Beyond Nurse Residency

Nurturing the Next Generation: Why Nurse Well-Being Is Critical

• Season 2 • Episode 8

Share episode

Over half of new graduate nurses face distress, and 91% report burnout—putting both their well-being and patient safety at risk. In this episode, Dr. Cory Church of Texas Tech University Health Sciences Center shares groundbreaking research on the challenges new nurses face, from financial stress to unsafe staffing levels.

Dr. Church highlights how leadership, peer support, and organizational commitment to well-being can make the difference between burnout and resilience. He offers practical strategies, such as daily check-ins, peer connection opportunities, and rethinking sick time as "well-being time."

Whether you're a nurse leader, educator, or clinician, this conversation offers actionable insights to help new nurses thrive—and ensure safer, more stable healthcare environments for all.

GUEST: Cory D. Church, PhD, RN, NPD-BC
Associate Professor at Texas Tech University Health Sciences Center School of Nursing

Dr. Cory Church is an Associate Professor at Texas Tech University Health Sciences Center School of Nursing with a background in nursing education leadership, professional development, and workforce research. His work centers on the well-being and retention of newly licensed nurses, with a focus on how organizational systems influence the transition to practice. He has published widely on nursing workforce trends and well-being, serves on national committees focused on advancing transition to practice, and holds board certification in Nursing Professional Development.

https://www.nursingoutlook.org/article/S0029-6554(25)00058-2/abstract

Supporting nurses is our priority. Visit https://nursing.uiowa.edu/ionrp to explore our resources for new graduate nurses and beyond.

00:00:02 Host: Nicole Weathers

You're listening to the Beyond Nurse Residency Podcast, an educational series where we interview experts on all topics related to the transition of new graduate nurses into practice and beyond. I'm your host, Nicole Weathers, director of the Iowa Online Nurse Residency program. Thanks for joining us.

00:00:22 Host: Nicole Weathers

Let's jump in.

00:00:28 Host: Nicole Weathers

Nurse well-being is a topic we've been deeply committed to in our nurse residency program over the last several years, as many of our listeners know, we've been intentional about educating our nurse residents on the importance of well-being not just as a response to stress but as a proactive skill set. We focus on building interpersonal skills like optimism.

00:00:48 Host: Nicole Weathers

Emotional regulation and self-awareness to help nurses navigate the demands of the profession before stress leads to overwhelm or.

00:00:56 Host: Nicole Weathers

Burnout.

00:00:57 Host: Nicole Weathers

As we continue to face workforce shortages, increasing complexity and care, and emotional fatigue, the well-being of our nurses, especially those just entering the field, has never been more important. The transition from student to practicing nurse is a time of incredible growth, but also vulnerability. And if we don't support our new nurses well.

00:01:17 Host: Nicole Weathers

We risk losing them before they've had a chance to truly thrive.

00:01:20 Host: Nicole Weathers

In today's episode, we'll explore the challenges new graduate nurses face when entering the profession, the role of the organizational culture, and what we can do both practically and systemically, to create environments where well-being is not just supported, but it's prioritized. My goal is for you to walk away with practical strategies you can use to strengthen nurse well-being.

00:01:43 Host: Nicole Weathers

In your own organization.

00:01:46 Host: Nicole Weathers

And today, I'm truly honored to be joined by Doctor Cory Church, a nationally recognized expert in nurse residency programs transition to practice and nurse well-being so welcome, Cory, thanks for joining me today.

00:01:58 Guest: Dr. Cory Church

Hey, thank you so much, Doctor Weathers. It's good to be here. Congratulations on earning your doctor. That's a big deal. No small feat. Yeah.

00:02:07 Host: Nicole Weathers

Thank you.

00:02:08 Host: Nicole Weathers

It is no small feat and kind of this is a timely conversation because as we're talking about, you know, stress and burnout, it's kind of like as you come to the end of a big goal.

00:02:17 Host: Nicole Weathers

Like that? Uh, some of these things kind of start to show up. So I'm just really excited to kind of dive in today into today's conversation. But before we do, why don't you start off by telling our listeners a little bit more about yourself?

00:02:29 Guest: Dr. Cory Church

Yeah.

00:02:34 Guest: Dr. Cory Church

Well, again, thank you for having me. I've come to realize in all of my work that we always have transitions in life, so anything that's applicable to the new nurses can be applicable to to any nurse, any person. But again, my name is Cory Church. I'm an associate professor in the School of Nursing at Texas Tech University Health Sciences center.

00:02:57 Guest: Dr. Cory Church

And I have been studying new nurse well-being and retention and workforce development over the last eight years since earning my PhD. My dissertation was on looking at organizational commitment in nurse residents and nurse residency

00:03:17 Guest: Dr. Cory Church

At the time, we're just getting off the.

00:03:19 Guest: Dr. Cory Church

Around and we have done an incredible amount of work since then in the transition to practice arena, I've published in several articles on new nurse workforce.

00:03:31 Guest: Dr. Cory Church

Particularly last year, we published actually this year we published on the newly licensed registered nurse population. We looked at the National Sample survey. So we're going to hopefully get to talk.

00:03:43 Guest: Dr. Cory Church

About that. And I also just recently finished up a well-being study. So just happy to be here. Thank you so much.

00:03:50 Host: Nicole Weathers

Awesome. Well, I'm excited to hear as much as you can tell us about some of those studies and articles that you mentioned. So let's kind of begin by setting the stage a little bit. So the transition into practice, of course we know can be overwhelming emotionally, physically, professionally from your perspective. What are some of the most pressing?

00:04:11 Host: Nicole Weathers

Challenges new nurses face in maintaining their well-being during this critical time.

00:04:18 Guest: Dr. Cory Church

I think we most of us know that our profession can be emotionally intense, physically demanding the physical work of being a nurse is hard, and some new nurses are going to enter practice settings that may be under resourced or understaffed. And what we are seeing in our recent research is that 54%.

00:04:40 Guest: Dr. Cory Church

New nurses are at an increased or severe risk of distress. That's a big problem.

00:04:45 Guest: Dr. Cory Church

It's really staggering numbers and in our look at the National Sample survey that's coming out in Nursing Outlook this month, 91% of new nurses have reported burnout and that's all just since the pandemic. This research has been ongoing for many years, dating back to the 70s.

00:05:05 Guest: Dr. Cory Church

Nursing is not easy to work in, but the challenges that we're facing are different than they were before the pandemic. We're also looking at a workforce that is primarily Gen. Z.

00:05:19 Guest: Dr. Cory Church

And if you look at workforce demographics of Gen. Z, they're in a position where they're financially strapped. They're often overwhelmed or depleted. They are aware that they have some mental health challenges, but they are not necessarily prepared to enter a system that may or may not.

00:05:39 Guest: Dr. Cory Church

Prioritize their individual well-being or the system has not developed to prioritize the well-being of our workforce.

00:05:47 Guest: Dr. Cory Church

They are already what we're seeing in academia is that our new nurses or our new nursing students are already coming to us that way.

00:05:55 Guest: Dr. Cory Church

And we're having to build cultures of resilience and well-being while they're in nursing school and they are going on to become nurses.

00:06:07 Guest: Dr. Cory Church

In a system, again, as we said, that may or may not prioritize that a lot of our Gen Z nurses are living paycheck to paycheck. You can look at our National Sample survey research that shows that a majority of new nurses are taking out loans to be a nurse.

00:06:23 Guest: Dr. Cory Church

School. And we're also seeing a housing and food crisis in students. So as they're coming into nursing school, we're seeing this. And then we're placing them in an environment where they may or may not be prepared to handle that. So this is not just a necessarily a nursing practice then that may also be a demographic.

00:06:43 Guest: Dr. Cory Church

That we're working with and that's a little bit different than what we have dealt with in the past.

00:06:49 Host: Nicole Weathers

So I want to just pause one second right there because two things that you said really stood out to me and kind of reminded me of some other conversations that we've had on the podcast. So first is this idea of, you know, are the students ready to enter this practice setting, but also are our practice settings ready for the students?

00:07:10 Host: Nicole Weathers

And so when we talk about like.

00:07:12 Host: Nicole Weathers

New grad preparedness and readiness for practice like we fail sometimes to talk about organizational readiness and are we ready to bring these new nurses into our organization? Are we prepared to meet them where they're at, to help them kind of overcome some of these challenges? And so I really just like that you.

00:07:31

Yeah.

00:07:32 Host: Nicole Weathers

You bring some attention to that because I think that's something that we don't talk about enough. And you know, when we talk about sort of this in between practice and academia, and are you sending, you know, practice ready nurses, the fingers usually pointing back at academia and not necessarily at, but are you getting?

00:07:52 Host: Nicole Weathers

Prepared because this is what we're sending you. Uh. So I think that's just an important conversation. And then this idea of, you know, you're talking a lot about, you know, personal finances, housing, food.

00:08:04 Host: Nicole Weathers

We spoke with Doctor Rose Sherman on a previous episode of the podcast, and she kind of brought up this idea of I'm trying to think of what she called it. So.

00:08:16 Host: Nicole Weathers

Social determinants of work health, I think, is kind of what how she phrased it. So these are things that don't aren't necessarily like works responsibility or something that work can directly impact. But because of these things because of these social determinants of work health, it has impacted at the workplace.

00:08:36 Host: Nicole Weathers

And so maybe we need to start thinking about again what we can do to kind of support those pieces.

00:08:42 Guest: Dr. Cory Church

The thing about academia, I always say is there's only so much we can control and do within the time frame that we've been given to educate nurses. If I had a magic wand and everything was great, I would probably make nursing school longer and residencies longer. What we're seeing is nursing practice doesn't look like it did even 20 years ago, 10 years ago, and we're still expected to prepare nurses to fully practice, be fully practiced ready.

00:09:12 Guest: Dr. Cory Church

In an environment that doesn't look anything like it used to, and nurses are being expected to do more with less often times, and yet I hear about these academic practice partnerships where they're saying we're speeding up the transition to practice. We're getting people in there, we're getting them ready, you know.

00:09:32 Guest: Dr. Cory Church

Our nursing programs are getting shorter and shorter. I don't know that that's necessarily a good thing. And then you know.

00:09:41 Guest: Dr. Cory Church

A residency doesn't have to necessarily be one year. It could be 6 months. I don't know. That's always the best thing we get in nurses and we push them out and.

00:09:51 Guest: Dr. Cory Church

Yes, we have a.

00:09:51 Guest: Dr. Cory Church

Shortage. But I I think that nursing school.

00:09:56 Guest: Dr. Cory Church

Could stand to be longer and allow us time to actually embed nurses.

00:10:03 Guest: Dr. Cory Church

More into our clinical practice environment before sending them out to be work, work ready, but that's a great point that Doctor Sherman makes. I've never heard of that term before, but it fits perfectly because your new nurses are going to bring all of that with them to work, that they're going to take it throughout their day.

00:10:23 Guest: Dr. Cory Church

They're going to reflect on it during the day. It's something that's constantly in the back of their mind.

00:10:28 Guest: Dr. Cory Church

So it that's a great point. Great point.

00:10:30 Host: Nicole Weathers

So do you think these are things that didn't exist for prior generations of nurses, or is it just generationally how these?

00:10:42 Host: Nicole Weathers

You know, things are sort of looked at or talked about is just different.

00:10:49 Guest: Dr. Cory Church

So I think we have seen some of it in earlier generations, but we are seeing a generation that's being impacted by world events and by financial stressors and that hasn't gotten better. It's just gotten worse. On top of that, going to school.

00:11:09 Guest: Dr. Cory Church

Nursing school may be a challenge for some. It definitely the idea of your you're earning a degree that costs less is not. It's not there. So you're you were seeing some of these things even for like millennials like me. But it's just gotten worse.

00:11:26 Guest: Dr. Cory Church

A lot of Gen Z nurses are looking to pay for things on their own. They're having to because their parents are not necessarily able to provide that for them. There's just a lot of different factors. I think it's just gotten worse over the generations.

00:11:42 Host: Nicole Weathers

And kind of this point that you made about.

00:11:48 Host: Nicole Weathers

Quality over quantity or like quickness I guess. I mean I'm a firm believer of quality over like how fast we can maybe get some things through. I think there's obviously a fine line there, but I tend to agree I get a lot of questions about actually just yesterday there was a question about you know, do you see any organizations that are kind of like speeding this?

00:12:08 Host: Nicole Weathers

Up from a year or to like 6 months or nine months so that we can get through it a little bit quicker and I tend to respond like you, I don't.

00:12:15 Host: Nicole Weathers

Think that that's.

00:12:16 Host: Nicole Weathers

Probably the best thing to do, especially when you look at the theory around transition and when reality shock hits and all of those things, it just doesn't make.

00:12:23 Host: Nicole Weathers

Sense to have that support end at that very specific time when they are probably at their lowest, through their transition. And so I just again like that you emphasized that.

00:12:35

Yeah.

00:12:36 Host: Nicole Weathers

And what you shared?

00:12:37 Guest: Dr. Cory Church

You know, here's the thing. Nicole is you look at any of our other HealthCare Partners, you look at OT’s, PT's, physicians.

00:12:47 Guest: Dr. Cory Church

And pharmacists, they don't expect, they're not expected to rapidly in our practice and go through nursing. You know their program in a short period of time and you know, you speak to other therapists and providers and they have an extent amount of clinical hours before they are released.

00:13:07 Guest: Dr. Cory Church

On their own a lot. And yes, nurses are serving on the frontline. Yes, we have a responsibility to get them in and get them working. But you look around at our inter professional team, they're not expected to do the same thing. So why is nursing?

00:13:26 Guest: Dr. Cory Church

You know, it just it. It's always puzzled me so.

00:13:28 Host: Nicole Weathers

That's a great question.

00:13:31 Guest: Dr. Cory Church

Yeah.

00:13:32 Host: Nicole Weathers

Mm-hmm. Mm-hmm. Well, that's it. It is a great question. And you see all these accelerated programs popping up, and we just have to churn out more and more nurses. But.

00:13:42 Host: Nicole Weathers

Few people are talking about.

00:13:45 Host: Nicole Weathers

Why do we need to keep churning out more nurses like what's happening in the practice setting? You know, what are some of those holes that we need to start plugging? And I think our topic today is probably one of those things, right?

00:13:53 Guest: Dr. Cory Church

Yeah, absolutely.

00:13:55 Host: Nicole Weathers

Is how our organization sort of preparing to support the well-being of the nurses as they come?

00:14:01 Host: Nicole Weathers

So we know that individual resilience, you know, is often talked about, right? We need to build more resilience in these new nurses. But we know that that can only go so far without the right environment. So why don't we talk a little bit now?

00:14:15 Host: Nicole Weathers

About sort of that organizational impact, how does organizational culture?

00:14:20 Host: Nicole Weathers

Like leadership, staffing, psychological safety. How does that all impact the well-being of these early career nurses?

00:14:28 Guest: Dr. Cory Church

I will add that a lot of the research on well-being and new nurses is outdated. That's what prompted me to get back at just identifying where we are at in terms of well-being with new nurses. But a lot of the early research just entered around new nurses found that.

00:14:47 Guest: Dr. Cory Church

Leadership styles are a great contributor to well-being and new nurses. Heather Laschinger was a Canadian researcher that did a lot of work around new nurses and their well-being.

00:15:00 Guest: Dr. Cory Church

She found that authentic leadership was a significant predictor of well-being, meaning that you're showing your new nurses that it's OK to make mistakes, you're providing a safe place for them to speak about their mistakes and their well-being. You're showing them the humaneness of, of being a leader, so absolutely leadership.

00:15:22 Guest: Dr. Cory Church

Has a lot to do with it, and if you look at our National Sample survey research that comes out in Nursing Outlook, what you'll find is.

00:15:30 Guest: Dr. Cory Church

That leadership styles or leadership and management behaviors is a top reason why new nurses leave. So that tells you that it's certainly important.

00:15:42 Guest: Dr. Cory Church

In terms of staffing, I tend to say that staffing is.

00:15:46 Guest: Dr. Cory Church

Not always in the control of a nurse, resident or a nurse residency program. Obviously, it's a priority, should be a priority for your organization, but there's just certain things out of our control when it comes to helping new nurses. I like the fact that.

00:16:01 Guest: Dr. Cory Church

New nurses, you know, are only taking care of a certain number of patients, and they're growing that as they get more practice and gain more confidence. So certainly, scaffolding the number of patients they receive.

00:16:16 Guest: Dr. Cory Church

You know, staffing may or may not be within our control. It is a, it is a top reason why new nurses decide to leave. So it should be a strategic priority.

00:16:27 Guest: Dr. Cory Church

But one thing that organizations should be leaning heavily on is making well-being a strategic priority. I don't know if you were able to sit in on some of the sessions at the Transition to Practice Symposium, but there was one organization that they sure showed their organizational strategic plan.

00:16:48 Guest: Dr. Cory Church

And right there, beside financial stewardship, they had well-being.

00:16:54 Guest: Dr. Cory Church

That says to me your organization is prioritizing that you're making it an important factor. You are maybe even monitoring it or collecting data on it just like you would do any other quality data. So that's certainly a system level priority that should be there.

00:17:12 Guest: Dr. Cory Church

So yeah, all of those things are important. What we what we know over time is that there's not just one single magic pill for well-being in new nurses. It takes a comprehensive approach.

00:17:27 Guest: Dr. Cory Church

Mindfulness practices and resilience building and nurse residency program. Check. You got to have that. That's just one important component. Having opportunities for them to connect with each other with their peers, certainly a priority. And then again, well-being being a strategic priority and investing in that peer support.

00:17:50 Host: Nicole Weathers

In that presentation that you were talking about, did they give any examples of what?

00:17:58 Host: Nicole Weathers

They are.

00:18:00 Host: Nicole Weathers

Kind of strategic actions looks like to support that that idea of well-being.

00:18:06 Guest: Dr. Cory Church

Certainly they're monitoring well-being. They are I didn't necessarily catch what they're doing at a strategic level like an organizational level.

00:18:15 Guest: Dr. Cory Church

But a lot of.

00:18:15 Guest: Dr. Cory Church

What I saw from nurse residency programs or fellowship programs at these presentations was they're doing daily check-ins. They're checking in on the well-being of their new nurses.

00:18:25 Guest: Dr. Cory Church

And their fellows consistently.

00:18:28 Guest: Dr. Cory Church

They're offering well-being huddles where it's an opportunity, psychologically safe environment for them to talk about their feelings, their emotions, their struggles and practice. And they gave some of the examples from their residents and fellows, and it was like, you know, the opportunity to share my experience with other people.

00:18:50 Guest: Dr. Cory Church

And hear that I'm not the only one experiencing this was fulfilling to me.

00:18:56 Guest: Dr. Cory Church

Those are all good strategies.

00:18:58 Host: Nicole Weathers

Yeah. And I would say that is something that come when we talk to our residents a lot in the program, that is something that comes up over and over again. It's just this chance to hear from others and know that it's not just me. I'm not the only one that like, you know, at six months felt like I wasn't cut out for this and I wasn't sure that I wanted to be here.

00:19:18 Host: Nicole Weathers

Or, you know, I'm not the only one that has, you know, that difficult coworker or I'm not the only one that has whatever it is. Just knowing that you're not the anomaly of being the only one to have some sort of experience. Just give you a little bit more peace, I think.

00:19:33 Host: Nicole Weathers

Peace of Mind that it's normal. There's nothing wrong with me. There's nothing wrong with my unit or my organization, and that this is just what?

00:19:42 Host: Nicole Weathers

What it's like, what the experience is like.

00:19:45 Guest: Dr. Cory Church

Yeah, and.

00:19:46 Guest: Dr. Cory Church

Normalizing that offering the safe space for people to talk about it, we hear the term psychological safety.

00:19:54 Guest: Dr. Cory Church

Absolutely has to be there in in a residency program, but offering that space where even if you're nursing professional development practitioners don't necessarily have the time or the space to do that. Maybe offering a counselor or a therapist or just someone who can navigate.

00:20:14 Guest: Dr. Cory Church

A peer support group.

00:20:16 Guest: Dr. Cory Church

And allowing them the opportunity to, you know, speak up and.

00:20:20 Guest: Dr. Cory Church

Share.

00:20:21 Host: Nicole Weathers

And I like that you bring up. It doesn't always have to be the NPD, right? Or it doesn't have to be the person running the residency programs. What other resources do you have available? What other people players do you have on your team that maybe you could pull in? It doesn't always have to be kind of that same person.

00:20:38 Guest: Dr. Cory Church

Absolutely. And it's not just about speaking at your residents about these things. It's not sitting them down in the chair and just speaking at them and saying, yeah, you need to be healthy and you need to work out. But actually living it out, showing them that it's real action, that's the one thing about Gen Z is.

00:20:57 Guest: Dr. Cory Church

And I speak to Gen Z because they're the primary demographic here, but and it's just for context.

00:21:03 Guest: Dr. Cory Church

But they want to see real action. They want to know that when you say that you care about their well-being, what are you doing about that? It's not just, you know, you're not just speaking it, you're actually living it out.

00:21:15 Host: Nicole Weathers

Yeah. So we have a kind of a, a different approach to nurse residency where we have like a flipped classroom. So there's online content that they do before they come together for that discussion. And we had one organization in particular who because of their policies, they were like, everything has to be done sort of on site within this time frame.

00:21:35 Host: Nicole Weathers

So.

00:21:36 Host: Nicole Weathers

What they did to sort of accommodate that, and I think also sort of attributes to this like showing them that I really do care about your well-being as they allowed them to. They just told them bring your earbuds, you know, bring your phones and then just come on campus and, you know, listen to the podcast for this month. But go for a walk. Right. And so they're.

00:21:57 Host: Nicole Weathers

Not only you know learning, but they're also kind of getting that opportunity to get paid to move their body a little bit, which I thought was really a unique sort of approach to that.

00:22:08 Guest: Dr. Cory Church

Absolutely.

00:22:09 Guest: Dr. Cory Church

So again, I just want to reiterate like it doesn't have to be some fancy curriculum, just offering a space for them to reconnect or share with peers. But absolutely you've got to have some sort of.

00:22:25 Guest: Dr. Cory Church

Well-being strategy in your residency program, not just.

00:22:28 Guest: Dr. Cory Church

To sit down and we're going to talk about well-being today. It needs to be intentional. So yes, there are things that your organization can do, but then there's things that you can do within your residency program to sort of help add that a little bit to help it to, to amplify their well-being. So that definitely has to be there.

00:22:49 Host: Nicole Weathers

And I think one of the big things that's been talked about a lot at the PTAP level anyway is that it also isn't kind of one and done right. We don't just talk about it. You know one month and then we don't mention well-being again throughout the rest of the year.

00:23:04 Host: Nicole Weathers

So I think you know that's another kind of thing is not just how do we add it in because we used to do that in our 1.0 curriculum, it was we talked about it kind of the first month and then we sort of moved on from it. And then when we did our curriculum redesign, it was really like how can we pull this in each and every month.

00:23:19 Guest: Dr. Cory Church

Yeah, yeah.

00:23:25 Host: Nicole Weathers

That's, you know, kind of this constant reminder that these are some of the things that we also need to be focusing on that are just as important.

00:23:32 Host: Nicole Weathers

As those professional skills.

00:23:34 Guest: Dr. Cory Church

Yeah, and I forgot to disclose to the audience that I serve on the Commission on Accreditation for Practice Transition Programs at ANCC. And so, we have a lot of influence when it comes to rewriting accreditation standards. But if you look at the current standards for ANCC, it states that these things have to be integrated.

00:23:55 Guest: Dr. Cory Church

Throughout the program, and that was intentional. We had the same thought. Nicole was like.

00:24:00 Guest: Dr. Cory Church

You know, it's not just a one and done. Show us how it's integrated throughout and well-being is one of those, one of those standards.

00:24:09 Guest: Dr. Cory Church

So just making sure that it's there, that it's intentional.

00:24:12 Host: Nicole Weathers

Uh-huh.

00:24:14 Host: Nicole Weathers

Because it's so easy to you know, mention it once and check the box and say we get it. It takes a lot more intentionality, I think, to think about how can this be integrated throughout? OK. So anything else you want to share about sort of this idea of well-being kind of at the organizational level or when it comes to organizational culture.

00:24:35 Guest: Dr. Cory Church

Again, like I said, a lot of organizations are making well-being a strategic priority. And if your organization is not, I would say that you need to be advocating for that to be a component and then that's what your nursing strategic plan is taken from. And I would say it certainly has to be a nursing strategic plan priority.

00:24:55 Guest: Dr. Cory Church

One of the other interesting topics that I heard at the Transition to Practice Symposium was I believe it was, yeah, it was Rush Copley (Medical Center) shout out to Rush Copley (Medical Center), but they were talking about how they take their residents off site and they provide opportunities for them to engage in Wellness activities.

00:25:16 Guest: Dr. Cory Church

It could be pickleball it could be you know something else. But again, they're very intentional about it, but they receive organizational support for that. I believe they were talking about how they are offered an opportunity to fund.

00:25:31 Guest: Dr. Cory Church

Those from their organization and so that that shows again that you're being intentional about it, you're creating the space for it.

00:25:41 Host: Nicole Weathers

And I could see where. I mean, if that isn't part of the organizational plan, it would be hard to kind of get the support for some of those things that are of the nursing level, so.

00:25:52 Host: Nicole Weathers

That's great.

00:25:53 Host: Nicole Weathers

OK, so let's move on to the topic of research. So you've done a lot. It sounds like you've done a lot of research in this space. So tell us about your recent work, what you know, interventions or strategies and maybe have you found that are showing promise to improve well-being among new nurses?

00:26:10 Guest: Dr. Cory Church

Yeah. So I started looking at the literature on well-being because it started to become an important topic.

00:26:18 Guest: Dr. Cory Church

If you follow the National Academy of Medicine, they started in 2019 with an action collaborative. That said, this is an issue we need to focus on it. That was before the pandemic, ironically. And then after the pandemic, it became even more important. But when I started to look at the literature on well-being and the nurses.

00:26:38 Guest: Dr. Cory Church

What I found is that most of the studies were outdated.

00:26:41 Guest: Dr. Cory Church

And then you have the studies about transitioning during COVID, but there was nothing after that. It was like we don't have a sense of.

00:26:50 Guest: Dr. Cory Church

The well-being of our new nurses after.

00:26:53 Guest: Dr. Cory Church

And with any research, you can't really build on something that you don't have proof of. So that was my first step. I needed to get an understanding of where we're at. So I was funded by the Association for Leadership, Science and Nursing. And thanks to them for their support for this study.

00:27:09 Guest: Dr. Cory Church

But what we looked at is we just wanted a baseline prevalence of well-being. So we took the Mayo Clinic nurse well-being index and we assess well-being and a couple of 100 new nurses.

00:27:25 Guest: Dr. Cory Church

We found that 54% of them are at increased or severe risk of distress and what that means is there's a strong likelihood that they will fall into a state of depression, burnout or even worse. Beyond that, we also found that well-being was a significant predictor of.

00:27:47 Guest: Dr. Cory Church

Negative safety practices.

00:27:48 Guest: Dr. Cory Church

So the worse their well-being was the more likely they were to perform negative safety behaviors and that's concerning because it's not just the well-being issue now, it's the patient safety issue.

00:28:03 Guest: Dr. Cory Church

We also found not surprising that well-being was a predictor of job satisfaction and turnover intent.

00:28:10 Guest: Dr. Cory Church

So now that we have that baseline prevalence level of well-being and our new nurses, we can start turning to things that are.

00:28:19 Guest: Dr. Cory Church

You know, interventional studies, so I haven't necessarily done an interventional study.

00:28:24 Guest: Dr. Cory Church

There are some good ones out there. Marlene Sampson and Bernadette Mazurek Melnyk out of Ohio State University. They looked at an intervention program called Mind, Body Strong. And this was specifically in nurse residents.

00:28:39 Guest: Dr. Cory Church

And that was everything from talking about well-being to activity, physical activity and exercise. That was a very strong intervention. Mindfulness practices have shown to be good at building both resilience and lowering stress levels, and there's even a study that.

00:28:59 Guest: Dr. Cory Church

Has looked at mindfulness apps.

00:29:02 Guest: Dr. Cory Church

And whether they work or not. So those are all things that work, we know that those work looking also at our National sample survey. Again we know that many nurses experience burnout. There's a high rate of turnover in new nurses. But one thing that's notable about looking at the National Sample survey is you're not only just looking at why they leave.

00:29:22 Guest: Dr. Cory Church

You're looking at why they stay.

00:29:25 Guest: Dr. Cory Church

One of the reasons that they stay is.

00:29:28 Guest: Dr. Cory Church

They say that the experience they have at the site is important to them. So the, the, the more experience they feel like they have the better whether they have a balanced schedule is important to them.

00:29:45 Guest: Dr. Cory Church

And then this sense of community with their peers.

00:29:49 Guest: Dr. Cory Church

And bam, that goes back to what we were talking about is investing in peer support, offering an opportunity to engage.

00:29:56 Guest: Dr. Cory Church

With your peers.

00:29:57 Guest: Dr. Cory Church

Sit around and talk about the well-being challenges you have, going off side and participating in something where you can connect in a positive.

00:30:06 Guest: Dr. Cory Church

Way with your peers.

00:30:08 Guest: Dr. Cory Church

And then the other thing was just a good sense of liking the job.

00:30:14 Guest: Dr. Cory Church

So those are the reasons why they stay that that the research that I have for you to date. And I think the next important thing is figuring out both system level and residency program or transition to practice program level interventions that work. One thing to note about my recent study on well-being is it doesn't necessarily drill down in the specific issues.

00:30:37 Guest: Dr. Cory Church

So, one of the things I'm looking at studying next is getting a more comprehensive measure and looking at is it your social life? Is it workplace violence? Is it your safety culture at your workplace? Like really drilling down and saying, what are the different things that we need to focus on?

00:30:59 Guest: Dr. Cory Church

So for now, that's that's what I've been doing and that's.

00:31:02 Guest: Dr. Cory Church

The research I have.

00:31:04 Host: Nicole Weathers

Yeah, that's awesome. I mean, I think first of all, your statistics here of you know 54% are at risk of distress and 91% have reported burnout.

00:31:13 Host: Nicole Weathers

Like that's mind blowing to me. That’s a lot.

00:31:16 Host: Nicole Weathers

And then you know well-being and sort of how they rated their well-being was a significant predictor of negative safety practices. So, when I talked to organizations like how do I get you know leadership buy in organizational buy in. I mean I think that right there is huge to coming back to the patient and coming back to patient safety.

00:31:34 Host: Nicole Weathers

The whole reason that we're here as nurses and so if we want to improve the safety and the quality of care that we're providing our organization like this is one place where you know, we could potentially focus.

00:31:48 Host: Nicole Weathers

And begin to move a lever. Again, it's not going to fix all of the problems. It's not going to be a magic bullet solution, but definitely something that we have evidence to suggest that those two are related.

00:32:01 Guest: Dr. Cory Church

Yeah. And that's The thing is we, we've got to, we've got to speak up and say how residency and transition programs are.

00:32:12 Guest: Dr. Cory Church

We we've got to prove their value. Unfortunately, we work in in a setting where we may or may not always be valued for the work that we do, we have to speak up. We have to point to things and metrics and data points that speak to our executive leadership and.

00:32:32 Guest: Dr. Cory Church

Speaking to patient safety, I would think that that speaks volumes to people. We've got to be able to say, hey, by investing in residency program, here's what we have by not doing it. Here's what we have.

00:32:46 Guest: Dr. Cory Church

I think residency programs have to monitor. We have to monitor outcomes. Yes, patient outcomes are not always easy to monitor within a certain population. But this is all self-reported data. So yes, there are limitations to that, but one thing I note in my article which I have submitted for publication and hopefully it will get accepted.

00:33:05 Guest: Dr. Cory Church

But one thing I note in there is, you know, measuring self-reported patient errors and patient safety outcomes is one way that we can ensure that whether we're hitting a certain level that we need to be concerned about well-being, it starts with monitoring it and then doing something about it.

00:33:22 Host: Nicole Weathers

So I'm just thinking like as you're talking about this.

00:33:27 Host: Nicole Weathers

So we have used the National Council State Boards of Nursing (NCSBN), patient safety indices. Yeah, so we have we've sort of integrated this into our Casey-Fink survey. So along with all the Casey-Fink questions, they get these questions about positive and negative safety practices.

00:33:46 Host: Nicole Weathers

And so and we were just meeting actually earlier this week with some bio stat consultants on kind of digging into our data a little bit more. And what do we all want to look at. But I think with the revisions to the Casey-Fink survey and including some questions there

00:34:03 Host: Nicole Weathers

About more well-being related topics and then what you've shared here as far as you know what you've seen as it relates to positive and negative safety practices that might be an interesting thing for us to look at as well.

00:34:17 Guest: Dr. Cory Church

If you look at Spector. Nancy Spector's article from 2015, she obviously used that and we found similar results as her.

00:34:28 Guest: Dr. Cory Church

And of course, our study wasn't just focused on nurse residents. I didn't want to limit it to just nurse residents. I wanted to say any new nurse, so we're about half and half in terms of those that were in the study were in a residency program, and those that were not.

00:34:46 Guest: Dr. Cory Church

I think that also is something that remind me to come back to that point about the differences there, but we found similar results and one of the things is positive safety practices are not always a predictor. They weren't a predictor in my study.

00:34:59 Guest: Dr. Cory Church

And I think that shows that new nurses want to have positive safety practices. I mean, that's a given. We all want to take good care of our patients.

00:35:10 Guest: Dr. Cory Church

And patient safety. Patient errors.

00:35:12 Guest: Dr. Cory Church

Are not always the responsibility of the individual nurse. They're they can be system wide issues, right? So those two things were not necessarily predictors, but when we're when well-being worsened, negative safety practices got worse.

00:35:27 Guest: Dr. Cory Church

So I think that's the that's the key indicator that we should be focusing on, but also we can focus on positive safety practices like you know that those are good things too. Going back to the difference between residency programs and non-residency programs, that's the other point that we have to continue to hammer home is.

00:35:47 Guest: Dr. Cory Church

We have outcomes for residencies, and we have outcomes for non-residencies and when we can demonstrate the value in terms of the patient safety or patient outcomes from residencies, we've got to hit that point higher.

00:36:00 Guest: Dr. Cory Church

That's another area that I'd love to research. I have so many that I look at and think about every day, but is looking the difference to say these are great investments for your organization.

00:36:11 Host: Nicole Weathers

Well, that's something I think we've been talking a lot about too, is the fact that all of the things that we talk about, whether it's competency or safety.

00:36:20 Host: Nicole Weathers

Or, you know well-being yes, we talk about them in terms of new graduate nurses because that's our focus, but all every nurse, every nurse across the career continuum, no matter what level of experience or setting or whatever, they need these same things. And so that is something that I could totally see.

00:36:40 Host: Nicole Weathers

As maybe a more experienced nurse.

00:36:45 Host: Nicole Weathers

And maybe not in that leadership, you know, haven't hasn't maybe crossed the creek into leadership, but there's there are those experienced nurses who aren't in some sort of you know leadership development program or anything and they're not in nurse residency. It's kind of like what are we doing for those folks to bring some of these same things into practice.

00:37:05 Guest: Dr. Cory Church

Any of this is applicable to nurses. Early career, late career that they're all applicable. I like I said earlier, we all have different transitions in our life and I would argue that a transition theory.

00:37:19 Guest: Dr. Cory Church

Is pretty similar to anyone going through any transition. There's going to be periods of ups and downs.

00:37:25 Guest: Dr. Cory Church

And then in the end, it's going to level out. These are all priorities that can be taken for, for other nurses, not just new nurses.

00:37:34 Host: Nicole Weathers

Absolutely. So, if you had the opportunity to completely redesign transition to practice with well-being sort of at the center, what would that look like?

00:37:46 Guest: Dr. Cory Church

Unlimited money, unlimited time, something I spoke about earlier is extending the time of residency.

00:37:54 Guest: Dr. Cory Church

You look around at our other healthcare professions partners and they're offered that sort of that extended time.

00:38:02 Guest: Dr. Cory Church

I know that's not ideal. I know that's not great, but that's what I would do is I would extend it. One of the challenges we face with that is preceptors and preceptor time, so that's hard.

00:38:13 Guest: Dr. Cory Church

I like the idea of having like a Chief Resident Officer or, you know, an attending nurse, that it sort of like a medical residency model that overseas that. I like the idea of definitely scaffolding the number of patients that we have, you know, and extending that scaffold out a little ways.

00:38:35 Guest: Dr. Cory Church

You don't plop a physician resident directly into a surgery on day one and expect them to cut into somebody. So, I like the idea of extending that scaffolding. I think we need to do better job of matching residents or nursing students to an area of practice that fits them.

00:38:56 Guest: Dr. Cory Church

I think a lot of new nurses get into practice and they realize maybe this is not the setting for me or they want experience with it, but then they want to transition to something different.

00:39:09 Guest: Dr. Cory Church

And so, sort of matching them before they come into residency is a good thing. I think we could explore that. 

00:39:21 Guest: Dr. Cory Church

Another idea would be we are monitoring your stress biomarkers or your well-being levels and when you hit a certain level, you get a well-being paid time off.

00:39:29 Guest: Dr. Cory Church

You know. No issues on the side of the organization. We just give it to you. Time to recover. Maybe you've had a stressful event at work. Maybe you are an emergency department resident and you've experienced a traumatic situation. You get a day off on us as a well-being day.

00:39:53 Guest: Dr. Cory Church

No questions asked. Time to recover from that.

00:39:57 Guest: Dr. Cory Church

I wish there was an opportunity or a way we could say, I always last because I log into my to look at my paycheck, sometimes at work, and I have several 100 hours of sick leave and I'm like this idea that I have to be sick to take time off.

00:40:14 Guest: Dr. Cory Church

What? What if I just need a day to just improve my well-being? So changing the mindset from sick leave to well-being leave.

00:40:19 Host: Nicole Weathers

Uh-huh.

00:40:26 Guest: Dr. Cory Church

And if there was a way to tie it to, hey, you go do a workout, you go to a counseling session, we'll give you a day off. So just prioritizing those things, if I could have it my way.

00:40:38 Host: Nicole Weathers

I love that. I mean, I love the idea of flipping this the sick time to.

00:40:43 Host: Nicole Weathers

Well-being time, I mean that would be amazing because I'm with you like I have so many hours of sick time, sort of built up that I never use because I'm not sick a lot. Thankfully, right. Knock on wood, but that doesn't mean that again you should have to wait until you're sick to.

00:41:03 Host: Nicole Weathers

To take that time.

00:41:05 Host: Nicole Weathers

And then this idea of like I'm envisioning Oura rings for the whole nurse residency program, where we're monitoring this and actually tracking their physiological stress response. Because I do have an Oura ring. And for the last year of this DNP program.

00:41:24 Host: Nicole Weathers

It just tells me that I'm stressed, right, so haven't quite figured out what to do about the information that it's giving me, but.

00:41:32 Host: Nicole Weathers

But it's still useful information.

00:41:34 Guest: Dr. Cory Church

It really is, that's a great thing. We can use AI for a lot of things. You know what if you now have an AI mentor or an AI peer that you can express your difficulties with, maybe we offer a space for residents to sit down and have a therapy conversation with chatGPT.

00:41:54 Guest: Dr. Cory Church

You know, virtual reality opportunities where you can you can reconnect. They're all just one thing, one time but sustaining.

00:42:03 Guest: Dr. Cory Church

Those.

00:42:04 Guest: Dr. Cory Church

And I talked about it earlier is.

00:42:07 Guest: Dr. Cory Church

There are things that are in your control and out of your control when you're leading a transition program. Some of the things that the organizational level or out of.

00:42:14 Guest: Dr. Cory Church

Your control but.

00:42:16 Guest: Dr. Cory Church

Taking the time to provide mindfulness or resilient strategies or peer support, or peer therapy or whatever it may be, there has to be something there. You've got to be intentional about it so.

00:42:32 Guest: Dr. Cory Church

There's a lot we can do, Nicole.

00:42:34 Host: Nicole Weathers

Yeah. And one of our previous guests, Dr. Patrick Jeffs, who does a lot in the space of of well-being and resiliency, you know talks about too, not only providing content or education around mindfulness and teaching them how, but then helping them find micro moments throughout their actual workday to implement these things. So.

00:42:56 Host: Nicole Weathers

Yeah, I can't take a 30-minute break to go meditate, but one of the things and I know I've shared this before that he's talked about.

00:43:03 Host: Nicole Weathers

Is taking the long way home, meaning what's the long way back to the nurses’ station to just take that extra minute to, like, let your brain settle a little bit before you have to jump into the next thing? And so I think that's something that we could all do better about is we know a lot, right? We know a lot about some of these different strategies, but what are we actually doing to support them?

00:43:25 Host: Nicole Weathers

Throughout the workday so that they can have that that impact on the well-being that we know that they can.

00:43:33 Guest: Dr. Cory Church

Absolutely. Yeah. Those micro recoveries. Yeah.

00:43:39 Guest: Dr. Cory Church

Again, and being intentional about doing daily check-ins with your residents, I think can.

00:43:45 Guest: Dr. Cory Church

Head off a lot of issues.

00:43:47 Guest: Dr. Cory Church

The one thing about our current workforce is they are not necessarily going to tell you.

00:43:54 Guest: Dr. Cory Church

Whether or not they are feeling burned out or stressed or whatever, and they will silently leave you from work, so it's important to create again, psychological safety, that it's OK to speak up about your well-being here and then two, you know, checking in with them constantly.

00:44:14 Host: Nicole Weathers

Awesome. So, looking ahead, What trends? What challenges do you see sort of emerging around this topic?

00:44:22 Guest: Dr. Cory Church

I think we're just starting last year the National Academy of Medicine published the National Plan for Health Workforce Well-being. Have you had a chance to read that?

00:44:34 Host: Nicole Weathers

No, I haven't. I mean, I've seen some of their work over the years, but not that one in particular.

00:44:40 Guest: Dr. Cory Church

I think what's important about that, Nicole, is it's now a national conversation.

00:44:45 Guest: Dr. Cory Church

And I think we have to, we have to continue to hammer home that national plan, that national plan says we're going to ship the focus from this being an individual responsibility to system accountability. Self-care is not going to fix understaffing. It's not going to fix poor leadership.

00:45:04 Guest: Dr. Cory Church

Holding leadership accountable.

00:45:06 Guest: Dr. Cory Church

You know, now maybe well-being metrics are a part of your performance review as a leader just like any other quality outcome. Being intentional about measuring well-being and then again making well-being a strategic priority. I would say to any of your listeners go and just read that even.

00:45:26 Guest: Dr. Cory Church

Even reading the high-level overview.

00:45:29 Guest: Dr. Cory Church

That is a great plan and I think the national academies have been very intentional about continuing this work. Again. It started in 2019. It has continued on and now they have a plan. It's got to be implemented. We're doing a lot of.

00:45:48 Guest: Dr. Cory Church

Small things in transition programs, and they're all just kind of spontaneous. Certainly, the (ANCC) Transition to Practice Symposium showed that people are being intentional, but that's because it's a part of our accreditation standards.

00:46:03 Guest: Dr. Cory Church

But again, it's important that the national conversation now, so we have to just continue to do to do the work.

00:46:11 Host: Nicole Weathers

Well, Cory, we have talked about so many great things today. You know, we've talked about the challenges that new nurses face, how the organization can kind of influence nurse well-being. You've shared your research, which I really appreciate and we'll make sure any articles that you've referenced, even this

00:46:34 Host: Nicole Weathers

National Plan for Clinician Well-being, we'll link all of this in the show notes so that our listeners can check those out. We've heard about some really innovative ideas. I'm still like thinking about this Aura ring thing and like how that could maybe work.

00:46:54 Host: Nicole Weathers

So, I really appreciate all your insights, all your perspective on this topic.

00:47:00 Host: Nicole Weathers

But before we go, I do have one more quick question and I ask this of all of our guests who come on the show. But when it comes to nurse well-being and supporting nurse well-being, what's the one thing that you've seen organizations do that made a significant difference and something that you wish more organizations would just adopt?

00:47:22 Guest: Dr. Cory Church

The one thing that I have seen is creating a space for you to talk about your well-being. There's no agenda, no PowerPoints, just true connection, a place where you can talk, you can decompress, and you can feel heard.

00:47:38 Guest: Dr. Cory Church

So it's not sitting down in a class, it's not looking at a PowerPoint and telling you what well-being resources we have.

00:47:44 Guest: Dr. Cory Church

Just offering an opportunity to say, let's huddle up and let's talk about these things being intentional and creating that safe space. I wish more organizations were doing that intentionally, and I use the word intentional, meaning that there's no questions asked. It doesn't get rescheduled, you don't cancel it for the week.

00:48:04 Guest: Dr. Cory Church

It's there. It's a standing item and it happens. And it happens consistently.

00:48:11 Host: Nicole Weathers

And that seems like a very doable change.

00:48:15 Guest: Dr. Cory Church

Yes, I think so. I think that's a great place to start. Let's just start there.

00:48:19 Guest: Dr. Cory Church

Yeah, some organizations are going to be better resource. They're going to have more money to do things. They're going to have the opportunity to go off site and do things. But those organizations that don't always have that, you can create the space, something simple that you can do.

00:48:36 Host: Nicole Weathers

Great. I love that. Well, thank you so much, Cory, for your time today. This is a really great conversation, an important conversation. I think one that we need to continue to have, and I look forward to checking out some of these resources that you have shared.

00:48:41 Guest: Dr. Cory Church

And thank you.

00:48:48 Guest: Dr. Cory Church

Yeah. Let's keep it up.

00:48:55 Guest: Dr. Cory Church

Thank you. And I'll be sure to share with you when I get my well-being article published though.

00:49:02 Host: Nicole Weathers

Perfect. Yes. And we will we can add that to the show notes at any time.

00:49:06 Guest: Dr. Cory Church

OK, Nicole, it's been a pleasure to talk to you.

00:49:11 Guest: Dr. Cory Church

You've got national influence as well, and it's, man, I was honored to come.

00:49:17 Guest: Dr. Cory Church

On the podcast. Thank you.

00:49:22 Host: Nicole Weathers

Wait before you go, I want to make sure you know all about our suite of resources you can use to support your new graduate nurses. This includes our Academy, a coaching program designed for organizations as they prepare for the implementation, and ongoing sustainability of a nurse residency program. Work one-on-one with residency program.

00:49:43 Host: Nicole Weathers

Experts to make sure your organization is residency ready.

00:49:48 Host: Nicole Weathers

Our clinician well-being course is an asynchronous online course that aims to enhance the well-being and resiliency of healthcare professionals, equipping them with the necessary psychological capital to navigate challenges inside and outside of work. Supporting nurses is another asynchronous online course for preceptors, mentors and coaches.

00:50:07 Host: Nicole Weathers

To learn the.

00:50:08 Host: Nicole Weathers

Skills they need to support any new hire.

00:50:11 Host: Nicole Weathers

Both of these offerings can be used as they stand alone, professional development opportunity or to augment any nurse residency program. And we can't forget about the program that started it all. The Online Nurse Residency Program. This includes a comprehensive curriculum designed to support new graduate nurses, applying all the knowledge they learned in school.

00:50:32 Host: Nicole Weathers

To their practice, we focus on professional skills, personal well-being competencies, and new graduate nurses even get the opportunity to create real change in their own organization.

00:50:43 Host: Nicole Weathers

Offered completely online and in a blended format, this program is highly adaptable to all clinical practice settings. You can learn more about all of these programs and more of what we offer using the links in the show notes below.