By Dorothy Brooks
Understanding the critical importance of nurse well-being in a robust healthcare system, Washington, DC-based MedStar Health created a new position dedicated to this work in 2021.
Crystal Morales, MS, BSN, RN, then the senior director of education for the MedStar Health Institute for Quality and Safety, was tapped to be the direct of nurse well-being. Since then, Morales has been blazing a trail focused on learning everything she can about what nurses need to feel valued and supported in their work, and how to ensure their well-being needs are met.
It helps that Morales is a nurse herself, but she quickly recognized the needs of colleagues vary considerably based on several factors. “We have nurses who are in their early 20s, but then we also have nurses who are in their late 60s who are nearing retirement. Well-being means something different to everyone along that pathway,” Morales says. “It is my job, essentially, to understand who is in our system, what their needs are, what well-being means to them, and then to create programs that ensure we have resources to support all their needs.”
Morales began by asking nurses about their well-being needs. A few trends emerged immediately. “Everyone wanted to better understand what mental health resources were available,” she says. “They also wanted education ... to better understand why they feel the way they do.” Nurses also wanted resources for their families, and they wanted options for physical fitness activities in which they could engage outside work.
To meet some of these needs, Morales realized MedStar’s peer support program, which was developed to assist clinicians involved in adverse events, needed to be strengthened and expanded.
For instance, while the program used to wait for clinicians to reach out for help, Morales understood that with COVID, that was not going to work.
“Everyone was in crisis, so we needed to take this to the frontlines,” she says.
Thus, Morales and other peer supporters from MedStar’s Care for the Caregiver program began conducting wellness rounds on the frontlines to ask staff about needs and offer resources on the spot. In addition, Morales set up a 24-7 peer support hotline so nurses could call any time. “It is completely confidential, and then we return any calls within 20 minutes to those individuals who are reaching out,” she says.
In fact, the need was such that Morales required more people to help with her mission of well-being. Morales set up training sessions for volunteers, and developed a tiered approach for offering support. “Right now, our tier one supporters are just our boots on the ground; they are the advocates,” she says, noting these are people who will tell staff members about available resources.
“Our tier two supporters are those who actually provide the [peer-to-peer support] intervention, and will take calls from the hotline,” Morales shares. “Our tier three folks are where our trained professional partners come in for staff members who may need more than just peer-to-peer coaching or support.”
For example, tier three supporters are for staff members who may need to connect with a psychologist or a psychiatrist for themselves or for a family member.
A second resource Morales put into place is resilience coaches and nurse well-being specialists. “These are trained mental health professionals ... they perform that just-in-time coaching,” she says. “Anything that nurses might need around stress management, dealing with different forms of anxiety or just kind of talking through goals.”
When creating this program, Morales heard from nurses who greatly appreciated the program, but found it frustrating to speak with someone who did not really understand their nursing responsibilities. To address the issue, Morales hired three full-time coaches, all of whom are nurses who have spent time on the ground but also have earned coaching certifications.
“One comes from the neonatal/ICU space and can relate to the ICU and just working nights, weekends, and holidays,” Morales says. “Another nurse comes from the ED and the behavioral health space where she spent the last 12 years of her career and is really familiar with what those spaces look like. My third nurse has spent the last 10 years of her career doing corporate wellness as a civilian for the Army.”
These days, the resilience coaches are spending time focusing on lowering stress levels. In fact, she notes there is a particular emphasis on moral distress, a kind of distress clinicians can experience when they believe they cannot perform to the best of their abilities because of overcrowding or other factors. “A lot of people are saying they just aren’t sure why they feel this way, so we are building a program around moral distress ... creating a safe space, having those ethical conversations, providing tools on how to respond, and just how to recognize what it is,” Morales says.
In addition to putting resources in place to bolster mental and physical health, Morales also is devoting resources to professional fulfillment for nurses and nursing support personnel. “Professional fulfillment is a big part of what creates well-being at work,” she stresses.
To respond to this need, Morales is building a career hub, a place that will provide one easily accessible location where personnel can find anything they might need “from cradle to grave” for their careers. For instance, Morales explains nurses will be able to access information about what options are available to them if they want to move on to a new role within MedStar. Other topics will include obtaining a mentor, earning continuing education credits for providing grand rounds, and the types of assistance available for enrolling in educational programs to further career goals.
The idea is to ensure nursing personnel who want to advance their careers can do so within the organization rather than feel the need to look elsewhere. “It will be a one-stop-shop where they can come in, and all of their professional well-being needs can be met there,” Morales says.
There are no precise data available regarding the effectiveness of these initiatives. However, Morales is tracking overall utilization. “There has been a big spike [in the usage] of these programs, so word-of-mouth is our best nursing tool right now,” she says. “If [a program] works well for somebody, that person will encourage his or her friends to [to use it as well].”
In particular, Morales notes nurses are calling the Care for the Caregiver hotline, and the booking calendars for the nurse well-being specialists are filling up. Also, departmental leaders are asking Morales to speak to their groups about well-being.
For other organizations just starting to integrate well-being programming into the workforce, Morales suggests asking staff what is important to them, and what they need most. “Why build a program that isn’t meeting the needs of your personnel?” Morales asks.
Colleagues might be surprised at how many services are in place. “There was so much interest [in well-being programming] across the country, and there were already buckets of things that were kind of happening, but not being fully supported,” Morales says. “Resources were kind of buried in other kinds of communication and not on stage for everyone to see.”
Once Morales and her team understood what people wanted and needed, she started cataloguing all the available resources and putting them under one umbrella. “We further developed [these programs] while recruiting people who were interested in some of this work and wanted to be involved in serving on some of these committees,” she says.
When looking for advocates, think about natural leaders in this space. For instance, at MedStar, the palliative care team members are the best communicators in the hospital. “They are the most caring, compassionate folks that we have,” Morales says. “Our pastoral care team [members] are natural-born leaders and communicators as well.”
Morales recommends colleagues in other health systems assess what they have, and then enhance those programs.
“Then, identify the gaps and put plans in place to tackle them one at a time,” she says. “Unfortunately, we have been unwell in healthcare for a long time. We definitely can’t fix it overnight, but we can chip away at it slowly.”
Understanding the critical importance of nurse well-being, a Washington, DC-based health system created a new position dedicated to this work.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content