WEBVTT

00:00:00.843 --> 00:00:03.978 position:50% align:middle
- [Host] Amy Witkoski-Stimpfel
is an assistant professor

00:00:03.978 --> 00:00:07.630 position:50% align:middle
at the Rory Meyers College
of Nursing at New York University,

00:00:07.631 --> 00:00:12.251 position:50% align:middle
where she is deputy director of the
NIOSH-funded doctoral training program

00:00:12.252 --> 00:00:16.618 position:50% align:middle
in occupational health nursing.
Dr. Witkoski-Stimpfel researches

00:00:16.619 --> 00:00:21.033 position:50% align:middle
work environment factors that
influence nurses' health and wellbeing

00:00:21.034 --> 00:00:22.987 position:50% align:middle
as well as patient outcomes.

00:00:22.988 --> 00:00:27.389 position:50% align:middle
Her research has been published
in leading health policy, nursing,

00:00:27.390 --> 00:00:29.501 position:50% align:middle
and occupational health journals.

00:00:36.329 --> 00:00:39.272 position:50% align:middle
- [Dr. Witkoski-Stimpfel] So, greetings.
I'm happy to join you today to discuss

00:00:39.273 --> 00:00:42.679 position:50% align:middle
my research on nurses' sleep,
stress, and substance use.

00:00:42.680 --> 00:00:46.488 position:50% align:middle
And we're drawing on findings
from virtual focus groups.

00:00:46.489 --> 00:00:49.870 position:50% align:middle
Before beginning the presentation,
I'd like to acknowledge and thank

00:00:49.871 --> 00:00:53.352 position:50% align:middle
the National Council of State Boards
of Nursing for funding this research,

00:00:53.353 --> 00:00:57.523 position:50% align:middle
report no conflicts of interest, and
acknowledge both my collaborators

00:00:57.523 --> 00:01:00.758 position:50% align:middle
as well as the participants
who made this research possible.

00:01:02.708 --> 00:01:06.324 position:50% align:middle
By way of background, many of you
are likely familiar with the high levels

00:01:06.325 --> 00:01:10.026 position:50% align:middle
of work stress, sleep disruptions,
and fatigue that are commonplace

00:01:10.027 --> 00:01:11.994 position:50% align:middle
among U.S. registered nurses.

00:01:11.995 --> 00:01:15.956 position:50% align:middle
And they also recognize the overlap
in highly stressful work conditions,

00:01:15.957 --> 00:01:19.264 position:50% align:middle
sleep problems,
and co-occurring substance use.

00:01:19.265 --> 00:01:23.193 position:50% align:middle
Given the limited domestic qualitative
literature specifically focused

00:01:23.194 --> 00:01:27.102 position:50% align:middle
on these three issues, we were
interested in exploring and learning more

00:01:27.103 --> 00:01:32.098 position:50% align:middle
about the intersections of these issues in
registered nurses using their own words.

00:01:32.099 --> 00:01:36.438 position:50% align:middle
I'm first going to speak about the
results of my study in parts one and two.

00:01:36.439 --> 00:01:39.547 position:50% align:middle
And then for the third part of the
presentation, I'll briefly summarize

00:01:39.548 --> 00:01:44.254 position:50% align:middle
the work and offer some
recommendations and next steps.

00:01:44.255 --> 00:01:49.300 position:50% align:middle
To achieve our study's purpose, we
conducted a qualitative descriptive study

00:01:49.301 --> 00:01:51.096 position:50% align:middle
using virtual focus groups.

00:01:51.097 --> 00:01:54.341 position:50% align:middle
And we were guided by the
Work, Stress, and Health framework

00:01:54.342 --> 00:01:57.410 position:50% align:middle
which was developed in the
occupational psychology literature.

00:01:57.610 --> 00:02:01.491 position:50% align:middle
And it depicts work stressors
such as shiftwork or understaffing

00:02:01.492 --> 00:02:04.923 position:50% align:middle
that can lead to harm to the
worker and to the organization,

00:02:04.924 --> 00:02:08.951 position:50% align:middle
depending upon how the stressor
is perceived and coped with.

00:02:09.671 --> 00:02:13.089 position:50% align:middle
The effects of the work stressors
can be buffered by individual

00:02:13.090 --> 00:02:15.379 position:50% align:middle
or organizational resources.

00:02:15.380 --> 00:02:19.851 position:50% align:middle
So this framework helped us to construct
our focus group guide, questions,

00:02:19.852 --> 00:02:21.777 position:50% align:middle
and our analysis.

00:02:22.371 --> 00:02:25.322 position:50% align:middle
We recruited participants
who had previously participated

00:02:25.323 --> 00:02:28.925 position:50% align:middle
in the RN Work Project,
which was a 10-year panel study

00:02:28.926 --> 00:02:32.926 position:50% align:middle
of newly licensed nurses funded by
the Robert Wood Johnson Foundation.

00:02:33.140 --> 00:02:35.961 position:50% align:middle
These participants had
consented to being contacted

00:02:35.962 --> 00:02:38.362 position:50% align:middle
for future research opportunities.

00:02:38.481 --> 00:02:43.924 position:50% align:middle
We recruited our participants via email,
and we ended up with a sample size of 41,

00:02:43.925 --> 00:02:47.460 position:50% align:middle
which we randomly split into
two identical virtual focus groups.

00:02:48.540 --> 00:02:53.448 position:50% align:middle
So we conducted focus groups in early
2019 using a threaded discussion board

00:02:53.449 --> 00:02:57.869 position:50% align:middle
called QualBoard, part of
20/20 Research's platform.

00:02:58.070 --> 00:03:00.726 position:50% align:middle
Participants and researchers could
engage in discussion using

00:03:00.727 --> 00:03:03.919 position:50% align:middle
any internet-enabled device
and at any and at any time of day.

00:03:04.300 --> 00:03:08.062 position:50% align:middle
We were able to probe, ask additional
questions both to the group and

00:03:08.063 --> 00:03:11.195 position:50% align:middle
to individuals, and to
monitor the data for saturation.

00:03:12.077 --> 00:03:15.806 position:50% align:middle
Conventional content analysis
was used to analyze the data,

00:03:15.807 --> 00:03:18.632 position:50% align:middle
and we imported all
the data into ATLAS.ti.

00:03:19.403 --> 00:03:24.577 position:50% align:middle
Initial analysis included a line-by-line
review of the focus group transcripts

00:03:24.578 --> 00:03:26.640 position:50% align:middle
by each of the three researchers.

00:03:26.799 --> 00:03:30.296 position:50% align:middle
A priori codes from the Work,
Stress, and Health framework

00:03:30.297 --> 00:03:31.915 position:50% align:middle
were included in the coding scheme,

00:03:31.916 --> 00:03:34.825 position:50% align:middle
as well as additional codes
generated by the researchers.

00:03:35.209 --> 00:03:40.402 position:50% align:middle
Next from the codes, categories
were developed in an iterative process,

00:03:40.471 --> 00:03:42.854 position:50% align:middle
achieving consensus
among the researchers.

00:03:42.998 --> 00:03:47.703 position:50% align:middle
And finally, themes based on portions
of the narrative assigned to each category

00:03:47.704 --> 00:03:49.036 position:50% align:middle
were developed.

00:03:49.205 --> 00:03:54.250 position:50% align:middle
A team maintained a code book to
ensure consistency and conceptual accuracy

00:03:54.311 --> 00:03:58.044 position:50% align:middle
during the coding process
and as well for reproducibility.

00:04:02.094 --> 00:04:04.821 position:50% align:middle
In this next slide,
you'll see a screenshot

00:04:04.822 --> 00:04:06.686 position:50% align:middle
of the threaded discussion boards.

00:04:06.687 --> 00:04:10.333 position:50% align:middle
It's not a real setting, but it can give
you an idea of what the researchers and

00:04:10.334 --> 00:04:13.076 position:50% align:middle
and participants saw when
they logged into the QualBoard.

00:04:13.897 --> 00:04:18.793 position:50% align:middle
Each section was focused on one
domain of the study: work stress, sleep,

00:04:18.794 --> 00:04:20.260 position:50% align:middle
and substance use.

00:04:20.404 --> 00:04:22.981 position:50% align:middle
Participants were then
assigned an anonymous ID,

00:04:22.987 --> 00:04:26.023 position:50% align:middle
and no identifying information
was revealed on the focus groups.

00:04:28.395 --> 00:04:31.557 position:50% align:middle
At the conclusion of the focus
groups, we invited participants

00:04:31.558 --> 00:04:34.355 position:50% align:middle
to provide us with some
sociodemographic information.

00:04:34.605 --> 00:04:37.207 position:50% align:middle
We had a total of 19
participants who did so.

00:04:37.910 --> 00:04:41.272 position:50% align:middle
As you can see from this
table, most of the participants

00:04:41.273 --> 00:04:45.594 position:50% align:middle
were 40 or younger, female,
and about 68% were white.

00:04:46.106 --> 00:04:48.699 position:50% align:middle
Over two-thirds were educated
at the baccalaureate level.

00:04:49.485 --> 00:04:52.496 position:50% align:middle
These demographics and
educational attainments reflect changes

00:04:52.497 --> 00:04:55.834 position:50% align:middle
in newly licensed nurses who
are increasingly diverse in gender

00:04:55.835 --> 00:04:57.645 position:50% align:middle
and racial and ethnic background.

00:04:57.646 --> 00:05:00.595 position:50% align:middle
And we compared these
findings to the 2018 sample

00:05:00.596 --> 00:05:03.197 position:50% align:middle
of the National Sample
Survey of Registered Nurses.

00:05:06.907 --> 00:05:10.621 position:50% align:middle
In this next table, I'll give a quick
overview of the work characteristics

00:05:10.622 --> 00:05:12.096 position:50% align:middle
of the participants in our study.

00:05:13.399 --> 00:05:18.697 position:50% align:middle
Most participants held a primary job
as a staff nurse, worked 12-hour shifts,

00:05:18.803 --> 00:05:20.639 position:50% align:middle
about half were working day shift,

00:05:20.640 --> 00:05:24.200 position:50% align:middle
and almost half had been in their current
position for three years or longer.

00:05:28.401 --> 00:05:30.931 position:50% align:middle
Now that you have an idea
of what our sample looked like,

00:05:31.207 --> 00:05:33.789 position:50% align:middle
I'm going to speak about
our first set of themes

00:05:33.790 --> 00:05:36.696 position:50% align:middle
connecting sleep, work
stress, and substance use.

00:05:39.626 --> 00:05:42.672 position:50% align:middle
We did some summative content
analysis to examine the types

00:05:42.673 --> 00:05:47.385 position:50% align:middle
of work-related substances, that is, those
that helped the participants to stay awake

00:05:47.388 --> 00:05:51.001 position:50% align:middle
in preparation for their work
shift or during their work shift,

00:05:51.002 --> 00:05:53.605 position:50% align:middle
as well as to help them
go to sleep after work.

00:05:54.347 --> 00:05:59.196 position:50% align:middle
And we described this by tallying the
frequencies of substances mentioned

00:05:59.197 --> 00:06:00.598 position:50% align:middle
by the participants.

00:06:00.779 --> 00:06:04.102 position:50% align:middle
We then categorized these
into stimulants and depressants.

00:06:04.103 --> 00:06:07.806 position:50% align:middle
We found that caffeine was, by and large,
the most commonly used stimulant,

00:06:07.809 --> 00:06:11.264 position:50% align:middle
while other stimulants mentioned
included things like Adderall and Nuvigil.

00:06:12.598 --> 00:06:15.948 position:50% align:middle
In terms of depressants, participants
described alcohol as the most

00:06:15.949 --> 00:06:19.392 position:50% align:middle
common depressant, and smaller fractions
of the sample mentioned depressants

00:06:19.393 --> 00:06:23.130 position:50% align:middle
like antihistamines, like common
over-the-counter drugs like Benadryl,

00:06:23.131 --> 00:06:26.037 position:50% align:middle
and prescription
sleeping pills like Ambien.

00:06:29.739 --> 00:06:34.117 position:50% align:middle
The three themes that developed
were titled "See no evil, speak no evil,

00:06:34.118 --> 00:06:36.710 position:50% align:middle
hear no evil," "It's
somewhere out there,"

00:06:36.711 --> 00:06:38.711 position:50% align:middle
and "Caffeine is king
and alcohol is queen."

00:06:40.249 --> 00:06:44.661 position:50% align:middle
So, participants flat out denied knowing,
hearing, or seeing substance use, that is,

00:06:44.662 --> 00:06:48.506 position:50% align:middle
illegal or recreational substances, in
themselves or those who they worked with.

00:06:49.159 --> 00:06:52.319 position:50% align:middle
We have many examples similar
to this first quotation, saying,

00:06:52.740 --> 00:06:55.932 position:50% align:middle
"I have not heard any nurses I
work with mention substance use."

00:06:56.704 --> 00:06:59.049 position:50% align:middle
There were a few exceptions, however,

00:06:59.050 --> 00:07:01.235 position:50% align:middle
in which there was some
discussion of marijuana,

00:07:01.240 --> 00:07:05.699 position:50% align:middle
particularly in cases where it was legal
and outside of the work environment,

00:07:05.700 --> 00:07:08.200 position:50% align:middle
which were noted
clearly by the participants.

00:07:08.553 --> 00:07:10.009 position:50% align:middle
Here is an example.

00:07:10.010 --> 00:07:11.916 position:50% align:middle
"While it's not brought
up in conversation,

00:07:11.917 --> 00:07:14.699 position:50% align:middle
it would not surprise me how
many people  use marijuana,

00:07:14.700 --> 00:07:16.420 position:50% align:middle
even in the nursing profession.

00:07:16.420 --> 00:07:19.558 position:50% align:middle
If it helps people cope and
enjoy themselves, I'm all for it.

00:07:19.902 --> 00:07:20.902 position:50% align:middle
Just not at work."

00:07:23.747 --> 00:07:27.364 position:50% align:middle
So, our second theme reflects the
indirect reporting of substance use.

00:07:27.599 --> 00:07:31.459 position:50% align:middle
While not reporting substance use
among colleagues or themselves directly,

00:07:31.460 --> 00:07:34.154 position:50% align:middle
nurses were quick to point to
a problem with substance use

00:07:34.155 --> 00:07:36.268 position:50% align:middle
in the larger nursing profession.

00:07:36.355 --> 00:07:39.059 position:50% align:middle
Several participants made
comments like this one.

00:07:39.060 --> 00:07:42.052 position:50% align:middle
"I think it's a lot more prevalent
than most people would like to admit."

00:07:43.471 --> 00:07:47.853 position:50% align:middle
Another example is "I would go as
far to say as that most nurses use

00:07:47.854 --> 00:07:49.840 position:50% align:middle
some substance to get through the day,

00:07:49.840 --> 00:07:54.069 position:50% align:middle
whether that's coffee, alcohol,
sleep aids, recreational drugs, etc.

00:07:54.070 --> 00:07:57.199 position:50% align:middle
I can't think of any nurse who
I know who is substance-free."

00:07:58.202 --> 00:08:00.365 position:50% align:middle
This theme suggests
that there is still hesitation

00:08:00.366 --> 00:08:02.366 position:50% align:middle
to openly discuss substance use,

00:08:02.386 --> 00:08:06.157 position:50% align:middle
reflecting similarities in previous
literature describing substance use

00:08:06.158 --> 00:08:09.966 position:50% align:middle
as taboo or unacceptable among
nurses and other healthcare workers,

00:08:09.967 --> 00:08:14.100 position:50% align:middle
yet perhaps is a problematic
issue in some proportion of nurses.

00:08:17.033 --> 00:08:21.305 position:50% align:middle
And finally, we developed a theme called
"Caffeine is king and alcohol is queen."

00:08:22.105 --> 00:08:26.307 position:50% align:middle
Here we reflected that participants
readily described, at times, heavy use

00:08:26.308 --> 00:08:30.822 position:50% align:middle
and reliance on legal substances
like coffee, tea, energy drinks,

00:08:30.823 --> 00:08:34.424 position:50% align:middle
and beer or wine, related to preparing
and managing for their work day

00:08:34.425 --> 00:08:36.003 position:50% align:middle
and subsequent time at home.

00:08:36.653 --> 00:08:40.008 position:50% align:middle
The first two quotes reference caffeine,
and the third references alcohol.

00:08:40.805 --> 00:08:43.770 position:50% align:middle
For example, "I drink coffee,
three to four cups a day.

00:08:43.770 --> 00:08:46.571 position:50% align:middle
And most of my coworkers
drink coffee in varying amounts.

00:08:46.952 --> 00:08:50.176 position:50% align:middle
Some drink other caffeinated
beverages such as pop or energy drinks.

00:08:50.177 --> 00:08:52.801 position:50% align:middle
And I've seen some people using
herbal supplements as well."

00:08:53.933 --> 00:08:58.139 position:50% align:middle
Another said, "It seems like we all
come in with a coffee cup in our hands,

00:08:58.140 --> 00:09:00.808 position:50% align:middle
and most of my coworkers
crack a Red Bull by lunch."

00:09:01.877 --> 00:09:05.965 position:50% align:middle
And then finally, "I love my after-shift
beer, and I'm not afraid to admit it.

00:09:06.196 --> 00:09:10.204 position:50% align:middle
I run a hot bath, drink a beer or two,
and then can actually get to sleep."

00:09:11.604 --> 00:09:14.208 position:50% align:middle
The full manuscript
detailing these findings

00:09:14.209 --> 00:09:17.643 position:50% align:middle
are published in the Journal of Nursing
Regulation, if you'd like to learn more.

00:09:20.926 --> 00:09:24.583 position:50% align:middle
In the second part of this
presentation, I'll focus on another paper

00:09:24.584 --> 00:09:28.112 position:50% align:middle
that we're developing based on the
participants' description of their sleep,

00:09:28.113 --> 00:09:31.772 position:50% align:middle
shiftwork, and work stress, and
how that impacts their wellbeing

00:09:31.773 --> 00:09:33.018 position:50% align:middle
and patient outcomes.

00:09:35.204 --> 00:09:40.699 position:50% align:middle
Again, we've developed three themes: "Our
voice should matter," "Tired but wired,"

00:09:40.700 --> 00:09:42.031 position:50% align:middle
and "We're only human."

00:09:45.175 --> 00:09:48.103 position:50% align:middle
In our first theme, we
found a multifaceted narrative

00:09:48.104 --> 00:09:52.354 position:50% align:middle
regarding stress related to
staffing, overtime, and on-call hours

00:09:52.360 --> 00:09:54.858 position:50% align:middle
and the use of organizational
resources and budget.

00:09:55.749 --> 00:09:59.130 position:50% align:middle
Overwhelmingly, participants
wanted a safe patient care environment

00:09:59.131 --> 00:10:01.790 position:50% align:middle
that included their
voice in staffing decisions

00:10:01.791 --> 00:10:03.791 position:50% align:middle
since they were the
workers at the bedside.

00:10:04.101 --> 00:10:06.903 position:50% align:middle
There was an undercurrent of
frustration when administrators who made

00:10:06.904 --> 00:10:10.720 position:50% align:middle
staffing decisions either weren't
nurses or unfamiliar with the clinical

00:10:10.721 --> 00:10:14.022 position:50% align:middle
challenges that nurses faced
in an understaffed situation.

00:10:15.000 --> 00:10:19.547 position:50% align:middle
This participant described, "I don't feel
like we have a voice in staffing issues.

00:10:19.548 --> 00:10:22.881 position:50% align:middle
The CNO and other administrators
are fully aware of the stress that

00:10:22.882 --> 00:10:24.561 position:50% align:middle
we are under due to poor staffing.

00:10:24.562 --> 00:10:28.220 position:50% align:middle
They are reminded of it at least
every month during nursing forums.

00:10:28.555 --> 00:10:31.401 position:50% align:middle
The solution would seem to
be just to hire more nurses,

00:10:31.402 --> 00:10:33.768 position:50% align:middle
but we have been told
that that is not in the budget.

00:10:33.769 --> 00:10:37.728 position:50% align:middle
It adds a sense of hopelessness
because the admins do not provide

00:10:37.729 --> 00:10:39.227 position:50% align:middle
any solutions whatsoever."

00:10:42.907 --> 00:10:46.280 position:50% align:middle
Being asked to work overtime
or take on additional cases

00:10:46.281 --> 00:10:48.819 position:50% align:middle
was described as another form of stress.

00:10:48.820 --> 00:10:51.095 position:50% align:middle
And at times, it was
met with mixed feelings.

00:10:51.096 --> 00:10:55.589 position:50% align:middle
Some felt like they could comfortably
decline overtime, which is a good thing.

00:10:55.590 --> 00:10:59.960 position:50% align:middle
However, others expressed a
sense of guilt in declining overtime

00:10:59.961 --> 00:11:02.148 position:50% align:middle
because they could
empathize with their colleagues

00:11:02.149 --> 00:11:04.406 position:50% align:middle
who are working in an
understaffed situation.

00:11:04.988 --> 00:11:09.680 position:50% align:middle
For example, this participant described,
"I feel like I can say no to the overtime,

00:11:09.680 --> 00:11:13.355 position:50% align:middle
but I know what it is like to be at
work and no one volunteers to work.

00:11:13.356 --> 00:11:17.205 position:50% align:middle
You are on a sinking ship and no one
is willing to help out, and that stinks."

00:11:19.280 --> 00:11:24.256 position:50% align:middle
When a bonus or overtime hourly
rate was offered, the financial incentive

00:11:24.257 --> 00:11:26.231 position:50% align:middle
was often not worth
the additional stress

00:11:26.232 --> 00:11:30.103 position:50% align:middle
of working in an understaffed
environment or on a scheduled day off.

00:11:30.104 --> 00:11:34.709 position:50% align:middle
This participant said, "We must really
have a good reason not to take extra work,

00:11:34.710 --> 00:11:36.932 position:50% align:middle
or help a coworker, or take a file.

00:11:36.933 --> 00:11:39.015 position:50% align:middle
Depending on my day and the work,

00:11:39.016 --> 00:11:41.649 position:50% align:middle
money or bonusing doesn't
usually make a difference.

00:11:41.650 --> 00:11:44.255 position:50% align:middle
It doesn't make a crappy
or stressful day any better."

00:11:48.008 --> 00:11:51.315 position:50% align:middle
Our second theme demonstrated
nurses' articulation of the link

00:11:51.316 --> 00:11:55.162 position:50% align:middle
between work stress, whether related
to understaffing, difficult schedules,

00:11:55.163 --> 00:11:59.180 position:50% align:middle
shiftwork, or sleep problems, and how
the two are connected in a vicious cycle.

00:11:59.826 --> 00:12:03.257 position:50% align:middle
One participant explained the
physiological experience of work stress

00:12:03.258 --> 00:12:05.249 position:50% align:middle
and the impact on sleep.

00:12:05.250 --> 00:12:08.255 position:50% align:middle
She said, "Your adrenaline pumps
so much during a stressful shift

00:12:08.256 --> 00:12:11.316 position:50% align:middle
that it's hard to wind down
and go to sleep afterward.

00:12:11.317 --> 00:12:14.672 position:50% align:middle
Sometimes I get no more than
four hours of sleep due to this."

00:12:15.613 --> 00:12:18.904 position:50% align:middle
Ruminating about a stressful shift
at work or needing to decompress

00:12:18.905 --> 00:12:22.941 position:50% align:middle
after a long shift often resulted
in difficulty going to sleep.

00:12:23.550 --> 00:12:26.788 position:50% align:middle
This participant described,
"As time has passed,

00:12:26.789 --> 00:12:30.187 position:50% align:middle
I have found increasing difficulties
sleeping after a difficult shift.

00:12:30.188 --> 00:12:35.352 position:50% align:middle
I may be physically tired, but my mind
is or can be so frazzled from the work day

00:12:35.353 --> 00:12:37.608 position:50% align:middle
that I dwell on it while trying to sleep.

00:12:37.609 --> 00:12:40.927 position:50% align:middle
I will try to meditate or deep
breathe to relax my mind,

00:12:40.928 --> 00:12:42.928 position:50% align:middle
but sometimes it's not successful."

00:12:46.376 --> 00:12:49.958 position:50% align:middle
Our third theme explores nurses'
description of what happens to them

00:12:49.959 --> 00:12:53.158 position:50% align:middle
from several dimensions
physical, mental, emotional

00:12:53.159 --> 00:12:57.810 position:50% align:middle
when they're sleep-deprived due to
their work schedules and/or shiftwork.

00:12:58.401 --> 00:13:00.932 position:50% align:middle
The nurses further detailed
how their exhaustion can lead to

00:13:00.933 --> 00:13:02.722 position:50% align:middle
patient care problems.

00:13:02.723 --> 00:13:04.957 position:50% align:middle
We titled this theme "We're only human."

00:13:06.454 --> 00:13:09.914 position:50% align:middle
First, the nurses described physical
exhaustion from grueling work schedules,

00:13:09.915 --> 00:13:11.707 position:50% align:middle
long shifts, and heavy workloads.

00:13:12.297 --> 00:13:15.036 position:50% align:middle
This nurse describes, "When
I work several days in a row,

00:13:15.037 --> 00:13:17.984 position:50% align:middle
I feel drained and almost
hung over with exhaustion,

00:13:17.985 --> 00:13:20.296 position:50% align:middle
but I do get as much
sleep as I am able to.

00:13:20.562 --> 00:13:23.090 position:50% align:middle
It just feels constantly
like I need more."

00:13:24.425 --> 00:13:27.709 position:50% align:middle
The 12-hour shift was the
most common shift in our sample,

00:13:27.710 --> 00:13:29.704 position:50% align:middle
and it's the most common
shift in the country.

00:13:29.705 --> 00:13:33.048 position:50% align:middle
But this shift is mentioned by
participants as particularly tiring

00:13:33.049 --> 00:13:37.086 position:50% align:middle
when working back to back to back
or greater numbers of consecutive shifts.

00:13:37.671 --> 00:13:40.920 position:50% align:middle
For example, this participant
said, "Working three 12s

00:13:40.921 --> 00:13:42.384 position:50% align:middle
makes my sleeping erratic.

00:13:42.385 --> 00:13:46.285 position:50% align:middle
I'm usually in various states of tired.
Feeling well-rested is not the norm."

00:13:49.857 --> 00:13:53.036 position:50% align:middle
Nurses communicated the mental
toll that sleep deprivation caused

00:13:53.037 --> 00:13:56.525 position:50% align:middle
in their performance at work, and
the consequences were notable.

00:13:57.050 --> 00:14:01.015 position:50% align:middle
This participant describes it very
clearly, saying, "Stress and poor sleep

00:14:01.016 --> 00:14:04.010 position:50% align:middle
definitely alters work performance
for me and my coworkers.

00:14:04.011 --> 00:14:06.908 position:50% align:middle
It causes an inability
to focus, forgetfulness,

00:14:06.909 --> 00:14:10.146 position:50% align:middle
disorganization, irritability,
and lots of other negatives.

00:14:10.584 --> 00:14:13.585 position:50% align:middle
I notice that I'm not able to
devote adequate time to my patients

00:14:13.586 --> 00:14:16.542 position:50% align:middle
when I'm having to spend
extra time scrambling to organize

00:14:16.648 --> 00:14:19.182 position:50% align:middle
the next steps I need to take
because I can't think clearly.

00:14:19.700 --> 00:14:23.805 position:50% align:middle
Charting definitely becomes less detailed
and is probably inaccurate by the time

00:14:23.806 --> 00:14:26.421 position:50% align:middle
it gets filled in at the end of the
day because there isn't time to chart

00:14:26.422 --> 00:14:27.100 position:50% align:middle
as you go."

00:14:28.841 --> 00:14:32.088 position:50% align:middle
Others described difficulty in
communicating and working with their

00:14:32.089 --> 00:14:34.555 position:50% align:middle
colleagues, saying,
"When I work night shift,

00:14:34.556 --> 00:14:37.299 position:50% align:middle
I had trouble word
finding towards the end of my shifts.

00:14:37.300 --> 00:14:40.386 position:50% align:middle
And during report, I would always
pray that I didn't forget anything.

00:14:40.977 --> 00:14:44.503 position:50% align:middle
My reports always felt like word
vomit, and I would always be apologizing

00:14:44.504 --> 00:14:47.177 position:50% align:middle
because my mind wouldn't
follow a normal SBAR report.

00:14:47.178 --> 00:14:48.789 position:50% align:middle
It just kept jumping around."

00:14:51.815 --> 00:14:55.698 position:50% align:middle
And lastly, I wanted to share an
exemplary quote of the impact that fatigue

00:14:55.699 --> 00:14:58.013 position:50% align:middle
played in part on a
patient safety outcome.

00:14:58.654 --> 00:15:01.767 position:50% align:middle
One clear description was
recalled by a participant, saying,

00:15:01.768 --> 00:15:05.217 position:50% align:middle
"I've definitely forgotten things
in report by the end of the day

00:15:05.218 --> 00:15:08.656 position:50% align:middle
when I'm exhausted, or felt like I was
missing something that was happening

00:15:08.657 --> 00:15:10.596 position:50% align:middle
with my patients due to fatigue.

00:15:10.905 --> 00:15:14.328 position:50% align:middle
One time, I was coming in on nights
exhausted because I hadn't slept well

00:15:14.329 --> 00:15:17.842 position:50% align:middle
during the day, and I didn't reset the
bed alarm for my patient when we left

00:15:17.843 --> 00:15:19.843 position:50% align:middle
the room after bedside report.

00:15:20.104 --> 00:15:22.898 position:50% align:middle
That patient fell out of bed 20
minutes later and had an injury

00:15:22.899 --> 00:15:24.300 position:50% align:middle
that needed surgery.

00:15:24.301 --> 00:15:28.116 position:50% align:middle
It was a horrible night and a reminder of
how being tired can make me miss things."

00:15:32.308 --> 00:15:34.990 position:50% align:middle
So, I'd like to acknowledge
the limitations of this work

00:15:34.991 --> 00:15:37.732 position:50% align:middle
in that early career nurses
are not representative

00:15:37.733 --> 00:15:42.226 position:50% align:middle
necessarily of all nurses, and that we
were talking about some sensitive topics,

00:15:42.227 --> 00:15:46.190 position:50% align:middle
so we might not have had the whole
scope of the problem described to us,

00:15:46.191 --> 00:15:49.295 position:50% align:middle
even though we ensured
anonymity and a virtual format.

00:15:49.795 --> 00:15:53.285 position:50% align:middle
And that finally, that this study
design is not meant to generalize.

00:15:53.744 --> 00:15:56.510 position:50% align:middle
However, I do want to note an
important strength of this work

00:15:56.511 --> 00:16:00.894 position:50% align:middle
in that it represents an
underused methodology in nursing

00:16:00.895 --> 00:16:05.829 position:50% align:middle
and it proves that we could be successful
in recruiting a national sample of nurses

00:16:05.830 --> 00:16:09.675 position:50% align:middle
who would not otherwise have been brought
together in an in-person focus group.

00:16:11.003 --> 00:16:13.356 position:50% align:middle
In summary, we found
that our research fit well

00:16:13.357 --> 00:16:15.583 position:50% align:middle
within the Work, Stress,
and Health framework,

00:16:15.584 --> 00:16:18.847 position:50% align:middle
and that nurses were experiencing
troublesome levels of work stress

00:16:18.848 --> 00:16:21.372 position:50% align:middle
fueled by heavy workloads
and understaffing,

00:16:21.373 --> 00:16:24.016 position:50% align:middle
as well as exhaustion from
shiftwork and schedules,

00:16:24.017 --> 00:16:26.583 position:50% align:middle
and signaled potential
problems with substance use

00:16:26.584 --> 00:16:28.584 position:50% align:middle
outside of caffeine and alcohol.

00:16:29.086 --> 00:16:32.100 position:50% align:middle
Interventions regarding sleep
hygiene, when to seek evaluation for

00:16:32.101 --> 00:16:35.219 position:50% align:middle
possible sleep disorders, and
healthy coping strategies without the

00:16:35.220 --> 00:16:38.035 position:50% align:middle
use of substances may
offer promising next steps.

00:16:41.190 --> 00:16:45.972 position:50% align:middle
The findings of this work are relevant and
timely, especially given the high stress

00:16:45.973 --> 00:16:49.585 position:50% align:middle
that the COVID-19 pandemic has
brought upon the nursing workforce,

00:16:49.586 --> 00:16:52.340 position:50% align:middle
where we're observing
skyrocketing sleep problems related to

00:16:52.341 --> 00:16:53.745 position:50% align:middle
work stress and anxiety.

00:16:54.373 --> 00:16:57.691 position:50% align:middle
Our findings confirmed previous
quantitative studies on these topics

00:16:57.692 --> 00:17:00.833 position:50% align:middle
that were studied separately
and point to several action items

00:17:00.834 --> 00:17:04.350 position:50% align:middle
to mitigate the negative sequelae
of work stress and sleep problems.

00:17:05.160 --> 00:17:08.927 position:50% align:middle
First, self-care activities are
crucial, whatever that means

00:17:08.928 --> 00:17:13.069 position:50% align:middle
to the individual nurse, whether
that's going for a hike, practicing yoga,

00:17:13.070 --> 00:17:14.634 position:50% align:middle
or socializing with friends.

00:17:15.602 --> 00:17:20.423 position:50% align:middle
Second, careful attention should be
paid to scheduling and overtime practices

00:17:20.424 --> 00:17:23.267 position:50% align:middle
with oversight from nurse
managers and upper management,

00:17:23.268 --> 00:17:25.943 position:50% align:middle
depending on how the
schedules are created.

00:17:27.325 --> 00:17:31.275 position:50% align:middle
Third, there's an importance
for sleep hygiene and education

00:17:31.276 --> 00:17:33.276 position:50% align:middle
and how to manage shiftwork.

00:17:33.398 --> 00:17:37.564 position:50% align:middle
Interestingly, our participants reported
virtually no pre-licensure education

00:17:37.565 --> 00:17:38.404 position:50% align:middle
on this topic.

00:17:39.260 --> 00:17:43.401 position:50% align:middle
And finally, there's a need to
encourage nurses to seek help

00:17:43.402 --> 00:17:46.860 position:50% align:middle
when their coping turns maladaptive
or they might have a sleeping problem

00:17:46.861 --> 00:17:48.707 position:50% align:middle
that warrants further evaluation.

00:17:50.037 --> 00:17:53.178 position:50% align:middle
Thank you for your time and
attention today, and please feel free

00:17:53.179 --> 00:17:57.143 position:50% align:middle
to reach out to me via email if you
have any further questions or comments.

00:18:16.424 --> 00:18:21.996 position:50% align:middle
There is a question regarding
participants' discussion of how the stress

00:18:21.997 --> 00:18:25.842 position:50% align:middle
may contribute to their desire
to leave the profession.

00:18:26.632 --> 00:18:31.935 position:50% align:middle
We didn't have enough to aggregate
to a theme to talk about turnover

00:18:31.936 --> 00:18:34.185 position:50% align:middle
or leaving the profession.

00:18:34.186 --> 00:18:41.215 position:50% align:middle
However, we did have several participants
who described switching positions

00:18:41.216 --> 00:18:47.043 position:50% align:middle
within their organization or switching
their schedule because they couldn't adapt

00:18:47.044 --> 00:18:51.926 position:50% align:middle
or felt unable to work a
night shift, for example,

00:18:51.927 --> 00:18:56.370 position:50% align:middle
and they felt so ill or they just

00:18:56.371 --> 00:18:58.794 position:50% align:middle
didn't feel like they could stay
in the profession if they work

00:18:58.795 --> 00:19:03.210 position:50% align:middle
in that existing shift, so they
did switch within their institution

00:19:03.211 --> 00:19:07.095 position:50% align:middle
to either a different unit that
could accommodate a day shift

00:19:07.096 --> 00:19:17.238 position:50% align:middle
or the more preferable shift,
or another unit or another shift

00:19:17.239 --> 00:19:19.716 position:50% align:middle
within their organization.

00:19:35.408 --> 00:19:39.302 position:50% align:middle
Another question came in about
asking if a PowerPoint can be shared,

00:19:39.303 --> 00:19:41.881 position:50% align:middle
and I would be happy
to share a PowerPoint.

00:19:42.631 --> 00:19:47.169 position:50% align:middle
I think we'll ask our conference
hosts how we can do that,

00:19:47.170 --> 00:19:50.460 position:50% align:middle
but I'd be happy to share
a PowerPoint, for sure.

00:19:54.897 --> 00:19:57.590 position:50% align:middle
I'm seeing one more question.

00:20:12.920 --> 00:20:18.145 position:50% align:middle
Another question was asking
about participants sharing any sort of

00:20:18.146 --> 00:20:23.075 position:50% align:middle
self-care activities to help
mitigate stress and fatigue.

00:20:25.200 --> 00:20:29.602 position:50% align:middle
We did have some nurses talking
about what they did individually.

00:20:30.310 --> 00:20:35.578 position:50% align:middle
There was less discussion about
sort of organizational level interventions

00:20:35.579 --> 00:20:41.613 position:50% align:middle
to mitigate the effects of stress
and fatigue, so I think that's an area

00:20:41.614 --> 00:20:46.174 position:50% align:middle
that is certainly ripe for additional
research and questioning.

00:21:08.605 --> 00:21:12.506 position:50% align:middle
Someone's commenting about
the theme "We are only human,"

00:21:12.507 --> 00:21:17.134 position:50% align:middle
and the talk about being heroes is unfair
and inaccurate and leads to nurses using

00:21:17.135 --> 00:21:20.440 position:50% align:middle
substances, legal or not, in
order to meet expectations.

00:21:20.441 --> 00:21:25.663 position:50% align:middle
I think there's certainly a
lot of dialogue happening

00:21:25.664 --> 00:21:29.896 position:50% align:middle
regarding the hero narrative that
has occurred post and during COVID.

00:21:30.999 --> 00:21:37.345 position:50% align:middle
And I agree with the comment
that sort of it can lead, in general,

00:21:37.346 --> 00:21:43.982 position:50% align:middle
nurses can have this expectation that they
have to always meet the care of others,

00:21:43.983 --> 00:21:47.504 position:50% align:middle
and that if somehow perhaps
they care for themselves,

00:21:47.505 --> 00:21:51.777 position:50% align:middle
that that's not the most ideal situation.

00:21:51.778 --> 00:21:56.380 position:50% align:middle
So I think there's a lot of work to
be done in ways to support nurses

00:21:56.381 --> 00:22:03.279 position:50% align:middle
in their self-care and how to do that in
a way that's positive and it doesn't lead

00:22:03.280 --> 00:22:05.620 position:50% align:middle
to substance use.

00:22:28.855 --> 00:22:35.336 position:50% align:middle
So, we have a comment coming in
from a new nurse graduating in May.

00:22:35.337 --> 00:22:38.341 position:50% align:middle
Congratulations.
That's a huge milestone.

00:22:38.342 --> 00:22:41.043 position:50% align:middle
We welcome you to the profession.

00:22:41.044 --> 00:22:47.436 position:50% align:middle
And the questions are about why
the admins don't hire more workers

00:22:47.437 --> 00:22:53.217 position:50% align:middle
to improve staffing and how to support
a new grad like yourself and coworkers

00:22:53.218 --> 00:22:57.106 position:50% align:middle
with self-care and stress
management during a demanding

00:22:57.107 --> 00:22:59.543 position:50% align:middle
and caring work environment.

00:22:59.544 --> 00:23:07.350 position:50% align:middle
I think those are great
questions, and they certainly are

00:23:07.529 --> 00:23:11.711 position:50% align:middle
big questions that I'm not sure
I'm equipped to fully answer.

00:23:11.712 --> 00:23:22.293 position:50% align:middle
I think it's difficult for many in
management to simply hire more staff

00:23:22.294 --> 00:23:24.253 position:50% align:middle
for a variety of reasons.

00:23:25.407 --> 00:23:32.879 position:50% align:middle
And we can certainly hear the frustration
in our participants' description of why

00:23:32.880 --> 00:23:36.742 position:50% align:middle
simply hiring more nurses, which
seems like a very logical approach

00:23:36.743 --> 00:23:39.128 position:50% align:middle
to these issues, would be.

00:23:39.685 --> 00:23:42.157 position:50% align:middle
So there's a lot at
stake and a lot at play

00:23:42.158 --> 00:23:44.907 position:50% align:middle
and a lot of stakeholders
in those decisions.

00:23:45.710 --> 00:23:50.599 position:50% align:middle
But I think there are certainly ways to
support yourself and your coworkers.

00:23:50.600 --> 00:23:58.815 position:50% align:middle
And that's also something that we
can do something about as individuals.

00:23:58.816 --> 00:24:05.221 position:50% align:middle
So identifying those sorts of
self-care and destressing activities that

00:24:05.222 --> 00:24:10.157 position:50% align:middle
have been successful for yourself
as a student will probably translate into

00:24:10.158 --> 00:24:12.158 position:50% align:middle
your first professional role.

00:24:12.623 --> 00:24:17.634 position:50% align:middle
So working and understanding what those
are is an important endeavor and something

00:24:17.635 --> 00:24:21.991 position:50% align:middle
that takes a look
at yourself and what you really need.

00:24:21.992 --> 00:24:31.502 position:50% align:middle
So there's no one way to answer that
question, or one approach that will work.

00:24:32.200 --> 00:24:38.528 position:50% align:middle
So I would encourage learning
a little bit more and finding ways

00:24:38.529 --> 00:24:43.153 position:50% align:middle
to understand sleep hygiene
and your sleep practices.

00:24:43.154 --> 00:24:50.361 position:50% align:middle
And we found a lot of this rumination
and anxiety that interfered with sleep,

00:24:50.362 --> 00:24:55.606 position:50% align:middle
so ways that you can
sort of release that stress

00:24:55.607 --> 00:24:59.134 position:50% align:middle
and let that go so that
your body is able to sleep

00:24:59.135 --> 00:25:01.763 position:50% align:middle
is one area to potentially think about.

00:25:11.395 --> 00:25:14.397 position:50% align:middle
We've got another question coming in.

00:25:18.297 --> 00:25:21.786 position:50% align:middle
So, another question is regarding
sleep hygiene and education

00:25:21.787 --> 00:25:25.902 position:50% align:middle
and best places to access
some of that information.

00:25:25.903 --> 00:25:30.015 position:50% align:middle
The National Sleep Foundation is
one place online to look.

00:25:30.694 --> 00:25:36.044 position:50% align:middle
The CDC and NIOSH have
actually developed a whole toolkit,

00:25:38.101 --> 00:25:43.385 position:50% align:middle
like sort of a little
curriculum for nurses

00:25:43.386 --> 00:25:46.991 position:50% align:middle
to understand how to manage
shiftwork and to improve sleep.

00:25:47.397 --> 00:25:52.697 position:50% align:middle
So that's another free and fully
available resource that nurses can use

00:25:53.646 --> 00:25:59.407 position:50% align:middle
to learn about sleep hygiene and
help improve their coping with that.

00:26:05.805 --> 00:26:08.345 position:50% align:middle
Another question coming in.

00:26:08.346 --> 00:26:10.540 position:50% align:middle
These questions are so great, everyone.
Thank you.

00:26:10.541 --> 00:26:14.182 position:50% align:middle
"Are you going to pursue an
intervention related to sleep hygiene

00:26:14.183 --> 00:26:15.504 position:50% align:middle
with a post-survey?

00:26:15.505 --> 00:26:19.354 position:50% align:middle
I agree that many nurses do not know
how to do this, especially new nurses."

00:26:21.492 --> 00:26:28.482 position:50% align:middle
And the answer to that question
is yes, that we are looking

00:26:28.483 --> 00:26:35.237 position:50% align:middle
to pursue additional funding for
intervention work based on these findings.

00:26:35.240 --> 00:26:37.840 position:50% align:middle
So I'll have to keep you posted on that.

00:26:37.840 --> 00:26:45.124 position:50% align:middle
But yeah, we're definitely seeing
a need for sleep hygiene and

00:26:45.794 --> 00:26:49.996 position:50% align:middle
stress management
interventions for nurses.

00:26:53.253 --> 00:26:55.920 position:50% align:middle
One last question.

00:27:07.797 --> 00:27:09.403 position:50% align:middle
Let me see.

00:27:12.205 --> 00:27:16.893 position:50% align:middle
"Do you have any recommendations
for nurse regulators?"

00:27:17.906 --> 00:27:24.090 position:50% align:middle
And I would definitely say that the
findings from this work and others

00:27:25.055 --> 00:27:32.396 position:50% align:middle
should certainly be considered when
debating and thinking about implementing

00:27:32.901 --> 00:27:42.239 position:50% align:middle
regulation over new-to-practice
nurses or nurses upon re-licensure,

00:27:42.240 --> 00:27:49.203 position:50% align:middle
and thinking about potential questions
around the impact of scheduling

00:27:49.204 --> 00:27:54.707 position:50% align:middle
and their sleep and any additional
interventions that could be included

00:27:55.159 --> 00:28:02.120 position:50% align:middle
perhaps at those junctures that
could help promote the self-care

00:28:02.121 --> 00:28:03.991 position:50% align:middle
and the wellbeing of nurses.

00:28:11.298 --> 00:28:16.660 position:50% align:middle
Okay. I think I got
to all of the questions.

00:28:17.406 --> 00:28:22.394 position:50% align:middle
And again, I am happy to answer
any additional questions via email,

00:28:22.395 --> 00:28:28.123 position:50% align:middle
send my PowerPoint slides, or anything
else you might have questions for.

00:28:28.124 --> 00:28:31.895 position:50% align:middle
So, again, thank you so much for
these great questions and the discussion.