CNOs must help nurses feel both physically and psychologically safe.

With rising workplace violence and burnout rates, it's important for CNOs and other nurse leaders to be aware of the safety and wellbeing of their nurses.

During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke about how CNOs can help their nurses feel physically and psychologically safe at work.

Here's what CNOs need to know about safety for nurses. 

Click here to read the accompanying article. 

Physical and psychological safety should be key focuses for CNOs.

With rising workplace violence and burnout rates, it's important for CNOs and other nurse leaders to be aware of the safety and wellbeing of their nurses.

Safety goes beyond just the physical. Nurses must feel psychologically safe as well—they should be able to voice their feelings and concerns without fear.

During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke about how CNOs can help their nurses feel physically and psychologically safe at work.

Workplace violence prevention

There are several investments that health systems can make toward workplace violence prevention. According to Giordano-Mulligan, at Huntington Hospital Northwell Health, they have technology that boosts security, including quick badge alerts, metal detectors, and drones that fly around the campus, which remains well-lit at all hours.

Giordano-Mulligan also said they have signage that displays how respect from patients, family, and visitors is a requirement, and that the hospital does not tolerate violence toward the nursing staff or other healthcare workers.

"[For] any patient that is considered a high risk, we do have enhanced safety measures, and there [are] workplace violence processes in place," Giordano-Mulligan said, "and the staff is very appreciative knowing that they are supported in those processes."

Support is also provided to nurses after incidents occur, in the form of both employee assistance programs and employee health services if injuries are sustained.

"They're also given the option to file a police report as well and press charges," Giordano-Mulligan said, "and we will support them in that because they have that right."

In terms of mental health and psychological safety, Giordano-Mulligan said Huntington Hospital has processes in place for helping nurses improve wellbeing.

"If they need support for any other concerns…there is a process in place to help them with employee support services," Giordano-Mulligan said, "and there's a committee that is very active working with…executive leadership and with team inputs to enhance those processes in the future."

Psychological safety

Burnout is a huge contributing factor to mental health in the workplace, and according to Croland, one of the subgroups that has the highest degree of burnout is nurses who have under three years of experience.

"I've seen lots more people who are only working for a year and then they're choosing to leave the nursing profession," Croland said.

CNOs are also concerned with the public perception of nursing, and how that contributes to participation in the industry and potentially the culture of a health system.

"If you're on social media at all, you've probably seen the TikTok [videos] that are disparaging to the profession," Croland said, "so we have some accountability, I think, in changing that image of nursing." 

Croland recommends implementing more transition to practice programs that go beyond orientation and onboarding. Nurses need to develop a sense of belonging in their units and learn the necessary communication skills.

"How do you work in a culture where you can respectfully escalate a concern to another nurse who's working, who may be shutting you down?" Croland said, "and I think transition to practice programs are gaining a lot more traction."

The ANCC has criteria for transition to practice programs that Croland recommended. The criteria exist to help nurses acclimatize better to the profession and become more equipped to deal with the stressors that accompany the job.

"When you think about what we do, it requires high reliability, really high stakes outcomes, [it's] life and death, and that's a lot to put on a young person who's new in their role," Croland said.

CNOs must create environments where nurses can come forward and admit that they are not sure whether they did something right or wrong, or that they made a mistake that affected the patient.

"I think those programs are worth their weight in gold," Croland said, "they have demonstrated successes with reducing turnover, increasing retention, and really keeping people within the profession of nursing."

CNOs must stay vigilant and help their nurses avoid burnout.

Burnout is being cited across the industry as one of the top workforce challenges. So, what can CNO’s do about it? 

During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke at length about how CNOs can reduce burnout among their workforces.

Here are some tips for addressing burnout. 

Click here to read the accompanying article. 

Nurses everywhere are feeling the effects of burnout, and so are nurse leaders.

Burnout is being cited across the industry as one of the top workforce challenges. A report from AMN Healthcare found that 72% of nurse leaders experience some level of burnout. 

So, what can CNO’s do about it?

During the HealthLeaders’ Nurse Labor and Compensation NOW Summit, Jennifer Croland, vice president and chief nursing officer at OSF HealthCare Saint Francis Medical Center, and Dr. Marie Giordano-Mulligan, vice president for nursing and chief nursing officer at Huntington Hospital Northwell Health, both spoke at length about how CNOs can reduce burnout among their workforces.

Identifying the problem

Croland compared burnout to “death by paper cuts.”

“Everybody has bad days,” Croland said, “but it’s when it’s happening all the time and we’re not able to recover from it that I think that analogy comes to mind.”

The first step in addressing burnout is to identify when nurses are experiencing more than just a bad day. If nurses are returning to work the next day and are back to normal, that is likely just exhaustion, whereas burnout presents a more consistent personality shift.

“[It’s] the person who’s no longer engaged, the person who doesn’t participate, or their personality has changed,” Giordano-Mulligan said, “even with collaboration with their peers, they just don’t seem to be the same.”

When a nurse begins to feel this way, it’s important for CNOs and other nurse leaders to intervene and help that individual. Giordano-Mulligan emphasized that outside stressors are a large contributing factor as well. World events and family obligations can bring additional stress into the workplace. 

“We have programs that come in to help reduce all of these stresses for employees,” Giordano-Mulligan said. “We have to help these individuals to feel comfortable coming to us so that we can help them with employee support services.”

Along with programs, having a personal connection with each member of a nurse unit is also critical for identifying burnout. Croland explained how that connection and relationship is necessary to be able to notice a change happening.

“Recognizing when there are subtle differences, whether they’re angry or more withdrawn,” Croland said, “those are going to be indicators that something’s going on.”

According to Croland, making sure employees are utilizing resources available to them is also key to preventing burnout. Nurses should have sick or wellbeing days, and CNOs must make sure that they are using them. If nurses are financially struggling, leaders should sit down with them and connect them to employee assistance programs or a financial counselor, or another resource offered by the health system or hospital.

“Sometimes the burnout isn’t necessarily caused by something that’s happening at work, but it’s being exacerbated by something in their home life,” Croland said. “We have the opportunity to connect them through to resources that could help them.”

Strategic solutions

One of the best ways to address and prevent burnout is having personal relationships with staff, and according to Croland, being intentional and having thoughtful conversations with them. At OSF St. Francis, they do monthly mission partner rounding.

“So very intentional, purposeful rounding that the leaders are doing with their frontline staff asking them [questions],” Croland said, “what’s going well, what frustrated [them] in the last couple shifts [they] worked…what problems have you experienced, [and] how can I help?”

Croland recommended making the effort to understand the nuances and pain points that nurses have, and to work to address each of those things, since burnout is often caused by the build up of those little stressors.

Additionally, Croland suggested putting more focus on having micro debriefings at the bedside, to help nurses deal with the frequent whiplash of handling one tough patient situation and then moving on to the next.

“We don’t often times give ourselves as the clinicians the opportunity to process what happened, [or] the opportunity to talk things through,” Croland said. “[It’s important] if you’re a newer nurse, [to take] the time to get the assurances that you did a good job and that you did what you were supposed to, to have that support.”

Giordano-Mulligan agreed, citing her focus on creating healthy work environments and authentic leadership in her career. CNOs need to build relationships with their staff so that when something is going on, the nurse is comfortable confiding in the CNO, and they know they have a safe place to go.

“Getting to know your staff and [having that] relationship building is extremely important,” Giordano-Mulligan said, “and to know when a team member is not who they normally are.”

At Huntington Hospital Northwell Health, Giordano-Mulligan said the hospital has a process called Team Lavendar to help nurses deal with patient losses.

“There’s a team that comes in and helps support the staff and [the other] people involved in that loss,” Giordano-Mulligan said, “to give them the time to decompress, [or] to go off to the tranquility space, and to have the time to come back…[and] go on the next assignment.”

The program also allows nurses to be relieved, so that they can come back to their next shift with the right frame of mind.

“Part of being able to care for others is to care for self,” Giordano-Mulligan said, “because if you’re not in that space to be in a good frame of health or mind, you can’t begin to care for others appropriately.”