A person can only provide optimal care for others when they’re properly taking care of themselves. For caregivers in children’s hospitals, that’s more important now than ever. And it’s the spirit behind RISE (Resilience, Integrated Ethics, Staff Support and Engagement), a program at Children’s Health in Dallas, Texas, designed to support and promote the well-being of their teams.
It began in 2016 as a moral distress consultation service and has expanded over time to support team members through a wide range of pressing issues—including traumatic or adverse patient-related events, cumulative stress, burnout and grief after the death of a long-term or well-loved patient, says Jessica Roumillat, MSSW, M.A., LCSW, HEC-C, program director, Integrated Ethics at Children’s Health.
Using an evidence-based approach, RISE supports Children’s Health employees through a variety of initiatives:
- Resilience. Education around general burnout principles, conflict transformation training, group support sessions and brief refresh periods to allow individuals or entire teams to relieve stress and reconnect to their purpose.
- Integrated ethics. Support for team members navigating moral distress, clinical conflict and caregiver grief through individual or group discussions or reflection sessions.
- Staff support. Following adverse events, unexpected outcomes or traumatic experiences, one-on-one “psychological first aid” interventions grounded in peer support and active listening.
- Engagement. Ongoing connection to the mission and values of the organization through supportive rounding designed to offer encouragement for both clinical and non-clinical team members.
Additionally, Children’s Health has implemented support programs designed to aid the entire organization, including a team member support intranet site providing easy access to all available resilience-related resources and quiet rooms for employee respite and relaxation.
Rising need for well-being
Over the three years since the pandemic struck, the RISE team has seen the need for the program skyrocket—and staff behaviors shift.
“The numbers have beyond quadrupled; we are getting requests on a daily basis, numerous times a day, from groups that previously never would request support,” says Elaine Beardsley, M.N., RN, ACCNS-P, program director, Clinical Resiliency at Children’s Health. “The culture is changing … not only the culture to recognize the need and be willing to address self-care, but also the perception of felt stress is higher.”
Physicians and graduate medical education residents are among the newer groups requesting the support of RISE, Beardsley says, which ultimately benefits the young patients under their careful watch.
“From a quality and safety perspective, you've got humans working in a very complex environment, and they have to make really challenging decisions and judgments every single day,” says Kristin Cummins, DNP, RN, CPHQ, senior vice president, Quality and Patient Safety at Children’s Health. “You need resilient teams and systems that have psychologically safe environments and venues for ethical concerns. That’s all important so we can give the best and safest care to patients.”
Better well-being, better engagement
Offering a psychologically safe space through one-on-one peer support has strengthened physicians, nurses and other health care workers in the face of challenging issues that can cause them to question their abilities or cause them grief. Sometimes, the support of RISE even helps staff see their own value in a whole new way—and fuels a new desire to effect positive change, according to Leslie Leach, M.S.N., RN, program director of the Second Victim Staff Support at Children’s Health.
“As an example, let’s take a medication error that causes some harm. I’ve heard some nurses or other health care professionals saying, ‘I might help rewrite policy around that,’” says Leach. “That is utilizing error for education and for your own professional and personal trajectory. That is thriving after an adverse event.”
And the culture of patient safety survey at Children’s Health points to evidence that beneficiaries of the RISE program are more engaged. Back in 2021, the team added a question to its Agency for Healthcare Research and Quality (AHRQ) survey, asking employees if they had experienced a patient-related event in the previous year that caused them distress—and if yes, did they receive support. The survey results revealed a direct correlation between those who had received support, whether through the RISE program or through the hospital’s leaders, and higher engagement scores.
“That was the awakening for the organization on just how important these programs are,” says Cummins.
Read more about how children’s hospitals are working to help their team members put the joy back into their work in the spring issue of Children’s Hospitals Today.