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Before COVID-19 was even identified, Ethan Lester, PhD, assistant director (clinical) of the Massachusetts General Hospital Department of Psychiatry’s Center for Health Outcomes and Interdisciplinary Research (CHOIR) and assistant professor at Harvard Medical School, was already concerned with the emotional well-being of healthcare workers who often experience high levels of job-related stress, occupational burnout and secondary/vicarious trauma. As the country begins year three of the COVID-19 pandemic, how we care for healthcare workers is even more urgent.
Dr. Lester shares a collective and collegial journey of developing a resiliency and wellness program for healthcare workers and how others can advocate for these services.
Caring for Those Who Care for Others
The physical and emotional toll of caring for another person can result in job dissatisfaction and occupational burnout in medical center staff (doctors, nurses, administrative staff). The COVID-19 pandemic highlights specific national healthcare system fractures (e.g., workload demands, a lack of administrative and treatment protocols, healthcare worker safety, staff morale issues) without clear direction for how to support those who take care of others. In this unprecedented time for healthcare workers, it became even more critical to find an innovative and impactful way of supporting medical center staff who dedicate themselves to delivering excellent patient care and administrative support.
By teaching resiliency and wellness skills to health care workers, Dr. Lester and his colleagues hope to promote greater emotional well-being, positively impacting patient care and decreasing staff turnover which is better for patients and less expensive for hospitals. The 2021 NSI National Health Care Retention & RN Staffing Report found that the average cost of turnover for a bedside registered nurse (RN) is $40,038. CHOIR hopes to be frontrunners in this important area of care and produce successful models and resources informed by clinical research that are necessary to make these initiatives happen at other medical centers across the country.
Developing and Designing Programs for the Needs of Specific Departments
As a lead clinician on the CHOIR Recovering Together Initiative, Dr. Lester designed an in-person and virtual nurse support program specifically for nurses in the Neurosciences Intensive Care Unit (NeuroICU) at Mass General. This program helps reduce emotional distress and promotes resiliency in care teams who serve high risk medical populations in the NeuroICU. Core skills from Recovering Together, as well as other new skills from cognitive behavioral therapies and behavioral medicine techniques, were adapted and help ICU nurses learn to effectively manage distress and influence their own resiliency and wellness while caring for others.
The key Recovering Together skills to improve emotional well-being include:
- Mindfulness – the ability to stay present and defer judgment in the face of adversity
- Coping – the application of strategies to effectively manage stress
- Social Support – empathic interpersonal interactions in response to functional needs
- Self-Efficacy – perceived ability to adaptation under adversity
After a successful informal pilot of the nurse support program at Mass General, he collaborated with David Hwang, MD, FAAN (Neurology), FCCM, FNCS, at Yale New Haven Hospital (YNHH) to design a monthly resiliency group for the early career nurses in the YNHH NeuroICU. This collaboration allowed them to trial inter-institution service delivery, as well as to establish a successful support group for early career nurses. YNHH nurses expressed high satisfaction with the groups which were facilitated with help from Victoria Grunberg, PhD, CHOIR.
Launching Wellness Programs Across Mass General Brigham Institutions
At Mass Eye and Ear (MEE), he collaborated with the chief resident of the Eye Trauma service, Marisa Tieger, MD, to launch a specific wellness curriculum for MEE’s second year residents to help them actively cope with the challenges of this training year.
Additionally, they created a virtual wellness support group for MEE administrative leadership spearheaded by MEE Vice President Debra Rogers with the chief aim of promoting positive staff support, increasing morale and providing a forum to discuss challenges of coping with the COVID-19 pandemic in their management team. Both groups are also currently ongoing and in their second running year under the direction of Dr. Lester and with the support of MEE Ophthalmology faculty members, Marguerite Weinert, MD, Alice Lorch, MD, MPH and Joan Miller, MD.
At Brigham and Women’s Hospital (BWH), Dr. Lester worked with psychologists from the Mass General psychiatry department, Rebecca Harley, PhD, Michelle Jacobo, PhD, Ellen Prairie, PhD and Lara Traeger, PhD, to help facilitate a psychosocial program for Brigham internal medicine residents called Project Safespace, which was initially formulated by Adaira Landry, MD, Brigham Emergency Medicine physician, as well as Drs. Harley and Jacobo. This focused, four-session program teaches key skills including mindfulness, dialectics, cognitive restructuring and diffusion and acceptance to enhance resident coping during notably stressful times during their multi-year residency. These programs are currently run in person at Brigham by Dr. Lester and Mass General staff psychologist, Sarah Bannon, PhD, for 5 separate cohorts of internal medicines residents during the 2021-2022 academic year.
I truly love this aspect of my work. It is so rewarding to feel like I am connecting with staff and making a difference in their overall wellness and resilience.
Advocating for Staff Wellness Programs at Your Institution
If you are interested in prioritizing staff wellness program at your institution, Dr. Lester offers some practical tips for getting started:
- Begin with strengthening interdisciplinary connections between departments at your institutions (e.g., neurology and psychiatry). This early relationship buildings provides productive “cross-talk” for key players in these departments to identify staff needs, potential barriers and available resources and funding for such programs
- Find wellness champions within these settings who will be strong advocates of staff support and wellness at your institution. These can include service leaders and attendings, chief residents, nurse directors and managers and administrative staff
- Reach out to your institution’s psychiatry department or faculty development office about existing staff wellness initiatives across the hospital and ask if any of their providers is interested in helping deliver these kinds of initiatives. They may be aware of resources already available, or can help you navigate how to start a new staff wellness program
- Find ways to work staff wellness and resiliency into the budget for future years so that wellness can be prioritized and institutional values can be reflected in what your department funds for its staff
- Finally, make staff wellness initiatives accessible to staff. Do your homework and survey what your staff is willing to attend and would enjoy participating in. “The only thing more discouraging than not having a staff wellness initiative at your institution,” Dr. Lester says, “is having one that staff are not able to attend due to practical barriers or are not interested.” Think about your desired outcomes
In addition to these tips, consider checking out these professional resources for staff wellness and resilience:
- Mass General Department of Psychiatry curated resources for health care workers early in the pandemic.
- Mass General Center for Faculty Development’s Office of Well-Being offers various resources for staff members.
- Mass General Wellness has resources on nutrition, exercise, mind/body medicine and more.
- National Academy of Medicine’s Resource Compendium for Health Care Worker Well-Being
- For further reading on qualitative work for designing wellness initiatives for physicians:
Read more about this work from the Mass General Center for Health Outcomes and Interdisciplinary Research (CHOIR)
- Feasibility and Efficacy of a Resiliency Intervention for the Prevention of Chronic Emotional Distress Among Survivor-Caregiver Dyads Admitted to the Neuroscience Intensive Care Unit / October 14, 2020, JAMA Open Network
- Making an Emotional Recovery Together In the COVID-19 ICU / December 4, 2020, Psychology Today
- Managing Emotional Distress in the Hospital and ICU / December 8, 2020, Psychology Today
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