Okay, it looks like we're at time, so we're going to go ahead and start. So you're going to lose your opportunity to scan the Wordle if you are interested in doing the Wordle at some point today. So it's not the Wordle from the New York Times, it's just a Wordle that we made. So we also have some handouts. Today's session will be interactive, so don't leave. It will be interactive, and so we do have some handouts, things that you can take notes, things that you can trash it on the way out, it won't offend me, but so you can go ahead and take one and just pass them down. But it gives you an opportunity to, gives us an opportunity to hand you a couple of items and articles that we weren't able to fit into our presentation that you might find helpful. Great, well, welcome, and again, we're so glad to have you here today. And we were speaking on, as you know, burn bright, burn out, which is compassion fatigue. Now, like Lonnie said, don't walk out because we know that this is a topic a lot like COVID that we've talked about, talked about and talked about, and it's still here. This is an important thing, though, because it affects every aspect of our lives and every aspect of the lives of people that are around us. Excuse me. As you've noticed, Utah is very dry, so I've got a lot of water up here. But I wanted to introduce myself. My name is Andrea Marziano, excuse me, and I've been a nurse for 33 years. I don't like to say which year that started because that sounds a lot older. And I have my certified case manager I got in 1993. I became a legal nurse consultant in 2013. And I have, I got my bachelor's in business as well, back in the day in 1996. I'm also a licensed massage therapist, I'll have office hours later on today. And I've worked for Tang & Company in the learning engagement leadership for the last three years. And I've worked for Tang & Company generally for the last five years. And Lonnie will explain more about Tang & Company. Go ahead, Lonnie. Okay. So I'm Lonnie Walker. I'm a registered nurse. I am back in school because I've been a registered nurse for 25 years, and I've apparently forgotten what school is like. So I'm back getting my FMP. And that, I tell you that because that will come in, I will mention that a little later. But I've been, I grew up here in Utah. I lived by that big U up there on the hill. By the way, it snowed there this morning. So if you haven't been outside yet today, feed your mental health and go out and look at the mountains. It snowed last night. So they're nice and white and pretty. So I graduated from the University of Utah, rolled out of bed, went to school in the morning. And back in 1998, and my basic background is in mostly now community health. So I live in Texas, you're going to find the y'all is going to pop up a little bit. But that's only because the English language has like really no really great, you know, second person plural. So y'all will recognize that. So I want to tell you a little bit about Tang and Company. So Tang and Company was started in 1977 by Brian and Helen Tang. They have three brick and mortar locations in California, and they have 20 that do medical surveillance, injury care. And they do have a 24-hour, 24-7 telemedicine and 24-7 telephonic nurse triage, which is where we both started. And we now run the learning and engagement. So the other thing, so that sub part of Tang and Company is called care on site. They also have another sub part called ASAP, which is our drug and alcohol testing solutions. And then we have OSCA, which does specific trainings, on-site trainings and computer based trainings that fit the client's needs. So that's all part of Tang and Company, those three sub companies. And we're happy to be able to be here to represent them and teach you about compassion fatigue. So I believe I start here. And I need a clicker. Okay, so that's us, but, you know. Okay, so here's our table of contents. Just briefly, we're going to pop it up for our class for the next hour or so. We promised this would be interactive, and that's what they asked us to come because we promised it would be interactive. So you're going to need to pull out your phone because we're going to have a couple of polls and some interesting pieces of engagement. So because I didn't fly all the way in from Dallas and she didn't fly all the way in from Washington so that we could hear ourselves talk, we could do that at home. So we're hoping that maybe we can spark some conversation, get some ideas from everybody. We don't need to relive everybody's failures. We can go ahead and learn from each other and see if we can come up with some ideas to improve the mental health of your employees and those in your organization. So I hope you took your vitamins this morning. If you need to go top off your coffee, we're going to get going. So the first thing we want to do is I want to, we're going to do a word cloud. So what you're going to do is you're going to go text to 22333. And when you type in 22333, you're going to send to Lonnie Walker. It's L-A-U-N-I Walker, 535. Yep, L-A-U-N-I, 22333, mm-hmm. And then you just type in Lonnie Walker, L-A-U-N-I Walker, 535. And that should get you into this poll. And I want to know, when you think of compassion fatigue, what is it that you think of? We'll just do a word cloud. What brings to mind the first thought of compassion fatigue? Is it working? Yeah. Or an increase in patient distrust. Okay. So the comment was an increase in patient distrust. And I agree with that entirely. I think that that is, we're seeing that especially since COVID, right, that that's really amped that up a lot. Other ideas if our little thing's not going to work? What about your colleagues? What are you seeing in your colleagues? Yeah. Exhaustion and cynicism, absolutely. Short staff, which is a cause and an effect, right? It hits both, which is a really interesting piece right there. So we'll talk about that. That turnover is a really big problem, as you all already know. All right. Okay. So I've got a couple of thoughts up here just to kind of lighten the mood here. I'm not, I really like this one from Drew Carey. Oh, you hate your job? Why didn't you say so? There's a support group for that. It's called Everybody. And they meet at the bar. So that, you know, and the fact that it's Drew Carey makes it even better. So go ahead, Andrea. All right. So these top 10 signs that you're suffering from burnout. My favorite one, you're so tired, you now answer the phone, hell. Have you ever done that? I know I've felt that. Or being at home and answering it for the work line. Anything like that. Some of the others are your friends called to ask how you've been, and you immediately scream get off my back. You get to the point with burnout and compassion fatigue that you just can't take anymore. You've got so much on your mind, you've forgotten how to pee. And you've got so much on your mind, you forgot whether you just did pee or not, were you standing up or sitting down for those ladies in the crowd. And so these top 10 signs that you're suffering from burnout, they're sort of funny, but do any of these ring true to you? Do any of these sound like things that you've experienced or you've seen people experiencing? I know I have. And the one comment before our class, the gentleman right here said, by the time I make it through my emails, I don't have time for a wordle. Right? Yes. So. That's awesome. And during our presentation, we're going to show the difference between burnout and compassion fatigue. Some people think that it's the same thing, but there are some subtle differences. And what's interesting is, this has been studied for a long time, Lonnie will talk about this a little bit more, but really since 1971, and we still don't have any answers. So the problem is, is in this case, can you see the cutout pieces of this person's clothing? When we are reaching burnout and compassion fatigue, we feel like a little of us has gone here, a little of us has gone there. And this happens to us because we are compassionate individuals. That's one of the reasons we went into the medical and caring fields, right? Because that's what we're about. And compassion fatigue starts to happen when we are overly responsive in this compassionate role, where we start being too empathetic, where we start seeing too much trauma, and we're unable to separate ourselves. Because typically, being compassionate helps us fill our buckets, right? It helps us feel like we're doing what we're put here to do. And when compassion starts taking away from us, when we start giving too much of ourselves, we'll start looking like this person, with parts of us taken away. And did that just go up? Okay, sorry. It distracted me because it just suddenly went up. But parts will be taken away from us, and we'll no longer be able to separate ourselves from the issues we're seeing. And one of the things that happens, as I said, about being with traumatized patients, is that we will start feeling and living that trauma, even though it didn't happen to us. And we're going to talk a little bit more about that later on. But it's called vicarious trauma. And we can have the same results and the same physiological responses as if we had had the trauma ourselves. And this has happened time and time again for many of us, even though many of us are not on the front line of COVID, we've seen it, whether it's been with our family, friends, our clients, our patients, that have either died or knew someone close to them that have died. And that's huge for us because I think sometimes when we're not the people that have walked into isolation rooms, which I am in no way diminishing, people forget that we may see it too, and that we're dealing with it with our patients and clients and the people we run across. So some of that support that might be there hasn't been there yet for us. And one of the things we want to address is how we can do that for ourselves and the people around us. Let me just, I just want to add, my husband works in financial services, and he does polling and data collection for his company for their marketing. He interviews people who have been affected by COVID financially because he's in financial services, and recently interviewed somebody who had 13 members of their family die of COVID. All because they are lower income, frontline, not workers in hospitals, but, you know, grocery store workers, people, bus drivers, people that were essential workers, 13 of their family members had died from COVID. So which to me is being in a position where I can work from home, my husband can work from home, we don't realize how privileged we were to be able to be given that gift at the beginning of COVID, because the people that were really suffering were those who had to go out to make their living, and without their PPE, you know, without that opportunity. Thank you for that example. Excuse me. We talk about various definitions of compassion fatigue, and this is one I wanted to read because I knew I wasn't going to say it correctly, and this is one of so many. When we started researching this project, it was all over the board, but this is one that struck me. Compassion fatigue is the physical, emotional, and spiritual result of chronic self-sacrifice or and prolonged exposure to difficult situations that render a person unable to love, nurture, care for, or empathize with others. And isn't that what our goal is, to do all those things? And if we're dealing with compassion fatigue, we can take all of that and just throw it out the window, because we can't do it anymore. We've just reached our limit. Go ahead. All right. So to understand compassion and compassion fatigue, we really need to understand this spectrum of empathy to start with. So we've got this pity and sympathy really take, like, no effort at all to give somebody pity or sympathy. But in order to hit empathy and compassion, that takes a whole lot more emotional involvement in there and understanding engagement to produce a positive change in order to hit this empathy and compassion stage. The word compassion comes from the Latin roots of to suffer together. So among researchers, it is defined as the feeling that arises when confronted with a another's suffering and feeling motivated to help relieve that suffering. So that is the biggest difference here in this spectrum of empathy, is that you can have pity for somebody or sympathy for somebody or empathy for somebody. But in order to hit that compassion area, you have to be able to help alleve that suffering. And that's why we all started in health care. It really is. We wanted to help others. We wanted to help them with their suffering. And that's why we're all here. But it also puts us at risk for compassion fatigue. And like Andrea said, the fact that this has been around for so long yet, it is not something well, I don't know. I haven't talked about it yet in my FMP program, but or studied it much in my FMP program. But nursing school 25 years ago, it is not something that they covered at all. I don't know any fellows, medical students, residents, I mean, is it something they're covering in medical school? Because it is huge right now. And it is not something that's being addressed. We're seeing this a lot in the news. If you're on any social media, it is really prevalent. We'll talk a little bit more about that. But the other idea here with this empathy spectrum is how they overlap. So they do overlap a little bit. You find yourself, even if you go into a patient room with the idea of having some empathy for them, I feel for you, I'm sorry that you're in pain, that's going to overlap into compassion. And after a while, it's going to get really hard to keep that up. Any of you see anything in your practices, your organizations, amongst your colleagues of how this overlaps, how this works? Find yourself in a bad spot here in this chain? One idea. Let me propose an idea for you. How many of you have said to your family members, have put some ice on it, I don't want to talk to you until you've taken an Advil. I do it all the time with my family. My husband, it's a good thing my husband's not here. Fortunately, my brother-in-law is here. So my husband had bilateral hernia surgery a few years ago. And I said, we ended up, he would not really come off of the anesthesia real well. After sitting there for so long, the nurses are like, you're a nurse? I'm like, uh-huh. Like, can you just take him home? I'm like, absolutely, I can just take him home. So I took him home, put him in bed. I said, it's been eight hours, get up and go to the bathroom. I don't have to go to the bathroom. You do have to go to the bathroom. Get up and go to the bathroom. Gets up, go to the bathroom. Oh, what do you know? I had to go to the bathroom. I'm like, and you can't get back into bed until you walk down the hall, touch the garage door and come back. And then you can get in bed. You're so mean. Uh-huh. I am mean. And part of that, I love my family, but part of that is, how many times does your family come to you and say, I have a headache, you don't talk to me until you've taken something for that. Right? And that's just a little bit of compassion fatigue. You know, Mom, my ankle hurts, put some ice on it. You know, we all say it, but that is a little piece of compassion fatigue. Or how about this one? Oh, you're a nurse. Is that a boil or a cyst? Right? And you doctors, you get that the same thing, right? You're a doctor, you mind looking at this mole? We all get that, and it just wears us down. Okay, so here, a little bit of background on the history of workplace burnout and compassion fatigue. So I find this really interesting. You can see how far back that it goes. So in 1974, let me look up this guy's first name, because he deserves it, Herbert Freudenberger, published two scientific articles describing burnout. So he actually, he was a psychologist, and he actually developed the idea of burnout by actually looking at himself. They did, in 2016, a really great short NPR news story on him, and I want to play that real quick. It's only three minutes. Or maybe I want to play that for you. If you're the type of person who checks your work email right before bed, and just as you wake up the next day, you might know the word burnout, but you may not know the story behind it. Noelle King from NPR's Planet Money podcast tells us about the man who coined the term burnout and then found a sort of solution. In the early 70s, Herbert Freudenberger had a successful psychology practice on New York's Upper East Side. He was a serious, driven man. He'd survived the Holocaust and moved to the U.S. as a kid. Here's his daughter, Lisa Freudenberger. Her dad died in 1999. His childhood kind of stopped at seven or eight, because he then had to grow up pretty quickly and survive in a new country. In the States, he was taken in by an aunt who was cruel to him. She made him sleep in an attic. In his teens, he ran away and lived on the street for a while. Herbert grew up to become someone who was always pushing himself to help more people. That's why, in addition to his practice on the Upper East Side, he opened a clinic on the Bowery, New York's Skid Row. He worked with drug addicts. These young people were really struggling. A lot of his clients' kids were just fried. He would see them literally holding cigarettes and watch the cigarettes burn out. He'd pull 12 hours on the Upper East Side, then he'd go down to the Bowery and work until 2 a.m. He began to get more and more fatigued, and he began to get stressed, and he was not that pleasant to live with. What was that like? Was he a yeller? Yeah. Yeah. He didn't use his inside voice, shall we say. So his kids tried to stay out of his way. When Lisa was about five, her mom booked a family vacation to California. On the day they were set to leave... He couldn't move. He couldn't get out of bed. Herbert realized something was wrong, but he was a therapist, so he started self-analysis. He would speak into a tape recorder for an hour or two, and then he'd take a little break, and he'd then analyze himself as if he was his own doctor. I don't know how to have fun. I don't know how to be readily joyful. That was Herbert in an interview he did with the Shoah Foundation. It wasn't just exhaustion. It wasn't exactly depression. It was something new. His mind went to the drug addicts down on the Bowery with their blank looks and their cigarettes burning out. He called his illness burnout. He wrote a book, Burnout, the High Cost of High Achievement. It was a hit. Stressed out social workers and doctors and housewives were like, I have that. Herbert went on Oprah and Phil Donahue, and here he is on All Things Considered in 1981. Burnout really is a response to stress, it's a response to frustration, it's a response to a demand that an individual may make upon themselves in terms of a requirement for perfectionism or a drive. But burnout isn't in the DSM, the official listing of mental disorders from the American Psychiatric Association. And to this day, companies struggle with workplace burnout. Is it over work? Is the problem individuals or the environments they work in? Herbert Freudenberger found a solution of his own. After burnout became part of the cultural conversation, he didn't work any less. But when he wasn't working, he was able to enjoy life. The family even managed to get him to take a vacation at a lake in upstate New York. And Lisa says he seemed happy. He says, come, let me show you how I swim, let me show you how I swim. He then got into the lake and he proceeded to do a dead man's float. And I, like, waiting to see any flapping of the arms or flapping of the legs or something, stayed there, got up with the biggest grin, and I could see, like, this inner child in him just flourished. And he was so proud. He goes, did you see me swimming? I'm like, yes, dad. Fabulous. The recognition of his work, she says, had made him a different person. Noelle King and P.R. Neuse. Perfect. I'm hoping that actually stops and just doesn't run again. So that was in 1974. So this concept is younger than I am, actually, so there we are. So in 1981, Maslach and Jackson developed three, a subscale which is now called the Maslach Burnout Inventory, where you go ahead and you fill out their inventory with these three topics of emotional exhaustion, depersonalization, and personal accomplishment to kind of get an idea of how burned out you are. And a little bit like this gentleman was saying back here about the not being able to, the emotional exhaustion, the not being able to trust the healthcare providers, that all kind of fits in this, in that depersonalization as well. When you're seeing your patients, when you're seeing your injured workers or doing your medical surveillance, are these still people or are they people, are they just an alcohol and drug test sitting in the back room waiting on shy bladder protocol? So they developed that. It has become almost the industry standard on burnout, but we're not here to talk about burnout, so let's keep moving. I'm not going to talk about this whole slide, but I do want to talk about Carla Joinson. So Carla Joinson in 1992 was the first person to coin the term compassion fatigue and relate it to healthcare workers. So she, healthcare professionals, and referred to it as being emotionally devastating, requiring awareness and recognition. That was way back in 1992. That was way before I even went to nursing school. Yet nobody was talking about it at the time. So these other people, there are a lot of people I could have put in here. These are the ones that kind of stuck out at me with their development. So this is by far not a complete list of people who have contributed to the research of compassion fatigue, but I do want to point out 2004. Yeah, it's not on there. 2004 is the year I left hospital nursing. Y'all don't need to remember that. There is no test at the end. But I was working. I had just moved to Oregon from here. And Oregon requires that to any Oregon, people from Oregon? Not a single one. It's a lovely area, by the way. Very dog-friendly. The people all drive like this, like nobody passes or complains or it's really chill. So I highly recommend it. I moved to Oregon. In Oregon, you cannot do continuing education to keep your license. So even though I had little ones, I had to get a job. So I got a job at a small, little community hospital near my home. It had MedSurge. MedSurge was my background at the time. I had worked MedSurge and PRN here at IHC, this hospital system, the big hospital system here, a hospital not too far from here, and I worked PRN and floated to their whole system. So kind of jack of all trades, master of none kind of a nurse, right? So took a job at this little community hospital. It had MedSurge floor of two, they were kind of separated, a 15-bed floor here and across the hall, a 15-bed floor here. I was always going to be working at this 15-bed floor over here. I worked the swing shift because I had little kids. I worked 3 to 11, and that way I was still, I hired a babysitter for two hours until my husband got home from work, and then I went and worked this job, and I wasn't like totally plastered to take care of my kids the next morning. After I had gotten there, they got rid of all their clerks, fired all their clerks. We don't need clerks, we're going to save money, no clerks, and shocking, kind of hard to do. And then a little later, 7 p.m., they got rid of all the CNAs. So no CNAs would work the night shift. So oh, and let me mention there's only two nurses for 15 beds. So I had seven or eight patients with only one other nurse. It was a new hospital system for me, which the hardest thing you all know about getting a new job is not the taking care of the patients. Patients are the same everywhere, but it's getting used to their computer charting, it's getting used to their Pyxis machine, are they using the brand name of drugs, the generic name of the drugs. So I was there with only one other nurse from 7 to 11. I lasted about six months, tops. So I, in 2004, bugged out of hospital nursing and moved to telephonic phone triage for a group of pediatricians in the area, which is what my specialty has been since, is telephonic nurse triage until I moved to education. So here's the thing. Either I saw this compassion fatigue coming, I didn't know that's what I had, or I'm just really impatient, and it could be a little bit of both. But it has been coming for a long time. We're just seeing it come to a head now. Any comments on this? Any thoughts? Anybody hear about it way back here? Did you all get it in training in medical school at all about compassion fatigue? I see a couple yeses and one yes, I think, and mostly noes. Anybody in education? Anybody have a little bit? Well, good. I mean, maybe this is something that we can move to, right? You know, we are the learning and engagement leadership at our company. This is absolutely something I will be presenting to our leadership on the 23rd of May and seeing what we can do to help our employees within our organization. All right. Just like empathy has a spectrum, compassion fatigue has a spectrum. That's not it, but I thought it was funny. Please tell me that I'm not the only one that hits meh at the end of the day. If I'm going to be totally honest with you, I hit meh on this presentation about three days ago. You can only handle that stress level for so long before you hit meh or zombie status, so you kind of need to figure out where are you in this, and we all sit somewhere in this crazy little funny spectrum. We do. And it changes from day to day. It's a spectrum, but it is real. Okay. Here's the real spectrum. All right. Thank you, Lonnie. And in case you're wondering why I'm hovering over here, I had hip surgery recently, so I can't sit for very long, so just ignore my wiggles and squiggles over there, if you will. So compassion fatigue, as Lonnie said, is on a spectrum, and this is one of the more official spectrums that we found, and it starts with moral distress. Has anyone ever heard of moral distress? Yeah. Does anyone like to share a definition they have? Okay. Moral distress, and I needed to look at this name because I always say it wrong, Andrew Jameson wrote a book in 1984 called Nursing Practice, The Ethical Issues, and it was, as it says, about nurses. So most of what he talked about is nurses, but this definition of moral distress can apply to anywhere, and it's being expanded in some of the textbooks is what I was reading. Moral distress is when, in the case of how he wrote it, a nurse knows what's the morally correct thing to do. They know they should do X, Y, and Z. However, there's a constraint of some sort that makes it so they cannot do the thing that they know is correct. We can think of probably hundreds of examples that we've experienced in this, and also, if we use the most common thing to talk about, the COVID experience, how many times do you suppose people being floor nurses, staff doctors in the hospitals, had to deal with moral distress? Even the idea of, remember how they were having to ration care a little bit? Who gets the ECHO machine that just became available? And to have to make that kind of decision, whether you're the medical provider or the direct floor caregiver, would be devastating to some people. So this moral distress is the first flag that is on the spectrum that we found about compassion fatigue, and it's one that, if you haven't had a time in your career that you've been in moral distress, I'm amazed and very happy for you. But I'm sure most of us have a time that we knew we had to make a decision of some sort. Hopefully it hasn't been a life or death decision, but I know in times it is. And that, if we don't have any kind of intervention or any plan to deal with this moral distress, this person, ourselves, will move on to the next step, which will typically look like workplace depression. Now, a lot of people have and are treated commonly for depression and can handle it and can manage it. But when it's brought into the workplace, because how many of us spend more time at the workplace than our own homes? Do you know your own home address? And so when your depression will be so intense that it will fill your entire workday, that would be crippling, right? And I imagine all of us have felt that to some degree. And like Lonnie said, we go, oh, my goodness, or I just can't. You have to check out. It's a coping mechanism. It is. And that's what we do. If we check out, that can mean life or death in some situations, right? And if we check out too much, it can lead to our sort of emotional life or death, right? And then the next stage we'll talk about copiously, so I won't really speak much on it, but burnout and compassion fatigue is the next in the middle set there. And that is, like I say, something we'll go over quite a bit. And I know a lot of you have heard it. You heard one definition already. And then the secondary traumatic stress and vicarious traumatization, I touched on a little bit already. And that's when we hear the story of someone who's had a traumatic event. So we hear them talk about it. And we get so ingrained that we can't separate ourselves. We start feeling too much empathy. And also, have you ever had a time where someone was telling you a story of a traumatic event that they had, and you flash back to one that you had, right? Yeah, I see a lot of nods there. Oh, I have a story. Sorry. Go ahead. Full of stories, but we have time. So did my preceptor ship in labor and delivery, and I was nine months pregnant by the time I finished it. There was a gal who was on bed rest there in the hospital who ended up coming. We had the same due date. She ended up going in, her baby was having problems, some late decels, and so they ended up taking her into an emergency C-section, and her baby did not make it. Can I tell you how long I cried about that at the workplace? And clearly, this baby of mine, that was 1998, this baby of mine is now turning 24 this month, and I still remember this, right? That is definitely at least secondary traumatic stress, maybe pushing, well, I have had more kids since then, so probably not a disorder, but certainly a stress. And since Lonnie brought it up just now, the difference, as you all probably know, between a syndrome disorder and disorder is primarily that, in this setting, is that with a disorder, you can no longer function correctly. And I know that's true generally for disorder, but in our setting, we look at how a person is not functioning in their care job. They're not able to care for their patients, they don't even, that's when we start going more into, hey, I'm gonna see the arm in 204, I'm gonna go look at the hernia in 116. They're no longer people anymore. And honestly, we do that sometimes anyway, because HIPAA, we can't say their names anymore, right? But when it becomes all they are is their thing, then we've reached this level of the compassion fatigue section. And then, like I say, it becomes a traumatic stress disorder. One of the things that can be different between secondary traumatic response and traumatic stress disorder is what Lonnie was alluding to is something that we experience. She experienced the death of that child and also had it in her lifetime. But what the traumatic distress disorder is usually based on me seeing someone having a trauma. So I didn't just hear about them telling me, I saw them have it, whatever that looked like. Great. So, as you say, burnout and compassion fatigue, what's the difference? I don't know if you can read this in the back, but it says, Frank just up and exploded. I hope I never get that burned out. And I love that, because how many days do you kind of just wish you would explode for a minute? But burnout is the state of emotional, mental, and often physical exhaustion, which is similar to the description I read a few minutes ago. Though it's most often caused by problems at work, it can appear in other areas of life, such as relationships, parenting, caretaking. How many times have you heard, mom, mom, dad, dad, and you heard the same story 19,463 times? And one time my son, we have stories, I hope you don't mind stories. One time my son came up to me, he was probably 12, and he said, mom, I don't think you're listening to me anymore. And I said, honey, my ears can only hear so many words a day. And I've already heard them. And he's like, oh, okay. And then he continued to talk, I just didn't have to pay attention anymore. One of my stellar mother moments. But one of the differences with compassion fatigue is it is reserved for the workplace. So compassion fatigue happens to people who have empathetic jobs, or caring and medical type jobs, which give them, it can go into the physical and mental health at risk, like we talked about. And it can make us wary of giving care to others. Because can I take one more time of that? Can I hear one more story like that? Can I do that one more time? Sometimes maybe it's a no. Where do you sit on that scale? Have you felt that? Are you feeling it right now? What I wonder is, who are you checking in with? Is anyone checking in with you, even yourself? Have you asked yourself why you sit on this? Because it's critical. It's critical to your mental health. It's critical to the care that you give your patients. And it's critical to your family and friends, the people you interact with. So I wonder when you've asked yourself that. And if you haven't yet, I invite you to do so. So this cartoon is another one that we like these little graphics in cartoons. And it says, do you ever get compassion fatigue? I'll tell you when I'm not so tired. So some of the fatigue manifests at these symptoms, anger, depression, guilt, self-doubt, powerlessness. We have a physician assistant who helps teach a class that I lead. And it's about dealing with various disorders and syndromes and things that happen to our people that we take care of in occupational med like you do. And he talks about a time where he had to decide whether to care for someone in-house or send them to the ER. It was an eye injury. He said he worried all night. He was worried what he did would create blindness in this individual. And he worried. He literally said he couldn't sleep all night. Woke up the next morning, the person had responded like he hoped he had and thought he would. But all night long, he had self-doubt. He felt powerless. He said he just really wanted to reach out to this guy in the middle of the night to make sure things were okay. But he had to trust that things were working and they did. And how many times have you guys gone through that? Like who hasn't had that experience? Yeah. Yeah. It's, we all worry about our patients. And then there's some of the physical things that can happen like headaches, heart palpitations and vomiting. Happily, neither of us have done any of those heart palpitations or anything today, so we're all good. But this is something that we really have to pay attention to and how we are. Again, where are you on the scale? How do you respond? How does your staff around you respond? Because while some of these things are not visible, in fact, except for the vomiting really, which most people will notice, but most of them are not visible, so we have to check in with each other. And you know what? One thing that just came up for me is with our masks, have you noticed that people aren't making eye contact like they used to? I've noticed it. And because, well, they can't see my smile, so I just won't look at them. And I'm an eye contact kind of person. She makes me turn on my, we work remotely, she makes me turn on my camera every time I talk to her. Yes. Everyone who has any- And so, you know, no makeup Wednesday looks a lot like no makeup Tuesday. And it's true. And people know that when they're in a class with me, they will have their camera on. And it's, I don't care what they look like. We just need that connection, right? We need to see and hear and be able to check in with each other. And the best way to do that is to see each other. And also, you know, I can see if they're sleeping through the class, but it's really more for that connection. So, thank you. All right. So, loved this graphic. Found this out in one of my, found a study that talked about the symptoms and the causes of compassion fatigue. So, I built this little thing, threw it in here because it was a whole lot interesting, more interesting than the way they presented it. So, we've got causes of compassion fatigue and the symptoms that they show as they show up. So, on top of the emotion. So, compassion fatigue can start with just a nervous system arousal, which is going to probably lead to some sleep disturbances. So, once you hit those sleep disturbances, then things start to snowball. Sleep disturbances can lead to emotional intensity increases, cognitive ability decreases, which can lead to behavior and judgment being impaired. So, that is huge in our industry. That is something that you and I, all of us, need to be on point with every single day. Is our behavior and our judgment, is it impaired? Is compassion fatigue impairing that ability to have our judgment on point? So, I also have, I have a son who's a cancer survivor. I remember going to my PCP in the early days of being in the hospital and just burst into tears. And he says, I think you're depressed. And I said, what makes you say that? He says, nobody sits here and cries in my office. I said, nobody? He's like, no. I'm like, really, I think if I could sleep, if I could sleep in this hospital next to my three-year-old son, I could deal with all of these problems so much better. The day I got married, across the street up here, my mom said to my husband, my new husband, just make sure she's had plenty to eat and plenty to sleep, and y'all will have a happy marriage. She didn't say y'all. She doesn't let me text. But it's true. I am grumpy. I get hangry, and if I haven't had enough sleep, I jump straight to all through these things. I can't be the only one. We all need to be. I always say, I said, I'm not a morning bird. I'm not a night owl. I'm just a very exhausted pigeon. OK, so once we hit all of that piece of it, then isolation, loss of morale, depression, PTSD, loss of self-worth, emotional modulation, identity, worldview, and spirituality is impacted. We've seen a lot of that during the pandemic, a lot of that during the pandemic. Beliefs and psychological needs, safety, trust, esteem, intimacy, control, loss of hope, existential despair, anger toward perpetrators or casual events, turnover being the huge one. We talked about that a little earlier. We'll talk about it more in depth a little later. But turnover is becoming, as you all know, a huge problem in our industry right now. People leaving the bedside by droves. What I did in 2004 is finally catching up to everybody else. So I really just am not very patient, I guess. So anybody seeing any of this in your practice, in your organization? What are you seeing? Turnover. Turnover? Turnover. A lot of turnover. Are you seeing anybody lower down on the spectrum before they hit turnover? Did you have a comment? I have a question. Question. Yeah. We'll probably all have to answer this. A lot of times, we are talking about compassion, but I think that all we're talking about the health work is saying that these same situations are approved in an office space with compassion fatigue or not. Let's repeat the question, or at least paraphrase. For people who are online, the question was, essentially, we talk about compassion fatigue in clinical settings all the time. But do we address it in office settings? Well, I can speak to that, if you'd like. I would say, yes, office settings are starting to realize it. And so are other kinds of work settings. Because right now, how many times do we see signs that say, health needed? I mean, we'll pay $30 an hour for you to be a. Isn't Chick-fil-A hiring for like $20 an hour right now? My son's about ready to leave kinesiology school and just work for Chick-fil-A. So they're addressing it with money, and they're starting to address it with other options, other things, other benefits, which we will talk about some of the things that we deal with compassion fatigue generally. When I checked in, I spoke to the bellhop. Do they call him that anymore? The gentleman who carried the luggage. And I asked him, how are you doing? And he said, fine. I said, how are you doing? And he said, well. And I said, I'm here for this conference to talk about compassion fatigue. Have you ever heard of it? And he said, no. And I told him what it was, and he said, oh my gosh, yes. People around me are so mean. I was just talking to this woman back here. People around us are so mean. And can you imagine to be in his position? So employers are going to have to shift. If they haven't yet, they're going to have to shift because it's universal right now. The pandemic is something I think that brought this all to fore. I think it's sort of one of those experiences that really tell us who people are. And so that's brought it to the fore. And programs and things are getting started. I talked to a friend of mine who works in an office and said that they're starting to realize that it's not just the caregivers. So long answer to your question, yes. All right, so one last thing about this slide here. 2021 NSI National Health Care Retention and RN Staffing Report estimated a 18.9% nursing turnover rate occurred in 2020. And that was just nurses. And that's in 2020. So 18.9% turnover in nurses in 2020. All right, let's give this another shot. We won't try too hard on it, but what percentage? So there was a poll done by, let me get this right so you all know, Mental Health America from June to September 2020. They surveyed 1,119 health care workers all across the spectrum to ask them about compassion fatigue. How many of them do you think reported? This is a percentage. Percentage of 1,119. If the poll doesn't work, we can just move on. We can guess. 52? Here it is right here. So compassion fatigue was at 52. Exhaustion and burnout was 76%. So this was June to September 2020, mind you. So keep that in mind. So it was pandemic, early days of the pandemic. So also early days of the pandemic, remember, we did not really know how to treat COVID. We did not really know what was going on really well. But this was also the time where people were cheering for health care workers, right? We all saw the videos. People in Spain at 7 PM every night would go to their balconies and clap for the health care workers. That's this time too. So the complete results of that study, Andrew will talk about on the next slide. I just want to talk about these little pieces right here. Do you feel like these bear true in your workplace? Do you feel like that number's a little high? Low? What do you think? Shocking? Not shocking. I see people saying, this is not a shocking piece of information. How about this? 76% of your staff and co-workers are wondering why they showed up for work today. How about that? Is that shocking? So I took a little bit of liberty with that. But that's not a far jump. I find that really, that to me is eye opening. That to me is eye opening. 76% of my co-workers that I work with every single day are wondering why they rolled out of bed in the morning. Yes? I was looking at some of the other things that are difficult to me. Storytelling is so much of the philosophy of being virtual. But I think part of the problem is connecting with each other. It's not just the last time. It's not really seeing the way things are going for so long. But the numbers are surprising to me. Because I don't think we can keep these jobs and keep the skills throughout the day, throughout the period, for both virtual workers. So I think that goes unnoticed a lot. Because folks who are separated, isolated, and still need a lot of time to express even though they're working. That is absolutely true. Let me repeat that for our online people. So she was saying that because a lot of us went virtual. Now correct me if I don't paraphrase right. A lot of us went virtual. We were not able to see and connect with people as well as we would previously. So we would not maybe have been privy to how bad off we all were. Is that about right? So for our people at home or upstairs in their hotel rooms in the shower? OK. But I agree with you that. So are we checking in with our co-workers? Are we able to catch them at the beginning stages of the COVID? And this is what we're going to talk about. This is how we're going to spend the rest of this class. We're going to brainstorm. How can we catch and help our co-workers and those in your organization back down here before we even get to this point? Can we find these people before they hit the turnover piece? And what can we do for them? Because we know this is a problem. OK. So 39% of these health care providers. And this was just an open survey on the internet. So this would have covered people working from home like me. Or because I teach at our organization, I can do that remotely. And they're in Long Beach, and I'm in Texas. So it's a good thing I can do remote. But I teach. Andrea teaches all the new hires. I do all the continuing education in our company. So we do have a lot of contact with everybody within our company, no matter where they are in the country. So where are we providing this emotional support to 39%? Are we reaching out to the people that are remote? That they roll out of bed in the morning. Maybe took a shower. Maybe not. They might be sitting in their pajamas. Maybe, maybe not. Where are they sitting on this spectrum? Because we don't have any idea. Anyway, 76% of your co-workers did not want to go to work today. OK. So that study that Lonnie referred to, these are the numbers. But before we look at those numbers, I'd like to invite you to look at the face of this care worker. So she looks like someone who's just going into work on a regular day. And if you can't see it, I'll read some of these words to you. On her mask, it says armor, perfectionism, pain, conflict, lack of empowerment, warrior. So to me, and this art, where did you say you got this art? This is an NRN project where they asked health care workers to make a piece of art that explained the pandemic in a health workers. If you Google it, it's very fascinating. It's very fun. It's a traveling exhibit. So to me, that gives this more impact, right? Because it was a health care worker during the pandemic who felt she looked like this. That while on the outside and from a distance, she probably looked like a regular caregiver. But these things are going through her mind and her heart. And so the answers that people gave, where they had 92% answered they had high stress and anxiety and frustration, exhaustion, burnout. 33% reported grief. I mean, in the scheme of things, was that 92%? No. But 33% reported grief. And as we talked about before, it may be professional. It may be personal. It could be anything. And we don't know. It's hard to tell. And the loneliness and disconnection. Some people, I know that I talked to a friend of mine who was a remote worker, lived alone, had no animals, and for six months did nothing but order things in, did not have actual contact with a person for six months. And that's got to take a toll. And so where are we even now? I know we ask that all the time. But really, we want you to consider, where are you now? And when we look at this, we don't have any idea what she's been through. So consider what you've been through even in the last nine weeks or so. For me, I had a hip replacement. I had family who had distress. I had a mother who was in the ICU for five days and has been back to the ER six times since then. This is in nine weeks. And on Wednesday last week, I had a friend who died after a long battle of cancer. You couldn't tell that by looking at me, except for my cane and my limp, right? But we all have things. I'm not saying that to make you feel like, oh, you know, and she came to here. But what I want you to remember is that each one of us has our things going on. Just like you were saying back here, right? We don't know. We don't ask. And each one of us may have moments in our life that we just wonder, how can we take that next step? Now, I know we've talked a lot about what compassion fatigue is. And you're like, OK, OK, what do we do? We'll be getting to that. And there's a lot of ways to do it. There's a lot of ways to do it. But the first way is to find out where your people are. There's some tools for assessing compassion fatigue. So now you can walk up and you said, Dawn, how are you doing on the scale of compassion fatigue? And you're just going to walk in and tell me all the things I need to know, right? Maybe, maybe not. Maybe he's done this study before. But can you open that? I don't know if I can. We have the. Nope. OK, well, we'll go back. There's a variety of standardized screening measures. The one that is standard of care is the professional quality of life scale. And this is a very handy list that's up there in the corner that you'll find in our materials. But unfortunately, this isn't live right now. But the exam is called ProQOL. And it's a really good way for a person to answer some questions. You know, like many of these kind of exams, you have a series of questions that, based on the response, will tell the person reviewing the exam where a person is on the compassion fatigue scale. So if you've purchased all the slides for the whole conference, you'll see the little Adobe Acrobat up here in the corner. You can click on that. It'll bring up the ProQOL survey. And it's really interesting. And when this question would have had even more impact had you seen the questions. But if you had taken a compassion fatigue questionnaire right now, the average score of people is 50. In order to feel like a person has a quality of life that is happy and fulfilling, it needs to be 43 or less. So the average score was 50. Where would you be? And like Lonnie said earlier, we're on a spectrum. It's not like every single day I'm at a 43, or every single day I'm at an 84. Heavens, I hope not. But some people are. And we have to know where we are on the scale. And the more we talk about it, the more people will be aware of the things that they need to look at. So it's just important to be able to start by finding out where a person is in their journey. And do you think by a raise of the right eyebrow, so no one else knows, do you think you're over 50? Not age, but on the scale. Because really, it's important to know where you sit. So I thought that was a really interesting study. So plenty of options out there for you to be able to assess yourself and your staff, so within your organization. So you can pick one. All of these help to get an idea of where you would be in the compassion fatigue scale. So who's most at risk for compassion fatigue? So a study entitled Burnout, the Moral Resilience in Interdisciplinary Healthcare Professionals was published in the Journal of Clinical Nursing. Their 2021 cross-sectional descriptive study by Ann's daughter, et al, pulled a convenient sample of 696 interdisciplinary health care workers. So it even included the priests that work at the hospital and all of the sub-care professionals that work at the hospital. They had to have at least one year of experience as well. And then they determined their demographic, their work characteristics, and whether or not those had an influence on those four things. The emotional exhaustion, personal accomplishment, depersonalization, and then they added turnover rate. So here is what they figured out. Here is what the people who are at risk, they determined that the work and demographic factors, such as religious preference, years worked in health care profession, practice location, race, patient age, profession, and education level have a unique relationship with burnout subscales and turnover intention, although not equally so. So this study, this 2018 study by Ann's daughter, actually, so if you want to divvy it out, the Jewish people did so much better. They did so much better. And I kind of did that as upbringing. The African-Americans did better. All of us white female Karens, not as good. We did not do as well. So there are risk factors, but moral resilience is able to pad our ability to not get sucked into compassion fatigue. So how can we help those who are at biggest risk? OK. So I have gathered from about seven studies ideas on how we can help, ideas of things that we can do to help with compassion fatigue. What can we do in our workplace to help with compassion fatigue? I've grouped them into three different groups. Proactive, so three groups. Proactive, so things that we can do before we start getting turnover rate, before we start seeing compassion fatigue in your workplace. Proactive items. The next slide will be reactive. So once you've started to see this in your workplace, what can you do? And then the last bit of suggestions will be individual, the individual approach of how we can help the individual, the one. How can you help the one? And how can that one person, how can you help yourself? So that's the third slide. So let me just, I'm not going to go over all of them. Y'all can read. I'm assuming you've read plenty over your years. But this is, I kind of did my own kind of a meta-synthesis of a bunch of different studies. So most of this information came from a 2017 published study in the Journal of Clinical Nursing by Nolte et al. And I'm hoping that something we gave you, there are, if you didn't get a handout, do you want to throw the handouts around again? There's places to take notes on the back. This is what we want you to take away from this class. It's something that you can take back to your clinic or your organization, something that you can do. It's all fine to sit in these classes. But if you don't take an action point home with you, then your company has spent $1,300 on some very nice meals and maybe some alcohol in the evening. You've got to take something home. This is what we want. We want you to come up with some ideas. We'd also love to learn from your ideas, because there's no reason why we all need to reinvent the wheel. So if you've tried something, please speak up and let us know what you've tried and whether it worked or didn't work. So a couple of these I want to point out. Anne's daughter said in a 2021 study that strategies to encourage teamwork and positive working relationships should be promoted. So this can facilitate the development of a peer support network, making it possible for nurses to seek early assistance in dealing with the effects of compassion fatigue. And this kind of to your point back here, being that if we don't know what people are experiencing, we don't know how to help them. The best way to help peers is to help them have a support network. Now, did any of you make it to the Land Rover Jaguar class on Sunday? It's phenomenal. Phenomenal. So if you missed that, I would encourage you to go ahead and look it up. They're talking about how in all of their plants they are putting in wellness centers for their employees. And the things that are succeed, so they're struggling to, they got buy-in early on. The buy-in wasn't the problem because they had a lot of buy-in early on. One of the things that failed is they tried group therapy with a bunch of 65-year-old men in England and Liverpool. That did not work out well. But they tried. And they didn't trash it. They just adapted it. It was a very interesting, very, very interesting class. So if you get a chance to go back and listen to that one, or check out his slides. He said he would post them in LinkedIn. And one of the things, to the point that Lonnie's making about taking something home, I, for our company, do the learning engagement. Part of the engagement is a wellness program I've been building, very slowly and very painfully. And one of the things that I don't remember the gentleman's name, but Stephen and I-L-E-Y, I-L-E? So Stephen said, was branding is all about success. And I've been calling it a wellness program. And he said, people do not respond well to those words. Wellness program didn't work. So he said, they just picked a random name that sounded interesting, and that brought interest from others. So I'm immediately- They used the Greek god of health and healing, or something like that, and called it that. It was very interesting. And so I'm going to go, the one thing that I've taken away, one of the things I've taken away, is that I get to rebrand, and renew my program, and stay away from the wellness word itself. All right, so the other one I want to point out is Slatton et al. in 2020 determined that managers can mitigate problems associated with compassion fatigue with a number of interventions, including patient reassignments, formal mentoring programs, employee training, and a compassionate organizational culture. With burnout, health care managers will want to focus primarily on chronic organizational problems. And to this gentleman's comment right back here, this organizational problem and staffing is a huge problem. I don't have answers for you on staffing issues. I cannot. If I did, I'd probably not be standing here, and I'd be making millions somewhere else. But there is the possibility of considering strategies for your assignments. We have one clinic in Martinez, California, and one in Long Beach, California. The clinic in Martinez is a little smaller. Everybody's cross-trained. Everybody in the whole office is cross-trained. They cross-train to do registration. They're cross-trained to do dog collections. They're cross-trained to do medical surveillance and cross-trained to do kind of, well, except they don't do the physical exams, like the MA part of the physical exam. They work really well. That clinic is working really well. We don't have very much turnover in them. We recently went there. We have an in-house EMR. And we went down there to teach it. They were compliant. Their charting is spot on. We are not having any issues with this clinic at all. Long Beach, holy moly. So they're not cross-trained. They all have their own little job. They come in every day. They do their one job. They come home. We're having problems with the training, with compliance with the training. I'll probably be back there in June to retrain. But this ability to be able to just, they go in in Martinez, and they look at the board and find out what they'll be doing for the day. And they're cross-trained. They get different things that they do every day as they move around the clinic. It's working really well for them. In fact, to the point where, as soon as we can get Long Beach all on board with the charting that they're supposed to be doing, it's a great clinic. Please don't think it's not a great clinic. But I think we have some compassion fatigue issues. So they will start cross-training all of the employees in that clinic. It also helps with, for example, one of the biggest and the hardest things in our clinic is registration. Registration to register a new injured employee or somebody coming in for med surg, it is the biggest backlog in our clinic. And it increases wait times. It increases the number of patients that come in. It increases wait times. It makes our injured workers or the workers coming in for MSS angry and ornery because they're waiting. It's the hardest piece. By cross-training, that helps all of the other people who work in the clinic have more compassion for registration. We have compassion for each other in their jobs. Now, we can't always do that. But certainly, the nurse that's assigned to maybe take care of the kidney transplant in one room and the, I mean, you'd never stick a MRSA patient with a kidney. But if they're taking care of the same patient day after day after day, they're going to get burned out, which is going to lead to compassion fatigue. If you can change up who they work with, give them a couple of easy patients with a harder patient instead of giving maybe them, even though they're totally able to do a bunch of hard patients, let's not give them all of the problem patients. Maybe one of them has anger issues, and you don't want to put that one with another hard patient. So there's a lot of stuff on here that maybe we can't do. Ensuring adequate staffing, we can't. That's a whole other animal, right? But maybe some of these other things we can do. Do any of these look like something that you could implement in your workplace? What do you think? Any of these spike any interest to you, things that you might be able to do? Do you have specific bottlenecks in your processes that you're finding? Is there something specific that always holds things up for you? Or is it kind of all over the board? OK, let's talk. Oh, yes, there's a question. I heard a comment. How does social determinants of health affect this? I've met a lot of employees. They have finances that you can issue, and all the answers or suggestions, like if you're using power or interventions, can we either take time away from money they can earn or the family? Or do you have a question? OK, so the question was, how does a lot the financial piece work into all this as well? And that's very true. So maybe that's where we need to go on to. It's not on this slide. It's on the next slide. This idea of just being aware of that individual, right? So if that individual is picking up extra shifts, because number one, you need them to, and number two, because they really need the money, just being aware that they're picking up extra shifts. And just saying, I understand you're picking up extra shifts. Are you doing OK? You go ahead, pick up extra shifts, but I just want to make sure you're doing OK. Let's not push you further than you need. Or maybe if they're working extra shifts, maybe adjust what patients they get for that extra shift. Yeah? So my follow-up question to that is, if one has compassion, if he gets 80 and he reduces to 60, is that a success? That's a success. The question was, if you have compassion fatigue at 80 and you can get it down to 60, is that a success? Absolutely, that's a success. They're going to feel that. They're going to feel that in their personal life. So sometimes just, and now there is that issue with we, as I'm not an employer, but you as an employer, if you're an employer, we are not privy to everything that goes on in people's lives, and we shouldn't be. But asking somebody how they're doing, I notice you're picking up another shift. Is everything going OK? Absolutely, take the other shift. But how are you doing? Just be aware. Yes? So I just wanted to ask, is there a lot of confusion about trying to figure out where someone is, and then just gauging how many changes you make. Because I consider that to be one of the things that we do. Oftentimes, folks don't ask, how are you doing? Because they don't know how you help them do their thing. So one of the things that we really try to do is one, just validate on your skills, rather than fix it. And that, I'm seeing, is a huge difference. So this sits on that empathy scale, right? You got pity, sympathy, empathy, and compassion fatigue. We can't, or compassion, we can't always compassion with everybody. It's OK to empathy with people, to empathize. So OK, so the comment was, it was a really great comment, about sometimes we don't ask because we don't know how to fix a problem. But it's OK just to listen. So is there a way to maybe offer counseling in your organization? So that kind of talks about this as well, on this one. Actually, I think you're on this slide, sorry. I am, no problem. Excuse me. You tire, I'm so sorry. And to your point, to find out where they are, and to really address it, and also if they notice the change. I know in caregiving, which again, I know we all are involved in, sometimes just someone saying, you know what, I get that you hurt there. I'm not totally clear why yet. I understand it. We're working on it. And just to relate to it is the biggest thing. I worked as a case manager in work comp for 23 years. And sometimes me just sitting there was all a person needed. They needed to know that somebody cared, that somebody had their back. And I couldn't always change anything. But if I could care, then that made all the difference in the world. And I could assist them to navigate the system. Because like I said, when I talked to the gentleman who moved the luggage, what if he said, oh my goodness, I'm suicidal? Well, that would surprise me. But I would be glad I asked. Because then I would assist him with the next steps, right? And even if we don't know personally what to do, all of us have networks. All of us have things that we can do to follow up with. And that person needed someone to reach out to. Unfortunately, he didn't say that. But still, if someone does, and like you said, we're afraid to go, hey, how are you? Well, what I meant was, hi. And so when we ask that question, this is something that we talk about with a reactive system approach. We ask them about what they're dealing with. We want to be able to build support groups. Sometimes that's just a peer partner, right? Sometimes it can just be a buddy to talk to. You just need to work bestie. Yeah. And we have them in our company. Everybody does, right? One person you call and say, hey, I had the best day ever because, or, did you see that? Did you hear that? What? And so sometimes. We actually played work bingo behind the scenes for a couple of months there, tracking what our CEO was saying during work meetings. And I was a thing that was not work related, which is why I can say this. And there was somebody in a meeting that we knew always said one word. So we did the bottoms up game. I had to stop because I'm like, you know, I know it's going to come a lot more, and I'm done. And that was inappropriate. If that was recorded, please erase that. But really, sometimes we notice these things. We have to do things to sort of blow off steam. And we, to the point of alcohol, obviously, we need to use that within moderation. And I can't believe I said that. But. Andrew, we have like 15 minutes. OK, great. And so we have where we can give them spaces sometimes to release their stress and to give them meditation. I run a meditation club at our company. People will call in. We'll take 15 minutes. We'll do meditation. And so this is the reactive approach. So this is when we know we have a problem. Go ahead, Loni. And then we have individual approach. We've talked about some of this, where we build something for the people individually. Sometimes we. Sorry to interrupt you. The one thing that I really want you to take away from this, and we're running out of time, is the fact that telling your employees that you just need to be more resilient. No gaslighting. Yeah. No gaslighting. Just a pizza party's not enough. Pizza party's not good enough. So telling them to go out and get a massage, not good enough. OK? Offering massages, it's a little better. Right? Have somebody come in. Have a massage therapist come in. Like, how much is that going to cost you? Under $1,000, I would think. I don't know. I don't know. What does that cost you? But have somebody come in periodically. You know, they'll appreciate that a whole lot more than they will a pizza party. OK. So these are all fantastic ideas of things that you can do on the individual level, things that you might be able to do for yourself. I would like to spend more time on this. Take a picture of it if you haven't bought the slides. It's a good idea. And a lot of these are really great ideas. But do keep in mind on all of these, the studies show telling somebody to do something in their off hours does not count. I will not go and just, on my own dime, and get a massage on my day off of work. And it's not going to help me with my compassion fatigue. Research. Tons of research out there on compassion fatigue. There is not a lot of research out there on what to do about it. There really isn't. But, I mean, also, as we've learned, we've seen three whole slides now of ideas of what to do about it. Some of them will not work for you. Some of them won't. Biggest problem? Stakeholders. You have buy-in problems. Red tape issues. But that's OK. We can start small. There are things that you can do that are small. OK, so this, I'm really sorry we're out of time. Hi, I'm Dr. Mike Evans. And today's talk? In my FMP program, I was required to take a couple of classes by the, it's called the Health Care Improvement Initiative. And I had to take this class on quality improvement projects. How to implement a quality improvement project. This is a free video. I absolutely recommend it on how to implement something new. It is eight minutes long. That's all we've got is about eight minutes. So I absolutely recommend it. Let me point out a couple of pointer things that I really, really like about it. You can get this video on YouTube. So if you Google quality improvement in health care, and then Dr. Mike Evans, you'll find this video. It is actually really, really good. So a couple of things that I really liked about it, and I pulled it out. You know, I'm in a research class this semester. Can you all petition my teacher and just tell her that the final I'm supposed to take tomorrow was actually really well done? This was all pretty well done, and so I should be exempt. So I used this as my project during the class on compassion fatigue. All the research that I did on compassion fatigue I used in my class, or I used for this. And she allowed me to do that. I was really excited about it. This study right here that I studied for my class says that mindful self-compassion was hugely successful. So teaching them how to let go of the mistakes that they made, let go, put things in perspective. It allowed health care workers to use mindfulness as they work. So it was very proactive, very interesting. And to me, it reminds me of just culture, which I also studied this semester. This idea also that mistakes are not we are people. And people need to remember that in the news right now. The news is really scary for all of us. So we are just people. I've made two health, in my 25 years of being a nurse, I've made two med errors and one close error. They haunt me all the time. When I read about this just culture, I wished that that was a thing back when I was in school. And you know what it was? They just weren't practicing it well. OK, one of them was giving Benadryl instead of Tylenol. I mean, so it's not like it was hugely problematic. And this one right here, moral resilience. Moral resilience is helpful. This one here says that resilience, teach resilience. But to me, that's a lot like the mindfulness. So we don't really have a good, clear idea. But one of the things that's in this video was the idea of what can you do by next Tuesday. Let's not take this all in one big bite. Today is Tuesday. You got a week. You got a week. What can you do for your employees in your organization? And you might just be an employee in your organization. What can you do by Tuesday? Can you go to HR and say, hey, I want to implement, or I think we should implement, or I think we should send out this pro qual and find out how our employees are doing? What can you do by Tuesday? And then when Tuesday comes around and you've done it, what can you do by the next Tuesday? Take that information from the pro qual. Maybe bring in a massage therapist for a day. What can you do by next Tuesday? Really interesting thought by this company. One of the things I wanted to remember to bring up is also that if you start a process and it doesn't work, please don't consider it a failure. Please consider it a learning opportunity. Because you will have things that don't work. You will have things that do work. And so if you start with a small group, it can really help if you build up. If it works with one person, build it to more and build it to more. And just remember, those moments are learning opportunities. We know there's barriers, but I like this little cartoon from The Simpsons. We've tried nothing, and we're all out of ideas. Things are not changing in health care as far as mental health goes. And that's appalling for us. That's embarrassing for us. So we are doing the same thing that we were doing 25 years ago, pizza parties. It's not working. Guess what? It's not working. So we've got some ideas, some things that we can do. I know there's going to be red tape. If it doesn't work, plan it. I'm sure you've all seen this. It's also in the little video. Plan it. Implement it with one person. If it works, fantastic. Implement it with five. If it works with five, try 10. Doesn't work with 10, go back to plan. It's not a failure. It's a lot like what the guy from Jaguar was saying, Jaguar Land Rover. So group therapy doesn't work with a bunch of 65-year-old men from Liverpool. Surprise, surprise. That's OK. That's OK. Start again with plan. So whatever, maybe the pro quo didn't show anything, because nobody would fill it out. Because that's a thing. That's OK. Maybe you just assume you've got a problem because everybody else does. Start it over again. So in conclusion, what we have to offer our clients in occupational health is ourselves. And we have to protect ourselves. And we need to protect our employees and the people we work with. They deliver themselves every single day. We deliver ourselves every single day. And we need to protect ourselves and our mental health. Last week, nurses at Stanford walked out, the Stanford medical system. I'm not sure if y'all are following this. Walked out, 5,000 of them. What are they're asking for? Y'all can guess, right? Pay. That's one. Mental health help. Mental and staffing, the three things. Pay, staffing, mental health. They want their mental health recognized. 5,000 nurses walked out. You know what Stanford did, the health system? They hired 2,700 people who would step over the picket line and paid them $13,000 a week. So if you had taken that $13,000, and we're here. My son was like, what are you doing here? $13,000 a week to help with that. So your staff are begging for mental health protection. So what can you do by next Tuesday? So take notes, reach out, find out what your company's doing. See if you can, that it should help with your turnover rates if you can catch those numbers low. Catch them when they're down at that 39% before you hit that 76% who are wondering why they rolled out of bed today. So that's what we have. So thank you so much for attending. We are so happy that you did. So chat with each other, come up with ideas. Let's not reinvent wheels. Thanks.

burnout

compassion fatigue

healthcare professions

symptoms of compassion fatigue

self-reflection

seeking support

self-care

increased awareness

employee training

support groups

empathy

workplace