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Bill Klaproth: Burnout in the healthcare profession, isn't something to be shrugged off or minimized. It's an important topic worthy of discussion. So with us as an expert from the Children's Health Resilience, Integrated Ethics, Staff Support, and Engagement Team, also known as RISE. To address the reality of burnout in the healthcare profession, the importance of self care and how they help support and navigate the healthcare staff in times of need. This is Pediatric Insights, Advances and Innovations with Children's Health, where we explore the latest in pediatric care and research. I'm Bill Klaproth. With us to discuss self care for healthcare professionals, managing burnout and wellness is our expert, Elaine Beardsley, Clinical Resiliency Specialist at Children's Health. Elaine, thank you so much for your time. It's great to talk with you. First off, can you explain a little bit about the RISE team at Children's Health and what your team specializes in?

Elaine Beardsley: Yeah. Thank you so much. So RISE stands for resilience, integrated ethics, staff support, and engagement. And what RISE does is it provides many different services specializing in really providing support to all of the staff members across the Children's Healthcare team.

Host: And it sounds like support is needed for healthcare professionals. So how long has the RISE team existed and how was it created?

Elaine Beardsley: So the RISE team was created by Stacy Smith in 2016, and it was initially developed to develop a service for moral distress and how she did that was she developed a training where a volunteer cohort would go through the training. And now there's about 70 who have either completed the training or who are in the training. And what the cohort would do is they would be available to meet with staff members related to moral distress or ethical issues, but additional needs kind of arose through that. And what they found was that there were additional issues such as caregiver grief, resilience needs, and support after an adverse event or education. So last summer, Stacy advocated for the core RISE team to grow and we call that revitalized RISE. So now there is myself who is in charge of the resilience arm. There's Jessica Roomalot who is in charge of integrated ethics, and then Leslie Leech, who does staff support, which is either one to one or group psychological first aid after an adverse event, or an unexpected outcome. And then we all do education around all of that.

Host: So this covers a lot of ground. So there obviously is a lot of need. You mentioned things such as moral distress, ethical issues, caregiver, grief, resilience needs, support after an adverse event, and even education. So there's a lot of issues that health care providers have to deal with. So can you share statistics on burnout when it comes to healthcare professionals?

Elaine Beardsley: Burnout really is almost being seen as an epidemic right now. There's a lot of different inventories that assess burnout. One of the gold standards called the Malachi Burnout Inventory and recent studies have shown that burnout is growing and the range is 40 to 70% between nurses, physicians, students, social workers, and other healthcare team members, leaders, even nonclinical roles because it's 40 to 70%. And that has increased in the last five to 10 years. The likelihood is very high that either individually we could experience it or that we can experience somebody around us in our team, coworkers also having burnout.

Host: That's a great point. I was thinking physicians and doctors mainly, but you brought up a good point on who this affects this burnout. You said nurses, students, social workers, other healthcare team members, as well as physicians. So this is wide ranging across the healthcare industry. What are some of the most common causes of stress and burnout in the entire healthcare space?

Elaine Beardsley: Absolutely. And first, I just want to give a definition to burn out cause burnout right now, the word sometimes can be so overused and what the word really refers to, it's a workplace phenomena resulting really in kind of three areas of kind of effect. And that is emotional exhaustion, we're just physically, emotionally depleted and then depersonalization. Whereas we develop a negativity or cynicism towards situations and others, and then a decrease personal achievement where we feel like we're not making a difference. And it really results from kind of a compilation of the demands and the perceived barriers of frustrations of not making a difference, but closely related to burnout are other constructs like compassion fatigue, where there's an ongoing strain of just providing that deep, empathetic and compassionate care in very hard situations. There's vicarious trauma, where we are hearing and watching and caring for people who've experienced such traumatic events.

And then I mentioned earlier moral distress, but there's also second victim where if there was an error or an adverse event, we feel responsible and the effects. So all of these can result in emotional exhaustion and can potentiate developing burnout to directly answer your question. What kind of lends itself more to burnout? It's a fast paced high intensity environment where there may be a high demand in relation to the hours in the day to do the work we go home feeling like maybe we have a bigger to do list, or we didn't get all our work done. There may be a perceived decreased level of control that we don't have a say in really the autonomy of our work, or we don't have a voice in how the work is done. Also, if there's a decreased feeling of mutual respect, if we feel somebody may be judging us or that there's not direct support for us, those can lend itself more to burnout. And then as I mentioned, in addition to that, just the ongoing emotional drain of hearing other stories, seeing the suffering in relation to those workplace demands can lend itself to burnout.

Host: So there's many different components to burnout. Thank you for sharing those with us. The list is really long and people can be suffering from any one of these are probably a combination of these. You were talking about emotional exhaustion, you know, negativity, decrease in personal achievement, compassion fatigue, moral distress. There's a lot of things that can ale our healthcare professionals. So although especially now during COVID-19, Oh my goodness. Although it may be difficult to avoid burnout altogether. What are some important self care tips for health care staff that may help alleviate complete burnout? Can you share some of those tips with us?

Elaine Beardsley: Absolutely. I think first is self-awareness because chronic levels of stress can be with us and when they are with us, we don't even know when we are in such a heightened level of stress. And with all the research that has been done, chronic levels of stress are so damaging to the body. So first and foremost, when you're at work, doing a check-in every couple of hours, just to kind of improve our self awareness abilities and check in and see where we're at, have we even stopped? Have we taken deep breaths? Have we had something to drink? Have we gone to the bathroom or eaten anything really honing in on that self-awareness first and foremost, just to check in. Then second kind of that down regulation of stress response. If we find, when we do check in, in that self-awareness yeah, we are feeling quite stressed. Do something to break that fight or flight response, take just even two to three slow, deep abdominal breaths.

Just some of these press just to recenter and kind of slow us down, you can also do a cold water splash to the face at that time, drink something only takes two minutes to do this. Often when we are having such high levels of stress that's when we tend to judge ourselves, provide our self with some self compassion. When you're just checking in and you take those deep breaths, just connect with yourself and say, I am doing the best I can right now. And instead of judging, just offer yourself some self compassion. And then later after you get home, find a place to unburden, a place to process all the difficult emotions it's through processing comes insight connection to maybe a larger meaning, or maybe we might learn something we might recognize, even though it was really difficult. Or maybe even though I don't feel like I responded in the best way, I might learn something that gives ourselves permission to then close it and move on. It can also connect us to our strengths and our values. So to unburden, find someone to talk to who will listen, not fix it, but who will listen?

You can journal, you can go on nature, walks, engage in some mindfulness exercises or then of course, spiritual practices. And then so important is to find ways to experience positive emotion through gratitude or optimism. Definitely find time for meaningful relationships and even in COVID that can be very difficult, but find other ways to still connect and have that meaningful support. Animals. Some people find such positive kind of replenishing energy by being with dogs, cats, or whatever animal they love, and then find joyful activities that just reconnect us to a sense of peace, a sense of meaning, and then find ways to create balance. Now, this is hard. All of this can be very difficult, but are there some boundaries that we need to set? And that might mean, you know, turning off electronics, turning off the news, setting a ritual between leaving work and then coming to home. And then finally healthy habits. And this cannot be understated, really ensuring that we do have a healthy diet, that we're getting enough exercise and absolutely that we're getting enough sleep. All of these can help provide some self care and just re-nurturing activities, amidst all of the stress.

Host: That's so important. Elaine, I'm just going to quickly try to recap those great steps you gave us. And I love how you say chronic levels of stress are so damaging to the body. So we need to find ways to lower that stress. And you mentioned one self-awareness understand that you are under stress, down regulation of stress. Give yourself, self-compassion try to unburden yourself. Find someone to talk to that will just listen to you. Find positive emotion and gratitude, create balance, and then work on those healthy habits. What a great list and a great way for us to, as you put it down regulate that stress. So then when it comes to specifically the RISE team, what support does the rise team offer to Children's Health members that may need support?

Elaine Beardsley: We are continually expanding our services based on what needs arise, but we offer quite a bit. And some of what that includes is resilience education to help people connect with their resilience factors. Everybody has them and there's stress that can kind of diminish. So we offer resilience education. We offer mindfulness exercises. I already mentioned that we offer moral distress education and a consulting service to develop into becoming a member of a consulting service. And then we offer one-to-one or group peer support after a traumatic or adverse event, just to unburden and to allow someone to tell their story, what is really kind of come apparent as a result of, not only COVID, but all of the racial injustice and health inequities that have come.

We are offering a place really for virtual groups to come together and to unburden and just to share both, all those difficult emotions that they're feeling, but also the positive and their strengths or areas of gratitude. And what we're finding is just having that place provides a safe place for people to start connecting to their insights and connecting to meaning. And often it even strengthens the team because they're hearing things from people that they may not have heard before. So it just really kind of humanizes people. It's not therapy, it's a place for unburdening. And then through all of this, we offer education, education and awareness on all of those different constructs, just to heighten awareness, to start creating a language. So we can normalize talking about all of this.

Host: So valuable that Children's Health offers the RISE program. Do you have any advice for other health systems that may be looking for ways to support their staff in this area?

Elaine Beardsley: First off, identify what resources there are currently. So even in addition to RISE, there is the Pastoral Care team. And then there's the Employee Assistance Program, knowing what resources are currently already in. For other healthcare systems, there may be local unit support systems that need to be expanded or replicated in other areas. So find out first off, do a needs assessment to see currently what's already there that we could maybe capitalize on and then really understand what are the needs of the staff? Start to build something, whether it be a staff support team and which elements they include, often organizations already have so many elements of this. They just need to kind of pull it together and then advertise it out. And then of course, reach out to see what is available in other organizations that they could consider replicating in their area. And definitely we welcome, you know, questions to us on how to do that.

Host: And when we help our healthcare workers, ultimately we're helping the people that we serve our patients and the community. Is that right?

Elaine Beardsley: That's absolutely correct. The more that we can focus on the caregiver and the care of the team, even the nonclinical, the more that we focus on their wellbeing, ultimately the better care that they're going to provide and the stronger team, supporting and just a nurturing environment to learn, grow and to care will be provided. Absolutely.

Host: Right. This has really been fascinating. Thank you for talking to us about the RISE team. Elaine, is there anything else you would like to share with us?

Elaine Beardsley: I think just in closing and with saying that I think it is so important to normalize that it is okay for us to talk about difficult emotions and not suppress emotions that every system and every environment should offer a place to do that. It's not something that we need to be embarrassed or shamed about that we normalize that this is just part of what we do, that we find a place to unburden in a safe space. So we really can normalize and take care of our overall wellbeing and mental health. Absolutely. And thank you so much for offering me a place to explain all of this.

Host: Well, thank you for your time and going through this and explaining to us all that the RISE team does. Elaine, this has really been informative. Thank you so much for your time.

Elaine Beardsley: Thank you as well.

Host: That's Elaine Beardsley and thank you for listening to Pediatric Insights. For more information, please visit childrens.com. And if you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. This is Pediatric Insights, Advances and Innovations with Children's Health. Thanks for listening.