk about those trade offs. Practically speaking, how do we help nurses heal? How do we give them recovery?

Karl Whitemarsh:
We can think about recovery in two kind of overarching buckets. We need to do what we can to help them physically recover, but then especially emotionally recover as well.

Rae Woods:
We are going to be devoting a whole episode to be talking about that physical side of recovery. But I don't want to ignore it here because it is so important. When it comes to the physical aspect of recovery, what's one of the big takeaways that you want to make sure you leave our listeners with?

Maddie Langr:
I would say that for physical recovery, I know that anybody who's involved in nursing, who's listening to this, knows that we can't just give all of our nurses a six-month sabbatical and unlimited PTO to take time away from work. But at a minimum, I think we can think about places to create flexibility in workflows and schedules and enrolls. So thinking back to that, that broader category of flexibility to allow some of that physical recovery to occur.

Rae Woods:
So what you're saying is, even though we don't have enough supply to, like you said, give nurses a sabbatical, we can still use the same principles of flexibility that we had to use during the worst moments of the surges, and we're continuing to use to meet very real nursing needs, as a way to move towards physical recovery.

Maddie Langr:
Yes. I think that's a really good point, too, that we're at a point where organizations are going to be thinking about, how do we staff coming out of crisis mode? I implore all nursing leaders who have implemented these pockets of flexibility to think long and hard about which ones will continue to serve us, but maybe for different reasons outside of COVID surges.

Rae Woods:
Exactly. Exactly. Well, let's move to that other side of recovery, which is the emotional recovery. Karl actually used the word trauma earlier as a way to describe what nurses have gone through. In fact, even going so far as to point out that trauma isn't necessarily new in the nursing space. But tell me about the concept of providing emotional support. Is that new for clinical leaders?

Karl Whitemarsh:
I would say it is and it isn't. I would say pre pandemic, many leaders were increasingly prioritizing emotional wellbeing, but the burdens of the pandemic made those alarm bells into a three alarm fire. So if we consider pre pandemic, there was an interesting phenomenon where nurses were actually the most engaged member of the care team, and sure, burnout had been on our radar, but mostly in the background. I actually want to attach some hard numbers to this by way of a study that actually came out on May 1st. Because what else would I be doing with my time on Saturday, if not delving into the latest figures on nurse burnout. But a group of researchers from the Ohio State University published in the American Journal of Critical Care, a survey of over 700 critical care nurses. The period of the survey is really interesting because it's August, 2018 to August, 2019. So squarely pre pandemic. And despite the data being from the before times, the results are still really concerning. And even more concerning when we consider how these figures may have very likely shifted for the worse during the last several months.

Rae Woods:
That's right.

Karl Whitemarsh:
So just to top line some of the results from the study, a clear majority of critical care nurses were rating their physical and mental health as very low on the scale provided by the study. And again, this was pre pandemic.

Rae Woods:
Wow.

Karl Whitemarsh:
Yeah. I actually want to call out a quote that the lead author provided, which is solutions oriented. It's that, "If nurses believe they work for an institution that is supportive of their wellbeing, they actually have better health outcomes." So again-

Rae Woods:
Oh my goodness.

Karl Whitemarsh:
Right? So again, speaking to the power of perception here. To quote what they wrote in the article, it's, "Critical care nurses who perceived high levels of wellness support from their organizations were twice as likely to have better health." So speaking to the importance of embedding, not just a culture, but an infrastructure of wellness support, especially emotional wellness, for your critical care nurses, and nurses in general, and pointing to how this will pay dividends for you.

Rae Woods:
How does an organization do that? If I understand just how important this is, especially in this moment, how does an organization actually provide emotional support, wellness support, to the most overburdened workforce we've probably had?

Karl Whitemarsh:
Yeah. I think it's about really going beyond the EAP, the Employee Assistance Program. Advisory Board's recommendation is that at a minimum organizations need to provide at least one formal emotional support resource for each of the following. So one, major events that could lead to emotional distress, trauma, grief, PTSD. Of course a pandemic would rise to that level. Two, moral distress. So again, moral distress is the feeling that you know the right course of action, but cannot take it due to some type of constraint. And then three, routine stress related to the rigors of healthcare. Delivering frontline care, which over time, the sum total can contribute to compassion fatigue. So again, that's major events, moral distress, and the routine stress related to a job in providing direct patient care.

Maddie Langr:
I'd add too Karl, that to go a level even more granular, there are specific experiences or emotions that clinicians have had across the last year that leaders need to consider how to address within those broader categories. The five that we've been talking about here at Advisory Board are fear, exhaustion, isolation, distress, and trauma. These are some of the many responses that clinicians have had across the last year. Some may experience all of them.

Rae Woods:
I feel like that across the last year.

Maddie Langr:
Yes, absolutely. It's been a rough year. Many people have all or some of these emotions. Healthcare organizations need to think about, how will we help our staff address these emotions moving forward?

Rae Woods:
Well, I want to thank both of you for having such a candid conversation about what we can really do to celebrate nurses. Again, we want to make sure that we're showcasing things like excellence and leadership and innovation, but I appreciate you giving some real world advice about maybe step one, two, and three, safety, flexibility, and recovery, so that we can actually get to that higher level of celebration. Before we round out our time together, I do want to give you a moment to speak directly to the listeners of this podcast, perhaps the nurses and the nursing leaders. Based on this conversation, what's the one takeaway or action item that you want our listeners to focus on during Nurse's Week. Karl, let's start with you.

Karl Whitemarsh:
I would ask nursing leaders to do some soul searching when it comes to what our goal is. Our goal cannot be to get back to or revert back to December, 2019. Why? Well, we've just discussed some of the reasons why from that study that I quoted. That can't be our aspiration. True recovery means that we have to get to a place that was better than 2019. So to borrow the current administration's tagline, we really need to build back better, in a way. Advisory Board, we are a non-partisan organization, but I want to use that phrase because I think it's very apt for this moment as well. Our aspiration has to be to get back to a place that was even better than December, 2019 when it comes to the emotional state of our workforce. So that nurses can truly excel, if we're thinking again about the theme of this Nurse's Week.

Rae Woods:
Maddie, what's your advice?

Maddie Langr:
Well, first, I just want to extend a thank you to all of the nurses and nursing leaders who are listening to this podcast. We appreciate everything that you've done across the last year at the forefront of the pandemic. For my advice, I absolutely agree with what Karl said. But I do want to mention something more on the business side of things here, that's that this will require a lot of investment from organizations and it must be a strategic priority. But on the other side, that is an investment that has a very strong business case. The health and well-being of your workforce is foundational to things like care outcomes, but also, even thinking to retention, engagement. Having a workforce that sticks around is absolutely important and can cost organizations a lot of money if we continue to lose nurses who are retiring at accelerated rates because of the trauma associated with COVID-19.

Rae Woods:
I could not agree more. Well happy Nurse's Week. Thanks, Karl, and thanks, Maddie, for coming on Radio Advisory.

Karl Whitemarsh:
Thank you, Rae.

Maddie Langr:
Thanks for having me, Rae.

Rae Woods:
We'll be right back with what our research team is watching this week.

Rae Woods:
Last week, President Biden announced a new goal. Now he wants 70% of American adults to have at least one COVID vaccine dose by the 4th of July. This plan is focused on getting states to scale their vaccine allocation based on demand in their local market. It also increases vaccine accessibility. And it's a big boost to a national vaccine campaign that has been slowing in recent weeks. Remember, most enthusiastic takers have already been vaccinated. That means that the government will have to push hard over the next two months to convince the unmotivated folks and those in the wait and see camp to actually roll up their sleeves.

Rae Woods:
And remember what I said last week, national vaccine rates only matter so much compared to local variation, where transmission continues to be high. Biden's new goal only applies to adults, but the FDA is expected to extend Pfizer's emergency use authorization to include adolescents ages 12 to 15. That means that a lot more children are likely to be vaccinated this summer as well. Pfizer is also planning to apply for an EUA for ages two and up later this fall. While many parents are desperate to get their kids back in the classroom and back into sports, medical misinformation is causing some parents to resist vaccinating their children. That means that the government, pharmaceutical companies, and trusted providers are going to need to work together to create a coordinated and compelling communication strategy.

Rae Woods:
In an effort to increase worldwide vaccination, the U.S. has said it will support a proposal before the World Trade Organization to temporarily waive patent protections for COVID vaccines. Now, even if all member countries sign on to the plan, it could still be weeks before negotiations are complete, and months or years before manufacturers can start actually producing vaccines. Democrats in Congress and public health leaders around the world are praising this as an important step towards global immunity. But critics of the policy, including pharmaceutical companies, say that patent protections aren't actually the problem, and that this move would diminish innovation incentives for drug makers. Instead, they site supply shortages and vaccine hoarding by wealthy nations as the primary barriers for lower income countries trying to access vaccines. Either way, there is no dispute that increasing vaccinations globally is the only way to prevent dangerous variants from developing and ultimately spreading. So remember, as always, we're here to help.