In recent years, Cleveland Clinic has turned increasing attention to helping its nurses deal with job stress and work-life balance issues. Cleveland Clinic’s high acuity environment, like so many others, can present nurses and other caregivers with ongoing physical and emotional challenges that can lead to burnout and poor health.
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A study featured in the American Journal of Critical Care found that nurses working in high-risk, high-pressure environments are more vulnerable to burnout because of patients’ intense needs and uncertain outcomes. However, nurse burnout is indeed a profession-wide issue.
In a May 2017 study led by Kronos Inc., 63 percent of the 257 U.S. nurses studied had suffered burnout. And, almost all of them described their work as mentally and physically demanding.
Similarly, healthcare market research and consulting company, PRC, released a 2018 report that included survey findings from more than 2,000 healthcare partners. According to the study, 15.6 percent of nurses reported feelings of burnout. Of those who planned to remain in their organizations, 97 percent said they experience emotional exhaustion.
Numerous studies like these have long supported the belief that nursing is one of the most stressful occupations and that nurses’ physical health and emotional well-being often are adversely affected by their jobs.
If the issue of burnout is not addressed, hospitals stand to lose as well, as nurses can become disengaged, and eventually opt to leave their profession. And, severe levels of stress are not only unhealthy, they can negatively affect patient care.
“As healthcare continues to evolve, more than ever, today’s nurses are faced with added stress and pressure. Their roles are expanding, they are continuously learning new processes and technologies, and the pace of all this change is incredibly fast,” says Kelly Hancock, DNP, RN, NE-BC, FAAN, Executive Chief Nursing Officer for Cleveland Clinic. “It’s highly important to support nurses and meet them where they are, addressing their current health and wellness needs. When a nurse’s personal wellness suffers, they cannot be at their best – for themselves, their patients or their families.”
Across Cleveland Clinic health system, there are more than 28,000 nursing caregivers. Cleveland Clinic’s Stanley Shalom Zielony Institute for Nursing Excellence partners with other Cleveland Clinic entities, such as the Employee Wellness Department, Office of Caregiver Experience and Centralized Staffing Operations to help reduce stress, increase job satisfaction and support work-life balance.
“We want to make a positive impact on the stress levels of our caregivers,” says Holli Blazey, CNP, Nursing Wellness Coordinator for Cleveland Clinic’s Employee Wellness Department, which offers a full menu of programs geared toward improving health and well-being.
For example, one of Cleveland Clinic’s Workplace Wellness programs is the e-coaching program. This is a 6- to 7-month long e-mail program that helps bridge the gap between knowledge and action in achieving a healthier lifestyle.
It includes e-coaches, such as social workers, nutritionists and others who provide participants with personalized guidance, support and accountability along their wellness journey. Coaches work with participants to establish goals and discuss topics based on those goals, such as: healthy eating, exercise, mindfulness and relaxation techniques or proper sleep. Participants are encouraged to communicate with their coaches two times per week.
Blazey also notes that Cleveland Clinic’s yoga offerings now include more than 16 onsite yoga classes at 12 Cleveland Clinic locations, online 5-, 7-, 10-, 15- or 20-minute “yoga on demand” demos, and a 200-hour teacher training program.
Other wellness offerings available to nurses, include:
In the past, Blazey and her team have partnered with the Nursing Institute to spearhead an annual Nursing Wellness Retreat, which featured Reiki, yoga, cooking classes, massages and more. In 2019, the annual event transitioned to a ‘traveling roadshow.’ And, new this year, the Nursing Institute will be hosting its first-ever Health and Wellness Nursing Fair during National Nurses Week (May 6-12, 2020).
Blazey says Cleveland Clinic nursing caregivers who are aware of the wellness offerings greatly appreciate and enjoy the programs. However, ensuring nurses know what is available to them is her team’s biggest challenge. To help spread the word, she regularly gives presentations at different health system locations. Additionally, Blazey and her team collaborate with the Office of Caregiver Experience (OCE) on a newer OCE initiative called Thrive Where You Are.
OCE’s mission is to make Cleveland Clinic the best place to work in healthcare and the Thrive Where You Are events were developed after learning caregivers wanted more information on personal and job growth opportunities, resources and benefits. The events last for a few hours and are held periodically throughout the health system to provide caregivers with the information they are seeking.
Events include a ‘Healthy You’ component in which caregivers receive health and wellness information, customized to their personalized needs. In February, an event was held specifically for nursing caregivers at Cleveland Clinic’s main campus. Roughly 400 caregivers attended and, in addition to information, nurses were also provided a healthy lunch.
Another key component to ensuring nurses’ personal well-being and job satisfaction is staffing and scheduling. Since 2010, Cleveland Clinic has been utilizing the Kronos® workforce management system. The Kronos Mobile App allows nurses to see their schedule, pick up open shifts and request time off.
“A manager truly works to accommodate nurses’ scheduling needs and wishes, which helps support work-life balance,” says Meg Duffy, MS, BSN, RN, Senior Director of Staffing and University Outreach.
Once a schedule is posted, adjustments may be needed in response to census fluctuations and last-minute staffing changes. To manage these changes, the implementation of SMS Quick Fill through the Kronos system allows Centralized Staffing Operations’ staffing associate caregivers to send text messages to alert nurses about shifts that suddenly become available.
“A top priority for the staffing office is to ensure safe staffing levels with the correct skill mix. When this is achieved, nurses feel more supported and ultimately more engaged and satisfied,” says Stephanie Gargiulo, MSN, BSN, RN, Nurse Manager, Centralized Staffing Operations for the Zielony Nursing Institute. “It makes a difference to nurses when they know we care.”
Additionally, in today’s age of technology, immediate access to health and wellness information is a must. On the Cleveland Clinic human resources portal that is available to all Cleveland Clinic employees, a “My Well-Being” tab is dedicated to “one-stop shopping for wellness activities and resources,” says Jill Prendergast, Senior Human Resources Director for Nursing.
The portal houses links to a full menu of support services, including the Healthy Choice program for employees to earn significant discounts off their health insurance premiums by meeting personalized medical, fitness and nutrition goals. Of the more than 36,000 health plan members who participate in Cleveland Clinic’s Healthy Choice program, 52 percent are in coordinated care programs to manage chronic diseases.
From the HR portal, nurses can also access their individualized career development plans, total compensation and benefits package and information on the many wellness activities available to them.
Additionally, Employee Wellness recently added a “Refresh” section to its website. The new section offers mindfulness classes, a 3-part class on stress and burnout, web-based programs on reducing stress and improving sleep, a digital toolkit on breathing, meditation and mindfulness, a ‘Mindful Moments’ app for guided relaxation, and a variety of additional tools, techniques and practices to support mental and emotional well-being.
Across the health system, nurse leaders and unit managers take advantage of Cleveland Clinic’s health and wellness offerings. Some unit managers have brought in massage therapists, Reiki practitioners and pet therapists/dog dyads. Others have held nutrition classes on nursing units and organized staff participation in Cleveland Clinic’s 5K nursing run and VeloSano cycling event as members of the Nursing Institute team, which is led by Hancock.
Employee Wellness met with a nursing unit recently to pilot the idea of a ‘wellness corner,’ which will feature coloring cards, relaxation techniques, yoga and more.
Another new pilot program that is underway is a nurse resilience group on burnout prevention. This pilot offers group therapy sessions at Cleveland Clinic main campus’ Center for Behavioral Health. In the sessions, participants discuss everything from the prevalence of burnout among nurses and the risk factors for burnout to sources of stress in the clinical setting and resources for supporting resilience, wellness, self-care and more.
Additionally, earlier this month, Cleveland Clinic’s Executive Nurse Leadership team participated in a session on using gratitude to help prevent burnout. Next, the session is going to be presented to nurses in Cleveland Clinic’s Florida region.
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