All About Nursing (39)

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Welcome to All About Nursing with your host, Dr. Joyce Bachelor. Executive nurse advisor, Dr. Bachelor, will present the significant role nurses play in providing health care in a multitude of health care settings.

Listen to some of today's key nurses who work in practice in academia settings and talk about the challenges they face in today's modern medical world. Welcome to the host of All About Nursing, Dr. Joyce Bachelor. Good evening.

I'm your host, Dr. Joyce Bachelor on All About Nursing and we're live on the BBM Global Network in Tune & Radio. This evening, I'm delighted to have a guest with me who is Carol Boston Flushour, who I would like to tell you a little bit about. I think you'll be very impressed with her background and the kinds of things we'll be talking about this evening.

So Carol is a managing director and chief nursing officer at the advisory board company, which is a membership-based research technology and consulting firm, serving more than 4,400 leading hospitals and health systems, as well as a growing international membership base. In this capacity, she serves as a global spokesperson for the firm's research at key membership constituency forums, including clinical and operational leadership, human resources and quality. She's responsible for presenting this research to member organizations throughout the United States and abroad. She has over 30 years of progressive health care experience in a variety of areas and has a series of areas of expertise that I think you'll hear more about as we talk this evening.

Carol also holds a clinical assistant professor appointment at the University of Washington with curricular responsibilities for graduate-level health care studies. She's active in various professional and community-based organizations. Carol received her bachelor's and her master's degree in nursing from Northern Illinois University and a juris doctorate from John Marshall Law School. She has advanced education and development and quality improvement in ethics and theories through inner mountain health care and the Institute for Health Care Improvement.

Welcome to the show, Carol. Thank you. I'm delighted to be with you this evening. So Carol, when and how did you decide to become a nurse because you have kind of an unusual pathway, so this will be fun to hear about.

You know, it's interesting. As far as I can remember, you know, everybody has their first moment where they can remember something about their lives. I think I was about five years old and I knew even at that early time that I wanted to be a nurse. I, in fact, got a nurse's kit for Christmas instead of a doctor's kit.

So my mom was, you know, hardwired as well in terms of what my passion was, but I knew at a very early age that I wanted to make a difference, you know, in caring for people in people's lives, especially when they were in very vulnerable states. So can you share some highlights of your career? Sure. I worked, you know, immediately after I graduated from undergraduate school, I worked as a med surgeon, various critical care roles, moved pretty quickly into nursing education.

You know, relatively early in my career, several diploma schools absolutely loved teaching. I loved teaching students, but for me, a big career move was taking on an entry-level education and policy position for the American Hospital Association. As you know, the National Trade Association representing this nation's hospitals and healthcare system. Honestly, it wasn't a planned move in terms of my career, but one that turned out to be tremendous in terms of opening my eyes to the world of healthcare in the world of nursing at the national level versus, you know, only thinking about nursing.

Practice and healthcare within the four walls of an individual hospital or clinic or, you know, service setting as up until that point had been the case for me. That was kind of an entrepreneurial move for you to be doing that early in your career. I mean, that ended up taking you on a very interesting path. So I was kind of curious too, your education includes a law degree.

Can you say a little bit more about why you chose that option as well? Yeah, you know, as it turns out, while advancing up the ranks at the American Hospital Association, again, you know, working in education and policy roles way back in the 1980s, quite frankly, I fell in love with advocacy. And so for me, at that point in time, I already had acquired a master's degree in nursing rather than pursue a doctorate, which at the time most of my colleagues were completing. I decided instead to go to law school.

Now, at the time, some of my colleagues in nursing couldn't understand the decision. But for me, it was great because I got all sorts of training and negotiation and conflict resolution, regulatory legal analyses and of course, advocacy for what I believed in. Now, I never practiced law, although I'm proud to say I did pass the bar, but boy, the skills I acquired, I think really positioned me for my first senior executive job in my career. I was the executive director of the American Organization of Nurse Executive.

Following that particular role, I then ultimately moved on into several additional leadership positions in various consulting firms across the country supporting not only nursing practice, but also healthcare redesign. In fact, I think I'm at least one of the poster children here. There is more than one educational path for nursing for sure. So when all is said and done, whereas I didn't think about what my career path was necessarily going to look like when I first became a registered nurse.

I, yes, had a very interesting path with a lot of twists and turns, but absolutely are just thrilled in terms of the types of experiences that I ultimately was able to acquire. And I think that you've just raised why I really started this radio show, which is to really educate people about all the different options that we have in nursing in the different positions and where we work. And I can only imagine that you did get a lot of feedback when you were making a decision not to get your doctorate, but to go for the become a lawyer, which I think is actually, as I listened to you, which sounds pretty exciting. You've got some really fine skills and from going on that pathway.

So you have a great position right now that you currently serve as the Chief Nursing Officer for the advisory board, which is rather unique role and still fairly new. Can you describe a little bit about what your job entails? Sure. You bet.

As you mentioned at the start of the broadcast, the advisory board is a best practice research company that serves over 4,000 hospitals and health care systems around the globe. And we are fundamentally committed to best practice research in terms of our teams focusing on those up at night issues that senior nurse leaders, including chief nurse executives, all the way down to frontline managers are attempting to address. So we're constantly looking for best practice examples to support nursing and health care priorities like care model innovation, high reliability, nursing practice, patient activation, consumer-centric care. And of course, strategies to deliver cost-effective care given value-based purchasing and all the aggressive reimbursement models that our nursing leadership teams are working so hard to respond to.

And so this is saying while nurse leaders are facing all sorts of operational challenges in this very chaotic health care environment, and of course, we can't forget what's going on with health care reform at the moment, and the ultimate state to the Affordable Care Act, I would say that one of the biggest issues for nursing leaders remains actually the health of our nursing workforce. More to the point, while leadership teams are working so hard to stabilize nurse turnover and nurse engagement, we have got a very serious problem right now with nurse resilience. I'm going to talk a lot more about that in just a little while. This is all about nursing.

Dr. Joyce Vadchelor, we're live on BPM Global Network and Tune in Radio, and right now it's time to take a short break. Wickewags brings harmony back into your home for male dogs and their owners. Inventor and entrepreneur Linda Janula has created the disposable doggy diaper wraps made with a male dog in mind.

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Welcome back everyone. You're listening to all about Nursing Life from the PBM Global Network in Tune & Radio. I'm Dr. Joyce Bachelor, the host of the show.

I had introduced my guest who's on the show with me this evening, who was Carol Boston, flesh hour, who was starting to tell us a little bit about the role that she plays as the Chief Nursing Officer of the advisory board, and what her team is finding us, top issues that need to be addressed. Carol, back to you. If you could tell us a little bit more about what you're working on. As I mentioned before, I'll work with nursing leadership teams all over the country on so many operational issues, financial issues, quality issues, and safety issues.

But again, I would say the health of our nursing workforce is top of mind for everybody right now, because if we don't have a healthy nursing workforce, we just cannot presume that we're going to be able to take care of the patients and families that are under our responsibility, no matter what type of environmental or facility or service setting that we're working. I mentioned that one of the biggest issues right now in terms of the health of our nursing workforce is resilience. So many contributing factors to the state of the state of resiliency or lack thereof in our current nursing workforce, it's really hard to narrow those down. For sure, the health care environment in terms of how complex our patients are and therefore how stressful it is to stabilize patients effectively and transition them efficiently to the big factor in eroding the resilience of our staff.

So, two of course is increased registered nurse turnover. It's really hard for our nursing staff to not be stressed when the team that they work with is changing in membership, right, due to registered nurses taking different positions or going back to school, leaving vacancies that they need to be at least temporarily filled with via contract nurses or, you know, agency staff. But right now, and boy, I am frankly so emotional about this this evening, less than, you know, two weeks since our country's latest mass shooting, but we must talk about this. And the issue, of course, is the increasingly violent culture that our country is witnessing and more to the point what that specifically means in terms of the resiliency of our nursing workforce.

I would agree. And I think that on prior shows, we've talked about the fact that it's the whole care team because it certainly is impacting physicians and pharmacists and everyone else that helps to care for patients. I think we've gotten a little numb about how much it impacts them when people are showing up having been injured in a variety of different types of violent settings. And so can you say a little bit more about what you think we might need to be doing in terms of working on this for like nursing officers or listening or others in health care?

What should we be really trying to work on? Well, I think it's important that we first just make certain that we're clear with the problem is, you know, because you're right, Joyce, it is more than just registered nurses. It is every member that care team is being impacted by what's going on in our environment. And quite frankly, in our culture, as it relates to registered nurses, we know three out of four registered nurses report concern about stress and overwork.

70% of registered nurses report feeling that they're literally burned out as comes from American Nurses Association Health and Safety Survey. And boy, we know that physicians are close behind, you know, in that regard as well. Again, because I mentioned that there's various contributing factors. I think the violent culture of this country and all that that entails is presently perhaps the most troubling of all the factors, both from the standpoint of the spectrum of violence that our nurses are experiencing, as well as what can be the solution.

And so when I use the term spectrum, I think it's important that we acknowledge, you know, just how wide the spectrum really is and therefore start to then better appreciate what we need to do in order to rebuild or shore up the resilience of our nursing workforce. When I use the word violence, it's not uncommon that, you know, people automatically think that what I'm referring to is mass shooting, stabbing, you know, extremely violent actions directed at our staff. And of course, it's hard not to go there even this evening, given what just happened in El Paso and Dayton. I'm going to come back to that type of violence in a minute.

But before I go there, the violence spectrum for our nursing workforce also includes less egregious, but still unacceptable forms of patients or visitor aggression that's literally directed at our staff. Things like spitting, scratching, chokeholds, even verbal abuse. American Nurses Association reports that, you know, gosh, upwards of 50% of registered nurses practicing this country had experienced behaviors like this in the course of their daily work. And yet have tended to accept this type of behavior that is demonstrated to them by patients and families as part of their job.

Nurses actually empathize with patients or families when experiencing these types of behavioral upwards because, for example, the patient or the family may be understandably upset about their health diagnosis. They're not themselves nurses would say. And so excuse this behavior, not addressing it, not reporting it, just looking the other way. Our nurses just can't do that anymore too many times.

These types of behavioral deterioration, although, you know, initially may feel a little bit harmless, can quickly escalate into something very dangerous for our staff. Bottom line, any type of violence should not be considered part of a nursing job. While these of patients come first, the caveat must be not at the cost of an individual nurses safety. Again, before we talk about violence shootings and unfortunately we have to go there.

Our organization also need to be very proactive in working with staff to be very clear in terms of what behaviors are considered acceptable and what are not acceptable behaviors. But that clarity not only has to be made, you know, very, very explicit to our staff. Our patients and our families, our consumers in our communities have got to be mindful of those boundaries as well. You know, I've had nurses tell me that sometimes there's mental health issues at play or it might be that the patients has dementia or a bit confused.

And so there is as you described a lot of empathy towards wanting to do the right thing for the patients and their families. And I think that they do in fact, they put themselves at risk, which I think is definitely something that we want to talk a bit more about. Right now we are coming to you live from the BVM Global Network in Tune and Radio. This is all about nursing.

I'm Dr. Joyce Bachelore. We'll continue this conversation when we come back. Dr.

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Joyce Bachelard, on All About Nursing. We're live on the BPM Global Network and Tune In Radio. Before the break, my guest, Carol Boston Flushour, who is the managing director of Chief Nursing Officer of the Advisory Board Company, was sharing with us what we were really trying to talk about is the kind of violence and the whole spectrum of what kind of behaviors staff are finding that they're encountering much more frequently in the work environments. One of the things that I'd started to ask Carol is, I hear nurses many times making excuses for patients because they may have some mental health issues, they may have some delirium or onset of Alzheimer's or other factors that contribute to the behaviors that they're concerned about.

I'd say, I think to want to discount that, can you say a little bit more about what you're also hearing from people that you're working with, Carol? Yeah, you know, as it relates to the behavioral health challenges that I think our care teams are facing in hospitals and health care systems across the country, we know approximately one out of every three inpatient admissions is an individual who has some sort of mental health issue as one of his or her diagnoses, perhaps not necessarily his or her primary diagnoses, but has got a history of some sort of mental health challenge as well. We are finding, despite the increased numbers of patients who are presenting in our health care systems that have got as a secondary diagnosis, you can see the frontia, early onset, dementia, Alzheimer's, extraordinary depression. They are detoxing from either an alcohol or an opioid overdose, an increasing number of organizations are realizing that our registered nurses are not adequately prepared to take care of that type of condition when it presents itself.

So as it relates to what health care providers must do is clearly invest in making certain that above and beyond providing physical safety strategies to support the safe work environment for our nursing workforce, quite frankly, our registered nurses are in need of some didactic and skill building in order to help them with this particular variable that can contribute to, unfortunately, behavioral escalation, if not managed correctly, if not violence, you know, directed at our nursing workforce as well. We are seeing all sorts of things, quite frankly, that organizations are trying to do here, you know, be it a behavioral health patient or a non-behavioral health patient, but as I was mentioning before the break, it's important that organizations work in collaboration with their nursing workforce to collectively agree to what is acceptable and what is acceptable behavior. That is to be demonstrated by patients and families while we are caring for them, what are the boundaries? We have to have some clarity here on the boundaries.

I can't help but think, boy, if I was in a restaurant, you know, being served a meal and I was verbally abusive to a server, I would be thrown out of a restaurant for inappropriate behavior. Well, we excuse that type of behavior frequently in our health care organizations' systems, but we just have to figure out where the boundaries absolutely are, and that makes certain that our consumers, our patients, our family members, our citizens and our communities understand what we're trying to accomplish here. You know, we have got to make certain that organizations are not only explicitly confirming examples of behaviors that shouldn't be tolerated. I'm finding that organizations are literally now putting up signs in parking lot in lobby, even in patient care units regarding the organization trying to consider itself and position itself to its public as a violent, free zone.

Let's face it, we have no smoking signs all over the place in our hospitals, right? Yes. You can finally alert our public to our hospitals and our clinics that we are violent, free zones as well. We're also seeing organizations, you know, train staff to detect and support, I should say, report subtle signs of behavioral escalation that could, if it's not, you know, dealt with early on, could, you know, escalate into some sort of violent reaction directed at our workforce.

We're also seeing organizations reach out to our community partners. Let's face it, the community has a vested interest in local hospital, as local clinics being violent, free. And so this idea of the Chamber of Commerce, the local police department, you know, everyone coming together to address this as a community problem, because quite frankly, you know, this is beyond what I'm talking about. What I'm talking about here in terms of what's happening only in a hospital environment.

This is happening everywhere, as we unfortunately know. We're seeing hospitals work very closely now with their patient advisory councils, if they have one, even their boards to ensure that everyone agrees and is on the same page here with respect to what are the boundaries for unacceptable behavior directed at our staff. I'm finding, by the way, that organizations are not getting any pushback from consumers on this. When they share their intent, they share their rationale.

Obviously, citizens within a local community want a violence free health care organization, just as much as our clinicians do. Also, you know, I should mention Joyce that we're also seeing an increasing number of organizations investing in behavioral de-escalation training for all employees, not only to support behavioral escalation management for those folks that have behavioral health diagnoses, but quite frankly, any patient. And so therefore, no longer is enough to train employees to understand how to de-escalate, you know, an escalating behavioral situation for staff just in the emergency department or just in critical care areas. Quite frankly, all employees need this because it can happen anywhere in a health care organization or system.

It's just another strategy, the best prepared clinicians for responding to these situations, you know, as constructively as is possible when they, in fact, present themselves. Quite frankly, baseline. I find, you know, the overwhelming majority of organizations are, you know, I think getting very, very, very specific here in terms of the types of things that all employees need to train that in order to help them. Yeah, and I've been seeing more organizations also really looking and having policemen as part of their security force and not just security guards that are not really trained as police.

So we'll talk a bit more about that in a little bit too. So we are coming to you live from the P.V. Global Network in Tune & Radio. This is all about nursing show.

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Joyce Batch with a host of the show. Prior to our break, Carol Boston-Flushour was my guest this evening, who was the managing director and chief nursing officer at Tharsi Board Company, was telling us what organizations are doing and what people are seeing and was starting to talk about the spectrum and really looking at how many people understand that it starts with things like the biting and hitting and kicking and verbal abuse. Do you want to say a little bit more about that, Carol, and then move into other sorts of things you're seeing? Yeah, I mean, when all of a sudden done, when we talk about the resilience of our workforce and the level of violence that our workforce is experiencing, I mentioned that there's a spectrum.

There's just a wide range of unfortunately violent acts that are being directed at our nursing workforce and get quite frankly all members of our care team. And so what I'm going to say is to say for those less egregious types of behaviors that I was referring to earlier in this broadcast that could morph into something outwardly violent in and of itself, if an employee sees that the organization is doing whatever it can to identify signs and symptoms of behavioral escalation, control those violations before they morph into something violent, that in and of itself telegraphed to the registered nurse that the organization cares about making certain that they are protected from those types of unacceptable behavioral escalation, which is one of the ways by which we can shore up our nursing staff's resilience. But here's the other thing, beyond behavioral challenges directed at staff that could morph into violence, we've got to unfortunately take a look at and have a conversation about the more violent acts that our clinicians are being exposed to here. Couple things as you know, one is extremely violent behavior directed at our staff in their work environment, if not mortally wounding a clinician on the grounds of the hospital or the health care system or the clinic.

I could cite several examples for your listening audience, but in the interest of maintaining privacy of all of these incidents that are occurring across the country, I choose to not list as much as to acknowledge that the number of incidences that are being now reported in the public media, I suspect, are just the tip of the iceberg in terms of what's not being reported. So there is this notion, unfortunately, of extremely violent behavior that's being directed at our staff. And then the other is the trauma that our clinicians experience when they must deal with acts of mass violence occurring in the community that then the clinicians themselves are called upon to support. And boy, unfortunately, the list is too long, but it starts with Sandy Hook, Las Vegas, Orlando, the Parkland School shooting.

And again, unfortunately, LTAFO and Dayton, that's not an all exclusive list. It's just unfortunately very tragic examples of when our clinical care teams in various health care organizations and systems across the country have had to respond. Let's be real, our nurses can't eliminate this type of violence in our country. So the question is, how do we find the resources needed to protect our employees from the effects of what we're talking about here?

I don't think we're yet seeing a massive movement to secure our hospitals and clinics like military forces, right, complete with metal detectors on every door, increased numbers of highly visible security guards that are armed and the like, because that's based at hospitals, like churches and schools, our places of service. And so, healthy organizations have to find the right balance between conveying a caring environment to the community, but also protecting its caregivers. But I would say that healthy organizations and boards are having very pointed conversations out about all of the options that they have in front of them to consider. And frankly, I personally think they should.

Honestly, I travel every day just about for my role at the advisory board. I go through a metal detector every day at the airport. When I pay a parking ticket, I go through a medical detector in the courthouse. Perhaps this may become the new norm for all public buildings.

I don't know. Yes, active shooter protocols need to be designed and routinely rehearsed just like cardiac codes, right? Security teams unfortunately need to be beefed up all over, not just in the emergency department, but in parking lots surveillance. We've got to have a lockdown drilled.

So, nurses of all ages and job descriptions really need to speak up here in their organizations regarding what they believe will help them feel safe as an employee. We just can't be silent on this. Yeah, and I do think that there are a lot of hospitals that are working to have more policemen in place. And I have seen many moving to metal detectors, particularly in emergency departments and some other parts of the buildings.

And I've had staff say to me that I would probably be shocked if I saw the number of weapons that were confiscated every day. And I think those are things that we probably have just been silent on, but that's becoming talked about a whole lot more in a lot of nursing circles. Because I've also seen nurses that have been injured in their livelihood. They can't go back to work or they're so demoralized.

And there's such a post-traumatic stress on it that they can't return to the same setting. And that's just not fair. When you start to think about that was the person's career. They want to be there and now someone's hurt them and they're no longer going to be able to have that kind of livelihood.

Are you hearing stories like that as well, Carol? Well, yeah, and it's interesting when we see, unfortunately, you know, unfortunately too many stories like that. And yet organizations who must support staff, you know, when they are caring for violent acts that occur outside the hospital. This is as you mentioned, Joyce, this is a major traumatic event in the clinician's life as well.

That that best in class organizations have got to therefore have very comprehensive, immediate, mid and depending upon the circumstance, even long-term emotional support strategies to frankly care for the caregiver. You know, let's face it, if you've got a team of clinicians who have been asked to respond and in fact have clinically responded to a local school shooting, for example, it's not enough to send those clinicians home after the trauma has stabilized and connect with them a few days later when you think they're ready to talk about it. The long-term impact of this type of trauma could take years to unravel. So, as a response, resources immediately deployed to involve staff, coordination of file what counseling is baseline, not just chaplains.

Other staff leaders were formally trained at how to coach and counseling support these employees after a violent act has occurred as well. Those are all great points, but we're going to need to take a short break. So this is all about nursing. I'm your host, Dr.

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Welcome back everyone. You're listening to All About Nursing, live from the PPM Global Network in Tune & Radio. I'm Dr. Joyce Bachel of the Host of the Show.

And before the break, my guest who is Karel Wausen Floschow, who is a managing director and chief nursing officer at the advisory board company, was sharing with us a lot of the action set organizations hospitals are taking in order to safeguard the environments because there's so many clinicians that are in fact getting injured on the job and also being exposed to so many different people that they're taking care of that are victims of a lot of the different shootings that we've had unfortunately in our country. So maybe I'd like to go back to that a little bit here because I think that's really key. And I think that it's the whole care team, including our EMS and the Rotten Mossean initially in the police department. I think sometimes we're kind of ignoring just how many people are impacted when these shootings and unfortunately incidents are happening.

Yeah, I mean, I think that we can talk about this both more narrowly to the needs of an individual workforce within an organization or system, or we could talk about health care professionals, period, regardless of what specific role they have because, to your point, Joyce, as it relates to being unfortunately exposed to some pretty significant violent acts, either directed at our clinical professional or needing to care for others who have unfortunately incurred harm through some sort of major violent event within the community that now is brought into the organization for health. Everyone touched by this. In fact, when I think about this, we've been talking about violence or rowing nurse resilience. I wonder at times if this is eroding all of our resilience, not just within health care, but regardless of industry.

So, you know, beyond being aware, speaking up internally, working on solutions that can impact, you know, an immediate place of employment, I think, you know, we need to start as nurses to think about specifically what we can do, right? Because yes, organizations are working extraordinarily hard to be as proactive as is possible to make certain that the employment institution and organization is as safe as is possible. In recognition, of course, that we are still trying to provide a caring environment for patients and families that need our care. But that said, you know, and by the way, when I think of things that nurses specifically can also do, here's where my passion for advocacy comes in.

First and foremost, we do know that there are an increasing number of states that have either passed or are considering passing legislation to formally make any assault, you know, on any type of clinical provider via a nurse physician and EMT doesn't matter the type of, you know, health care provider, but clearly making these acts of violence more formal charge with increased penalties as well as increasing the level of crime that the individual is alleged to have committed moving way beyond misdemeanors to felonies. And again, this is for, you know, acts of violence directed at nurses as well as any type of clinician within a health care organization. In fact, it's interesting in those states where this legislation has passed, right, hospitals and providers have no problem with publicly stating that exact fact about where the state law is on any signage that they have within their, you know, within their health care setting in elevators. In the lobby in patient brochures, even on websites, anything to put the public on notice that this is a crime to inflict, you know, this type of harm against our clinical employees and will be treated as such.

So, you know, for an individual nurse, I would say it's important that you take a look at the laws that exist within your state currently as it relates to what are the, what is the position of the state regarding how a defendant is viewed from the standpoint of the state. And this is a little dice here, I guess, from the standpoint of politics, and also I would say, this is not an official position for my employer. But this really comes from my heart. I think that the law is not as strong as it should be.

It's absolutely an opportunity for advocacy. Second, and this is a little dice here, I guess, from the standpoint of politics and also I would say, this is not an official position for my employer. This really comes from my heart. It's personal.

I, frankly, am no longer willing to not at least make a statement about the importance of all of us as professional nurses to come together and make a collective stance on common sense gun control legislation, as well as effective mental health support. Last I checked, we've got an election coming up. How many millions of registered nurse voters are there in this country? So, you know, the question that I have to ask all of us as a collective nursing enterprise for this country, where should we as nurses position ourselves on things like background checks, the banning of assault weapons in a way that we can't have.

So, you know, the timing of assault weapons in a related military like paraphernalia like magazines. Look, I respect the Second Amendment. I live in a state in the Pacific Northwest that embraces during various times of the year. But we have an obligation, I think, not only as providers of health care to others, but also to make certain that we ourselves feel the type of protection that we should have in order to feel safe in the work environments that we are committed to continuing to be employed in.

Thank you so much. This is all about nursing. I'm your host, Dr. Joyce Spadschler.

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And prior to the break, my guest who is Kiro Boston Flushauer, who works with the managing director and chief nurse for the advisory board company in DC, was sharing with us her passion around advocacy and the need for us to take a stronger stance on gun control and helping to really look at how to help prevent and decrease some of the violence that we're seeing in the workplace. I was sort of struck as I was listening to you as well, Kiro, that on prior shows, we've been talking about the quadruple aim and having Jui back in the workplace and how that's been a major focus because when people are not Jui, they're not going to be at their best. It really does impact patient outcomes. And so it really comes back to the people that are trusted the most, again, nurses have been voted most trusted for years now, are actually themselves having difficulties always being healthy when they're working.

And I think your whole point about resilience, we need to take care of the caregivers so that they can do what they went into the professions that they chose, which is to care for others without feeling like they're going to be hurt that day because that's just not been on our radar ever before. So, yeah. Yeah, I guess as we wind down here, you know, this notion of the health of our workforce, you know, is what I'm emphasizing again is top of mind right now for health care organizations and systems across the country for exactly what you just said, Joyce. If we have a clinician who is stressed, who is feeling vulnerable, who is not feeling safe in the environment within here, she is practicing, she or he will not be at his or her best in terms of caring for the patients and families that are under her, his care.

And so this notion of organizationally as needing to take a look at how we can shore up our clinicians resilience is extraordinarily important from the standpoint of clinical outcomes for sure. But it's also, as you mentioned, equally as important here for the individual clinicians engagement and satisfaction and, you know, happiness with what to do with she or he committed to and want to continue to do as a long career. This notion of advocacy, you know, I got to mention one other quick issue here beyond, beyond nurses coming together and thinking very, very critically about where we stand as a profession with respect to common sense gun control laws and legislation. We also got to watch very carefully what's happening with the mental health issue in terms of ensuring resources for prevention, diagnosis and the management, you know, of mental health challenges when they present themselves.

We do know that right now there is action going on in the courts to try and rule the Affordable Care Act as being unconstitutional, which would eliminate resources for basic mental health services that the current Affordable Care Act provides to millions of currently under and uninsured Americans. And so, you know, that's another example here, the mental health challenge, which one could argue is pretty tightly aligned with the whole violent culture that we are finding ourselves practicing in. We've got an opportunity here to advocate for continued mental health resources as well. This is, you know, this is an organizational issue.

It's a professional issue. It's also a personal issue. And so I'm hopeful that you're looking to take away some things that they can go back to their organizations and have further conversations about, but also reflect on what personally, you know, an individual can do to make a difference. And it's extraordinarily important area.

And that is the health of our nursing workforce. Thank you so much for being on our show this evening. Carol, it's been wonderful. You've given us a lot of really good things for us to be thinking about.

And I really appreciate all of the expertise that you have shared. You are listening to All About Nursing Live from the Bee-Bim-Bloven Network in Tune & Radio. I'm Dr. Joyce Batchler, the host of the show.

And I hope that you all will tune in again next week. Thank you. You've been listening to All About Nursing with your host, Dr. Joyce Batchler.

Tune in each week and get a daily dose of nursing and the health care services they provide and how nurses are finding innovative ways to address the key health care issues they're facing today. Here on Dr. Joyce Batchler's All About Nursing. You've been listening to the Bee-Bim-Bloven Network.

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