By Carol Davis
With nurse burnout at about 84%, according to the American Nurses Association, and 64% of nurses planning to leave healthcare one study says, the toll of burnout can seem overwhelming on many levels.
High levels of stress, anxiety, depression, and poor physical health correlated with an increase in self-reported medical errors by critical care nurses (CCN), according to a study co-authored last year by Bernadette Melnyk, PhD, APRN-CNP, chief wellness officer of The Ohio State University and dean of the university’s College of Nursing.
Nearly two-thirds (60.9%) of the CCNs reported having made medical errors in the past five years, according to the study. Occurrence of medical errors was significantly higher among nurses in worse health than those in the better health categories. For example, 67% of the nurses with higher stress scores versus 56.5% of the nurses with no or little stress reported having made medical errors in the past five years.
“These errors are made by very dedicated, caring, committed nurses who are experiencing their own symptoms of depression, anxiety, or poor physical health,” Melnyk says. “It’s important that hospitals … equip their clinicians with resilience, because we know that’s a protective factor for their own mental and physical health, as well as their ability to provide optimal care to their patients.”
“We’ve got to invest more in our clinicians, because if nurses and doctors are well, the safety and quality of healthcare is going to be better,” Melnyk says.
The solution to clinician well-being, says Melnyk, lies with a hospital or health system’s executive leadership. They must take the lead on shifting to a wellness paradigm and appointing a chief wellness officer with a team and resources to do the job correctly, she says.
Some organizations dip a toe into wellness waters, but they don’t go all in, she says. They’ll place wellness under the human resources department, or they’ll go as far as hiring a chief wellness officer, but they won’t provide the needed resources to do the job correctly and effectively.
“That person isn’t going to be able to move the needle that much,” Melnyk says. “This is an important component of an organization’s vision and strategic plan, so they’ve got to invest in a leader to spearhead their population’s health and well-being.”
Fix system issues
Though zen rooms, pet therapy, and affirmation boards helped nurses power through the darkest days of the pandemic, they are now experiencing long-term effects of that period, such as burnout, trauma, and depression.
To help nurses and other clinicians toward wellness, healthcare facilities must fix system issues that are known to adversely affect their health and well-being, Melnyk says.
“You can have all these fabulous wellness programs [because] they’re important, but at the same time hospitals have to fix their system issues that we know are causing problems, such as too many bureaucratic tasks that take time from nurses caring for their patients, which brings them joy, and length of shift work,” she says. “And all my studies have shown the longer the shift work, the poorer the health outcomes for nurses.”
While making systemic changes in healthcare traditionally takes long periods of time, there’s no time to waste in addressing clinician wellness, Melnyk says.
Ohio State’s culture of wellness
For more than a decade, Ohio State, home to nearly 68,000 students and almost 50,000 faculty and staff, has prioritized creating and nurturing a wellness culture.
Its vision is to be the healthiest university and community in the world, and Melnyk is helming that by taking a comprehensive approach to build a culture of wellness for everyone.
“At Ohio State, we take a multicomponent, multistrategy approach to wellness,” Melnyk says. “We target evidence-based interventions to middle managers and top supervisors, because if we’re not walking the walk and supporting the folks, it’s not going to happen.”
For example, the Wellness Partner Program was created to pair up nurse practitioner (NP) students with RNs at the university’s Wexner Medical Center and travel nurses to serve as wellness support partners. The student coaches listened as nurses expressed their fears or talked about their long, difficult days.
The program taught the student coaches how to help their nurse partners create a wellness plan to help them develop stress-relief activities, build resilience, and work on healthy behaviors.
“It was very successful,” Melnyk says. Indeed, in the program evaluation, 98% of participating nurses said that the Wellness Partner Program helped them engage in self-care and wellness, and 94.7% said that it helped them improve their mental and physical health.
Another Ohio State initiative is the Buckeye Wellness Innovators, in which faculty and staff who are invested in wellness volunteer three to four hours a month to develop grassroots plans for their individual units to champion the wellness culture.
The wellness innovators:
- Hold virtual dialogue sessions regarding diversity, inclusion, and belonging with small groups of staff.
- Encourage team members to designate an out-of-office point of contact to allow and encourage them to truly take time away.
- Host voluntary yoga lessons, painting parties, and other social events to build team camaraderie.
- Eliminate stigma surrounding mental health by creating a safe space for staff to share concerns.
- Organize wellness walks around campus with hydration stations along the way.
Part of Melnyk’s wellness strategy is to annually provide university and hospital leadership—vice presidents, college deans—with their department’s general health data.
“I tell them things such as their folks are doing great on blood pressure and A1C, but there are high levels of stress and depression in their unit,” she says. “We then work within the unit in implementing strategies to improve those specific outcomes.”
The impact of Ohio State’s commitment to wellness has worked at all levels, according to a case study by the National Academy of Medicine. Results have included:
- A cumulative productivity net savings of more than $15 million from wellness programming across the university
- $3.65 ROI for every dollar invested in wellness
- Decreased anxiety, depression, stress, and suicidal intent among students, faculty, and staff
- Increased academic performance
- Increased levels of healthy lifestyle behaviors
Melnyk’s newest project, courtesy of a grant from the American Foundation for Suicide Prevention, is to digitize her cognitive behavior skills program for nurses to help prevent suicide so that it can reach anybody.
Melnyk took an effective cognitive behavioral therapy training program she had developed nearly 30 years ago for children, teenagers, and young adults that lowered stress, anxiety, and suicidal ideation and created a new version, called MINDBODYSTRONG, for clinicians.
Suicide risk is significantly higher in the nursing population, with female nurses roughly twice as likely to die by suicide than the general female population and 70% more likely than female physicians, according to a 2021 University of Michigan study that examined suicide among physicians and nurses. Data for the study was gathered before the COVID-19 pandemic, which means those numbers likely are even higher now.
“This [wellness] culture, I can’t emphasize enough,” Melnyk says. “You’ve got to make it easy and the norm for people to engage in healthy behaviors, and to seek mental health help when they need it.
The right priorities
A workplace that prioritizes building and sustaining workplace wellness cultures has deep and positive outcomes for its largest labor force, Melnyk says.
Nurses who perceived their workplaces as supportive of their wellness had better physical and mental health and engaged more in healthy lifestyle behaviors than those who did not have the same level of support, according to Melnyk’s 2022 study, Associations Among Nurses’ Mental/Physical Health, Lifestyle Behaviors, Shift Length, and Workplace Wellness Support During COVID-19.
Nurses who reported having workplaces that supported wellness were three to nine times as likely to have good mental health, good physical health, no/little stress, no burnout, and high professional quality of life, as compared with nurses whose workplaces provided little or no support, according to Melnyk’s study.
“We know mindfulness works. We know cognitive behavior skills building works,” Melnyk says.
“It’s complex, but people have got to understand that wellness is an investment; it’s not a nicety,” she says. “This is necessary. We’ve got to fix our system issues and create wellness cultures and programming and staffing models we know are going to yield better health and well-being outcomes for nurses.”
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.