Lessons Learned in Healthcare

This is my 44th year working in the health care industry.  Before I became a nurse, I worked in a small rural hospital as a Respiratory Therapy Technician, then a Medical Records Clerk in a large hospital, and a Medical Transcriptionist in an academic medical center — all during college.  Each role provided me special insight about the inner workings of a hospital and a medical practice.  Who knew it would be so valuable as my career solely in healthcare progressed to where it is today!

Once I became a nurse, my work experience included Medical-Surgical, Critical Care, Emergency, Post Anesthesia, Nursing Supervision, Process Improvement, Nursing Management, and Executive Nursing Practice.  Then, after 25 years of employment in a hospital and earning an MBA, I made a conscious decision to become a nurse entrepreneur.  My solo boutique consulting and interim leadership practice for the last 19 years has focused in operations consulting, interim leadership and leadership development, as well as, teaching and speaking to audiences in a variety of settings.  More recently, I have renewed my interest in Leadership Fatigue and expanded my knowledge in the areas of health coaching, integrative nutrition and peak human performance.

Once of the most interesting things I noticed early on about my clients when I began consulting was that they all looked extremely tired.  I also had not really recognized the effects of my own executive practice until I wasn’t there anymore.  These observations over the next 7 years of consulting and interim leadership drove me to frequently ponder the true consequences of nursing and choosing leadership practice.  When I began my doctoral degree program, I proudly wrote during the first week of class that my research project was going to be about Leadership Fatigue.  And, every professor that came into the room that week and looked at all of our ideas written on the large sticky notes on the walls asked whose topic is this?  And, what is it?  Then, I knew I was on to something!

For those of you wondering, ok what does this background all have to do with anything?  Well, in 2010 I began a focused journey of study about stress, fatigue and burnout in nursing, as well as, self-care for optimal well-being.  My purpose of raising awareness about these topics today has evolved and is now twofold:  1) to recognize that it actually exists, and 2) to explore positive coping strategies for optimal health, well-being and human performance.  Unfortunately, in healthcare and many other professions, we are highly prone to experience increased stress due to the nature of the work.  There are immense pressures from both internal and external sources which add to the already existing complexity of nearly every professional role in healthcare.  All this in addition to the responsibilities in one’s personal life.  And, no one is immune to stress – we all just deal with it differently and some of us better than others.

I’d like to share two personal stories about work related stress:  my “emancipation” from official hospital employment and starting a business.  In 2003, two significant things happened to facilitate my interest in entrepreneurism and spur it into action.  The first, was when I was invited to leave an executive job at a hospital in which I had worked for nearly 10 years.  While it was not completely unexpected, I truly believe it was merely due to being in the wrong place at the wrong time and labeled guilty by association.  Since, I’ve learned good people do get fired.  Sometimes it’s a mismatch in values or about fit.  But what a blessing in disguise it turned out to be!  As shocking as the actual event was, I was motivated to explore my options in an expedited fashion.  I had just purchased a new home, had planned to move the following week and had yet to sell my previous home.  So, one job and two homes was not really the plan!

Within 9 weeks, I found the courage to go out on a limb and start my own business.  It was then that I learned about resilience and what it actually means to be truly resilient.  I was fortunate that my 1st client was a city requesting fire department training relative to legal issues and documentation challenges which were both in my wheelhouse of expertise.  As you may know, cities have a plethora of rules and very specific requirements (as government entities) which ensured I did everything by the book!

The point of this story is that two very stressful events were turned into positive action due to a positive mindset.  I was able to harness the stress which motivated me to take positive action versus ruminating about the negative aspects of the event by exploring all of the “what ifs”.  I knew I couldn’t change the circumstances — so it forced me to look at the possibilities.  Mindset is crucially important to peak performance — both related to work and our personal lives.

I also learned that workplace stress is undervalued and an under-reported topic affecting many areas of one’s life.  First, there are a plethora of credible worldwide sources in the literature who have studied workplace stress and say it has progressively escalated in the last few decades and is only getting worse.  The cost in the United States (U.S.) to industry alone is estimated to be over $300 billion due to injuries, lost time, as well as,  health consequences.  And, these estimates were all before the recent COVID-19 pandemic and all of its consequential fallout.  Second, nurses experience more work-related stress than the wider working population and it often goes unrecognized.  We’re expected to just deal with it.  During the COVID-19 global pandemic, the stress nurses’ encounter became glaringly obvious to the world.  And, the full repercussions of the toll it’s taken on all types of workers besides those in healthcare has yet to be fully understood.

The thing about stress is that it can be insidious, where extreme fatigue can progress to burnout.  And, this cycle of stress, fatigue and burnout leads to a host of negative outcomes.  A nurse researcher named Nuria O’Mahoney in 2011, summarized decades of research and the costly consequences of burnout in the journal, Emergency Nurse as follows:  1) low morale (measured in satisfaction surveys); 2) increased absenteeism (based on illness and injury data); 3) adverse health (based upon mental and physical consequences); 4) decreased job performance, effectiveness and productivity (all known to affect outcomes); as well as, 5) high turnover resulting in personnel shortages.  We now know this has only worsened for all healthcare personnel and quite possibly a number of other industries due to the negative effects of the pandemic.

In addition, advances in technology and pharmaceuticals have not improved the nation’s health over time.  They have presented new challenges such as rapid-pace continual learning, constant interruptions with alerts and alarms, new drugs which must be learned as they enter the market, as well as, adding to the chaos that inherently exists in a system known to cause stress and fatigue.

Recognizing and addressing the potentially negative impact of stressors is imperative so fatigue and burnout are not the result.  A more intentional approach to work in relation to the design of systems, forming efficient work processes, attaining more reasonable workloads and establishing boundaries for work-life balance are key attributes for all types of companies for success.  The global pandemic may have actually helped in this area by forcing all industries to get creative and expand their options regarding innovative and how work can be done.

So, where do we go from here?  First, I think we all need to take a more intentional approach to our own health and well-being.  There’s no pill that will erase a lifetime of stress and choices.  And, the complications of taking a handful of pills for a quick-fix recovery can be enormous.  Regaining health just doesn’t work that way.  In addition, there’s a growing shortage of healthcare personnel due to the lingering effects of the pandemic, those who “age out” of the physical nature of the work, and those who plan to retire or just do something different.  The pipelines for replacement haven’t been sufficient in the past and certainly will not provide the needed personnel in the future.

No one really wants to think about the impact of needing care with nobody to provide it.  The global pandemic gave us a birds-eye view to what the future trajectory could look like.  Over-burdened hospitals did the best they could each day – day by day.  So, our best bet is to attempt to stay healthy and not enter the maze of what is the current healthcare system.  It can be difficult to navigate, is fraught with complexity, and sometimes mistakes are made in treatment decisions.  Don’t wait for a catastrophic event to change your ways for optimal health and well-being.

Doctors aren’t miracle workers and only you know your body best.  Self-care and compassion are foundational to good health and well-being.  However, caring for oneself is rarely a priority in today’s world.  You should make it one.  The pandemic may also have shined new light on how fragile health actually is – and that without it, nothing else really matters.