Dr. Stephanie Sanderson 00:06
Leaders need to be on the same planet, as their employees and that they really need to be put themselves in their shoes. And, and, and understand the pressure and the and the circumstances that these nurses are in and work hard to remove some of the burden that we we impose on nurses, and figure out better ways to do this work because look at how far we've come. I think that there's only opportunity in all of this. And I think that if if healthcare organizations were more committed to the employees, at the bedside doing this really hard work, we probably wouldn't have these problems. I'm not trying to say that all organizations are like this. But I think that we need to do a little bit of like, re imagining how this how this could look in the future so that we don't lose any more of our workforce, or create a situation where people don't want to become nurses, or doctors or any, any health care provider.
Adrianne Fugett 01:32
I will tell you, one little thing that we haven't touched on that I think is important is everybody in health care, physicians, nurses, people giving care, we tend to burn out a lot quicker now. Right. So when I first started as a nurse, a seasoned nurse was considered eight to 10 years, a seasoned nurse now is two years. And so people in health care are burning out much more quickly. And that has a potential negative effect for all of us, right, because if we lose experienced physicians and nurses, that affects the kind of care that we receive as patients, so being able to provide this opportunity at at Med place where you can monetize your expertise away from the bedside, and be so excited about your expertise and the care that you give. So that when you go back to give care, you're like, oh my gosh, this is so interesting. I'm taking what I'm learning from these cases, and I'm applying it to the care that I give now. And I'm helping my peers and my colleagues.
Mark Greenawald 02:42
A lot of a lot of your listeners are probably familiar with your support programs, particularly if they're part of a larger healthcare organization, things like the second victim programs and things like that. So the second victim program was the name of which I find very unfortunate, but it basically says that in any kind of tragedy within healthcare, the first victim, if you will, the first people who suffer because of that are the family of the patient and the family of the patient. However, the care team also suffers in the midst of that, and they become the, quote, second victim. So those who are involved in that tragic outcome, also carry things with them. And that needs to be processed as well. So a lot of folks will be familiar with that kind of peer support that says, when an event happens, we are then reaching out and we're going to make sure that you know that we're here to support you in the midst of that. Fabulous, I think there's those programs are very important. Those programs are also very reactive. And they're also really for they're very impatient focused, because most of those programs do not get into the ambulatory space where a lot of health care is provided. So as I started to think about the pure RX program, I'm a generalist. And I also spend a lot of time thinking about prevention. So what I thought was, what would it look like to create something that is proactive, rather than reactive, and is supportive, independent of an event? So a tragedy doesn't have to happen before somebody reaches out and says, Hey, we care? What would it look like if somebody was reaching out to say, we care all the time, so that when the tragedy happens, because it's inevitable, we're going to have those happen? Along the course of our careers. You already have someone who is a peer, with whom you've developed rapport, and you're very comfortable reaching out to them and being able to say, hey, I need help. Because vulnerability is not a trait that a lot of physicians carry in spades. And so the ability to develop that when times are good, so that you haven't you have some of that emotional bank account, if you will, so that when times are not good. You don't hesitate.
Adrianne Fugett 04:58
How do you think Peer Support has changed with the COVID pandemic, as well as post COVID pandemic, like, where are we now in regards to peer support and hospitals and physicians and nurses really even understanding what this is? And do we need to implement it within our hospital? Like, can you tell us where you think we are? And where we need to be? Maybe even?
Jo Shapiro 05:21
Yes, I think it's a great question. And I would step back and say, you know, there's, there's, you know, peer support is a well being program, essentially a well being intervention away, to improve well being. But of course, it's not the only one. So these things have obviously grown in parallel. And I think as you know, we're, you know, from our past years in mind that we certainly did, this wasn't in anyone's consciousness that there was an issue of our well being. So I think that that had to happen first, in some ways for people to wake up and say, this is a problem. So now to your specific question about so where are we at, and I think we would recognize that we're, we're better we're down the road a bit from the well being, you know, lack of any thought that it was important to, I think there's so much data now by some great researchers who have shown this, this is a thing, it's quite prevalent, and it's devastating in many ways, and it can lead to very devastating consequences. So I think that's been incredibly helpful. And as you know, there's been a sea change of people saying, oh, gosh, we do have a problem. So then it comes to Alright, how do we solve what in what ways can we address the problem? I don't think it's a quick solution. Nor do I think it's a solution that we're used to, like, I'll take out your bankers and you won't have any swallowing problems anymore. This is not that kind of problem. So peer support it when it when we first thought of it, it was incredibly countercultural, incredibly, because for the reasons you say, we were taught, first of all, we shouldn't be suffering anyway. So why would you need support. So that's one. And the second is even if you're suffering, you really need to walk it off, you really just need to deal with it yourself. And we have a big culture in medicine, the culture, a culture of silence. And the other part of that culture that I think was so I was gonna say evil, it sounds a little extreme. But really, just so counterproductive was this idea that any support and any self care in any community organizational support was weak, a sign of weakness needing that was a sign of weakness. And so you know, the last thing we want in our profession is to look weak, like we should be able to tolerate this suffering. So I think people get that, that's just so counterproductive and understand, at least intellectually, that self care is not selfish. That said, we're still in that culture to some degree. It's not like we had a memo, I say this, when I do give talks about peer support, you can't change the culture by saying, Oh, we don't do that anymore. Like self care is no longer selfish, right? Culture change happens. It can happen in big leaps. But it doesn't happen by telling people we, you know, this kind of culture is dysfunctional. I mean, that's part of it. But then what are you going to substitute it with? So I think we have to recognize an answer to your question, that we still have a culture of where we equate, you know, strength with with lack of vulnerability. And fact, while we really know, and there are lots of people write beautifully about this, that vulnerability is strength, we're still in a culture that doesn't really believe that. So there's still stigma to needing and wanting and accessing help. Okay, that said, I think the stigma is getting better. I think also, the structural barriers to getting help are, are being lifted little by little by little, then you have all of this background. And we started peer support, at least, you know, when I was at the Brigham, and then helped others have helped, you know, over 100 organizations start their own peer support programs. It plenty of that was done before the pandemic, so we were making progress, right, then you have the pandemic. And you know, the first thing that happened is all attention goes to patients with COVID, basically, as a CIT, right. But a lot of people are now written about the fallout for healthcare professionals. And so what are we going to do about it? How are we going to help decrease the what we thought would happen, which is a lot of more mental health issues and burnout issues, which are not necessarily related to mental health. And so, I think, you know, so we had that so many people's and some people actually, actually were motivated during the pandemic to say, now we really need peer support, which was true, but others were like, we can't even have to, but I think we're coming out of it. People realize like, Okay, now we can't, we've got it. Now. We have healthcare providers who are absolutely burnt out from all the reasons they were before and now you had all the suffering and all the what's been expected of health care providers, etc. And it is pretty, it's pretty awful to see. So I think what we are in now is people realizing we've got to pay attention to taking care of each other. And the reason peer support the reason we started peer support in addition to being supportive of professional mental health resources, right, that's really important, in addition to looking at workflow issues, all those things that many brilliant people are working on, those are all important. And this came out of a study we did. We also knew that in the face of especially some of the acute stressors that we experienced, like errors, like patient aggression, like being named in litigation, and then the chronic sort of sub acute stressors like COVID, you know, racism, harassment, all the other, you know, there's lots of other things that we face, that we need, the, with the stigma of getting help, that we needed to structure a program that made getting help easy. And this our study showed that, in addition to that, there were barriers to seeking help that what, and this happened to be a physician study what physicians wanted after an acute event, like an error was they wanted help from up here, a physician colleague, even though you know, we have great mental health practitioners.
