Promoting Chief Nurse Executives’ Self-care Improves Overall Staff Wellbeing

By Barbara Seymour, DNP, RN, NE-BC, CPPS
Vizient Assistant Vice President, Member Networks

On a recent trip, I was reminded during the standard pre-flight protocols on the plane why a flight attendant instructs you in the event of an emergency to place your oxygen mask on first before assisting others. A rapidly depressurized cabin quickly becomes dangerous, creating weakness, disorientation and incapacitation in seconds. When passengers first don't ensure their own safety, they are unable to help others but also add to a list of individuals that desperately need intervention.

This same type of rapid shift and deterioration can be used to describe the current state of crisis in healthcare. Moral distress, fatigue and burnout — exacerbated by the COVID-19 pandemic — among healthcare workers have reached alarming levels. Health systems and programs cannot sustain a weakened workforce evidenced by declining numbers of skilled professionals and their fragile state of wellbeing.  

These conditions are heavily addressed in the nursing literature, offering various programmatic approaches to systems' problems and wellness interventions. While many sources reference the crucial role the nurse executive plays in ensuring the wellbeing of the caregiver workforce, few address the wellbeing of the chief nurse executive (CNE) as a subset of healthcare employees. In a recent informal Vizient survey of health system CNEs, we inquired about their personal wellbeing: How are you feeling? How do you feel about the work you are able to do? How will you be able to continue to lead into the future of healthcare? What do you do to invest in your own wellbeing?

The results are a wake-up call for the nursing profession and executive teams. These leaders are not immune to the documented motivations to leave the nursing profession, including challenging work environment, emotional distress, disappointment about the nursing reality and a culture of hierarchy and discrimination. While the average of CNEs who responded rated their wellbeing as a 7.7 on a zero-to-10 scale, half indicated they were more aligned to being "I'm okay" rather than "I am currently thriving." Several CNEs also forecasted career changes on the horizon, identifying preferment — how employees choose to spend their time including part-time professional work, pursuing new hobbies, spending more time with family, relaxing — or retirement as their career trajectory within the next 12 months and for a variety of reasons.

The CNE role also has become increasingly complex and demanding. Disruption in the C-Suite, barriers to clinical practice optimization, business model headwinds, fiduciary responsibilities and the use of advanced analytics have evolved chief nurse executive responsibilities and uncharted pressures of the job. Healthcare systems need to ensure that wellness starts at the top with proactive management of psychological hazards and job remodeling to encourage CNEs to "put on their oxygen mask first." This in turn will impact overall staff wellness — which has been well demonstrated — in positive, meaningful and measurable ways, and not contribute to the number of nursing professionals who desperately need intervention.

In addition to organizational wellbeing tactics, there are several practices CNEs can personally do to ensure their own wellbeing and that of others:

• Set aside time to invest in your own wellbeing: Leader burnout creates a vicious cycle of negative employee perceptions and experiences, creating further stress and burnout for the leader. CNEs must understand these pressures and actively participate in fostering their own wellbeing.
• Practice authenticity: Demonstrating vulnerability among trusted colleagues and with staff serves as both communication and a reminder that wellbeing is a journey, and one that does not have to be taken alone.
• Be purveyors of hope: Replicate behaviors that improve personal wellbeing and share their interconnectedness with others to build trust, bolster culture and create positive energy. CNEs are creating an example for others with their investment — or lack of investment — in their wellbeing.
• Differentiate discrete wellness and normal course-of-life activities: While many CNEs surveyed identified some engagement in enriching their wellbeing, many of the examples provided were activities such as work-life balance, growth and development, social connections and using paid time off — actions that should be normal course-of-life and not viewed as discrete wellness activities. Some examples of wellness activities can be as structured as practicing mindfulness and cognitive training, or as simple as device breaks.

While we work to continuously improve healthcare and perform the equivalent of safety checks on an airplane — securing cabin doors, ensuring seatbacks and tray tables are in the upright position and preparing the cabin for departure — let's also heed the reminder for chief nurse executives to "put your oxygen mask on first," for their benefit and the benefit of others. Here's to a healthier career flight and may we all arrive safely at our destination — high-value care for our patients, our staff and ourselves.

Discover unique insights and tactics for nurse workforce challenges in the most recent Nursing Workforce Intelligence Report based on data from Vizient and Vaya Workforce.

Learn more about Vizient Member Networks and register for "Workforce Wellness Starts at the Top," a webinar 11:30 a.m.-12:30 p.m. CT, Nov. 1, as part of the Vizient Clinical Leadership Series.