NURSES WEEK SPECIAL ISSUE 2022
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Table of Contents
In This Issue
Articles
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12 Nurse Resilience Through the Pandemic
Nurses’ Notebook
By Nachole Johnson, MSN, FNP-BC
16 ANA Commission Survey Reveals Extensive Racism in Nursing Industry By Julia Quinn-Szcesuil
22 The Pros (and Cons) of the 12-Hour Shift in Nursing By Michele Wojciechowski
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Nurses’ Notebook Resiliency through the Eyes of Two Frontline Nurse Leaders Resilience is a multi-faceted word. It is associated with a comeback after a setback, the ability to bounce back after an injury or physical or emotional trauma. An image of a stretched rubber band may come to mind, bending and expanding to its maximum capacity then easing back into its original form with time. Resilience is perceived as a positive quality. Resilient people are those who have faced adversity yet continue to rise to the occasion if challenged to do so. However, resiliency is not a characteristic we are born with. Instead, resiliency is an attribute that is fortified by simple acts occurring in our daily lives. In the world of nursing, resiliency became front and center during the pandemic. During the early stages of the pandemic, the public hailed nurses as healthcare heroes. Suddenly, our everyday triumphs and struggles were the headlines of news stations, newspapers, and social media. “Thank you” donations flooded hospitals to show support for the healthcare teams. Unbeknownst to some, nurses have demonstrated these “superhero” strengths since the inception of our beloved profession.
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However, we would like to paint a picture of what resiliency looked like inside the walls of our academic medical center. Although nurses have always demonstrated some form of resiliency, the pandemic showed another dimension of resiliency. Resilience was showing up day after day to care for patients infected with a virus we did not know much about. It was signing up for extra shifts to support our colleagues when ratios were rapidly changing to meet the sudden increase in patient flow. Resilience was surviving the most demanding, distressing, and downright exhausting two years that nursing has faced in recent history. Yet, we held onto the hope of better days. As time passed, we began to see that being resilient was more than just going through the motions of getting dressed and showing up to work. After speaking with many nurses, it came through loud and clear that being resilient is hidden in the simple things. Resilience was rooted in our faith, time spent with friends and family, or giving back through volunteerism. These are all ways we engaged in self-care and leveraged a number of outlets that refilled our cup so that we could keep persevering.
Andrew Bennie 212-845-9933 abennie@springerpub.com
As nurse leaders, we never thought the word resilience would be tossed around so much. Increasingly throughout the pandemic, each day colleagues and healthcare leaders were discussing resiliency like never before. Before the pandemic, resilience was just a vocabulary word we knew but never understood. Now in some circles, resilience has become an expectation. As the healthcare profession comes to the other side of these last two years, we are truly trying to understand how nurses can bounce back. Only through reflection can we find some of the answers we are now seeking. How were nurses able to show up and extend compassion and empathy to those in their care during one of the most challenging times of their careers? How were nurses mentally able to weather the storms associated with a pandemic? What lessons have we learned about our personal and collective resiliency? What lessons did we learn when supporting other nurses in our organization during the pandemic? Today, we are facing a time in nursing where we need to be creative in how we move forward in the profession. After facing so many stressors over the last two years, there is more burnout, depression, compassion fatigue, and anxiety amongst the nursing
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staff. How does an institution retain staff who are experiencing some of these situations? How do we make the nursing profession attractive to new recruits? We believe, as frontline nurse leaders, we need to focus on the wellness and well-being of all nurses. We need to advocate for a stronger emphasis on work-life balance. We also know that nurses are not good at taking care of themselves. The last few years have made us realize if we cannot take care of ourselves, we will not be able to take care of others. We will not be able to bounce back or demonstrate the resiliency that is required during tough times. Thus, a supportive environment is critical. We need the support from hospital administrators and healthcare leaders so that we can support others. Thankfully, we work in a supportive environment where we have access to tools and resources to help nurses do a better job at engaging in positive self-care practices. Of importance, as leaders who are supporting others, we need to be able to learn how to take care of ourselves first. Once we build our personal resilience, we will be able to help others handle the daily stressors that come with nursing every day. It’s only when we build our personal resilience that we will, in turn, be able support others as well as demonstrate the resilience needed to meet the challenges of one of the hardest, but most rewarding professions in the world, nursing. —Justine K. Alipio, BSN, RN, CCRN, and Lisa Phalen RN, BSN, RN-BC Rush University Medical Center
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Nurse Resilience Through the Pandemic BY NACHOLE JOHNSON, MSN, FNP-BC
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aring. Trustworthy. Empathetic. Problemsolver. These are all words used to describe a nurse, but there is one more word that has represented the nursing profession over the past couple of years—resilience. Of course, nurses have always demonstrated resilience, but it has never been so palpable until now. The COVID-19 pandemic has tested the resilience of nurses on the frontlines for more than two years now.
What is Nurse Resilience? “Resilience to me was walking into the pandemic not knowing the outcome or impact it would have on patients or health care, but charging full force ahead,” says Kim Shapiro, DNP, FNPC. “We did not know how to
“Resilience to me was walking into the pandemic not knowing the outcome or impact it would have on patients or health care, but charging full force ahead,” says Kim Shapiro, DNP, FNP-C.
treat many of these patients early on, but we adapted.” The nature of nursing involves quickly adapting to rapidly changing circumstances regarding patient acuity, staffing changes, and policy. Therefore, being resourceful and adaptable is an absolute necessity as a nurse. Kelly Korb, RN, a nurse case manager for an outpatient substance use treatment program adds, it’s
imperative to “be able to be flexible and a team player despite these changes.” Shapiro and Korb are spot on regarding the critical attributes of nurse resilience. Resilience in nursing includes social support, self-efficacy, work/ life balance, practicing selfcare, having a sense of humor, optimism, and being realistic. These traits allow nurses to adapt to the stressors of the job positively. These characteristics are demonstrated when nurses are able to bounce back quickly after significant workplace stressors like the death of a patient or a worldwide pandemic.
How the Pandemic Has Tested Nurse Resiliency During the pandemic’s peak, nurses were lauded with praise for being “heroes.” This viewpoint quickly faded as the pandemic progressed. Nurses supported those in need by being there for them even when the outcome was unknown. “Nurses worked together to get us to this point in the pandemic. We put ourselves and our families at risk working alongside the COVID population, not knowing if we were going to bring it home to our loved ones,” says Shapiro. Economic reports may present a bleak picture of
Economic reports may present a bleak picture of healthcare professionals leaving their current professions in the “Great Resignation,” but there are still nurses who thrive in their role and wouldn’t ever think of leaving.
healthcare professionals leaving their current professions in the “Great Resignation,” but there are still nurses who thrive in their role and wouldn’t ever think of leaving. Korb loves her job just as much as she did when she first became a nurse in 2013. “I love my patients. Everything I do, I do for them. They are deserving of a safe place to heal and grow in their recovery.” While discussions on nurse resiliency pre-pandemic were typically reserved for known high-intensity areas such as critical care and the emergency room, nurses who have worked in any clinical capacity during the pandemic need support more now than ever. Nurse resiliency was tested to the breaking point for many and continues to manifest itself in multiple forms when it comes to the nursing profession. Helping nurses become more resilient in practice can help conditions that nurses are all too familiar with—burnout, stress, anxiety, and compassion fatigue.
How to Foster Resiliency in Nurses In order for nurses to develop and sustain resiliency in today’s healthcare environment, there has to be a collective agenda among nurse leaders and institutions that employ nurses. There is no true way to estimate the depth of how the pandemic has affected—and will continue to affect—the mental health of nurses from this point forward. Resilience first needs to be acknowledged as something that can be fostered through education and support. Developing nurse resiliency has to start within the
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In order for nurses to develop and sustain resiliency in today’s healthcare environment, there has to be a collective agenda among nurse leaders and institutions that employ nurses. educational system to proactively address any mental health conditions that may develop while in clinical practice. The manner in which resiliency should be taught can be debated, but the nursing profession can model military training on the subject. Military personnel are subject to many situations that parallel nursing in stressful situations like a pandemic. The U.S. Army developed Master Resilience Training (MRT) to foster a proactive approach to post-traumatic stress disorder (PTSD) among soldiers. Nursing leaders could develop training for both students and experienced nurses to address mental health issues related to nursing practice, including depression, PTSD, social dysfunction disorder, and anxiety. For educators to provide a more holistic approach, programs can extend training to the families of nurses. Critical elements of nurse resilience include social support and a proper work/ life balance, so it’s only natural that resilience training is extended to families of nurses. Nurses who are active in the workforce should have continuing education to reinforce resilience training by employers to keep their staff optimistic and functioning at their best. Despite the massive impact the www.springerpub.com
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pandemic has had on health care, Shapiro remains optimistic: “I don’t believe many healthcare professionals feel like we have bounced out of the pandemic yet, but I know in my heart we will.”
Nachole Johnson, MSN, FNP-BC, is the CEO of ReNursing Edu and author of multiple titles that focus on NP education and business. Her vast experience allows her to offer knowledge to help others in nursing; whether wanting to pursue graduate NP studies or wanting to start their own business.
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ANA Commission Survey Reveals Extensive Racism in Nursing Industry BY JULIA QUINN-SZCESUIL
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s the nation continues to grapple with racism and its impact, the trickle-down effects of racism are found in every aspect of society—including the nursing industry. A recent report by the American Nurses Association’s National Commission to Address Racism in Nursing revealed high incidents of racism by nurses who have spent their careers experiencing or witnessing racism in their workplace. “The numbers and the information coming out of the report is stark when you see it on paper,” says Adrianna Nava, PhD, MPA, MSN, RN, a co-lead of the report and president of the National Association of Hispanic Nurses. “This is a larger societal issue, and it bleeds into all sectors and professions.” The ANA Commission conducted a survey of more than 5,600 nurses nationwide to ask them about their experiences with racism in the workplace. More than half of respondents (63%) said they have personally experienced racism in the workplace (92% Black nurses; 73% Asian nurses; 69% Hispanic nurses). While discrimination could come from leaders and colleagues, 68% of Black nurses said they were the targets of racism from patients.
Bringing Racism to the Front The report doesn’t provide solutions, but that’s not the point, says Rumay Alexander, EdD, RN, FAAN, and a professor of nursing at the University of North Carolina at Chapel Hill. “This is putting a light on the subject,” she says. “It’s a bold move for nursing to go into this space. Because if you don’t acknowledge what’s
occurring, you can’t address it.” No matter how much it’s discussed, an overnight fix isn’t possible. “Changing a culture is difficult,” Nava says, “and it can take years. But we can look at the data and work within our own organizations to do a pulse check to see where it’s at.” Alexander agrees, noting that making change, as difficult as it is, brings innovation to the workplace. “You can’t keep a policy in place for 30 years and think it’s still applicable now,” she says. Because the alarming numbers are gleaned from nurses’ lived experiences, reading the results requires some historical perspective. “We sometimes think if we don’t bring something up, it’s not happening,” says Alexander. Decades of bias, intentional and unintentional, has shaped attitudes, working environments, and workplace policies, she says, which can translate into hiring and promotion practices, strategic planning, retention work, leadership roles, and resource allocation.
Because the alarming numbers are gleaned from nurses’ lived experiences, reading the results requires some historical perspective.
What Racism in the Workplace Looks Like The survey invited nurses to share stories which give insight to what racism looks like to different people. Racism is sometimes as blatant as being
called a hurtful term or feeling racism from a patient. “It’s challenging with a patient’s preference,” says Nava. “When
The survey invited nurses to share stories which give insight to what racism looks like to different people.
they say, ‘I don’t want a Hispanic nurse; I want a white nurse.’” Then the nurse has to treat a belligerent or agitated patient or walk away feeling that discrimination deeply. Other times, racism is as subtle as being passed over for a deserved promotion, having a supervisor take credit for your work, or a course curriculum that’s not inclusive. “The question isn’t ‘is there bias here?’,” says Alexander. “The question is: ‘how does it show up?’ It’s not always intentional, but it’s still there.” Nurses who experience racism in the workplace are sometimes hesitant to report what happened. They may fear retaliation from peers, supervisors, or even patients. “Discrimination is really hard to prove,” says Nava, “and it’s about how it makes you feel. It’s challenging to be the trailblazer and speak up.” Organizations can support nurses in several ways, says Nava. Workplaces can provide resources including mentorship to help nurses navigate, education about state and federal policies, and human resources support for benefits or to understand the employer’s diversity initiatives so nurses can advocate for themselves.
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Alexander says individuals and organizations must work from the inside out—meaning they must critically examine values and beliefs to create an organizational environment where everyone can flourish. “It is not a one-size-fits-all process,” she says. And it starts with purposeful self examination that gets to the difficult topics and behaviors, she says. A diversity council isn’t helpful if it’s not examining the root of the problems.
Nurses as Advocates As this kind of racism reflects a larger societal issue, it can’t really be separated out as a nursing or health care issue. A greater and more robust approach to anti-racism practices takes work and emotional fortitude, says Nava. Organizations and nursing leaders must recognize that nurses who experience discrimination can contribute their stories or advocacy, but they’re
Nurses who experience racism in the workplace are sometimes hesitant to report what happened. They may fear retaliation from peers, supervisors, or even patients.
already burned out and cannot shoulder the burden of leading the charge alone. Nurses who want to find ways to make an impact can increase their influence by seeking out leadership or advocacy roles, says Nava. They can also branch out of their workplaces to work in government and to shape nursing policies
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Organizations and nursing leaders must recognize that nurses who experience discrimination can contribute their stories or advocacy, but they’re already burned out and cannot shoulder the burden of leading the charge alone.
and practices nationwide or in academia to teach equitable and inclusive nursing practices to the next generation of nurses. And for nurses who want to improve their immediate working environment, Nava suggests talking to colleagues and leaders to find ways to improve patient care and nurses’ wellness. If your own unit isn’t receptive, take it to other areas outside your unit.
“Ask the staff what they need,” says Nava. “And create action plans. It’s the only way to make it better.”
Julia Quinn-Szcesuil is a freelance writer based in Bolton, Massachusetts.
Survey Findings continued on page 1
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The Pros (and Cons) of the 12-Hour Shift in Nursing BY MICHELE WOJCIECHOWSKI
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or about 50 years, one thing has remained the same in the nursing field: the 12-hour shift—at least in hospitals and medical centers. The typical work week for these nurses is 7:00-7:00, either a.m. or p.m., for a total of 36 hours a week. But is it the best type of schedule to be working? “This approach to scheduling nurses started in the 1970s to address staffing challenges and caught on with health care systems, as it enabled easier scheduling practices when each nurse needed fewer shifts per week,” explains Kathryn Kay, DNP, RN, PCCN-K, Vice President, Academics at Emeritus Healthcare. “The longer shift also provides greater continuity in care, fewer hand-off reports, and supports the primary nursing care model that has been around for decades.” There are lots of benefits to this 3-days-on, 4-days-off schedule. “Having the extra days off allows for shopping during the week to avoid crowds, attending doctors’ appointments, or taking your children to theirs,” says Elizabeth Cantu, RN, BSN, who works at Float Healthcare and is a Certified Transformation Coach at Invida Coaching LLC who works with nursing suffering from burnout. She says some other benefits are making time for a hobby or side hustle
“The longer shift also provides greater continuity in care, fewer handoff reports, and supports the primary nursing care model that has been around for decades.”
or having the time to pursue higher-level education. “The importance of worklife balance with bedside
“The importance of worklife balance with bedside nurses is a major draw to this type of scheduling practice,” says Kay.
nurses is a major draw to this type of scheduling practice,” says Kay. That said, there are cons to the 12-hour shift as well. For example, while the shift is technically 12 hours, Cantu says that it’s often closer to 15-16 hours. “The cons can include prolonged exposure to stress, an empty self-care tank at the end of the day, disconnection from family and friends, and the time spent away from the home, with drive time, can be longer than a typical 40-hour week. Long, fast-paced shifts keep you in high-stress mode, making it more difficult to close the stress cycle after a long day,” Cantu says. Research has shown that these longer shifts can be harmful not only to nurse, but also to their patients. “Evidence has demonstrated that while nurses prefer to work twelve-hour shifts because of perceived work-life balance, those working that schedule are more likely to experience burnout than those working shorter shifts. Evidence also demonstrates that the further out the shift gets from eighthours, the greater the risk for a patient safety event. Overall, longer-shifts are demonstrating
a cumulative negative impact on nurses’ well-being,” says Kay. As for patients, studies show how they can be affected negatively as well. “There is an overwhelming amount of evidence that demonstrates that nurses and providers are at greater risk of a patient safety errors after the first eight hours of their shift. Sentinel Event Alert 48: Healthcare Worker Fatigue and Patient Safety particularly calls this out,” Kay says. Maile Mercer, MSN, RN, CCRN, a PhD Student at NYU Rory Meyers College of Nursing, shares more evidence that long shifts aren’t good for nurses or patients. She explains, “While at work, nurses often run nonstop through their shifts, skipping meals and even bathroom breaks. University of Pennsylvania researchers found that longer shifts can lead to burnout and job dissatisfaction and can push some to leave the profession altogether. Long shifts can also lead to health problems that reverberate across nurses’ lives, including fatigue, injury, cigarette smoking, increased alcohol use, sleep deprivation, and episodes of drowsy driving.”
Research has shown that these longer shifts can be harmful not only to nurse, but also to their patients.
“Some of the issues related to 12-hour shifts may spill over to patients as well.
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Evidence suggests that nurses are more likely to make mistakes when they are nearing the end of a long work shift. One study led by researchers at the University of Pennsylvania found that hospital nurses were three times more likely to make an error when their shifts exceeded 12.5 hours,” says Mercer. “There are other professions—pilots and truck drivers, for example—that have limited consecutive work hours for safety reasons. This may be worth considering
But the problem that arises is: if nurses weren’t working 12-hour shifts, how many hours should they work?
for the nursing profession as well.” But the problem that arises is: if nurses weren’t working 12-hour shifts, how many hours should they work? “Eight to nine hours per shift seems to be a consistent theme in the literature as not impacting nursing or patient well-being. However, I would challenge we should still explore alternate and more creative staffing approaches that promote the work-life balance the nursing profession looks for with their scheduling,” says Kay. “Promoting technology that allows for creative scheduling practices is one way to explore alternative ideas to the traditional twelvehour scheduling practice we have come so accustomed to. Staffing shortages are going to be around for the next several years, and we need long-term and short-term approaches
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to solving this challenge. Valuing nurses’ desire for scheduling flexibility and work-life balance should be at the forefront of nursing and health care leaders’ strategic plan in recruiting and retaining a high performing team.”
Michele Wojciechowski is a national award-winning freelance writer based in Baltimore, Maryland. She loves writing about the nursing field but comes close to fainting when she actually sees blood. She’s also author of the humor book, Next Time I
Move, They’ll Carry Me Out in a Box.
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