THE EXCEPTIONAL RESPONSE of the nursing profession to meet the demands of the coronavirus disease-2019 (COVID-19) pandemic has been significant and inspiring. Unfortunately, courageousness and selflessness can take an emotional toll on nurses' health and well-being. The impact of the pandemic includes exacerbation of the anxiety, burnout, fatigue, and distress that were already being experienced by nurses in ever greater numbers.1–3
Prior to the pandemic, urgent calls to action were made to address a national epidemic of clinician burnout caused by excessive workloads, long work hours, isolation, inefficiencies in staffing, team dysfunction, increased clinical demands, and moral distress.2,4 Burnout is associated with higher rates of depression, anxiety, substance use disorders, and suicidality for nurses and physicians.4,5
The health and well-being of clinicians have also been associated with medical errors, the third leading cause of death in America, highlighting the urgent need for health care system leaders to create wellness cultures and provide evidence-based programming that enhances the health and well-being of their clinicians.6 In 2017, the National Academy of Medicine launched the Action Collaborative on Clinician Well-being and Resilience to raise visibility on this public health epidemic and create evidence-based solutions.4
The onset of the COVID-19 pandemic was overwhelming for an already overwhelmed system and health care workforce. Consequently, calls to support clinician well-being have become even more urgent. Development of federal, state, and organizational programs and strategies is needed to deal with the national epidemic of clinician burnout within the COVID-19 pandemic.7
The prioritization and commitment to the health and well-being of the nursing profession led 2 organizations, a large Mid-west public college of nursing and Trusted Health (a nurses-first company that offers a national career platform), to collaborate on the creation of a program that would provide support in enhancing the health and wellness of nurses during the COVID-19 pandemic. As a result, The Wellness Partner Program8 was innovated by The Ohio State University College of Nursing, whose mission is to transform health and improve lives through dreaming, discovering, and delivering, and championed by Trusted Health, which connects more than 125 000 nurses nationwide with practice opportunities. Advanced practice nursing (APN) students at Ohio State are nurses who also are in clinical practice while enrolled in graduate degree programs, and they would provide wellness coaching support for the program. Therefore, The Wellness Partner Program was developed and implemented as a “nurses for nurses” initiative.
The aim of The Wellness Partner Program was to enhance the health and well-being of nurses on the front lines during the COVID-19 pandemic and beyond. Areas in the program that were emphasized included (1) personalized support for wellness; (2) prioritizing physical activity, healthy eating, sleep, and stress management; and (3) establishment of strength-based, sustainable solutions to improve well-being. The context of “on the front lines” was defined broadly as being in practice as a nurse during the COVID-19 pandemic.
PROGRAM DESCRIPTION AND IMPLEMENTATION
Recruitment for the initial launch of The Wellness Partner Program was limited to 200 nurses on a first-come, first-serve basis. Nurses employed by Trusted Health and working in COVID-19 hotspots were invited by email to opt in to the newly developed wellness initiative. Nurses who were registered for the company's online platform were notified by an online posting about also being eligible to participate. A Web site was created to provide details about the initiative, including expectations for wellness coaching sessions and information about healthy lifestyle behaviors. Nurses signed up to participate using an online survey and were provided details regarding confidentiality and privacy.
Advanced practice nursing students were required to apply for participation through the College of Nursing, and The Wellness Partner Program was viewed as a clinical placement opportunity. Those accepted into the program were required to have the availability to provide wellness coaching support for 3 or 4 nurse-participants. Orientation and onboarding included didactic content regarding wellness coaching, therapeutic communication (eg, motivational interviewing and appreciative inquiry), telehealth basics, and cognitive behavioral skills building. Students met synchronously with clinical preceptors and reviewed mental health first aid. Prior to participation in The Wellness Partner Program, students participated in peer wellness partnerships to learn to facilitate wellness support. The APN students were in their final year of their clinical specialty program.
Once recruitment was complete, nurse-participants were sent an email from their assigned APN student, and scheduled an initial meeting using Zoom (Zoom Video Communications, Inc), a web conferencing platform. The wellness support sessions were approximately 45 minutes in length; wellness partners were encouraged to meet every 7 to 10 days, with a minimum of 4 coaching sessions to be completed over 6 weeks. During the sessions, nurse-participants were provided wellness coaching support for establishing self-care and reaching individualized health and wellness goals. Wellness coaching in this context was defined as a strength-based, individualized behavioral health intervention to assist in the development of intrinsic motivation and confidence to work toward self-determined wellness goals and outcomes.9
Wellness support partnerships were implemented for 188 nurses by 49 APN students; more than 100 nurses (104) participated for 6 weeks. Advanced practice nursing students documented the dates of the wellness coaching support sessions, and the amount of time spent within their student clinical tracking system, Typhon. Typhon is a secure student clinical tracking platform that allows clinical faculty and preceptors to monitor student progress. Protected health information is not entered into Typhon; de-identified information entered by the students involved in this initiative included date and amount of time spent in supporting wellness partners. Advanced practice nursing students had access to a preceptor who is nationally certified as both nurse practitioner and nurse coach for the entirety of their participation in The Wellness Partner Program. Students had weekly “check-ins” with faculty preceptors to discuss any concerns, and to review wellness support implementation. Topics discussed during these weekly synchronous web conferencing meetings included the impact of uncertainty, challenges of behavior change, coping strategies for stress and burnout, use of skillful questioning, and the importance of self-care, self-efficacy, and resilience.
Response rate of the nurses to a program evaluation was 45.5%. During the 6 weeks of the program, 41% of the nurses met 4 times with their APN student-coach, 12.8% met 5 times, and 12.8% met 6 times. Nurses who completed the program evaluation were working across the United States, in 7 different regions of the country. In regard to length of practice as a nurse, 56.7% of the nurses had more than 6 years of nursing experience, 35.1% had 4 to 5 years of experience, and 8.1% had worked as a nurse for less than 3 years.
More than half of the nurses who responded to the program evaluation (68%) identified that they were motivated to sign up because they recognized the need to focus on self-care and wellness. Half noted that they had been experiencing stress, worry, fatigue, burnout, or exhaustion. Specifically related to burnout, 40.5% described themselves as “definitely burning out” with one or more symptoms of burnout, such as physical and emotional exhaustion, and 8.1% of respondents noted that they felt “completely burned out” and wondered whether they could continue working.
Nurses noted that listening and goal setting were the most important and helpful strategies that APN student-coaches used in working with them. Barriers to participation and meeting goals were primarily time constraints. Health behaviors discussed with APN students in order of most to least frequently identified:
Of the nurse-respondents to the program evaluation, 97.3% shared that The Wellness Partner Program helped them engage in self-care and wellness during the program, and 94.7% agreed or strongly agreed that the initiative helped them improve their mental and physical health. The importance of working with a student who was also a nurse was an important part of the program, according to 92% of respondents. Written comments from the program evaluation were overwhelmingly positive; some of the nurses specifically noted that the program helped them identify causes of their burnout, and increased their job satisfaction significantly. Comments from nurse participants included:
- “I really enjoyed the nurse-to-nurse relationship that developed with my Wellness Partner and looked forward to our weekly meetings. It makes a difference talking to another nurse who knows firsthand the challenges and stressors of nursing practice. Nurses helping nurses. Great program! Thank you.”
- “The wellness coaching was a great opportunity to talk through stressful situations ... I enjoyed being able to consider new ways to help me achieve goals.”
- “I received a lot of encouragement and vision for the wellness journey that I have been on and will continue to invest time and resources into become the best version of myself.”
- “I really cannot thank you enough. I have been going through a rough time and this really helped.”
- “I had a great experience. It was helpful to know I had an ally/friend to keep me motivated on my goals. (The APN student-coach) sent little positive and encouraging emails throughout the week between meetings which was a great boost to my mental health.”
- “Words cannot express how wonderful this experience was for me and my nurse friends who have participated. It was interesting how much clarity it brought me to my stress and burnout related to my job. I think it enabled me to identify the root cause AND also pushed me to make some much needed changes. Working with (the APN student) increased my job satisfaction x10. Know that you are appreciated and that it really is making an impact.”
The APN students completed a program evaluation as well, with a response rate of 44%. None of the graduate students responded that they were completely burned out; the majority of student respondents (55.6%) described their level of burnout as “occasionally” being under stress, and not having as much energy as previously. Although fewer APN students were experiencing persistent burnout symptoms, 16.7% of student-respondents shared that they were “definitely burning out” with one or more symptoms of burnout, such as physical and emotional exhaustion. Respondents varied in the length of time that they had been a nurse from 1 to 3 years (15.8%), and 4 to 5 years (26.3%), to more than 6 years (47.4%).
The majority of students (77.8%) believed that at least one of their participants who worked with them benefitted from the program. In addition, 77.8% believed that participating in The Wellness Partner Program helped them improve their own physical health and helped them personally improve engagement in healthy lifestyle behaviors. Written comments from the program evaluation were overwhelmingly positive; students noted specifically that participating in the program was meaningful to them, as they were able to support nurses who were working on the front lines during the pandemic. Comments from APN student-coaches included:
- “I had such a great time talking to my wellness partners, and understanding their situations. They have very unique circumstances and I think having a safe space for them to tell their story and let some of the pressure and weight off of their shoulders helps them cope. It's so exciting to listen to how they've achieved their goals for the week, and how they plan to achieve their future goals.”
- “The program helped me as much as it did the partners!!”
- “It was nice to feel ‘useful’ during the COVID crisis.”
- “This program has helped me develop telehealth skills that are valuable at this time in a changing healthcare landscape. In addition I have had the opportunity to use motivational interviewing/coaching skills learned in my APN program. I truly enjoy working with other nurses.”
- “I looked forward to my zoom coaching each week ... (My participant) started a jogging program to meet her wellness and personal goals for running a 5K. I felt the joy of her victory.”
- “It is very rewarding to work with nurses who are inspired to focus on self-care and wellness, and I believe it is one small thing I can do to support people who are doing so much for others.”
- “I think we have a rare opportunity to fill a much needed service for so many nurses struggling with their emotions and trying to cope during this epidemic. Nursing burnout is a very real issue, and now more than ever we have to support our own and teach self-care to those giving care on the frontlines.”
In the midst of the pandemic, nurses were supported to cope with stress, focus on self-care and wellness goals, and address challenges affecting their well-being through The Wellness Partner Program, an initiative resulting from an innovation by The Ohio State College of Nursing and collaboration with Trusted Health. While the program evaluation outcomes are not intended to provide valid generalizable data, the results do suggest that this innovative initiative was positively received and experienced for the 104 nurses and 49 APN student-coaches who participated for 6 weeks.
Feedback from the program evaluations completed by nurse-participants and APN student-coaches is consistent with findings from a rapid systematic review completed during the COVID-19 pandemic that suggests that clinicians are more likely to have greater reliance on social support and contact, as these could be less stigmatizing.3 Initiatives like The Wellness Partner Program do not require nurses to self-identify as experiencing distress, and instead focus on building strengths and meeting wellness goals. The key to the initiative was the connection, the social support, and partnership, which were prioritized as necessary for wellness and as an antidote for the isolation, moral distress, inefficiencies, and clinical demands that underlie burnout.2 Not surprisingly, nurse-participants identified listening as one of the most important wellness coaching strategies implemented, and connecting with a student who was also a nurse as integral to the initiative. Building resilience involves developing connections and support systems to improve well-being; the opportunity to build resilience, create a wellness vision, and take steps to meet wellness goals was created through partnership.
Through The Wellness Partner Program, APN students had the opportunity to create partnerships with other nurses in practice, address the impact of the pandemic, prioritize wellness and resilience, complete clinical hours through an innovative and meaningful practice experience, and develop competence in using telecommunication technologies. Integrating these strategies as a key part of APN clinical experiences has value for the nurses being coached and supported, and for the students as future clinicians in advanced practice. During the time that this initiative was implemented, clinical experiences were limited for APN graduate students; aligning their need for educationally sound authentic clinical experiences with the heightened need for resilience in health care workers led to a successful innovation and partnership.
Clinicians are reporting anxiety, depression, distress, and sleep problems during the COVID-19 pandemic.1,3,7,10 The Wellness Partner Program was implemented to answer the call to action for addressing clinician well-being, supporting wellness for front-line nurses, and creating meaningful partnerships during this time of crisis.
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