Legalwinner FON-Supporting Nurses-Final Transcript Page 1 of 12
The Future of Nursing Podcast – National Academy of Medicine (nam.edu)
Dr. Sharmaine Lawson (00:16):
Nurses are committed to meeting the diverse and often complex needs of people every day. For many
nurses, their careers include caring for the needs of people and communities with knowledge, care, and
compassion. While nurses may be motivated by a deep sense of service and purpose, the work can be,
and often is, demanding and exhausting. Nurses encounter physical, mental, and emotional, moral, and
ethical challenges every day. These challenges shift depending on the nurse’s role and work setting.
They can include managing and supporting the complex needs of multiple people, risk of infection,
physical or verbal assault, having emotional conversations with families, confronting social and ethical
issues or encountering health inequities such as food insecurity. As nurses have encountered these
challenges, it’s very clear that nurse’s health and wellbeing are affected by both the demands of their
work and the inadequate systems in which they care for people.
Marcus Henderson (01:21):
I think in cases where I have have not felt supported or a colleague of mine has felt supported, I mean, it
really does damage to you as a person, as an individual and as a nurse, because it makes you feel as
though that, well, what is my role here? What is my purpose in being here?
Dr. Sharmaine Lawson (01:38):
If the stresses and demands of nursing poorly impact a nurse’s wellbeing, well this in turn affects the
quality and safety of care they’re delivering to patients.
Dr. Marshall Chen (01:48):
The more fundamental problem is that many nurses are not feeling well because of systems issues like
understaffing, taking care of too many patients at the same time or feeling that they don’t have power,
that they don’t have a voice in how the systems are organized and how cures delivered or nurses and
other providers feeling that they can’t deliver the best possible care because what they’re supported for
doing isn’t the best possible system for caring for patients.
Dr. Sharmaine Lawson (02:19):
If the health and wellbeing of nurses suffer, the health of the nation and suffers.
This is the Future of Nursing, a series from the National Academy of Medicine, based on the
recently published report, The Future of Nursing 2020-2030, Sharmaineting a Path to Achieve Health
Equity. I’m Dr. Sharmaine Lawson and I’m a nurse practitioner, and I’ll be taking you through the stories
of nurses confronting health disparities, and together we’ll learn how nurses can use their unique skills,
knowledge, and dedication to address health inequities and overall improve the health and wellbeing of
the nation. There are many stressors that can impact nurses health and wellbeing. In this episode, we
are going to focus on three: burnout, racism and the reluctance to report when things go wrong. We’re
going to learn what it’s like for nurses to encounter these issues and what should be done to better
FON-Supporting Nurses-Final Transcript Page 2 of 12
Burnout for nurses is not new, but the COVID 19 pandemic especially exacerbated the severity
of existing burnout, compassion fatigue, and mental health stressors experienced by nurses. Burnout is
Sharmaineacterized by one or all three of the following Sharmaineacteristics: emotional exhaustion,
apathy, and/or a low sense of accomplishment at work.
Marcus Henderson (04:09):
Burnout can take many different forms.
Dr. Sharmaine Lawson (04:12):
That’s Marcus Henderson. Marcus is a practicing psychiatric mental health nurse and was a member of
the Future of Nursing 2020-2030 Consensus Study Committee. Unfortunately, Marcus has been all too
acquainted with burnout.
Marcus Henderson (04:27):
One example of how burnout has surfaced in my clinical practice experience has been when I work from
seven to seven and there oftentimes not being a nurse coming to relieve me. Now I’m tired, I’m
exhausted. And I have to come back in here the next day, and I’m tired and exhausted and I might make
an error. I might have poor judgment. But you’re relying on me to fix your problems when you’re not
thinking about how all of this is impacting me. And there’s a lot of evidence out there about how long
work hours and shift work impacts nurses’ health and wellbeing negatively.
Dr. Sharmaine Lawson (05:06):
Marcus’s burnout was attributed to many things. The main factor being that his health system was
understaffed. As a result Marcus was overworked. Not only did Marcus feel exhausted from being
overworked, but he began questioning whether the health system, he worked under truly prioritized his
Marcus Henderson (05:27):
I know many nurses that that’s how burnout has festered in their careers, is that the system use you as
expendable. Well, if you can’t do it, then I’ll just replace you. But while you’re here, I’m going to suck out
as much as I can.
Dr. Sharmaine Lawson (05:41):
As nurses experience the consequences of working with little support in an understaffed system, it can
lead them to question their value.
Marcus Henderson (05:51):
When we talk about the lack of support, do I feel valued by the system? Do I feel as though my
contributions are recognized? Do I feel as though that I have the resources to provide patient care?
Dr. Sharmaine Lawson (06:04):
There are several factors that can create an environment in which nurses feel the strain that leads to
burnout. These factors can include high workloads, staff shortages, extended shifts, and the burden of
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clinical documentation. Dr. Kenya beard, who we heard from in previous episodes has witnessed how
these factors have placed an unrealistic and unsustainable expectation on nurses.
Dr. Kenya Beard (06:30):
When we talk about nurses who are under-supported, first with COVID, we’ve seen some pretty
unrealistic demands placed on nurses across the board, which has impacted patient outcomes. But high
workloads, the high workload demands, they are not new to nursing.
Dr. Sharmaine Lawson (06:49):
Burnout creates a big risk, and that is, it puts the nurses’ mental health in danger. And this must be
acknowledged in the workplace.
Dr. Kenya Beard (07:00):
When I get evaluated as a nurse, I should be asked, first of all, do you feel supported? We have seen
that nurses are at a higher risk for suicide than the general population.
Dr. Sharmaine Lawson (07:11):
Even before the pandemic began, suicide risk was twice as high among female nurses compared with
American women as a whole.
Dr. Kenya Beard (07:25):
How are you protecting your mental health and your wellbeing and what is it that I can do to help
support your wellbeing? I think institutions need to recognize that when we talk about wellbeing, it has
to be operationalized in a way that wellbeing becomes a core value. And when we talk about core
values, we know that hospitals are actually demonstrating that it’s important.
Dr. Sharmaine Lawson (07:56):
There are several things that institutions can do to prioritize nurse wellbeing and monitor for burnout. It
starts with leadership choosing to routinely check in on their nursing staff.
Dr. Feedo Linda Lim (08:07):
Just sensing something from a staff member, having that extra feeling that, Gee, one of my staff maybe
is not feeling well today, or maybe this is something unique or a new experience that he needs to to
Dr. Sharmaine Lawson (08:23):
That’s [Dr. Feedo Linda Lim. 00:08:25]. Dr. Lim has worked in nursing for 33 years, both in critical care
and as faculty in nursing education. Throughout his career, Dr. Lim has seen why it’s critical for nurse
managers to consistently check in on their staff.
Dr. Feedo Linda Lim (08:41):
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So it’s a personal commitment by the nurse manager on a given day. You know, suddenly a stress
environment or a crisis comes in, you’re trying to balance your staffing. That random check-in huddle
with your staff, I think is vital in showing your support.
Dr. Sharmaine Lawson (09:02):
One of Dr Li’s former students is a practicing frontline nurse. Frank Boz is a nurse in the cardiothoracic
intensive care unit. During the height of the COVID 19 pandemic, he personally experienced how the
right kind of support from hospital leadership can make a world of difference in difficult times.
Frank Boz (09:21):
During the COVID 19 pandemic, it was a very stressful situation. We were overwhelmed with the
amount of patients and admissions and the amount of work and the leadership, the institution I work,
they were rounding on the staff and holding staff meetings and also having town halls where the staff
was able to come in and ask questions so that they can have their concerns answered and that everyone
can be kept in the loop. And that we all had a sense of what was going on and where we were standing
at the time. And that sense of transparency, that communication from leadership, from management to
the staff, really provided me with the support that I didn’t expect, especially when during this time we
were all overwhelmed with the amount of work. We were overwhelmed with the amount of patients we
had to take care of as staffing was also an issue.
And just to have the managers, the leadership, round on you on your busiest days, on your
busiest moments, meant really a lot. It provide a sense of ease to myself and to my colleagues as well.
And I think that idea of having open communication and transparency between leaderships and nursing
staff and healthcare workers meant a lot for a lot of us.
Dr. Sharmaine Lawson (10:44):
Open communication and transparency between leadership and nursing staff can help create an
environment where nurses not only feel cared for, but they also feel safe to request support. Therefore
it’s so important that hospital leadership commit to personally supporting each member of their staff.
When it comes to situations that cause burnout, the responsibility to support nurses doesn’t just fall on
nursing leadership. It’s the responsibility of the health system overall. But according to Dr Beard, our
health system has not been known to fully support nurses.
Dr. Kenya Beard (11:24):
It’s difficult because we have inherited systems that have not always been kind to nurses or really
appreciated the role of a nurse. And I use the example, if I was a surgeon and I was in the middle of
surgery, no one would interrupt that surgery to ask me to come out and address an issue with one of my
patients who had surgery, who might have an infection now, and they might need something. There
would be someone else to deal with that. And that’s how the system is designed to support surgeons.
But where is that support for nurses?
Dr. Sharmaine Lawson (12:10):
When nurses are under supported, it’s not just their wellbeing that suffers.
FON-Supporting Nurses-Final Transcript Page 5 of 12
Dr. Kenya Beard (12:17):
So when nurses cannot keep up with external demands and they feel that they are under supported,
everyone suffers. Hospitals suffer because when nurses leave prematurely, it costs hospitals millions of
dollars. And we cannot simply replace nurses without thinking about the collateral damage that a
nurse’s departure has on an institution. When a nurse leaves, they leave with knowledge and besides
the hospital suffering, patients end up suffering because the quality of care is jeopardized.
Dr. Sharmaine Lawson (12:53):
When nurses suffer from burnout, the entire health system suffers. Patients may not receive the best
quality of care. Hospitals may experience high turnover rates and costs of care may increase as well.
Costs of nurse turnover are high. Hospitals can end up spending between $3.6 to $6.1 million a year, just
on turnover alone. To prevent this structures in the health system need to change.
Dr. Marshall Chen (13:27):
The bigger solution is redesigning our systems of care so that nurses don’t get burned out. That nurses
should not be in this position where they’re under difficult work circumstances that cause the poor
wellbeing or the burnout.
Dr. Sharmaine Lawson (13:46):
That’s Dr. Marshall Chen. Dr. Chen is a general internist and health equity researcher at the University of
Chicago and was also a member of the Future of Nursing 2020-2030 Committee. Both Dr. Chen and Dr.
Beard recognize that to redesign systems of care, we need to figure out exactly what in the health
system has contributed to nursing burnout.
Dr. Kenya Beard (14:09):
We have to recognize and own up to the ways in which some of our policies and practices have
historically undermined the wellbeing of nurses. For example, when we arbitrarily assign a nurse to X
number of patients, what are we saying? That the needs of the patients, the experience level of the
nurse, the situation, or the dynamics of the institution, those things don’t matter? To say that a
everyone can take care of X number of patients is faulty reasoning and contributes to burnout.
Secondly, since wellbeing is so critical to the role of nursing, it has to be an integral component of
evaluations. Nurses should be asked what they’re doing, what they need and what the institution can do
to better support wellbeing.
Dr. Sharmaine Lawson (14:57):
To better support others, nurses must be fully supported by the health system. Throughout his research
Dr. Marshall Chen has observed that health systems need to adopt a more holistic approach. One that
acknowledges the needs of both the nurse’s wellbeing and the individuals they care for.
Dr. Marshall Chen (15:17):
Nurses are the health providers. They would love systems where they have the time to comprehensively
address the medical and social needs of patients. Right now, they’re not supported for that. Specialist
social needs really is an afterthought because even though everyone knows it’s important, the systems
don’t pay for spending a lot of time with patients to address social needs. So that’s an example, a very
FON-Supporting Nurses-Final Transcript Page 6 of 12
concrete example of how we need to have the two-prong approach, both supporting the nurses who
does not have wellbeing at the same time, creating the best possible systems of care to address patients
medical and social needs. That will also enable nurses and other health professionals to have a better
Dr. Sharmaine Lawson (16:06):
We have to acknowledge however, another major issue that impacts nurses health and wellbeing, and
one that can also contribute to burnout: structural and cultural racism and discrimination. These issues
have always been present, but are now receiving the widespread recognition it has long deserved.
Historically nurses have encountered racism and discrimination from employers, colleagues, and
patients. These racist and discriminatory actions can be made against themselves or against their
colleagues. Marcus Henderson, the frontline nurse, who we heard from earlier experienced a moment
like this during the summer of 2020,
Marcus Henderson (16:52):
I was taking care of a patient, a white patient, a white child, from a suburb of the city and I deal every
day with anxious parents or guardians who are worried about their child being in the hospital and trying
to kind of ease their anxiety, talk to them about the experience. But this child’s parent was particularly
challenging. And at this time their was no hospital visitation. So no parents could come in and see their
child. They could only speak with them over the phone and if we had Zoom capabilities which was only
during the week. And this mother drove up to the hospital and came to the lobby and requested to
speak with the nurse.
So I do my job as I would with any patient. I walked up to the front lobby, the mother is there,
anxious, and I begin talking with her about what’s going on, what to expect, call on Monday morning,
ask to speak with your social worker and ask these questions. Kind of like helping her to advocate for
herself and her son. And the woman looks at my colleague sitting at the front desk, a black woman. She
turns her back to the woman sitting at the front desk and looks at me and says, “Is it those kind of
people that work [inaudible 00:18:00] here? Because my son isn’t exposed to those people.”
I was in shock. I never said anything about race. I just said, “Your son is doing well in the unit.
He’s interacting with all of the children. He’s playing appropriately. He’s excited. He has a bright affect.
He’s very engaged in groups and in therapy. So your son has not identified any issues with his
interactions with other patients on the unit and our staff on the unit.”
Dr. Sharmaine Lawson (18:33):
Marcus found himself in a dilemma. He had to address the patient’s family member, but he also didn’t
quite know how to immediately address their racist behavior.
Marcus Henderson (18:45):
Most of the patients that I work with are children of color and the staff that I work with, most of them
are people of color. And I remember reflecting on that experience of was I wrong to not call out her acts
of racism in that moment? I think that I had the appropriate response. I didn’t feed into the prejudices
and the racism that she was giving off.
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Dr. Sharmaine Lawson (19:07):
Marcus was also unsure of how to handle this situation because of his own identity and lived
Marcus Henderson (19:15):
I’m biracial, I’m African American and white. Most people don’t recognize that, but I think what just
struck me the most was that she just had the audacity and she felt comfortable enough to look at me,
say, okay, this is is a white man. So I’m going to ask him about the black staff here. That really was like
this pivotal moment in my life that I was like, no, I can stand up for my colleagues. I can stand up for my
family and people in my community that experience racism and discrimination because I lived
experiences living in both worlds.
Dr. Sharmaine Lawson (19:50):
Marcus decided he could stand up for his colleagues and his community that have frequently
experienced racist and discriminatory behavior. But even when nurses choose to stand against racism,
racist actions still impact their wellbeing and their ability to provide high quality of care.
Marcus Henderson (20:12):
That happens all the time where patients say, “Can I get a new nurse?” I’ve heard where patients would
request a new nurse because they didn’t want the black nurse that was caring for them. I think it’s really
hard because clearly it can evoke a very emotional reaction when someone’s speaking to you and using
racist language that’s directed towards yourself or your colleagues. I mean that evokes a really
emotional response. So it’s really hard sometimes to kind of keep those emotions in, to maintain
professionalism and go about your day in providing the services and the care that you’re there to
Dr. Sharmaine Lawson (20:54):
Nurses are still human. It’s difficult for nurses to contain their emotions and maintain professionalism if
a patient is hostile because of a nurse’s race or appearance. Some times a patient rejects their nurse or
a nurse experiences discrimination because of their nationality, sexual orientation or disability. Nurse
managers must acknowledge that this puts nurses, especially nurses of color, in a situation that can
negatively affect their wellbeing. And they must be willing to support and protect the dignity of their
staff through it.
Marcus Henderson (21:32):
I think many nurses like myself sometimes are uncomfortable with addressing that head-on themselves.
So I think it really is important for leadership, your immediate supervisor, your nurse manager,
whomever is supporting you at that moment in time, who comes in and kind of reiterates the kind of
environment that the workplace is. This is an anti-racist work environment. We’re about inclusivity,
excellence, diversity, and we pride ourselves in providing high quality care, regardless of who the
individual that’s providing your care or the who the patient is. I think it’s important that the institution
acknowledges when those things occur, holds themselves accountable, whether it’s a patient that’s
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committing the act, whether it’s a peer, a colleague, whomever, that there’s, there’s acknowledgement
that it exists. There’s accountability and actions taken when it happens.
Dr. Sharmaine Lawson (22:24):
So what can institutions do to support nurses when they’re imp impacted by racism and discrimination?
Marcus Henderson (22:32):
I think first and foremost, institutions need to take a zero tolerance stance on …