MSN, RN, NPD-BC
The quality of patient care relies on several factors — effective communication between members of the interdisciplinary team and an effective treatment plan chief among them.
As nurses, we have to be knowledgeable of medications and nonpharmacologic interventions. And if we’re unsure about something pertaining to the treatment plan, we must be willing to ask questions. On the flip side, we also need to be ready to answer questions from colleagues who might be unsure of certain skills, protocols, or procedures. These are obvious factors. But let’s dig a little deeper.
A nurse’s well-being significantly affects the care given to patients and their families. As a nurse, have you ever felt that part of your role is to support the psychological well-being of your colleagues?
Nursing can take a toll on every aspect of your being. As a nurse at the bedside, it’s physically taxing to be on your feet and repositioning patients during busy shifts. It’s also emotionally and mentally draining, as we deal with everything from compassion fatigue, deaths, and communicating with aggressive patients, distressed family members, and providers to maintaining time management and being subjected to workplace incivility.
There are countless examples of trauma that stem from verbal abuse, physical abuse, toxic work environments, emergencies, and code blues with undesirable outcomes. Our priority is certainly to care for the patients’ and families’ wellbeing. However, can we shift our perspective a bit here?
If a nurse’s wellbeing is not being cared for, how can they effectively care for patients and families? We generally tend to look to upper and middle management to care for nurses’ well-being. However, we have to think about how realistic it is to prioritize so many people.
So, what do we do about it? Use the opportunity to build on this priority as a team. You’re just as capable of protecting the psychological well-being of your colleagues. And there’s evidence behind psychological first aid to prove it.
Psychological First Aid (PFA) is a supportive way to approach staff or colleagues following disasters, emergencies, and traumatic events. Originally designed by the National Child Traumatic Stress Network and the U.S. Department of Veteran Affairs’ National Center for Posttraumatic Stress Disorder, this evidence-informed approach promotes the understanding of human resilience with a goal to tend to matters as soon as possible to reduce initial distress.
However, PFA doesn’t have to be isolated to disaster settings. In many organizations, it gained attention during the COVID-19 pandemic when the stress of the healthcare climate posed a risk of long-lasting psychological effects. The lack of good coping skills and sustained high levels of stress are associated with unhealthy coping mechanisms (e.g. alcoholism, smoking, substance use disorder, sleep disorders, eating disorders, etc.).
PFA skills can be used in everyday situations at work. It’s in no way a replacement for professional therapy; however, nurses can use certain principles and techniques to recognize signs of distress and the need for support, provide immediate support and a safe space, and connect the person in crisis to resources and support. Again, this doesn’t always have to be a nurse leader providing PFA. What can a staff nurse do?
Various resources exist to help you put PFA into practice. There’s really no cookie-cutter approach to implementing psychological first aid. Recommended considerations when approaching a colleague in crisis are to create a sense of safety, calming, self-efficacy, connectedness, and hope.
You may be asking yourself “What does that even mean?” Let’s talk about it in simple terms:
After a workplace violence incident, your coworker might understandably feel unsafe. Remember that the core of PFA is addressing the issue as soon as possible after an incident. Creating a sense of safety could mean removing the nurse from the location where the incident occurred. As a leader, this could mean changing the nurse’s assignment. For a peer, this could mean asking the nurse if they want to take a walk or talk in private.
Help the nurse to manage stress and emotions. Assure them it’s normal to feel distressed immediately after an incident. Assisting with stress management in the moment can look different for different people. Some may offer prayer, meditative techniques, guided imagery, or deep breathing exercises, while others could offer fitness and nutrition advice.
There are a few things to consider before offering any help. Be mindful to remain culturally competent and sensitive. As cultures differ, make sure to ask permission to give advice or to demonstrate any stress management techniques. Also, be sure not to encourage the excessive use of substances as a coping mechanism.
Self-efficacy is defined as the belief that you can be successful when carrying out a particular task. It reflects confidence in the ability control your own motivation, behavior, and social environment. In this instance, a nurse leader or peer could highlight the nurse’s strengths in handling previous situations to encourage the ability to cope with the current situation. After experiencing a workplace violence incident, it is understandable that a nurse will feel out of control. Emphasizing things the nurse has control over can help.
If the nurse needs a few moments alone to gather thoughts, that’s totally fine, but try to discourage isolation. But remember — alone time is different from isolation.
Connecting the nurse to support groups and other resources is an integral part of PFA. Again, this doesn’t always need to be the nurse leader’s responsibility. As a peer, you have the power to empower your colleagues.
In some organizations, support may include the employee assistance (EA) program. Other organizations may have a peer-support program. Outside of the organization, promoting connectedness may look like connecting with trusted family and friends. Ask nurses if they have a support system outside of work. Once you have that answer, it’s easier to assess what support connections are needed. Again, PFA is not a replacement for professional counseling. Sometimes that connectedness includes a meeting with a psychologist or mental health counselor.
It only takes one incident for a nurse to lose hope. How others respond to the situation is vital in building hope. Take a workplace violence incident, for example. One thing I’ve heard while educating on workplace violence prevention is that nurses sometimes don’t feel supported post-crisis, whether it’s a slow response from public safety and behavioral health specialists or a nurse leader not checking on them in a timely manner.
Debriefing needs to occur as soon as possible. Nurses need to know they’re supported. There also needs to be a discussion on what actionable items can be implemented to mitigate risk and potentially prevent future events. Having that support brings hope that the organization cares about the well-being of the nurse.
As we continue to face inevitable challenges in healthcare, caring for each other’s psychological well-being is paramount. Whatever we starve will die. Whatever we feed will flourish. Offering immediate support is the food that distressed colleagues need to flourish. That flourishing subsequently will create an environment where nurses can provide the best care to patients and families. You don’t need to be a titled nurse leader to be of support.
If you haven’t done so already, I encourage you to consider becoming more proficient in PFA. Perhaps you can seek information on the existence of PFA training in your organization. If formal training doesn’t exist, consider connecting with your leadership (including educators) to bring training to your facility. I wish you all the best!
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