Trauma-Informed Professional Development

Episode 2: In this episode, we explore a new approach to nursing professional development that can help combat nurse burnout and workforce shortages. Our guest, Heidi Gilroy, PhD, RN, NPD-BC, NEA-BC, EBP-C, shares her insights on how we can support new graduate nurses and nurse residency programs through this new approach. As nurses, we often prioritize our patients' needs over our own, leading to stress, anxiety, and burnout. This new approach focuses on self-care and empowerment, enabling nurses to better care for themselves and their patients. By implementing this approach, nurses can develop the skills they need to thrive in their profession and provide the best possible care to their patients.

Guest: Heidi Gilroy, PhD, RN, NPD-BC, NEA-BC, EBP-C  is the Director of Professional Development, Magnet, and Research at Memorial Hermann The Woodlands Medical Center and serves as the Course Director for Leadership and Management at Sam Houston State University School of Nursing. She earned her PhD in Nursing Science in 2015 from Texas Woman's University and has certifications in Evidence-Based Practice, Executive Leadership, Nursing Professional Development, and Six Sigma methodology. Dr. Gilroy has spent more than a decade researching the effects of trauma on functioning in vulnerable populations, including students and practicing nurses. Her Trauma-Informed Professional Development framework is a result of this research. Dr. Gilroy is passionate about providing a healing environment for patients and nurses and teaches the framework to leaders and educators nationwide to reach that goal.

 SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach

Articles on Trauma-Informed Professional Development:

 Kobina, A., & Gilroy, H. (2023). Trauma-informed professional development: a concept analysis. The Journal of Continuing Education in Nursing, 1-9.  https://journals.healio.com/doi/full/10.3928/00220124-20231109-03

Gilroy, H. (2022). The healers are broken: A call for trauma-informed professional development in nursing. Journal for Nurses in Professional Development, 38(5), 273-278. https://journals.lww.com/jnsdonline/fulltext/2022/09000/the_healers_are_broken__a_call_for_trauma_informed.4.aspx

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Transcript

Transcript

Nicole Weathers

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, Director of the Iowa Online Nurse Residency Program. Thanks for joining us. Let's jump in. 

So, as nurses, our duty is to the patient. We spend countless hours putting the patient's needs above all else, and after long, exhausting shifts, we, as nurses, are often drained and unable to give that same care and consideration to ourselves. This, along with those continuous small but sometimes large traumatic events experienced day in and day out in healthcare, leave nurses feeling stressed, anxious, depressed, and burnt out, with the results being workforce shortages and nurses leaving the bedside and sometimes the profession. So, in this episode, we will discuss a new approach to nursing professional development and how we can begin to apply this concept to our work with new graduate nurses and nurse residency programs. So, my goal for this episode is that our listeners will walk away with the ability to discuss these new concepts and have actionable steps to improve their work. So I have with me today our guest, Heidi Gilroy. So maybe take a minute to tell our listeners a little bit about yourself.

Heidi Gilroy

So, first of all, I'm so honored to be on the podcast. Thank you so much for giving me the opportunity to share about really my passion using professional development as a tool to enhance wellness in clinicians. So my name is Heidi Gilroy. I'm the Director of Professional Development, Magnet, and Research at Memorial Hermann The Woodlands Medical Center. I've been a nurse a little over 20 years. Seems crazy to say that now. Seems like time has flown by, but I've spent. Most of those years being involved in some type of education, whether that be academic or clinical education. I love being an educator. I love being a nursing professional development specialist. I think it really is the greatest job in the whole hospital. It's also my primary research area. So I spend a lot of time not just teaching and learning. But also thinking about how we can teach and learn better as nurses when I'm not at work, I love to travel. I love being outside, even though I'm in Texas and it's 100° here right now and love hanging out with our animals. We have 3 cats and two dogs and that's kind of me in a nutshell. So thanks for having me.

Nicole Weathers

Awesome. Well, I think there's nothing better than talking with somebody about their passion, right? There's so much good stuff, I think, to, to get from that. So I'm really excited to delve into this topic on trauma informed professional development. Trauma Informed Care is something many healthcare professionals are likely pretty familiar with. Trauma informed professional development, though, is it's at least a new concept for me, and I had the opportunity to hear you talk about it just a couple of years ago. So I think it would be great if we could start off by having you tell us about this concept of trauma, informed professional development and really where this idea came from.

Heidi Gilroy

You know, during my PhD program and then during my postdoctoral training, I actually was in a public health setting. I moved outside of the hospital and was working in, in community and public health. And I was a part of a seven-year longitudinal study about women and children that had been involved in intimate partner violence. And as part of this study, obviously, I received a lot of training about trauma informed care and trauma informed approach, and so that was something that I was accustomed to using, accustomed to using a trauma informed approach in my communication and and in some of my interventions that I was doing even in the research study. So when the grant. For the study, I decided to go back to the hospital setting and I became a unit based educator for a pediatric intensive care unit, which was actually the the PICU that I had started my career. And so obviously I knew that the nurses there were exposed to really high levels of traumatic stress, both directly and indirectly. You know, we were working with critically ill children and they're extremely distraught family members every single day. So that's difficult for most people to take emotionally. So I did have that background knowledge and I was a very young person too. I started my career, so I was kind of in my transition to practice dealing with that stuff. But I was surprised to find, as I was working as a unit based educator back in the same unit that many of my new nurses that I was training and helping to, to transition. And they were exhibiting many of the symptoms that I had seen in the women and the and the older children that had been exposed to intimate partner violence. So pretty quickly I got the idea we needed to do something to help the nurses with these traumatic experiences that they were dealing with that really were as severe as experiencing violence in the home. So once I had that idea, it was pretty easy to see the solution I I already had that trauma informed approach training from my doctoral program and from the study, and I had the nursing professional development practice model. So I thought to myself, what happens if we combine the two? And that's really where trauma informed professional development came from. It's really an integration of the assumptions and principles of the trauma informed approach into the NPD practice model.

Nicole Weathers
Do you have a definition of what trauma informed professional development is?

Heidi Gilroy
Yes. And you know, and and fortunately we're coming out with a paper soon in the journal nurses and Professional development that really digs into this, I. So I was fortunate to work with a team. Of experts in nursing professional development as well as experts in trauma informed approach, and we dug into the the substance abuse and mental Health Services Administration trauma informed approach document as well as in the scope and standards for nursing professional development and we were able to kind of pick out things that were. Common to both. So you'll you'll be pleased to know that a lot of the competencies and a lot of the things that we need in order to do trauma informed professional development are already a part of our scope and standards of practice. So obviously, I'm not going to read you an entire paper. There's a lot of stuff in there. But essentially what we're looking for with the trauma informed approach. And specifically with trauma informed professional development is the ability to create an environment where someone can heal. After a a traumatic experience, so we don't have to. You know, we don't have to identify who has experienced trauma. We don't have to know if they're having any symptoms. What we're doing is we're making a big picture approach to to creating a healing environment. So we already think about the learning and practice environment as part of our. Scope. So all we have to do is add into that, making sure that learning and practice environment is is healing. That's it in a nutshell.

Nicole Weathers

That's great. I love that. And I and I love the idea of like we don't need to know. Who's experienced trauma? To be able to provide an environment in which they can heal and, you know, continue to grow. So I mean, from working with new graduates for the. Past over 10 years now, people come to work with a lot that we don't know about, right? They have a lot going on in their personal lives. They've experienced a lot in the practice setting and just being able to keep some of those things in mind while we work to support them. I think we'll really go a long ways. So I appreciate you sharing that with me and I'm really excited to to see that new publication come out. Is that expected soon?

Heidi Gilroy
It will be out in 2024.

Nicole Weathers
Awesome. So Speaking of publications, so recently you wrote an article, you talked a lot about safety and healthcare, but not how we typically think about healthcare safety as it pertains to patients, but instead you were really focused on this safety approach with the focus on the nurse. So maybe now you can talk to us about that. In the article you you mentioned three kinds of safety for nurses. So what are those? And then maybe we can go into, you know, what healthcare organizations can do to begin to create that safe workplace, keeping all of those things in mind.

Heidi Gilroy

Yeah, this is. This is a really important area and I think an area that we are diving into a lot more, you know kind of post pandemic. I think we can all agree that the COVID-19 pandemic was pretty terrible, but. We did get several great things from it seems like we all have more awareness of some of the things that may have been festering below the surface. You know, quality issues, DUI issues, you know, healthcare disparities. And in a huge way, mental health issues. I mean, how how often do we talk about mental health in meetings now versus, you know, three years ago? It almost never came up, and now it's a regular topic of conversation and I think that's a great. Thing, and so safety is really at the forefront of all of this. So we want to make sure our patients are safe. Our visitors are safe and now more important than ever both to to, you know, direct care practitioners as well as hospital administrators, care team well-being and safety is also hugely important. So we've already been talking a lot about psychological safety and healthcare. It's it's part of the, you know, whole high reliability organization framework to be able to speak up. If you think there's a safety issue or even just a way to make a process better. And even beyond patient safety, psychological safety is important for organizational culture as well. So I mean, any of you who are part of a magnet organization, you know that that ANC puts a huge emphasis on the empowerment of nurses to speak up and use their voice. There's there's a whole lot of literature to back that up. So. We see outcomes like turnover, work, culture and mental health nurses being associated with this ability to to use, use your voice as a nurse. So in addition to psychological safety, nurses also need physical safety, so feeling physically safe is really important to well-being. So we think a lot about like specifically workplace violence or the actual physical events that happen to nurses. But we don't talk as much about just fear. So like. To our nurses feel safe walking through the garage, getting to work. You know, after the sunsets or even driving to work, or getting on a bus or or however they they get. To work, how do our nurses feel about our policies about weapons in the hospital? Like, are they fearful every day that someone's going to bring a gun into the hospital? And really, whether someone brings a gun or not, whether the nurse is is safe or not, coming to work, or whether something happens or not, that fear of injury? That fear of violence can be just as damaging to a person's well-being and really affect their feelings of physical safety. So that's kind of so we've got our, you know, psychological safety. We have our physical safety, the third type of safety is kind of a new concept. We really discovered that this third type of safety was an issue when we did an intervention mapping study with nurses to see how we could implement trauma, informed professional development at the system level. And the nurses that we talked to discussed wanting a sense of professional safety. And so I've been talking about this with more and more nurses as I've traveled around talking about trauma, informed professional development. And they really understand and resonate this concept, even though it's really not something in the literature, something that we have a lot of science. Behind so professional safety is kind of being comfortable that you have the knowledge and resources you need to function as a licensed nurse without risking an error or risking your license. And a lot of nurses right now don't practice with professional safety. They they might be working in a unit that's under staffed or maybe they don't have enough training to deal with a certain type of patient or a group of patients that they're seeing in the hospital. They could even be floating to units where they don't have the competency or even know where stuff is. So these nurses are really vulnerable to making an. Error that could cost them their job or even their license, and so that can really affect your mental health. So if you're not secure that you know what you're doing and then something bad happens, it's much more difficult to do. With that kind of that outcome, if you're feeling nervous and not confident to begin with.

Nicole Weathers

So I would venture to say that this, this idea of professional safety is probably one that we hear a lot about from our new grads. Specifically because you know, with the workforce shortages, with the staffing issues, we are pushing new grads to get competent quicker, right? We we're pushing them through orientation. We're trying to get them out there working independently as quickly as we can because we need. Them and a lot of times, you know, they are feeling like they don't have the the competence or the knowledge they need to be safe. And I think there is sort of a fine line a lot of times when you talk to leaders, when you talk to new grads about. Are there going to be some new grads that? Never feel like they are knowledgeable or they don't have the confidence or you know, I mean not that they will never get there, but that it will take them a very long time. And so any thoughts on that like where or how you can determine is it a sense of just their confidence or is it that they do have more of that knowledge?

Heidi Gilroy

Yeah. So we're thinking about like social learning theory and, you know, bandura and kind of the foundation of some of that, some of the theory that we use in our practice is is thinking about self efficacy and building self efficacy. And I think that is a an extremely important piece of this professional safety. So just as an example, my new grads in the in the pediatric ICU, we had a kind of incidences where the new guys were like, we're just not feeling comfortable, we're embarrassed and and we kind of we're trying to dig in further and they're like. You know what? We just want to be able to practice using some of the devices before we go into the room with the parents. So like one of the new grads described trying to set up pressure tubing and I don't know if you've ever worked in an ICU, but if you set up pressure tubing, nobody looks smart setting up pressure tubing, you tangle. Up your yourself and the pole and you know the the small baby in the bed and everything else while you're trying to unwrap this pressure tubing and set it up. And so they were doing this for the first time while a parent of a sick child was staring at them. And how how frightening that is and how nerve wracking. So the simple intervention of letting them practice, putting that pressure tube together in a simulated setting instead of at the bedside, made a huge difference. And so these areas of self efficacy. So one of the ways that we can increase self efficacy. See is to is to help them have mastery. So any areas that you can help your new grad have mastery before they're exposed to that actual patient assignment or that actual area where they could potentially make an error and hurt somebody is is really important so you know doing skills days. That are that help them get their hands on machinery, making sure that they have people with them the first time they do things and that they're kind of protected from these. These other things is really helpful with self efficacy.

Nicole Weathers

Reinforcing the idea that nurse residency programs or these transition to practice programs are going to. The key in building that self efficacy so that we do have that sense of professional safety absolutely. I mean, I just I when you talk about this idea of professional safety, you know, I look back at my nursing career and I can identify countless situations that you're kind of forced into, whether it's floating to another department or we're going to have you cross train and then we need somebody to cover this shift and you're kind of. Off orientation, we're going to go ahead and have. You do this so many situations that you've been in where you feel unsafe. As a nurse, you probably couldn't find a nurse that hasn't. Experience that.

Heidi Gilroy

Absolutely. And we're really at a paradigm shift, I think in the way of developing knowledge and nursing. So before we were knowledge stores as nurses and I, I remember being a new graduate nurse in the pediatric ICU and I had in one of my pockets of my little lab coat, I had my. Book, you know my pediatric critical care little book and in the other pocket I had my little handy reference guide with medications in it and all the knowledge that I needed were in those two books. And that's just not the truth anymore. Our nurses need such a huge span of information. They just can't remember it all and they just can't keep it all in their brains. So we actually have to start training nurses. How to be knowledge retrievers and setting them up to where they can retrieve that knowledge in a fast way so that they can make good clinical decisions rather than being knowledge stores. So. So rather than pumping them full of of. You know, kind of didactic knowledge in their head, we really have to get them to be able to find that knowledge exactly. When they need it.

Nicole Weathers

I 100% agree. I mean I think we are at at that point where there is no possible way for a nurse to know all the things that they need to know to do their job because it's constantly changing. I mean, there's new equipment, there's new technology. There's all of the things that are changing every day in healthcare. I always say the only constant thing in Healthcare is change. And so I think you're spot on. So you got into self efficacy a little bit and I think in your article you talked too about threats to professional safety or threats to the nurses, mental health and in the last three years we talked about that rise in trauma anxiety, burnout in the profession that's leading to turnover and nurses leaving so. So you know. Additional being has been identified as a systems issue. There are many issues needing to be fixed within the healthcare system. There's also individual factors, and so that's where I'm always like on this. I I feel kind of caught in the middle sometimes because I do agree there's a lot of things in the healthcare system that need to be fixed in order to improve the mental well-being of our bedside clinicians. But there is sort of that individual factor that I think is also. Essential, and I think this is particularly true in new grads and kind of goes back to this idea of self efficacy that we got into just a minute ago. So this concept that I've been reading a lot about psychological capital and what psychological capital is, and maybe now we can delve into how MPD practitioners can begin to help build towards this. So we talked about self advocacy, but maybe you can go back, tell us a little bit more about what. Psychological capital is, and if there's other things that we can do beyond helping with mastery to begin to build that in our nursing staff.

Heidi Gilroy

Yeah, I think that really the the two major areas that especially NPD's can assist with psychological capital. Are really that self efficacy and peer support. So let's start with the like social peer support because I think it's the easiest concept to understand in an area we already know works with new grads. A big part of nurse residency program models is bringing the new grads together with with mentors, bringing them together with each other. With leaders with residency coordinators, we love to get new grads, all in a room together to talk. It's like a huge part of what we do. So they need that social support as they're going through the process of transitioning to practice. And we know that. But we're probably just scratching the surface of what social support actually means, not just for the new grads, but also for more experienced nurses. So we did a Delphi methodology study with our newly licensed nurses to determine which relationships were more important to them and their transition to practice. Obviously we know that that that supports. Important and some of the answers were obvious. Like they they mentioned their leaders, the clinical coaches. So we often address that in our residency program. So we're we're already training leaders, we're already training the clinical coaches and how to interact with folks going through the transition. But some of the really important relationships that. That the new grads said we're affecting their transition to practice. We're not directly related to their orientation, so people like their family members, they talked a lot about friends who are also nurses and have the same experience. So it might be a friend that they went to nursing school with or maybe even an older person that they knew who had been. A nurse before. And then connections and this is really important. Connections that they made with other staff on the unit. So those forming friendships that they started with people that were that were working with them on the unit. So these were some of the very most important relationships to them for their transition to practice. So as an NPD, I obviously can't control what relationship our new grads make, but we can teach them and we can connect them with other people. So we can teach newly licensed nurses how to leverage the supportive. Relationships that they have both outside and inside of the hospital, not just now, but also for their future transitions. So if they're changing jobs, you know, becoming a charge nurse, so kind of thinking about those relationships and how they affect future transition. And then even just kind of dealing with the unusual lifestyle of being a nurse, how can we leverage that friend who's also a nurse? You know, are they? Will they drive with us to Walmart at 2:00 in the morning, cause to make cookies because they're up at the same time, you know, so kind of understanding those relationships and how important they are. And then we can also. Really connect new grads with their colleagues on the unit through strategic conversations, so even. You know, getting one of our more experienced nurses to sit down and have coffee with one of the new people, or maybe you know that your new grad has something in common with one of the nurses that are on the unit and can just come in and kind of tell the the new grad and the the other nurse. Hey, you both guys really? Love baseball, you know, and maybe start a conversation. So some of these facilitating techniques of getting people to talk to each other and and really start building those relationships. And another part of the the social support structure in the unit really is the NPD practitioner themselves. I think most of us who've ever been in a unit based educator especially knows that, I mean, our office is kind of the, the the chatting zone. People come by to talk about what they're annoyed about, what they're sad about, what happened at home, what happened in the unit. And so we really make a difference in peer support for the new grads. So I mentioned earlier an intervention mapping study that that we did for trauma informed professional development. So another finding from that study was that the nurses felt very supported during their onboarding and orientation that kind of felt abandoned afterwards. So they still needed that support. They needed the leader in the NYPD to come by and check on them. But suddenly they didn't have like the scheduled one or two week connections with those folks, they would have to actually seek them out. And so they kind of felt abandoned, so creating purposeful connection points between the NPD and the new grad or experienced nurses is really important. You know, you were talking about individual issues, and I think this is a really important thing for folks in transition to practice programs to understand. So there are a lot of individual characteristics of new grads. That put them at greater risk for mental health issues. Some of them already come in with mental health issues. Some of them have experienced really horrific things in their life. I'm working with our local university to do a study of new graduate nurses and we have found that twice as many of the new grads at this school have experienced. Or more adverse childhood events. Essentially things like child abuse. Neglect something that happened during their childhood that could traumatize them. They've experienced those things at a much higher rate than the the general population. So by the time they get to us, they already are kind of at this risk. So these folks are going to have much more difficulty interacting with some of the traumatic experiences that they'll find. In the workplace? Uh, so they're. You know a patient dies and one of your new grads experienced child abuse as a child, and one of them didn't. That one that experienced child abuse is going to have a much harder time dealing with that, and no one ever tells the new grads this. No one ever says, hey, you know you you've experienced this in your life. And as a result. Fault you're going to have more trouble with some of these issues that come up in the hospital setting, and so it happens. And they feel surprised. They feel frightened. They feel crazy. They feel like something's wrong with them. And so if we could just let graduating nursing students and student and nurses transitioning to practice. Know that these are things that might happen to them and it it doesn't have to be just adverse childhood experiences. It could also be, you know, sexual assault during college. It could be they might be in an abusive relationship at home. And again, we don't have to identify these traumas or know about them. In fact, it's none of our. Business. But we do have to prepare the group as a whole, like I was talking about before, trauma informed. Professional development is really creating an environment that's healing. And so when we have this environment that's healing, we also have conversations that say, hey, if you've experienced these things in the past, don't be surprised if you have a more difficult reaction. So even be that awareness and that understanding can help someone get through those situations.

Nicole Weathers

Oh my gosh. Like as you're talking about this, I'm thinking back. You know, you always like flash back to your nursing career in certain situations where like my my first death was really hard and, you know, thinking about what were maybe some of the childhood things that could have impacted that or, you know, made that be such a difficult time for me. And I was five years old and watching my grandfather like, drop dead in front of my eyes and. That was hard for a 5 year old to deal with, and then my very first death as a new nurse like was also very hard because it was. I lived in a small town. It was actually a friend of mines grandfather who I it was my first patient that I ever had died. And so, you know, as you're sort of talking about this, it's like. Ohh, that would have been helpful to know that that was probably going to be a thing and that there wasn't something wrong with me that I had a hard time. You know, dealing with this, but that, you know, it would potentially be expected that that would be. Something that would bring up a lot of thoughts and and feelings and and probably dealt with emotions from many many years ago.

Heidi Gilroy

Yeah, when you're when you're a child and your brain is forming and those things happen, you know, it changes the actual structure of the brain. And so it sometimes we feel kind of weird or out of control if we have these reactions. It's really based on how our brain developed when we were kids. And you know what you said is a statement that I've heard from lots and lots of nurses, you know, they you asked nurses. Is why did you decide to become a nurse and they have a story, and usually it's a traumatic event. It's they were diagnosed with some kind of a a condition as a child. I was diagnosed with type one diabetes in 1984. So I was a three-year old, you know, in the pediatric ICU. And one of my very first memories is it's funny, it's of a. Of a nurse. She you would never do this. Now, Speaking of safety, but she clicked off the, you know the needle part of the syringe and gave me a little Styrofoam cup and taught me how to spray the doctors passing by with with water from my little syringe. So. In my case, I didn't feel I don't feel that as traumatic, but you know, it was a situation for a child that was very, very weird and odd and and yet I find myself drawn to that same place where I experienced that to to take care of other other people. So I think if trauma is such a big part of why nurses choose to become. And this is really true for a lot of the helping professions. We know from research that a lot of other helping professions, social workers, other folks in the hospital along with us, are experiencing the same kind of thing. They choose to be in this role in this profession because something happened to them. And so, you know, really at the beginning. It's more challenging, but we also have the opportunity, you know, sometimes this is kind of a bummer subject talking about trauma and and what we have to deal with every day. But we do know that there's also trauma post traumatic. Growth, so growth and improvement and great things that happen as a result of of being exposed to trauma. So we have the opportunity not just to have symptoms and not just to have some bad outcomes, but we also have the opportunity to have some great outcomes. And I think NPD's can can kind of participate in that too. Making a learning environment where not only are people for protected from having bad outcomes, but having a learning environment where really they can even elevate above their prior functioning and do even better be even more connected with patients and their colleagues, be even more open to possibilities, be even more. You know, connected with their spirituality or their religion as a result of those experiences, I think that is that puts us in even a more, you know, important position in the lives of these new grads where we can we can kind of help them to, to elevate to that growth.

Nicole Weathers

I love that yes, I mean I think that is that is such good and I think I could listen to you talk about this topic all day. It's just it's so interesting to me. So I want to circle back to what we were talking about just a a couple minutes ago regarding residencies and how you said, you know, we love to get them into a room and offer this peer support. And then they feel like eventually they they lost that right. The need to help them grow the social support so. So you know that is something that we've talked a lot about with our, the people who use our residency program is, yes, it's about that personal mastery and all the topics that we talked about related to like, you know, the professional skills of being a nurse. But this support piece, I think cannot go. Unemphatic sized. Because we always say we can do so much as residency coordinators to help grow their skill set, but they they have got to have somebody on the unit that's connected with them, that cares about them, that cares about how they are doing things. And so we've really encouraged check in points throughout the residency program from these people. Insight. So I just wanted to kind of go back. 2nd and say thank you for bringing that up, because now it's not just me saying I, I noticed that this makes a difference in their engagement in the program and their completion rates, but that there's actually science to support how important those that social support and those social connections back on the unit are. Absolutely.

Heidi Gilroy

And this is actually an area when we were looking when we were doing our work to see what what parts of trauma informed approach are actually in the already in the NYPD scope and standards and peer support is not. Not as highlighted in there. So I think it's an, it's something we do as part of everything else we do. But maybe we haven't talked about it a lot or trained on it or it's not a competency were checked off on. So you know a focus on that and helping and PD's get better at that is really important. And I just want to. Say like as far as the the peer support. Thinking about a trauma informed approach lens, so peer support in the trauma informed approach is someone who's also experienced the same type of trauma. So essentially the person is helping you heal not just by their presence, but also by their experience, and so having an NYPD. You know, like me and you, we both experienced a death, you know, in our past, in our work, early on in our nursing career and we dealt with it. And so using that trauma in our own lives to then reflect with the new grad is hugely important. I talked a little bit about really nursing self efficacy. So the the new grad feels confident in the nursing skills, but there's also such a thing as coping self efficacy. So essentially you know the definition of self efficacy is is really the belief in one's own ability to survive something or one's own ability to. Accomplish something or have success in something so coping self efficacy is just a person's belief that they can cope with something, so you get a diagnosis of cancer. Immediate first thought can I cope with this? Do I have the coping mechanisms to survive? This same thing happens at work like you know, if if one of these new grads does an error that hurts someone, or if one of these new grads, you know, experience is a difficult patient death. The first thought that they have is how am I going to get through this? How am I going to cope with this? And so if we're able as a peer support who's also experienced these same things, if we can help with that coping self efficacy build up not only their coping skills but also their confidence in their own coping skills. We can really make a huge difference in their ability to confront some of these first traumas that they have when they're getting into into their practice.

Nicole Weathers

Yeah, absolutely. And I think. Also, having residency programs, having those one-on-one discussions with them are the only ways sometimes to learn. Earn that they are struggling with some of those things that they have had some of those first traumas, as you said, otherwise they just hold that inside and it just they ruminate on it and they can't let it go. And so I think as PD practitioners, as people who are running residency programs, whether we're the 1 reaching out. Or we're coordinating some of those connections with other people on the units. That is how, from what I hear you saying, that's really how we begin to cope with the traumas that we are experiencing and that's how we begin to kind of move past that and grow that self efficacy at the same.

Heidi Gilroy

Absolutely. And I think it's important some of the folks. So when you're talking about making connections, some of the folks that are actually having symptoms like you were talking about, sometimes it's hard to identify unless you're talking to them face to face even when you are talking to them face to face. Sometimes it's hard to identify as well because these folks that are having symptoms of trauma exposure. They're going to have avoidance symptoms. They're not going to want to talk about it or think about it or even be where the trauma happens. So that's going on. They might have some mood changes, so they might be kind of jumpy or or actually have angry outbursts and things. That they might have intrusive thoughts and have difficulty concentrating, so this kind of paints a picture of someone who's having difficulty with a residency program that's maybe not gonna cut it. You know, the maybe your preceptors are saying. Yeah, this person is they can't remember which patients room to go in first. They can't remember. How to do this? They they get distracted. They are, they're grouchy and all this stuff. And it sounds like an education difficulty when it really is a trauma. Difficulty, and I think sometimes folks that have experienced that same type of trauma and have have experienced those same type of symptoms can have more compassion. So preparing your preceptors as well thinking about those social support connections to understand that some of those symptoms can be trauma related and not you know kind of education. Related and giving them some simple strategies to intervene. Then that can be a really powerful intervention as well and can help you as the NPD if you're not able to be face to face every single day with every single new new grad, you have, at least you have preceptors who have some of that same knowledge and can provide that peer support as well.

Nicole Weathers

Yeah, and that is that is huge because how many times have we heard like, oh, this new grad just not going to cut it, right they. They're struggling with this or like you said, they're not remembering that or whatever, and we take it so much at face value sometimes when there's probably something much bigger going on.

Heidi Gilroy

Absolutely. I saw a little man the other day, and I'll just read it to you because I think it's really important here as well. It says when the stories about a student are saturated with negativity, have the courage to not join in, tell a story of their unique abilities and moments of kindness. Tell the story of hope. And this is really thinking about a classroom. And you know, a young child, but I think the same can be true. About a nurse and you know you'll start to hear about a a new grad. Ohh. They're just not going to make it. And you know some of the preceptors will start talking to each other and then other folks in the unit. And if we think about kind of the trauma informed approach and trauma informed professional development that can really blockade a lot of the potential interventions we have with self efficacy with social support. I mean, if the the people around you don't have confidence in you, it's hard to have confidence in yourself and build up that self advocacy. And if you know people are talking about you, it's hard to reach out to them for peer support. So I think as NPD's we can also change the conversation and use that hopeful land. Which and identify some of those areas where they're succeeding to help not just the new grad, but the folks around them to really be hopeful about that person too.

Nicole Weathers

Yes, that's great. So you know these topics that we've talked about today obviously are important for any nurse in any stage of their career. Why do you think it's particularly though important for new grads?

Heidi Gilroy

Trauma informed professional development specifically. So there are some risk factors that that new grads have, kind of by definition. So younger age is a risk factor for developing some of the conditions like post traumatic stress disorder. These folks are really you know, so we talked about potentially having someone coming from. A traumatic background or experiencing some past. Comma and they are for the first time experiencing these retraumatization factors that are really, you know, able to kind of start that symptomology up all over again. So maybe even if they recovered in childhood, they are retraumatization. So this is the point where they have these experiences for the first time. So that's kind of a big. Deal. And certainly the stress around transition to practice, I mean we've been talking about stress and crises of transition to practice and all of these things really since the 1960s as a profession. So this isn't anything new. We've always known that that new nurses go through really stressful periods of time. I mean, let's think about it. Not only are they coming to learn a whole new job and a whole new profession, a lot of them are out of the house for the first time. You know, maybe getting an A. Equipment. They're trying to figure out how to buy a car. You know, they didn't know insurance was that expensive or cable. You know, they don't know how to budget. They might be getting in a a relationship for the first time, a romantic relationship. So all these things are going on and at the same time as they're having this really stressful transition to practice. So so having stressful life events around traumatic experiences can put you at more risk. So definitely these guys that are in this first year or so, there's a lot of stuff going on that that makes them more at risk for some of the poor out. And also you know we we don't want to lose them at this point. You know, they've worked really hard to get here. They've gone through school, they've gotten many of them, did many interviews to try to get where they really wanted to go. And so, you know, we really owe it to them to help get them at least through this first couple of years. So they can, you know, they can be. Successful in their in their future role.

Nicole Weathers

So if our listeners wanted to look at their residency program from sort of a trauma informed lens, I guess first, like where would, where would you suggest as a a good place to start and then where might they find like some quick wins?

Heidi Gilroy

Yeah. So the substance abuse and mental Health Services Administration has a document about the concept of trauma and the principles of the trauma informed approach. So this is really the foundation. They're the ones that made this all up. So you can go straight to the source and look at that document. And I think you listeners. Just like me will find as you're going through this. Gosh, a lot of this stuff is really what we're doing already. And so just starting to integrate those things into your practice, the four assumptions of the trauma informed approach that you'll find there at that Samsa website or the Samsa document are that we want to realize the widespread impact of trauma. We want to recognize the signs and symptoms of trauma. We want to respond with evidence based interventions, and then we want to resist retraumatization. So these are kind of the four steps to go through in order to in order to address trauma in order to make this healing learning environment. So one of the things that you can do just at the very beginning is to start with the first R to realize I think awareness makes a huge difference. In the way we interact.

Nicole Weathers

I love it. Oh my gosh. We have talked about so many good things today. We've talked about trauma, informed professional development. We talked about safety. We talked about self efficacy. You know, before we go, I have one last question for you. So when it comes to transition to practice and our topic today, what do you, what's one thing you often see organizations doing wrong? Or maybe wasting resources on that really isn't making a difference for their new grads. And what would you maybe tell them to do and?

Heidi Gilroy

I think this goes back to what we were talking about before, with nurses being information retrievers as opposed to information stores. We are still just like in decades and centuries past trying to teach new grads every single thing that they need to know in these didactic. Classes and. Really overfilling their brains, which I think causes them problems in in more than one way. First of all, it sets up the expectation that they're going to be able to remember all this stuff and that it's just an unrealistic expectation and and that kind of sets them up for failure because they'll have that stress around that which as we mentioned is is increased. Risk for some of these poor outcomes of trauma exposure. Doing this kind of old fashioned method of teaching new grads, I think it's really doing a disservice and our our academic partners are actually really far ahead of us. They have started transitioning to a model where they. They're really getting the people, the students in front of them, the exact information that they need right when they need it and really focusing on skills and applications of things. And I think we can do the same in the hospital setting. Just just thinking of a a new graduate nurse who's already worked in the hospital 10 years, you know, maybe in the business. Office or maybe even as a patient care tech, you know, do they need hours of education on communicating with patients and families? Probably not, because they've already been doing that. Or if you know they've worked in a specific area, do they still need to go to the class on on you know, clocking in and using the scheduling functions, or we're still making everyone go through every single piece of the classroom model. And I think we need to move past that and really start to personalize our new graduate education for the people right in front of us. And there's a lot of ways to do that. I think, you know, doing a better job at that environmental scanning, knowing what they need to know and knowing what they already know and really having good conversations that a lot of people ask me when we're talking about trauma, informed professional development. How do I know something? How do I know if the information is traumatizing? How do I know if this experience is causing more harm than it's worth? How do I know if my you know learners really need this stuff and my answer is very simple, ask them. You know, I think sometimes we we want to. Think of some really complicated way of designing education for people and one of the best ways we can design education is by having the learners design it with us. And that is really a part of trauma informed professional development as well. One of the principles of the trauma informed approach. Is empowerment so having the learner control their own destiny, you know, kind of choose your own adventure with learning can actually be a trauma informed intervention as well. So I I hope you know in this the next few decades we'll start to see that shift and that the hospitals. We'll move to what our academic partners are already doing and really personalizing education to each person that comes through the door.

Nicole Weathers

That is a awesome idea and I think something that gives us a lot of food for thought as we close out our conversation today. So Heidi, I just want to say thank you so much for your time and your expertise and sharing this passion of trauma, informed professional development and professional. Safety with all of us, so I know it's given me a lot of good things to think about and I know that that is also true for our listeners. So I appreciate you and all of your work and you know, we might have to have another conversation again like this. On the road.

Heidi Gilroy

I would love that. Thank you so much for inviting me. And just for any listeners out there, I would love to connect with you and help you with your thoughts about trauma informed professional development, because this is a developing concept, this really is going to require all of us to get this to our new grad nurses and and our experience. Courses and make a big difference. So so reach out would love to partner with you on any research or projects that you're working on.

Nicole Weathers

Well, thank you, Heidi. Thank you listeners and we will see you next time. 

Nicole Weathers

Wait before you go, I want to make sure you know about all the resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare to implement and sustain A residency program, work one-on-one with a residency program expert. To make sure your organization is residents. Ready. Then we have our online nurse residency program. This is an evidence based, comprehensive curriculum designed to support your new graduate nurses as they transition from school into practice, wherever that might be. We focus on professional skills, personal well-being competencies. And new graduates even get the opportunity to create real change in their own organization. How cool is? App and we can't forget about our supporting nurses course. An asynchronous continuing education course for preceptors mentors and coaches to learn the skills they need to support any new hire. You can learn more about all of these resources and everything we have to offer using the link in the show notes below.