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New age program reduces stress, cuts turnover

Health care is a stressful line of work, and employees often get burned out. In normal circumstances, that’s not necessarily a crisis. But when there are shortages in nursing, pharmacy, imaging, and other areas of health care, it becomes paramount to try to keep staff happy just to keep them on staff.

That’s something that the leadership at Clarian Health Partners in Indianapolis knew. "We were always very employee focused here," explains Tawnee Parrish, RN, CNOR, nurse retention coordinator for the three-hospital system. "They were looking for a program that would make a difference in the lives of their employees. They wanted it to be a gift for them to use in both their professional and personal lives."

The resulting search for such a program was the Spirit of Caregiving, a program developed by Lant & Associates, a health care consulting firm based in Winter Park, FL. "We knew that if we have a culture of caring for our employees, it can only help us care better for our patients," she says.

The program is a two-day interactive workshop that incorporates everything from music and video to conversation. "This isn’t something where you have teachers or presenters spewing out information and you take notes," Parrish explains. "It’s circular learning that incorporates several activities."

Among the topics discussed by participants are:

  • Critical aspects of being a caregiver in today’s environment
  • The role of conversations as an interpretation of success or failure
  • Creating possibilities for personal and organizational growth and development
  • Exploring seven critical distinctions of caring (for more on these, see list)
  • The daily choice to be a caregiver
  • Communication that generates action
  • Seeing through the eyes of a patient, a physician, another caregiver, and a leader
  • Forwarding action
  • Letting go of the past and creating tomorrow’s future
  • Being present in a nonpresent world

Parrish describes one of the exercises involving being present. The group first discusses what it means to be present with themselves. Participants each have pillows or blankets. They are asked to get away to any part of the room and experience "getting in touch with themselves," Parrish says. "Then we come back together and explore what it was like, how hard it was, how easy it was." The group talks about how long and how often we stop to think about what is really going on with ourselves.

"Next, we get present with everyone in the room," she continues. "One person starts and makes contact with the next person in the circle without using words. It’s about connecting without using language." Some use hugs; some use looks; some use high-fives.

If it all sounds a bit airy-fairy and new age — and Parrish admits it does — she says this, in surveys of those who’ve gone through the program, is usually the most popular exercise. More than 90% see the value in the program. "Most people go in there and give it a go," she says. "It may be uncomfortable for many of them at first, but this program is about choices. You don’t have to participate at all. But almost everyone does, even if they are uncomfortable."

Most of the time, those in health care are so busy doing their jobs and rushing from one task to another that they are not present with what they are doing, Parrish continues. "Our mind isn’t on what we are doing now, but on the third or fourth or fifth task down the line. But in health care, not being present can lead to mistakes, and mistakes can lead to injury or death. This kind of exercise helps people understand the difference between just being in front of someone and being [present with someone]."

It’s good for everybody

Once the initial 12 facilitators were trained in April 2001, nurses and other direct patient caregivers were targeted to take the program. "That’s because we felt it would be the biggest bang for the buck," she says. "There was a crisis in this area, and keeping people in the field was very important."

About nine months into the program, however, Parrish says administration at Clarian began to see the potential value for all employees to take the program. Now, each staff member is given the opportunity to take it. One of the benefits to this is that everyone in the organization begins to see how they are each a caregiver. "We all impact the patient, whether we are in environmental services or accounting," she notes. "It’s not just about nursing. It’s about caring and creating a community where each of us can impact the patient in a positive manner."

There were a lot of goals attached to this program, says Parrish. Among them: shifting the focus from what’s wrong to what’s right, investing in staff, reversing burnout and improving morale, and improving staff retention.

The course is presented twice a month off site, and so far about a fifth of the 10,000 employees in the system have taken it. Proof that the program works, though, comes from more than just the numbers of people taking it. Prior to the program, staff were given the Maslach Burnout Inventory. It measures burnout using three criteria: emotional exhaustion, depersonalization, and personal accomplishment. Emotional exhaustion and depersonalization decreased an average of 24% among participants in the six months following the course. Personal accomplishment increased 13%. Turnover rates also declined: from 12.9% in 2000 to 7.45% by 2002. Vacancy rates for the first quarter of 2003 were at 5.4%.

Parrish doesn’t think she should convince others to consider a program like this. "I would ask instead why you wouldn’t do this for your staff, especially considering the positive impact it can have on personal and professional lives."

Considering too the cost of a single person walking out the door and having to replace him or her, spending money that can reduce the likelihood of that is something of a no-brainer, Parrish says. "This has saved us millions of dollars in reduced turnover," she concludes. "I know of one person who told me that he had been looking for another position, but after going through the program had changed his mind. And what about all those who haven’t verbalized that to us? This gets people plugged back into the passion of what we do. It is a perk for both the employee and for the system."

More information on the program is available at the Lant & Associates web site,


Tawnee Parrish, RN CNOR, Nurse Retention Coordinator, Clarian Health Partners, MH-A2375, P.O. Box 1367, Indianapolis, IN 46206-1367. Telephone: (317) 962-5485.