SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities.
I'm Sarah Hexem Hubbard, Executive Director of the Pennsylvania Action Coalition and the National Nurse-Led Care Consortium.
On this episode, we’re going to have a conversation with Dr. Dewi Brown-DeVeaux about burnout at a systems-level as well as its interplay with vaccine confidence at this point in the pandemic.
Dr. Brown-DeVeaux is joining us from New York City. She’s currently the is the Director of Nursing Services for Interventional Radiology/Infusion/Family Group Practice at a major academic Medical Center in New York City.
SARAH: Welcome Dewi to At the Core of Care.
DEWI: Thank you.
SARAH: We’d love to hear from both of you first about how you decided to go into nursing.
DEWI: So nursing overall was not my first degree at all. My personal motivation for nursing was through my parents. My mom was a college grad from Jamaica in accounting. And however, when she migrated to the United States, she became a home health aide and a nurse's aide. When I really graduated from college, my mother started the process of becoming an LPN. I was employed at Pfizer Pharmaceutical at the time; however, compensation was not the best. So, after several conversations with my parents and my other five friends that we graduated from college with, and we were unable to find decent jobs, we decided we were going to apply to nursing school because we thought that was the next thing. And my mother was also doing it. This was my initial motivation, but quickly it spiraled into an innate ability that I had, which was empathy, compassion, caring and the ability to optimize health care for others. I think there's nothing more rewarding. I'm actually getting sweaty when I talk about nursing. There is nothing more rewarding than being a nurse and I can't really think of anything else that I would have rather done. This is truly my path.
SARAH: Can you tell us about your current position, what it involves?
DEWI: In my role as a nursing director, I oversee the daily nursing operation in an administrative capacity, combining years of clinical nursing experience education, as well as managerial skills to develop organizational structure. And I liaison between my team, the patient and other executive leadership. So when you're in the nursing director role, you now oversee leaders of others and leaders of leaders, so it's a broader profile.
SARAH: And during the pandemic, what has your day to day been like? What does an average day look like for you?
DEWI: Unfortunately, the pandemic lives on. And we're still living through it. When the pandemic first hit, New York City was the epicenter, as most people knew. And we found ourselves on the frontline caring for more critically ill patients than we've ever done or ever even imagined in this lifetime. During that time, I can recall doing a lot of self-talk. And a lot of people might ask what that is.
I would go home and for three weeks, I didn't see my kids when the pandemic hit New York City. Because I had to send them to my parents in order to keep everyone safe. But I would have self-talk every day. We're unmatched. We're unparalleled. We make changes. We are strategic. And I had to really talk through really what our position was as nurses.
We got scared and we also got tired. And in an instant, COVID-19 really became the leading focus of the nation. And the rapid spread of the disease led to quarantines, business closing and above all social isolation. So, in a role that I was in, in a leadership platform, it was more of a 50% administrative and 50% leadership. And that really pivoted to about thirty-seventy, in which 30% was administrative. And we spent literally about 70% being leaders and protectors for our staff. And this was through really guided communication, a clear vision and motivation. It was a sense of perspective, making sure that our team was motivated to come back the next day.
And sometimes we talk about the word resilience if you go home, you know that you're coming back into a battle and what gets you up to go the next day. So I really had to pivot my day to day activity. I was more staff focus because I strongly believe that if I'm staff focus, then the staff will more likely focus on the patient.
SARAH: So we're spending this episode talking about burnout. And when you hear that word, what first comes to mind for you? How do you define that?
DEWI: Before the pandemic, I had a love-hate relationship with the word burnout. I really believed that I thought that it was a word that was exceedingly overused. That everyone just used it. If they have a bad day at work, I'm burnt out. So I had that love-hate relationship with it. And I knew that nurses even before the pandemic that they get to a point that they think they've done enough and it was so hard to push forward. But I just never like using the word. And when COVID-19 hit, in an in-depth conversation with a colleague of mine, it allowed me to take a deeper dive and a deeper look into the word, and I start doing more research on it.
So now when I hear the word burnout, it has a different perspective for me. I look at it differently. I think about exhaustion. I think about tiredness, I think about fatigue. I think about limited self-care. So burnout, by definition, the World Health Organization defined burnout, and it's not verbatim, but when you look into it, it's an emotional and physical and mental exhaustion that is really caused by excessive stress. And it's like a depleted bandwidth to work and you feel an inability to meet work requirements. It's really something that really snap your energy. So when I hear the word burnout now, it kind of shed light a whole lot differently than prior to the pandemic when I had to look into it a little bit more.
SARAH: And from your vantage point, as a nurse leader who you know is obviously seeing burnout from the system's level and probably experiencing some yourself at times, what are you seeing as the major causes of burnout in the healthcare space?
DEWI: So in the healthcare space, and as you know, I'm representing me, I can't really represent NYU. But from a person that's in a lot of organizations and looking at it from multiple organizations into many research, is that healthcare providers are currently at the mercy of COVID-19. And they're also at the mercy for individuals that refuse to take the vaccine. If we look into history seldom does a pandemic end abruptly. It just doesn't exist. Yet nurses right now, we really crave the immediate end to this pandemic. It's just so many lives lost. So the critical aim during this crisis was really and truly initially was triumphant success. Let's get our patients through it. Let's get our team through it. Let's get the general public through it. And we were literally at the mercy of saying let's get a vaccine and a vaccine is one of the most proudest moments in public health. And it's not just for COVID, for everything else. So we were praying for this magic to happen. And then it happened. And we are here. And now, a large volume of people don't want to do it. So in the healthcare space, COVID-19 is extremely crippling. Cause not only does are we working with COVID-19, then we have short staffing issues. That's the result of COVID-19, working extended hours, because we don't have enough staff. Workplace turnover. Increased patient acuity. Sicker patient. Lack of sleep, because you're so stressed and just emotionally drained.
So from a healthcare perspective and healthcare space, I think the number one thing that we are actually grappling against right now is COVID. Because it's causing so much stress, as I stated earlier, and what that does, is that stress is the body’s way of actually responding to a kind of demand of stress and your body automatically go into a fight and flight response. And just imagine doing that on a daily basis, and you're unable to get off that high. That's not good for the system overall.
SARAH: That's very helpful to break down COVID is causing burnout period. But there's lots of different ways that it's doing so.
So especially at this point in the pandemic, so many nurses are navigating COVID, whether getting sick themselves or their family members or they're directly involved through care, vaccination, testing. The nuance here is like nurses are in the position to be promoting vaccine confidence, but at the same time, they're the ones that are receiving the added stress of the system, because of the folks who are choosing to remain unvaccinated. So how do you talk with nurses that are in that position, that are experiencing COVID and all of these different ways and that are still trying to inspire vaccine confidence and trying to go to work the next day as you described before? What do you say to them?
DEWI: We are talking about vaccine confidence not only for the general public, right? It's vaccine confidence with our own team. And that's a tough one. It's an extremely tough one. And one of the things that I always start off by saying, because I have to lead with compassion, right, is that nurses are people, too. And it's understandable that they have questions about the vaccine. And there was a lot of conflicting information out there at the beginning of the pandemic and that still exists today.
So one of the things that we have to approach each individual is that we have to approach them without judgment. But speaking to the nurses out there, as nurses, we have to think about the common humanity. And nurses should trust the science because that's the foundation in which our profession is built on. So at some point, it's very difficult to be practicing as a healthcare provider and now say I don't trust the science.
And nurses that did not take the vaccine, they should. They need to extend a hand and extending a hand to all the other nurses out there that's being burnt out. We care for each other. We care for our families. We care for our patients. And one gift that we can provide in this moment is to say okay, let's get everyone on board. Let's end this pandemic as quickly as we can, that we can go on and we can move on and we can decrease the anxiety level that is out there right now that is caused by this.
SARAH: So have you have you seen specific strategies that have worked? How can nurses help each other get to that point? Maybe any experiences you had? Any conversations you had where you were able to help someone build that trust or move toward a space of more confidence in the vaccine.
DEWI: I know that one of the major population, at some point that had hesitation towards when we were doing this entire vaccine at the beginning was the minority population, especially in the African American community. And as a part of the greater New York City Black Nurses Association, one of the things that we did that we wrote a paper on it is that we went into the neighborhoods. So we buddied with FEMA, and we went into church base, and we were there, we set up shop there, and we would go there four days a week. Because we wanted people to see just because of history itself, we wanted people to really see that, and come and have a conversation with us. And for us to have an authentic conversation. It's not to force them to actually take the vaccine, but to actually provide as much knowledge and empathize with their concern and tell them that we don't understand where they're coming from. But when we do take the vaccine, where we expect to go. And that is the same profile that we have done within the healthcare system is having a lot of different platforms. And I think that a lot of times it starts with leadership is having that platform.
So we develop platform, that we can talk to whoever have doubts about the vaccine, have a conversation with them about it. And again, it's not to persuade anyone to do it is just to say, we understand you. But this is what we're telling you works in this moment. And then based on that they can make an executive decision.
SARAH: I think it was it was important to elevate again, the fact that nurses are people, nurses are themselves, you know, working through whether or not to get vaccinated, their family members are having those conversations. But for the nurses who as you said were waiting for the day they could get vaccinated, they got vaccinated, and here we are more than a year out. And many, many folks are still choosing not to. What advice do you have for nurses who are feeling frustrated with that situation?
DEWI: One of the things is that I always I have a big strong belief that we meet people where they are. And I try even within my team when I'm having conversation, and they get upset, and I was like, Okay, we have to really sit in where we are right now. Getting frustrated about the situation, what is going to do is that it's going to also increase your anxiety. So what can we do right now with what we have? And I think I'm a person that kind of think about things in that profile, is let's work with what we have versus work with what we think we want to get. And let's allow people to kind of come to that decision when they feel that it's appropriate for them.
And one of the great thing about in New York City, New York State overall, is that if you're working within the healthcare space, you have to get vaccinated. So it wasn't whether or not I'm working beside someone that is vaccinated or not anyone that worked within that healthcare space, they had to get vaccinated. So we were not at that disadvantage. If either someone decides to lose their job, or they decide to Okay, let's do the vaccine, whether or not I believe in it, but it was a state mandate, that that has to happen. So I think that's the great thing about us right now is that we know that everyone that we're working with, that they're vaccinated. And I try to tell my team, even not only with the vaccine, but everything else is that you can't really fight what you have no control over. Let's work with what we have in this space.
SARAH: So keeping that in mind, from a systems level, what practical tips might you have for administrators as they’re thinking about how to help prevent and cope with burnout? What can be done from a systems-wide level?
DEWI: One of the things is that you have to be authentic leader, that has to be within. You have to have an open door policy that your team can walk into your space and say I am feeling extremely frustrated right now. I'm feeling that I'm at that edge.
A lot of organizations and most organizations that I know of within New York City right now as a healthcare organization, they do provide a lot of support. So there's a lot of hotline. There is a lot of private psychologist counselors that you can speak to. And it's encouraging your team to actually do that.
One of the things that I did when we were in the height of the pandemic with my team, was that if you see that someone is running around all day, they are at the height, just stop them for a minute and do a couple of breathing exercise. So we try to implement a lot of wellness technique. So that we are able to recenter. There are going to be moments that you are at a 10. How do you take it down? Take that two, three minutes away, whether it's in the bathroom, whether it's in a room, do some good breathing exercise to kind of bring you back down. And when you do it properly, it kind of clear your mind of a lot of things. And I would recall, when my staff would cry, I would say, Okay, fine. Now I need you to speak to someone because we had a lot of resources that were available.
And encourage your staff. We need to remove the stigmatization that is on wellness. We need to remove that stigmatization that is on, you're not supposed to feel frustrated. And we need to be extremely transparent. From a leadership perspective, you've got to be transparent with your team, and letting them know every single moment what we're going to do next. If people are able to anticipate, okay, fine, we are down two nurses. But we're in the process of interviewing and hiring, have them walk through that step with you, have them help you with the interview, so that they know that we are about to have change, instead of them thinking that there's nothing that can be done.
And another big thing is that the team needs to lend themselves compassion as well. So what does self care look like for them? They first need to know who they are, know what their purpose is, know what are their own limitations. And I think because not two persons the same. What is your support system? Because your support system might not be your family, it might not be your friends that is not in the healthcare space, because they might not understand what you're going through.
Join an organization. So I'm a part of multiple organizations. We talk about wellness technique all the time. We have people come. We are able to share this one voice. So have a good support system that can really relate to you that you guys can talk about some of the turmoil that you're going through, and what is your own self of control.
So I'm on the other spectrum, I'm extremely optimistic. [LAUGHS] People always say to me, Dewi, the world is not like that. I'm optimistic. I'm a person that I strongly believe that tomorrow is going to be a better day. And if I don't fight today, then I will get through to tomorrow. But not a lot of people can really sit into that space. So I can't really say because I feel that way others should. So what you need to do is that know people that are around, know, what are their attitude and their outlook on the situation. And don't dismiss their concern, because you don't feel that way.
Through the height of the pandemic and through it all, I never fluster because I had to have a sense of control for my team. So it's just keeping that for your team and making sure that they're okay with each stride as well.
SARAH: Thank you for bringing that. It's amazing to see you continue to carry that forward after years in this space, and certainly not easy to work in the healthcare system beforehand.
DEWI: It's not. And one of the things being that motivator and supporter for your team, you get into leadership because you want to make sure that your team is doing well. And you get into leadership to make sure that every single moment that they can call upon you. And you have a vision, you model the way. So you have to be vulnerable to your team and have them to be vulnerable to you. And before that there was like a divide before COVID. I think there was a divide that you’re a leader you lead in the space and you don't really go into their home space. But then when the pandemic hit, I realized that I had to change that concept. I need to be there for you not only at work, but also what kind of support can I provide for you or what kind of support I can provide for you when you're home? How can I help you to navigate that? And for you to verbalize your feelings and your fears? Because as nurses, I think one of the things that they want is that they want to say hear me, protect me, prepare me for what's to come, support me for what I'm going through and care for me, regardless of what's happening. So it's some of those tools that we have to use in order to move forward.
SARAH: It reminds me of the concept of being able to bring your whole self to work, and not having to compartmentalize and separate that out all the time.
But you've talked a little bit about decision fatigue in other conversations and seeing decision fatigue as part of burnout. Could you describe for us what you're seeing in nursing related to that issue?
DEWI: So in nursing overall, there's a pathway that you follow, right? So we have these theory that we live with, and it's the Benner’s theory. And it's come from novice to expert. So your novice, your competency, you go through all these phases. So now you're in that expert level. And now you're dealing with COVID, you don't know what decisions to make. How is that possible? I'm able to walk in, look at my patient know exactly what's happening before even touching them. And now you're at a point that it's difficult to make major decision because you don't really know what's happening. And that for expert nurse can be frustrating. And then you have a newer nurse that is coming in, that the expert is supposed to provide guidance. And it's difficult to provide that guidance because you yourself is unsure as to what the processes are currently are because we had to change them consistently, initially. So burnout comes at different level before I be like, Nursing is a young person sport, when you come in, you're not supposed to be burned out. But I can understand a new nurse coming in, because you're coming into a whole different profile of nursing that you've never heard of before this, and you're unable to kind of make executive decisions, because you don't know what that decision is going to be. So you'll find that a seasoned nurse will be frustrated by that. You'll have a younger nurse that's going to be frustrated by that. And how are you able to kind of merge the two. So I had to conceptualize like really, truly why is a seasoned nurse being burnt out? Why are we having younger nurses being burnt out and realize that there are two different platforms in their life. And they're burnt out for different reasons and different moment in time.
SARAH: So how can nursing respond? I mean, how do we address that?
DEWI: One of the things that I always say to my team, especially my expert team is that you made the best decision that you can make in this moment, and I will support you. You do that decision with integrity. And that means you will always make that decision when no one is looking and when someone is looking. So if you made that decision in that moment, and it's the best decision that you could make based on all of the information that you do receive, I will support you. And I might say we could have done it differently next time. And this is the process that I would follow. And then for the younger nurses is really and truly is always tapping into someone. It's making those fine decisions is that you have to tap into someone even though the person might not know. So just knowing that and I always say nurses are a team sport. If you decide to do nursing by yourself, you will never survive. Nursing is a team sport. You have to do it together and you cannot do it in isolation.
SARAH: I'm going to go back to the self-defined optimist. But how do you institute breaks for yourself? I mean, no one can be on all the time. And being a vulnerable leader means that it's sometimes you struggle, too, right? How do you handle that? How do you institute breaks for yourself? What creative outlets do you have? How do you handle burnout?
DEWI: I changed jobs in the last year and I realized that the same thing is following me. My team check on me. They really check on me. My team, my direct report, who reports up to me, they really check in me. In the height of the pandemic, and one of the things that I always talk about this and will forever talk about it. And I remember about five of my nurses, they came to my door. And one of the things they said to me, I don't want you in the room because I was a person, I was wearing scrubs every day, I was running into the room. And sometimes I'm running into the rooms, without even thinking, and I remember them coming to me, and they were like, you cannot afford to get sick. Because if you do, who is going to take care of us? So on a daily basis, they will stop by, did you have lunch?
My support system are my friends, my husband, my kids, my parents. They are one of the best in the world. So in a moment time, I will say we're meeting up and now we start meeting up because I told you that five of my friends, we went to nursing school together, and we meet up now more than we've ever met up when we didn't have the pandemic. And it's the check in, and it's to have a conversation. And it's to laugh, and it's to talk and it's to get our kids together. Because we know there's no other space that is out there. So those are some of the things that I've used to challenge what's happening. To just know that I can turn off. I have moments when I'm at work. And I'd be like, Okay, this is too much. And if it's five o'clock, depends on what's happening. I leave my desk as dirty as it is. And I walk out. And I be like, You know what, I pick this up tomorrow. And it's my way of saying that I've had enough for the day. Or I'm in my office, I'm doing something that is frustrating. And I say, ‘you know what, I need to walk away’ and I walk away. I'll go check in on the team, they always make me happy because there's always something that we're laughing about. And that kind of recenter you and then you go back and I do my breathing as well. That is my number one, my Apple Watch. There's a breathing app on it. You go in it. At least two cycles. That's two minutes. And you're recentered.
SARAH: From a leadership position, what does it look like to help your staff take breaks? Like how do you make that happen? Breaks for your staff?
DEWI: Breaks is important, and all the nurses out there, we know that it's has never been something that we kind of incorporate in our day. [LAUGHS] It wasn't it just you go and go until you can't go anymore. And then you say, let me go grab some lunch. Let me come back, because you want to just finish your day. But it's extremely important for your staff to take break. And that is instituted and incorporated at the beginning of the day. I was just having a conversation with my infusion team. And I was like I heard that you guys don't take break. Can you please explain to me why? And within that moment, I said, Okay, let's plan it out that you can at least go outside, walk around the block a couple of minutes and come back. And I say it's important and I know there's going to be days that you will not be able to take it because you don't want to fall behind. But each time we do get an opportunity it has to be something that you incorporate in your daily routine. I said just walk to my office and walk back. Sometimes you just need to take a breather.
And COVID had taught me so many different things that not that I wanted it at all. But has taught us to actually kind of care for herself a little bit more and to give ourself grace and to give ourselves some more compassion and that we will be able to complete the day whether or not we take break is just how are we able to kind of more manage your time.
SARAH: So before we come to an end, any final thoughts, reflections that you would like to share with our listeners?
DEWI: My biggest thing that I would want to share that I want to share with the listeners is that burnout exists. It does happen. It doesn't really happen in a moment in time, it may be something that actually gradually creep up on you. But you need to step into it if it does, and you need to acknowledge it. If it does, and you need to take care of it if it does. And it's not stigmatized for you to go sit on someone's couch, and tell them what you're feeling and tell them what you're going through. So that they can better help you.
Because with high level of stress comes depression, comes anxiety, comes suicidal thoughts, because you don't know how to deal with it. Because you cannot live in that space of being stressed all the time. And really give a helping hand when we can and make sure that each person that you're working with on a daily basis as nurses out there that you check in on them. Even if you've never worked with the person before you might have floated to a floor, check in how are you doing? Do you need any help?
And sometimes you don't need any help. But the thought of someone asking you, you feel so good, because you feel that someone do care and you feel that you're not in the struggle together.
So just making sure that we're taking care of each other on a continuous basis. And if we're able to take care of each other on a continuous basis and for leaders is being authentic. It's not saying that I know this is what we have, and this is what we have to do. But if I understand what you guys are going through, and what do you need from me? I will give your patients some water. I will come in there if you need me to, I’ll turn a patient for you. And it's not that you staff want you to do it. They just want to hear you say it. Because I just have to say and they're like No, no, no, it's just knowing that you care, and that you care about them as people and that you care about them as individual and not just you are a nurse.
SARAH: Thank you Dewi so much for joining us.
DEWI: It was such a pleasure to be with you guys. It was a great conversation and I hope that it will touch at least someone out there for us to kind of try to get ahead of the burnout that we're seeing in healthcare.
SARAH: And if you’re interested in hearing another nursing perspective on burnout, check out our episode with Dr. Ali Tayyeb from California. He doesn’t even use the word anymore.
ALI: I call it burn down because it's systemic. So the system is burning you down from forcing you into these situations where you are under such stress.
CREDITS:
SARAH: Support for our special COVID-19 pandemic coverage comes from the Centers for Disease Control and Prevention.
You can find our most current and past episodes of At the Core of Care wherever you get your podcasts or at paactioncoalition.org.
For more information about related upcoming webinars and where to find COVID-19 resources, log on to nurseledcare.org. And you can stay up to date with us on social media @NurseLedCare.
At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder.
I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. Thanks for joining us.
