Wellbeing

EPISODE 4: The topic of this conversation is the impact of chronic stress and burnout on nurses and how it affects patient care and the healthcare system as a whole. Nurses often work long hours and face emotional and physical trauma while caring for their patients. Their wellbeing directly affects the quality of care they provide, as well as their own job satisfaction and the nursing workforce. Our guest, Dr. Patrick Jeffs, will discuss ways organizations can improve clinician wellbeing and provide actionable steps for listeners to support themselves and those they lead.

Guest: Patrick Jeffs, PhD, Founder and CEO of The Resiliency Solution, Consultant, Trainer, Coach, and Keynote Speaker. Dr. Patrick Jeffs is renowned for his expertise in mitigating the adverse effects of chronic stress in the workplace. Dr. Jeffs enhances organizational creativity, productivity, and capacity by emphasizing the critical role of burnout prevention and the power of brief, restorative pauses. His work extends across a diverse spectrum, from healthcare and academia to government and corporate sectors, always with the aim of bolstering resilience to foster peak organizational performance.
 
With a distinguished tenure of 15 years as a Resilience Trainer, Coach, and Consultant, Dr. Jeffs has dedicated his career to guiding individuals through challenges and nurturing a culture of innovation, collaboration, and creativity. His resiliency coaching is particularly focused on identifying stress impacts and implementing strategies to maintain a balanced work environment.
 
In addition to his consulting and training work, Dr. Jeffs contributes his insights as affiliate faculty at UNC Kenan-Flagler Business School, blending academic rigor with practical application. His commitment to resilience extends beyond professional realms, as he actively embodies these principles in his personal life, exploring North Carolina's trails with his family and preparing for endurance challenges. Dr. Jeffs embodies the resilience he champions, making his guidance not only professional but profoundly relatable.

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To learn more about our nurse residency program and other offerings, please visit our website: https://nursing.uiowa.edu/ionrp

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. Nurses work long shifts with sometimes unrealistic workloads, often putting the needs of their patients ahead of their own. They experience mental, emotional, and even physical trauma regularly while they continue to care for every patient they encounter with compassion. It has been recognized that the nurses wellbeing has a ripple effect. Impacting the quality of patient care delivered. It also can impact the patients perspective of their care and the nurse's perspective of their work. How a nurse views their work directly impacts the healthcare system in terms of turnover and the nursing workforce. An increased focus on nurse wellbeing is essential for the stability of the healthcare system and the health and safety of patients and the nurses themselves. In this episode, we're going to be talking about the impact of chronic stress and burnout in the workplace, along with what organizations can begin to do to improve clinician wellbeing. My goal for this episode is that our listeners will walk away with actionable steps they can take to support their wellbeing and the wellbeing of those they lead. So today I have with me our guest doctor Patrick Jeffs. So, hi Patrick, how are you today?

Patrick Jeffs

I'm doing great, Nicole. It is wonderful to see you again after all of these years.

Nicole Weathers

Yes, I am so excited. I we were just talking before we hit record that we actually connected spent almost four years ago. Now that we've been talking about this topic and working together to kind of integrate some of what we're going to talk about today into our residency program. So I'm really excited to have this. Conversation. So why don't we start off by having you just introduce yourself to our listeners and tell them a little bit about what brought you to this work?

Patrick Jeffs

Thank you, Nicole. So I have. I've been in Chapel Hill, NC for 14 years now. My wife and I came down, we were in the Berkshires of Massachusetts before this. And I was originally from Flint, MI was born and raised in Flint, and my early career was actually in management and got into management and realized that it was the people side that I truly enjoy. And after a number of years in that field actually took a a left hand turn and went back to school to get a Masters degree in counseling within moments of even starting, my schooling realized that I had landed in the place that I was always meant to be worked for a number of places in New York and Massachusetts. And then ultimately came down to North Carolina for my PhD in counseling. My wife is also a counselor by training, and we opened up a trauma clinic here in Chapel Hill called NC Center for Resiliency. It was a body based psychotherapy clinic here in Chapel Hill and. Part of that work was working with people that have been traumatized and, you know, struggling with depression and anxiety. And I found a lot of people that were gravitating to my practice specifically were in healthcare, primarily physicians and nurses and just started working with them day in and day out. Just understood that there more was needed so that that's kind of my my origin story. So my my wife does a lot of this work as well. We have two young girls who we weave in and out of our work as well they are. They are truly wonderful and an inspiration day in and day out. And we've just been trying to figure out how to do more of this work in a in a systemic nature and that's really what I've been focused on the last 6 to 8 years is how to do this work resiliency work in a more systemic way.

Nicole Weathers

Excellent. Well, like I said, I'm really excited to jump into our conversation and share a little bit more about what we've been working together on here over the last several years. Now with all of our listeners. So I I was thinking, you know, in order to set the stage, we could start with talking about. Just the concept of. Clinician wellbeing and this focus on building resilience and healthcare because it really is a fairly new concept for most of us and it continues to gain more attention. So could you tell us a little bit about the history of these topics and healthcare and why you believe maybe it's getting more attention today than ever?

Patrick Jeffs

I think COVID did a lot to bring this to the forefront. Like I said, we've been doing this work for a really long time and. Even 13 years. Ago, when we had moved to North Carolina, physician burnout was quickly becoming a specialty of mine. But nobody really knew what to do about it, right. So we see resiliency as and what are we going to do about all of this. For now and I I think what makes a lot of our work unique is bringing in this business side of it all and. That I mean business in the ways that we are running the business of seeing patients and you know what, what does workflow look like and and how can we reduce that. But I just I think there's such a need to fill this burden that's been building and building and building part of this conversation I was having yesterday was. Just how much? Access there is to providers, right, nurses, physicians. We work with a lot of AP's. As well the. Amount of access that patients have the the pressure from administration to have that, that patients that have full access to provide. Matters that didn't exist five years ago to that level, that it is now certainly didn't exist 20 years ago or 10 years ago. So I I think the access piece, it's just people are so far over threshold and their capacity to manage all of the expectations that are at them. One of the big. Ways that we've come around to think about resiliency a little bit different is not to do more, but how do we shift our own capacities around all of this? What's been really unique in some of our models and and and we've certainly talked about this, Nicole is how do we do this together? Right. So you know it's it's a very masculine sort of model that says go back out, fix yourself in isolation, come back. And once you're feeling better then we can then we can move on and it it's a more feminine leadership style. My wife does a lot in in feminine leadership. It's a very different model that says let's do this. Together, let's heal together. Let's build our resiliency together and and I think that's a really new and novel. In people's access to home, right. So I I'd mentioned that I have two young kids before we started this, I got a. Call. That's like one of the buses is going to be late, which doesn't impact me but but it impacted my day and now you know has me thinking about my kids in A at an overly distracted way, but so many nurses especially. That I've worked with are caregivers on both sides, right? They're in this middle generation and they have aging parents and often young children. And there's just there's so many demands that didn't exist before. And so part of this is also that we're just living in. A different world and we're having to recalibrate. So we use the word recalibrate a lot in our work. And when we're talking about resiliency and and how are we shifting and recalibrating to just new and different expectations, COVID was a big part of that as well. When we come in, we're often brought in either through HR, which is different than administration from the lens of what the organization is needing. But most often I'm brought in from a champion style head nurse, champion style lead physician or chief. That says we just we need help. We need help in a lot of ways and the model is to see all of the individuals work with all the individuals. I'm I'm on the clinic floor. I'm I'm shadowing nurses and physicians and AP's. But then we're also looking through the lens of how are these teams working together? How are they communicating? Everybody probably needs less meetings in their lives and part of that feeling of I need less meetings is the way in which we are operating these meetings. Working so bringing in my business background, we're able to retool how how people are running. Meetings and we're looking on a systems level like what are our processes, what are our communication patterns, how are we setting up our daily schedules. So really looking at you know the individual, each individual and the unit, what are the teams, how are they connecting and then the systems and when you are working on that level? You will only. Make change which is beneficial for the nurses, physicians, AP's medical assistant schedule. But also impacts the bottom line right? In not in ways that are always most important to administrators, which is how quickly our patients getting seen from the first time that they they need to be seen. But when you're thinking about turnover and loss of a nurse or a physician that costs. A lot. Of money and you know, it serves as an insurance policy for things like turnover because we're shifting the burnout and how people are feeling about their work.

Nicole Weathers

I really like that and I really like that. You know, you're talking about this, not just that on the individual level. And I know you know, part of the work that we've done together is getting nurses, specifically education around many and and many tools to help them combat burnout and manage stress and prevent burnout, but also looking. That more of that systems level right and all the things within healthcare that contribute to this. So it's really is multifaceted. So I do think maybe we got a little bit ahead of. Ourselves. So maybe now we can. Rewind and just talk so that our listeners, when we're talking about resiliency when we're talking about wellbeing, they know exactly what it is that we're referring to. So do you want to talk about? What those things are, and again why it's so important today.

Patrick Jeffs

As far as. How we view resiliency we we think about it in resiliency, 1.0 and resiliency, 2.0 resiliency. 1.0 is the very traditional model of which there's not a a great unified definition, but we think about it in how do we rebound after difficult things, whether it's, you know, a 14 hour shift. Using a patient fill in a negative emotional experience, you know what is our ability to rebound from that. And there's a lot of different components that go into that which we can certainly get. To, but that's the most classic definition. We call that resiliency 1.0. And then there's what we're calling resiliency 2.0, which is actually a little paradoxical, which says if we grow our capacity so big, we actually need to be less resilient. And we've talked at length before about things like boundaries and boundary setting, personally and professionally. And if we are holding to some of those things, it's actually by doing less that our capacity grows to actually handle more and that's that's a really cool science. And when we had our our trauma clinic, we're actually acquired 5 weeks before. Good, not too long before before I met you. But that was that was the basis of our entire clinic, which is how can we grow our? Clients capacities and such that whatever future things come their way, it shifts how they are interpreting things as traumatic or not traumatic. So that is that's where it becomes a little paradoxical. The more we grow our resiliency, the less resilient we actually have to go to that resilient reservoir. Because we're we're setting up a life and a lifestyle that is really protective in a lot of ways. I think this is so important for nurses because. They are on the front lines of a really stressed out population who is struggling in so many ways and I feel like a lot of folks because they are struggling or just looking for a way to unload and I have. I've talked to so many nurses just in in my own practice. And my consulting practice where they knew it wasn't personal and their reaction that they were having with a patient, but for whatever reason, they just they were on the receiving end of somebody just having a really bad day and probably a a really bad couple of weeks or months. For years, and I've worked with a lot of nurses who knew that they were signing up for things like that. But that doesn't make it any easier either. So we're trying to figure out ways on how to how to support after things like that as well critical incidences.

Nicole Weathers

Yeah. And I mean, I think that's. Something we hear. Hear a lot like that narrative is out there. A lot of like you knew what you were getting into when you signed up for this. You know, you knew that this you were going to deal with life and death things and you were going to work long shifts and you were going to be over well. Filmed, and perhaps you did know that going into becoming a nurse, but like you said, that doesn't make it any easier to deal with that and you're still a human being, right? And there's only so much of that that you can take before you break whether or not you knew that was part of the job description.

Patrick Jeffs

I think what's what's? A little caveat to that is while some of that might be true, when you pair that next to the increasing burden, the increasing access and then you put all of those things together. It's like the first one we were just talking about the experience of that is much bigger, right? And much more difficult to try to manage and get over. And because there's less time, then there's less recovery and and we'll get into some of the models of this. But recovery is such a big component of resiliency. Both in the very near term, in the short term and kind of medium and long.

Nicole Weathers

And I want to just go back to and point out when you said setting up a life and a lifestyle that is protective. And I think this is really what we recognized back in 2020 when we reached out to you and started collaborating on some things is that we're dealing with new nurses and our residency program. Who are experiencing all of this for the first time, right? They're experiencing those first deaths and they're experiencing. Doing the long shifts and and some of these things that they've only known in theory, they're actually, you know, having those things happen in real life. And so by integrating this work into a residency program, it really hopefully, I mean my goal is that it allows them to do that thing right to. To specifically set themselves up, build that foundation, that protective lifestyle that will help them to be able to continue. To show up and do this work because we don't want to lose them in that first year, we don't want to lose them at our organization. We don't want to. We can't afford to lose them as a healthcare system, we need them to continue to show up. And so giving them those tools so early on will help maybe prevent some of those bad habits that US nurses who have been doing this for a really long time. Have sort of developed because we didn't have those tools available to us until now, right. And through some of this work. That you're doing.

Patrick Jeffs

And I think one of the things I've learned in working. With you over the last. Four years is is how, how often. Unfortunately, the nursing profession mirrors the counseling profession in which the the most novice of practitioners are often put in the most difficult, complex situations. Which that alone is a recipe for burnout. And when you had reached out to had me work and have us Co collaborated design on how to support nurse residents, I thought that was just so visionary. To build this into how someone starts their career, I just. I don't know. I'll, I'll remember that experience for forever. I just really appreciated that. Just understanding where they were at in their career, what they were needing and quite frankly, having the courage to just say. I don't know what this is going to look like. I don't know what it will take, but let's we got to do. Something like let's figure. Anything out and it was just great to say. Yes, and four years later, here we are.

Nicole Weathers

Yeah. Well, and I I was just going to say I look back on my first year as a nurse and you know the first death, the first cold. The first physician you know conflict the you know all of those first things that kind of are a lot to handle both mentally, emotionally. And I think of some of the skills that we're teaching through this program around self-awareness and self regulation and those terms. Were completely foreign to me, right? Those weren't necessarily things that I had heard in school. They weren't things that I heard throughout. My first few years, quite frankly, any of my time in the clinical setting, those weren't things that were talked about. And so as I began to learn about these things, see the work that you were doing, it was like, yeah, this is exactly what is missing. So we've talked about resiliency, what it is. I love the the 1.0 and the 2.0 definitions that you provided. I think we've talked pretty well already about why this is an important topic. In general. You know, I think the thing that drew me. Because when when? I first started looking into this. I looked at a lot of different things that were out there, a lot of different. Programs that were available, but there was something about the uniqueness of your take on this topic that drew me this direction versus some of those others. So maybe you can talk now about what makes your perspective and the way you teach this so much different than maybe some of the other things that are out.

Patrick Jeffs

Yeah. Thank you. And and and I get that a lot and it's really difficult to communicate things that you've learned over the course of 30 years where you're pulling from various fields and domains and some of the work is, you know, based on research that's not grown and some of it's distilled and the exercises are very much your own. So the it's been a really unique. Have to even imagine how to describe all of this. The delivery is just fun and seems like play even in the most stressful and sad situations. I mean, I I was literally and and I try not to cry with people too often. But I was on a call with someone yesterday about a consult, and it brought me to tears. And this I mean. This stuff is very real. And that's that's not lost on me, but. There's a lot. Of you know, Doctor Martin Seligman is probably the the biggest conduit of resiliency to date and and you and I have connected. Around his work and and he comes from a positive psychology lens that that really focuses it in my opinion. And and people's thoughts and and thoughts and behaviors and and I think a lot of the structure that he and a lot of his colleagues at Upenn have done, some really great work and and have really proven some really great models and and we've adopted certain parts of their model like self-awareness, self regulation, connection optimism. Those are those are really. Essential to the work that we are doing. However, the physiological piece was, in our opinion, what was missing from a lot of those early models, and because myself and my wife and you know everybody at our our clinic, we're trained in body based or somatic psychotherapy. What we've been able to do is. Take things from the positive psychology world, blend that and and really deliver that through somatic psychology, but through an understanding of and what does this look like at work and in real time? And I think too. And people would quote come to a training and then it's just the it's not matching up of. OK. But when I'm on a 14 hour. Shift you know. What does this look like in real time? And I think that that has been one of our greatest successes, right. And I I spoke earlier about. Shadowing folks and you know I'm in the workroom with with the providers and and we're seeing it. And you know when you're when you're shadowing somebody for a 7 hour shift, I'm there for seven hours there, there for much longer. But you get to see. All of these micro moments. To build in these skills. And what we learned years ago and helped develop our model is these aren't folks that you can necessarily pull out. For a training. Right. So how are we going to build this into the system of things that everyone is doing day in and day out? So we're always looking for opportunities to insert these skills in, in real time in a. A given example and this just came to me because I was shadowing somebody. It just clicked on just how many door handles nurses were grabbing over the course of the day. Right, going to see a patient. Leaving a patients room to to go back to the workroom, hitting the door handle to go into the work room, hitting the door handle again to go see the next bit right and on and on and it it just dawned on me just how often there was a hand on the door handle. So. So what? We were doing, you know, through this concept of self-awareness and self regulation. Was to pair a breath every time your hand hit a door handle. Just to kind of calm yourself down and and that has had a tremendous impact to settle yourself before you go meet with a patient, whether it's somebody you're excited to see, right, maybe you know them or maybe it's something that you're really concerned about or you just don't know what's on the other side of that door, always looking for ways to work a through the level of the nervous system. Right. Because if if we're going to the breath, you know we're going into the nervous system, which is our our primary way to manage stress. But also just finding multiple ways in in these micro opportunities, you know I would get feedback, not that I was promoting this, but I would get feedback on early days of you know if if I could had extra time to go to a yoga class every day like I would do that. So you know whatever we're doing with folks, we're not recommending necessarily taking. For vacation, we're not necessarily recommending, you know, going to an extra yoga class, but it's like, what are all of these hundreds of micro moments and decisions that we can build in that shift our experience. To taking care of people because that, you know, at the end of the day, it's like, how do I just show up better for the people that are on the other side of? That door and if if we? Can just take a moment to pause and, you know, pulling that from from the the trauma resolution world. You know, I I think about a lot of the nurses. That I've worked. With and and what has in our conversations, what has. Led them into that field. Well, there there's only. A handful of themes that come to mind of why someone moves into nursing and and it's pretty similar for folks in the mental health field as well. Like I I'm not saying that this is a similar statistic necessarily, but of all the therapists that I've known over the last 17 years of being in the field, I would argue 100% have. Mild to moderate to extreme trauma histories. Right. So there's so much value in building day-to-day skills that have come out of trauma resolution work in just getting through a day, whether it's traumatic or not. It's just it's validated ways to manage stress day in and day out. So that by the end of the day, your upper threshold of where your stress is is a lot lower than if you hadn't done all of these things right. So it's the the concept. Of I'm not going to wait until the end of the day to manage my day, right? Because that's where heavy drinking comes in. That's where awful television comes in. That's where, you know, staying up too late, doing both of those things come in, so you know. If we can. Leave work with a lower upper stress. Threshold because we've been just managing it slightly different throughout the day. Then we can show up at home a lot better as well. So that those are those are the ways that we're always thinking about these models like it, it has to be very practical. It has to be very accessible. I've shared this with you in the past, but you know I I grew up in a home where my mom was a massage therapist and yoga instructor. She's a meditation teacher. You know, crystals, the works, right. And then my dad was kind of on on the other end of the spectrum where, you know, he, he was a roofer, went to one year of college on a basketball scholarship. Enjoys things like hunting. And you know, he can just sit. He can sit in a field during hunting season for 8 hours and monitor his breath and monitor his surroundings. And and that's not that different than the other end of the spectrum, which is my mom. You know, who can sit in a a 48 hour meditation retreat. They're still targeting the nervous system. They're they're both having mindfulness and it just shows up so different. And I just tell that story to. So that. People just need to find what works for them, you know, here's an idea. Here's a skill. What does this look like in your world? Because everybody's world shows up entirely different. And our our goal is always what can fit best for what? What your world looks like. And that that's just asking a lot of questions and being. Curious with folks and not believing that that your ideas have to be the ideas.

Nicole Weathers

Well, and I think that that, you know, talking about. Really focusing on what are some of the things that we can do throughout the work day, I really think that that's. Probably what speaks most. To the nurses that we are working with is because we're not telling them that they need to eat healthier and physical exercise and get more sleep. And all of those things that yes, those contribute to wellbeing. Right. And resiliency, but that is really not. Where the focus. Is they don't need to be told that for the 100th time in their life that those are the things that they need to do. They need help coming up. That these things that they can do throughout the day, and I would say most of the people as we get feedback from people who are doing this work in our residency program, that is this idea of the the 32nd break or the deep breath before they walk into a patients room. You know, the threshold of the door being sort of their trigger. To to do that like those are the things that people are walking away with and saying that that is making such a big difference for them. So I do think that that's what. Kind of makes your work unique and I think the piece that really spoke to me so much is is that these are things that they can do. They don't need to set big blocks of time in their day to do it. They don't have to find more time to get these things done. It's just a part of their their daily life already.

Patrick Jeffs

Yeah. So there's been a big how I want to say this. There's been such a wonderful learning that we've watched happen around something that we brought from the somatic world, something from the trauma world around. This concept of activation and settling cycles, right? So when when a nurse goes to see a patient, their their system, their attention, their thoughts activate to go do that thing, how we build resiliency is there needs to be settling on the other side of that. So we go in we're in. A more sympathetic state, but. Coming out of that, we need to engage our parasympathetic to be able to be into that settling and and the goal of all of this is to have these, you know, multiple, multiple, multiple repeated cycles of activation and settling throughout the day. Burnout is the absence of that burnout is. I get activated from the time that my eyes open in the morning. Unfortunately, I'm grabbing my cell phone before my feet hit the floor and I'm on and. I'm I'm on all day at a really high level until I pass out at the end of the day, probably scrolling something right, so we just go from activation to activation to activation the the real and and this is the science behind it and truly what needs to be figured out for an individual. Is. How do I practice what we call these activation and settling cycles throughout each and every day, and let me give you a great example. So when I'm when I'm shadowing somebody, we'll go in and they'll on the way, walking to to meet the patient, they'll say who? We're meeting with. And then of course, we'll pause for, you know, a second and a half at the door before we walk in. You know, we're not talking about 30 seconds of deep breath, no, like second and a half, just a a little bit of a settling moment. So coming out of that room. Say it's a 15 second. Walk from the work room. Or the desk and in the patient's room, if it was, if it was that easy, you know, just to check in or it went really well, we'll just, we'll go back to what we were doing as if nothing had ever happened because their their activation didn't have to get too high. And yet, I'm sure everybody listening to this can imagine a different scenario in which they walk in and the patient might be struggling. Maybe the patients even fine, but the family. You know, there's a room full of four, and you can just, you know, you sense it in your body that that the walls are just kind of closing in on you and your body is kind of lighting up and that now it's really activated. Now your your voice is getting a little shaky. Maybe you can tremble a little bit. And now we're in a really high activation state. And what we have to really care for ourselves on this is we call it taking the long way home. So when you walk out of that room, if it was a direct walk, 15 seconds back to wherever you were. What's the long way home that you can take? So what's what's a 42nd walk that you could do instead? Even if you're, you know, quote walking around the block just on the floor. And in that all you have to do you you commit to taking the long way home and you just ask yourself the question, how's my breathing? Because the towards the end of that visit, if not from the start, because of that high activation state, you stopped breathing you you started either breathing really shallow. And we have to reengage that sooner. So we're not specifically saying take a deep breath. There's reasons to do that. There's reasons not to. In the beginning, it's really best to just ask yourself the question, how's my breathing? And just by asking the question, our body will naturally do what it needs to do. If it just needs to take a little breath and then a little bit bigger, and then it'll, that's fine. If we're asking the question, it's like, here's one big breath, then that's fine, the body's. Intuition will kick in. We just have to ask the question. So building in these activation. Settling before and after seeing every patient and and when that becomes your norm, I think. People will be. Amazed how different they experience their work, how much more present they can be with their patients, how much more present they can. Be once they are. Leaving for the day, that is just. That is the magic sauce of building resilience in real time.

Nicole Weathers

I love that I actually read something the other day that kind of similar, you know, it talked about how your brain is a muscle and it's just like going to the gym like you wouldn't go to the gym and lift the heaviest weights for 12 hours straight. So why do we expect our brains to be able to do that for a full 12 hour shift without giving it these little breaks throughout the day? And so I, you know, I really like put those two things together and where you know that that good reminder that sometimes we expect way more from our mental and emotional self than what we really. Are able to do and that these small little breaks these long. I love that idea of taking the long way home, that those are the things that, even though they don't add a ton of extra time, I'm not setting aside a whole hour to do this right or I'm not trying to find a a 30 minute break in my day to go meditate, but that those are the little breaks that really help us. To increase that capacity for resin.

Patrick Jeffs

And I really like that gym analogy. You know, we wouldn't go to the gym one time. Say it's a great workout and think ohh I don't have to go do that for the rest of my life. So it is about like, what? How do we build a practice that we, you know, we can see results. You wouldn't imagine it would be really difficult to go to the gym day. After day doing everything right and never seeing results. So we also have to be oriented towards you know, what are the benefits that I'm seeing and and just to say one last thing about taking the long way. We have to protect ourselves against introducing more activation in that, so that's not the time to while you're quote taking the long way home to also check your cell phone, checking social media check this is the only thing that you are oriented to is the space around you and your. Breath. That's it. Maybe. Feeling yourself walking is like a bonus. But that's it.

Nicole Weathers

And that's a hard habit for some people to break, right? Because for many of us, we find maybe that phone checking, it's our drag of a cigarette. It's our drink, it's our some it releases something in us, right when we are stressed. And so it I I feel like it's. It is a hard habit to break and it might be very difficult to walk for those 40 seconds and not, you know, given to that habit of doing that. But again, with practice and with, you know, kind of continuing to work at it, that we can. Get there and then reap the benefits of what that feels like to not have that added stimulus, because that's really what that is. And I think that was a big take away when we first started talking about, like, what does a good break look like is a good break going to the break room and scarfing down your food and scrolling your your Instagram feed for the full? You know, 10/15/20 minutes whatever you get, that's not a good break and calling calling people out on that is it. Think difficult, but I think it's important and I do think that a lot of the people in our residency program have walked away with that as well that I really need to look at what these breaks, big and small, actually do look like and and am I just feeling the silence with more activation. Because for many of us, I think that's very true. That's what's happening.

Patrick Jeffs

I mean, it's really uncomfortable to feel all that activation in your body and you know, Speaking of the practice of it all, if we can learn what it feels like to deactivate, then that muscle to your point can get a lot stronger and more efficient as well.

Nicole Weathers

So clinician wellbeing has been identified as a systems issue. And so we did kind of get into this a little bit already. You know looking at examples of ways organizations have started really approaching fixing this issue with burnout and building resiliency. So could you talk to us a? Little bit more about that.

Patrick Jeffs

Yeah, I I think it's a a pretty advanced organization that would think about how do we build resiliency into the system, right. And when we were talking about the activation and settling cycles, that's the lens in which we are looking through the systems approach as well. I think looking at meetings, right, collective experiences is a really great place to start and it's often a place where I start where we can build in the expectations that we have for people to do. Previously go do by themselves, but we can do this in a group, so one of the easiest cost effective, most efficient ways to capture everyone and this will take a little while is to start every meeting with 60 seconds of silence. Everyone is coming from, you know. Take take a morning. Stand up. Right, so maybe half the group has been on for a while. Maybe half just got there. Maybe you know some have been. Seeing patients already, some were, you know, dropping off kids at school. Some have been up for four hours, some have been up for 14 hours. Everyone is so often coming to morning stand ups and such from such different angles and for so many reasons. Starting that meeting, not even as a meditation, it would be a bonus to be able to describe to people different exercises or experience. And maybe you know somebody owns it for a month and then the next month somebody runs just that 162nd portion of the meet. But to be able to start every meeting with, let me just catch my breath, let's all catch our breath together. People start thinking differently. Our empathy goes up, we start listening better because we've down regulated. So thinking again about these activation and settling building in the settling cycles into how the system operates. Similar at the end of the day, how wonderful it would be instead of people. Just rushing out. The door and I know this is nearly impossible to be able. Pull off. But what if we just deactivated together in that transition, before we then left the unit left the hospital for the day. So I think looking for points of access in the system certainly points of connection. We also just follow the stress, right? So if we were to list out. Like what are the five most stressful moments? Right. We're always looking for moment. Of our day. And then, you know, collaborating, have the collective conversations around how could that go better and not the things that we can't control, but how can we experience that different? How can we slow that down? So not totally dissimilar from that back station and settling is pacing. So as a as a culture and a unit, what does our pace look like? And that that's a systems piece, right? Are we always rushing as a group? I give homework to people sometimes to go grocery shopping 10% slower, just 10% slower and notice the down shift that often has to happen to be able to go grocery shopping 10% slower and if we can imagine it and this sounds counterintuitive. Somewhat paradoxical, but if we could deliver care 10% slower because everything feels so. Rushed the I call it the badge of busy. It's like, hey, how how are you doing? Busy. It's like let's a let's get rid of that. But in the effort of that, how do we just do everything about 10% slower? And notice that we'll be more connected to ourselves. We'll be more connected to the people around us. Our mistakes will probably go down. I mean, there was a time, you know, last week I just like, ran into a door because I was just moving too fast and like, I mean, I didn't have to, like, go to see anybody for it. But I was like, that really hurt my shoulder. Because I just. I was moving too. Quick and you know I'm. I live and breathe this stuff and I'm victim of it too because I'm a person in the world that's had a life. So just to also slow down, not 50% again, right, you were saying? About, you know, we don't. Need a 30 minute meditation a day? That would be great. But like, let's let's start with a A10 second, a 32nd. And what would it look to just slow down by 10%? We could just focus better, right? See more things coming. Not so surprised if you work with anybody that has. We called it an exaggerated startle response, right? They're probably holding on a little too tight and. And so for moments like that for folks like that, like we just, we got to slow down because then we can see the world coming a little bit better and we'll we'll just make better decisions and quite frankly, we'll enjoy it better. Right. So especially slowing down when patients right. So that breath right before we go in and meet with them, we can be present, we can be connected to them and that that's under the grand assumption that that people get into healthcare and nursing specifically to connect with patients which from my understanding it's. 100% Right is is the work with the patient, the rest is just you're getting in the way of me connecting with my patients. And so the last piece I'll say about that is really, really paying attention from a systems perspective on how are we all protecting the time that we have with our patients. Right. How do we slow down right before that? How are we supporting each other? If somebody has to take a little bit longer with the patient and those are conversations and that that's a culture piece. So I use culture and systems somewhat interchangeably because they're they're just so closely related and. And I don't know if people are ever really having conversations without a consultant coming in around. What's our culture like and what's a couple of things that we could do? To. Change that and what would that? What would that truly take? So I think I think the questions around systems and culture are almost as important as the answers.

Nicole Weathers

It is. I mean, I hear this and I think this is the complaint. For lack of a better term of nurses, a lot when. They are beginning to feel that burnout is, you know, I didn't get into this to Doc spend hours upon hours documenting. Right. I got into nursing to take care of the patients and they feel that through all the. System level things that have been put into place and and they're important right documentation is important and and you know scanning medications and doing a lot of those things that take time are important to keep our patients safe and get care paid for by insurance companies and and there's a purpose behind a a lot of those things they do. Who oftentimes take away from what I got into this profession to do in the 1st place, and that is where. People begin to recognize and, I think begin to feel burnt out is because of those things. So you know, I really like that you, you brought this piece up about what are we doing to protect our time and still be able to slow down and show up and connect with our patients. Because I do think when we slow down, we're actually able sometimes. To get more done because we're there, we're focused. We're taking care of multiple needs probably at one time, whereas if we're in there and we're rushing, then we're back in there. You know. That's later. So I think that's that's great. That you pointed that out. So if we switch conversation now a little bit and so we talked about from a systems level. Now let's talk a little bit from the an individual approach. So you know, yes, healthcare organizations need to create work environments that support wellbeing. But I I really do believe that individuals also have some responsibility and investing in themselves. So from your perspective, what what does this look like? I know you've given some really good, actionable steps already as far as like those short breaks and 60 seconds of silence at the beginning of the meeting. And those are all fabulous things. But what are some other things that individuals can begin to do to build their own resilience or even in terms of, you know, these nurses that I'm leading to? Is there something I can? Do to help. Them build their individual resilient.

Patrick Jeffs

The basics around sleep, nutrition and movement cannot be undervalued. We in our House, we are militant about what time we go to bed because waking up feeling somewhat rested is so essential for our brains to operate. And we have to kind of get over the idea that I deserve to watch this extra show. I've just. I've really come around on just how important sleep is it. Personally, I'd wrestle with it a lot. I'm I'm an early morning. Because I just. I really want to tackle the day. But sleep is so essential for our brains to process emotion, to process what the day was. So I think having boundaries around sleep. And I I know people's homes life are really complicated. So I don't want to minimize that, but we can also get in our own way. And I. Think that was part of what you were asking. Or that's how I'm interpreting part of that. It's like given given. Whatever our circumstances is like, where should we invest and sugar is a stimulant and sometimes really helps us get through in a pinch and. And we can have too much of it. So, so sleep and sugar are personally for Patrick, things that I've been working on for the last probably 18 months and not totally giving it up, but just just paying a little bit more attention again that the little 10%. And then movement is a really big one. It's it's very difficult for folks that are on their feet all day to imagine moving more. So maybe things like stretching are more more along the lines of what's needed. But really taking care of our body is. Is really important because our our bodies help us do. So much and I I think so many of us and so many nurses that I've worked with, just talk about being so exhausted. Right. And and of course, it's paradoxical that says when we, when we exercise, when we stress our bodies more, we can handle stress better. But it's like, are we making time for for these more positive? Sorts of stress moments and again, I know. I know this doesn't always fly, but it just I can't not highlight it enough. I think boundaries are really essential. What's really difficult I think for so many of us is what is our connection to outside of work while we are at work and and somebody had mentioned this just this last week like no one. Would really allow a nurse to bring a child onto the floor of the unit, right? That would be irresponsible and yet so many of us and and I'm in on this as well. But we're we're pretty connected to the outside world while we are doing our work at work and and I'm not even judging that or saying that that's a bad thing. But what I will say is that is a lot to balance and navigate over the course of a day. So we just want to be mindful of that. Just something to think about where's where's our boundaries. You had mentioned how can a how can a nursing leader maybe support someone? I think we all want to take better care of ourselves and to be more resilient, to engage in some of these activities. We've actually had a number of organizations build it into their annual reviews. So they they set a goal. OK, here's a goal that I have to increase my resiliency and maybe it's I'm gonna make sure that I drink 2 liters of water during every shift, for example. Say this. This is a quarterly goal. By sharing that with a supervisor, by even putting it in writing, it increases the likelihood because we've we're in the shared bond of I want to help you. Like, let's let's all support each other and this gets back into the culture piece and the systems piece. Of just healthy accountability and that accountability, and if you don't accomplish this goal, you're gonna be it's gonna. There's gonna be a punitive experience after this. But just to be in a relationship about being healthy together again, getting away from, I'm going to go take care of myself in isolation, but rather, how can we collectively support each other? Because this is really hard and to be able to make time and space for ourselves in caring for other people is. Next to impossible. So how can we again create a dialogue around? So what are? What are some of your favorite things? Like what are, what are the things that you're working on these? And I think for leaders to also share what they are working on, there's some really great work around psychological safety. You know it at in the workplace, what is our ability to bring up things without negative consequences so that there's this whole field of study around psychological safety. And they say that one of the best ways to develop psychological safety is from a leaders perspective. To share what they're working on to improve themselves. So I think there's a great opportunity for nursing leaders specifically to share some of the things that they are working on themselves.

Nicole Weathers

Yes. And I think that that you know that is even something I try. To do with my. Team too is is talk about like I'm really trying to work on boundaries around work and not answering emails outside of this time frame and I and I do think that by me talking about that with my team, it gives them the permission to say ohh, you know, maybe. Maybe I I thought she expected me to respond to these things outside of this time frame or be available 24/7, but if she's working on not doing that, maybe that's OK then for me to do that. As well.

Patrick Jeffs

I mean what a healthy conversation around expectations of responding. There's all these assumptions around this and no. 1. Really ever has the conversation around. When am I supposed to be available? So then we all just default to. I'm supposed to be available. 20. 4 hours a day and that's not sustainable.

Nicole Weathers

And it's a lot of times the I think the story that we make up in our head. Right, for whatever reason, we have developed this way of thinking about work and. When we start having those conversations, we realized that like no one ever expected that in the 1st place and maybe for whatever reason, that is is the default. You know, we live in this world of hustle, like you said, busy, always moving on to the next thing and it's OK to slow down. And I think to the quality, quality of our work sometimes. Next up, when we slow down.

Patrick Jeffs

You all are helpers, right? I consider myself a. Helpers disproportionately have a great excuse to do more and push harder, right, because that there's direct impact, you know, let me see another pic. I have this really strong relationship with this patient. Like, let me just let me call in and check on them right and that's. Because it really matters for nurses. It does make these boundaries like thinking back to for everybody listening. Like, why did you get into this in the 1st place and how do you protect yourself from the other side of that coin so that you can continue to do this for a really long time? When we're moving. Too fast. That is a really difficult thing to sort through.

Nicole Weathers

I agree. I definitely agree, and it is hard. I mean, it is hard when you know, Speaking of like we're the helpers, right? We we like to care for people. We like to help people. We're working in these healthcare organizations where there's a lot of workforce issues right now and people are short staffed and we don't want to leave our coworkers. Bringing short staffed right. So then we pick up another shift or we, you know work extra and and those things are good and we can sustain that for so long. But then there comes that point where it's too much and that's another thing that leads to burnout a lot is because we feel like we have to be the ones to fix it and help. And and be there. But we do have a whole team and there's a lot of people that can help with that. And there are other alternatives out there, even though sometimes those are hard from a systems level as well to get. OK. So, clinician wellbeing resiliency in healthcare, we talked about how this is a fairly new concept and I am so excited to see it being integrated into the work that we are doing with our nurse residency, but also healthcare in general. So I would love to hear now what are some of your maybe current projects? What do you where do you hope to see this work go in the future?

Patrick Jeffs

Yeah. I mean as far as where I see the work in the future, I just, I want to see more champions. I want to see more champions on the ground in the units who like a a Chief Resiliency officer or even just not just but you know a a head nurse. Or someone with a nursing degree, a social worker. Who? Who is? Tasked with protecting the resilience of the organization right now it's just some some rogue people like yourself are, you know, these visionaries who are trying to put it in all of these places. But there's, I can imagine, it feels lonely sometimes. So. So my my biggest vision and. And where I see it going is. Kind. Of train the train, the trainer models, building champions. Who are really spreading this? You know, it really only takes about 3% of adoption to change a culture, whatever the thing. Is. And and I think we're actually pretty close to that in, in a number of different areas. Certainly it's gotten a lot of traction since COVID. If we're thinking about, you know, a silver lining around. COVID the the. Expectations, the language around and understanding of the need for resiliency has never been higher. In the 17 years that I've been working on it. So I. I think there's a. Really great opportunity. It just needs to be solidified. There just needs to be a couple of these small practice. That are built into the systems. So that's a lot of the projects that I'm working on right now, it's really about how do we build these into the systems. We're also what's what hasn't been happening that that we are really facilitating more and more is a lot of people collaborating on the solutions. So we run little Micro focus groups like a 20 minute session. So you know on the floor, on the unit bringing all the nurses together, sometimes it's eight, right, sometimes it's 14. And just having very brief targeted conversations about what do we need to do, what practices are people doing that is working and really utilizing time together, just building the conversation and not let's all list out all of the difficult things that we're going through that's. It needs to be so solution focused. I stopped actually talking about burnout as a concept years and years and years ago because it it it was preaching to the choir really right. And there's a point where unless you are giving really strong. Oceans. You're not really helping me here, so a lot of the projects that we're working on are battling people, right? So we're trying to develop a number of people who can just shadow somebody for a day or shadow the entire unit and and have eyes on people. You know, you can have. Somebody come back into the at the workstation and say, hey, Stacy, how should we thing right? And so having someone. Someone who's in charge of that, and quite frankly, it can be anybody and they can have, you know, minimal training like some of the things that we've done with folks. But if they're responsible for it, maybe they're just responsible for it for a month and they don't have to. Do anything extra. But it's just, hey, like I got you all this month and having that rotate, I think bringing more people in to be responsible for everyone else's residency in a really healthy. Supported way. That's a lot of the projects that we're trying to sort out, right.

Nicole Weathers

Now, that's great. I love this idea of a Chief resiliency officer. Like, I wonder it would be so interesting to see the impact of that in these organizations. So of that, OK, so we've talked about a lot of great things today. You know, we talked about clinician wellbeing and resiliency and definitions for resiliency. We talked about system issues and system fixes. We've talked about individual approaches to building our capacity and we've talked about the future here of what maybe you would hope to see. When it comes to these topics, so before we go, I have one last question and I know we've talked about wellbeing and building resiliency in all clinicians. And as you know though we work of course specifically with new graduate nurses. So when it comes to this transition into practice, so this is true, whether it's nurses or social workers or like you said, there's this period of stepping from academia into the working world and it comes to these topics that we've talked about. What's one thing that maybe you see organizations doing? Thing maybe wrong or maybe you feel like they're wasting resources on that really isn't making a difference for those individuals. And what would you tell them to do instead?

Patrick Jeffs

I'm going to answer it just a little slightly different, but it has to do with what's not working. So what's not working is expecting. Everyone besides leadership to be in on. It. Right. It's like all the all the frontline, all the nurses, you know, they're the ones that are struggling. They need this help and and that feels virtuous for administrators or leadership often to to want to get their. Their folks help, but unless we are weaving this into the fabric of the organization, I think it would. It lands a lot better. If if leadership and whatever that looks like right, whatever levels people are landing, that's landing with folks having leadership be a part of the conversation, being in on some of these as well and really understanding that this is what it's going to take to really change in organization because. Too often talk about wasting resources. Somebody will send you know. A group to trainings or they'll bring somebody in like me, and without the without the real buy in. You know, it'd be like, hey, we need a car. OK, go. Go ahead and go buy a tire. And then maybe next quarter we can buy another tire and then, you know, maybe by the end of the year. I have 4 tires. That's like, but we need a car.

Patrick Jeffs

So it it needs to be semi comprehensive in nature. So I do you know I I I point to leadership and I've been really amazed and surprised how often I've come into an organization because Someone Like You, someone I on the front. Line. Has just put it up the. Chain of hey, can we can we try something? Can we do something a little? Bit different so. I I guess in closing I would, I would encourage especially new nurses. Just to try to introduce things like maybe take a risk because if somebody hasn't been entrenched on the same unit for five years, 10 years they they might be so locked in that the idea of change is just like they can't even imagine it. And yet maybe they would really welcome. New ideas, new ways of doing things as well, so I would encourage folks to try to make change and that it might be really welcomed.

Nicole Weathers

Excellent. All right, Patrick. Well, I feel like we could continue this conversation for a whole other episode probably, but I do think we've came to the end of our time. So I just want to thank you so much for being here with sharing all of these great things with myself. I mean, I always learn something new every time I talk to you. But also our listeners, so I appreciate you and all you're doing in this field of resiliency.

Patrick Jeffs

Thank you for having me. It's been great. To be with you over all of these years to the future.

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 residency 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 wellbeing competencies and new graduates. Even get the opportunity to create real change in their own organization. How cool is that? 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.