Fostering Nurse Renewal Through Compassion: A Model for Alleviating Nurse Workplace Stress

Friday, 28 July 2017

Marie M. Shanahan, MA1
Gayle Novack, MAOM, BSN2
Veda L. Andrus, EdD1
(1)The BirchTree Center for Healthcare Transformation, Florence, MA, USA
(2)Ascension St. John Hospital & Medical Center, Detroit, Michigan, Detroit, MI, USA

Nursing workplace stress is a known deterrent to nurse satisfaction with the work environment. (Cranick, Miller, Allen, Ewell, & Whittington, 2015) It can lead to compassion fatigue and burnout. It is a contributing factor to nursing turnover and decreased retention of a skilled workforce (Edmonson & Asturi, 2015). Nurse workplace stress is an element of the downward spiral in patient safety and quality. If left unchecked it creates a cascading effect that diminishes effective organizational functioning, costing millions and endangering patients’ lives (Birmingham, Dent & Ellerbe, 2013). Sadly, it can rob nurses of the joy and fulfillment they derive from caregiving (Bauer-Wu, & Fontaine,2015).

Nurse workplace stress is most often associated with perceived and actual stressful elements of the work setting. It can be caused by challenging professional or personal relationships, inadequate staffing, demanding clinical workloads, patient acuity, unresponsive leadership, unresolved moral distress, and weak psychological boundaries. Regardless of the cause, it is threatens the nurse’s ability to perform at peak levels. (Richards, 2014).

Because nurse workplace stress is closely related to patient outcomes, it is imperative that nurse leaders create realistic avenues for nurses to develop coping skills and build resilience on the job.

This 900 bed urban hospital nursing team recognized the signs of nurse workplace stress and opted to take on the challenge. The nursing leadership had set the stage by adopting Jean Watson’s Caring Science theory as their guiding philosophy of care. It fit well with their mission of providing spiritually centered holistic patient care. Nurses were educated in the tenets of Watson’s theory and sought to enact them in clinical practice. They quickly realized that while nurses strongly desired to practice more caring centered care, they were failing due to tremendous workplace stressors related to heavy patient workloads, persistent staffing shortages and pressure to respond to multiple organizational initiatives. Nurses were describing their workloads as ‘unbearable’ and ‘overwhelming to the extreme’.

To address this problem, nurse administrators developed a pilot project. They created a renewal room on the women’s health unit. The purpose was to have specifically designated spaces for nurses to rest and re-focus while they are on shift. (Bullen,2016). It needed to convey a sense of tranquility and peacefulness where nurse could reflect and re-connect to their love of nursing. It also needed to be a place where nurses let go of their burdens for a short period of time and practice the art of self-care (Andrus, 2016). As part of this project, it was hoped nurses would find relief from their day to day stressors and develop greater resiliency with regard to their workload.

A room that held excess equipment was selected as the designated space. It was close to the nurses’ station, too small to be a patient room and had a privacy lock on the door. The nurse manager quickly enlisted clinical nurses to transform the room into a tranquil and soothing space. Nurses donated a comfortable chair and foot rest. They decorated with soft lighting, pillows and an electric tea pot and cups. Soon other nurses provided a portable music player and relaxing music. Also added were uplifting reading material, inspiring sayings and a journal to share thoughts with other nurses.

The renewal room became an overnight success with nurses utilizing it to refresh and rejuvenate before, during and after their shifts. As the usage increased, nurses from other units began to request their own renewal room. Today there are 17 renewal rooms throughout this organization, including one in the nursing administration office. They are in all patient services areas including the emergency department and surgical services. All employees are permitted to use the rooms for the purpose of quiet reflection and alleviating their stress. The rooms are not used for eating, sleeping, consulting, charting, or meeting. They are separate from nurse break rooms and patient-family meeting areas. One person at a time may use the room and electronics are strongly discouraged. Some rooms contain massage chairs and many have essential oils for aromatherapy.

Included in this poster is a communication from one nurse to another that poignantly captures the need and success of the project.

First entry: “My nurse manager took me to this room today because I had my first breakdown on the unit. She is making me stay here for 30 mins. So while she’s caring for my patients…and I cry my eyes out…I am still worried about doing things for them ON TIME. Being a new nurse is so stressful. This chair is cozy, te teas is yummy and I feel like I failed today. When does that feeling go away? My patients need me :-(”

Second entry: “Hang in there, we were all once a new nurse! Each day focus on one thing that went smoother, time management takes organization and in time will come. Things will all come together. BREATHE . It helps to have support, ask for help, ask for tips from your TEAM. How they prioritize, time save. Sending you + thoughts for an easier day! I’m sure your patients can feel your kind spirit,let it shine through! Be yourself! :-)”

Nurses were confronting tremendous work stressors, robbing them of their joy and resilience. This organization was committed to addressing workplace stress for their nursing team and they did so in a creative and compassionate fashion. Learn how they improved nurse renewal and embedded self-care in their culture. Today the renewals rooms are part of their culture and have contributed to a caring nursing work environment.