Opportunities Abound for Cardiovascular Nurses’ Wellness in the Face of Work Challenges

In the AHA Scientific Statement, Nursing Wellness in Academic and Clinical Cardiovascular and Stroke Nursing, Pike and co-authors¹ describe a steadily diminished nursing workforce as the result of aging and retirement, nurse burn-out, stress, and job dissatisfaction. They identify the evidence for drivers of burn-out and intent to leave the profession specific to clinicians (RNs and APRNs), nurse educators, and nurse scientists. Importantly, they do not leave readers with only evidence for contributing factors but also provide strategies to mitigate dissatisfaction and improve wellness. For example, shared governance, schedule flexibility, recognition activities, and support for self-care can reduce dissatisfaction among clinical nurses; adopting flexible work practices and favorable work-life policies, along with transparent faculty workload expectations, can improve satisfaction among academic educators; and support for nurse scientists that includes the provision of start-up research funding, facilitation of interdisciplinary collaboration, a reduced teaching workload, and an effective office of research support.

As reported in the scientific statement, the COVID-19 pandemic created significant challenges and heightened stress for all nurses – RNs and APRNs assumed care for high volumes of acutely ill patients, were exposed to infection and often became ill themselves, and witnessed the increased loss of life among patients, colleagues, and loved ones.¹ Nurse educators had to quickly use alternate formats for teaching and create effective simulations when face-to-face education and clinical experiences were not allowed.² Similarly, nurse scientists and their research teams designed virtual recruitment, data collection and intervention innovations so that studies could continue during the pandemic although research processes were ramped down.³ Despite the excessive workload and emotional exhaustion, the pandemic rendered a different healthcare environment and new opportunities for nurses which persist today: leadership in emergency preparedness and response; innovations in telehealth and tele-critical care services to provide surveillance activities of critically-ill patients; ⁴ leadership of interprofessional teams; innovative care delivery models that address social determinants of health, advance health equity, and may be situated in unique community settings such as homeless shelters; and nursing education that better incorporates population health and social, economic, and environmental factors that influence health and well-being. ⁵

The increasing demands of nursing roles within hospitals and universities affect the health and well-being of nurses. Nurses will more likely engage in new roles and leadership opportunities if they believe an organization has policies and provides resources for their health and well-being. Although employee wellness programs existed in healthcare institutions and some universities prior to the pandemic, the experiences of clinicians, educators, and nurse scientists during the pandemic underscored the dire need for programs that offer activities for stress reduction, encourage respite, provide counseling and coaching, and perform health screenings. As showcased in the scientific statement (1), one exemplar program from Ohio State University, led by a nurse leader appointed as Vice President for Health Promotion and Chief Wellness Officer of the university created strategic partnerships and resulted in the population's cardiovascular and mental health outcomes improving over several years. Given the nursing profession's focus on health of the whole person, the role of Chief Wellness Officer is an excellent opportunity for nurses, especially those with a background in population health, program management, prevention education, human resources, and what constitutes a wellness culture within organizations.⁶ Exciting opportunities abound to address the concept of workplace wellness through new innovations.

Many wellness programs promote strategies at multiple levels including at the individual nurse and organizational levels. Individuals are encouraged to acknowledge the stress emanating from roles and care responsibilities, and to develop strong self-care and individual resilience behaviors. Thus, both individual and organizational approaches are key since workplace resilience is considered an ongoing interactive process between the nurse and the workplace to promote well-being and healthy responses to emotional distress and buffer against adversity ⁷. Self-care can include developing individual goals around physical activity, nutrition, adequate sleep, and stress-reducing or resilience promoting behaviors which encourage overall and cardiovascular health, and can be fostered through a wellness partner. ⁸ A strong plan for individual self-care can be guided by the American Heart Association's Life's Essential 8 which includes four health behaviors (healthy diet, physical activity, never smoking, and good quality sleep) and optimal levels of four health factors (blood lipids, blood sugar, blood pressure, and body mass index).⁹

Promotion of resilience, that is the ability to bounce back after adverse circumstances and essentially thrive in contemporary healthcare challenges, can be enhanced with such activities as practicing mindfulness and meditation.¹⁰ One example is the Community Resiliency Model which can be effectively taught and practiced for individuals or in a group.¹¹ Importantly the authors point out the need for both education and training on addressing stress and promoting individual wellness early in a nurse's education or career ¹² and for more research due to the minimal data available and the low sample sizes in many intervention studies.

The past few years have had a profound impact on elevating the importance of humanism or the dominance of human value and goodness which resonates as core for many nurses. ¹³ Reclaiming this value through nursing leadership activities designed to create a culture of resilience might include recounting profound stories of nurses, nurse leaders, and nurse scientists making a difference for patients in a variety of settings, sharing gratitude for colleague's actions, and fostering relationships to support greater bonding as a team.

To address the shortage of nurses, nursing faculty, and leaders, and to continue to enhance the quality of care, the authors note mentoring and mentorship throughout the statement. Mentorship programs have been recommended as an approach to improve development of knowledge and skills as well as to support and enhance nurse retention.^14,15. Organizations are encouraged to develop mentorship programs to train mentors and promote activities to enhance the mentoring relationship. The return on investment is seen in improved career optimism, enhanced organizational commitment, and greater personal attitude to take charge of their nursing career and transform it. ¹⁶

Volunteerism within one's organization, serving in professional associations or other health care agencies, or advocating for change in any level of government on behalf of the nursing profession or for patients /communities can promote engagement and inspire a great deal of satisfaction in nursing's professional role. Appointed or elected positions within a shared governance model in hospitals can provide nurses with input into decision-making on clinical, staffing, quality, and leadership issues and a greater sense of control over their work environment. These strategies are important in helping rebuild a compassionate and effective nursing workforce. Within professional nursing or interdisciplinary associations, committee membership, committee chair or elected officer positions often provide nurses with educational, leadership, social, and collaborative opportunities as well as career growth.

Advocacy is always empowering and can reinforce one's expertise as a nurse. Nurses have countless opportunities to serve as advocates for themselves, other nurses and health care professionals, and most importantly, their patients. They can advocate for organizational policies and systems that support nurses, facilitate improved patient care, and promote equity. (5) Nurses can and should engage in grassroots advocacy to use their voices through emails or phone calls to legislators in support of several professional issues that impact safe nursing practice. Current bills can be found on the RN Action Center by the American Nurses Association https://www.nursingworld.org/practice-policy/nurse-staffing/nurse-staffing-advocacy. Furthermore, a bill is now in Congress that proposes to rebuild the nursing workforce by reducing the nationwide nursing faculty shortage and enabling schools to accept more qualified applicants. In addition to grassroots advocacy, nurses feel empowered when joining colleagues at the state or nation's capital to share their stories in-person with legislators and express the importance of bills that impact nursing practice and education.

The health and wellness of the nursing workforce, similar for other health professionals, is important for individuals and organizations to address through evidence-based approaches. These efforts are key to not only mitigate burnout and to promote retention, but they are also vital for quality of care and patient outcomes.