Thank you for inviting me and having me here today. I'm going to be talking about a topic that I don't think we talk about enough. And that's really how do we care for ourselves and our teams when we do the work that we do. I'm a professor at the Medical College of Wisconsin in the Department of Surgery in the Division of Trauma and Acute Care Surgery. And I am a psychologist, so it's probably not going to be a surprise to you that I talk about this. But in the 16 years that I've been providing care to our trauma patients at our level one trauma center, I see the tremendous work that our entire team does to make a trauma center efficient and provide extremely good quality of care for our community. And I know that is true in every trauma center across the US. So I really hope that you think about the things that I'm going to present today, thinking about your own wellness in the work that you do and how to facilitate that within your team. And I'm going to make sure, yep, there we go. So we're going to talk about stress and the impact on the mind and the body and what that looks like. We are going to talk about how to cope with that stress and how that impacts our teams. This really feeds into things that I like to think about as a leader. In the work that I do, I do quite a bit of research and lead a strong research team. I lead our mental health team, and I also lead our injury prevention center on campus. And listening to the advocacy talk before, there's a lot that comes from the work that we do. And we do the work that we do often because of the values that we have about caring for others. And so really thinking about our own values as leaders in the individual areas that we're in and how we care for ourselves feeds into that. This also really highlights the need for thinking about not just our own emotional intelligence, but the emotional intelligence of our team members and how we can facilitate that to provide good quality of care, good service, to really hone in on optimizing the functioning of our trauma center. And really to make sure, and this is a big one. This is a big one for those that are naturally caregivers. Making sure that we're caring for ourselves so we don't sacrifice ourself to care for others. We need to, we're all in this to take care of others, to save lives, to make sure that people get back to the best quality of life possible. But we need to make sure that we're not doing it at our own sacrifice. So one of the things I really like to highlight when I give a talk like this is the first point is stress is very individually based. I can experience a stressor and have a colleague experience that same stressor. Let's say, I don't know, a world pandemic that hits our hospital. I might see that as extremely stressful and my colleague may not. How we perceive situations depends on our lived experiences. And even though we may experience a similar stressor to another colleague, we may have very different responses because of our individual lived experiences. I say this to say because we shouldn't be judgmental of individual responding to stressors because of our past lived experiences. Also, what was stressful to me five years ago may be different than what's stressful to me today. And so we need, if we see individuals that are struggling in working in a trauma center, for example, and they've been at the job for decades, and we say, well, it just doesn't make sense. They've always been doing really well. And all of a sudden, it doesn't seem like they are. Something may have shifted. Something may have changed. So stress is very individually based. And it's really important that we think about when an individual feels that stress to be non-judgmental about it. So I'm going to ground us in some definitions that are really important for us to think about, because you hear a lot of terms these days. And I don't know about at your hospitals and your organizations, but we've done a lot of work when it comes to facilitating wellness. We have our first ever chief wellness officer at our enterprise. And it's important that we're talking the same language and we understand the definitions. So we're going to talk about compassion fatigue, secondary trauma, vicarious trauma. Those are used synonymously. And burnout, and then second victim, which sometimes gets lumped into secondary trauma. So let's first talk about professional quality of life. This is what we all strive for, right? This is what we want. We want to have a good quality of life at work. We want to have compassion satisfaction. We want to feel good about the work that we're doing, the people that we're caring for. And we don't want to feel drained by that. We actually want to feel satisfaction in the work that we do. On the other end of that spectrum is compassion fatigue, which encompasses burnout, secondary or vicarious trauma, and second victim syndrome. When we think about compassion satisfaction, something that we're all striving for, we really want to feel a sense of positivity about the work that we do. We want to go into work the next day and feel like we're contributing to something that really gives us a sense of meaning and purpose and really grounds us in our values. There's reasons why you all are here and do the work that you do. And we want to make sure that our values align with that work. And when our own values align with the work that we do, we feel a strong sense of satisfaction. And in turn, we want to feel a sense of reward and fulfillment in our work-life balance. Whatever initiatives that we're working on, whatever programs that we're developing, we want to feel a sense of fulfillment. And we want to feel like we are making change in the care that we're providing our patients or the programs that we're developing at our trauma centers. On the other end of that is what I mentioned before is compassion fatigue. And this is really a sense that it can kind of present itself in two ways. It can be slow growing over time where it's not one instance that leads to a sense of distress, but it's over time feeling a sense of being worn down by the work. And another piece of that is where an instant situation may happen, a situation that's highly stressful to that individual, and the result is a significant change in distress. So the first one I mentioned is called burnout, where over time we accumulate a sense of stress that we don't necessarily address, and all of a sudden we're kind of at a point where we don't feel the same about the work that we're doing anymore. We feel a sense of hopelessness, difficulty in dealing with work, difficulty focusing on work and doing our jobs as effectively as we did before. It can really come on, as I mentioned, gradually, and really makes people feel like they're not moving the needle. And if you think about satisfaction in our jobs, if we don't feel like we're making a difference, if we don't feel like we're moving anything forward, that stalemate can really have an effect on how we feel about work. And this oftentimes presents itself when there's a high workload and an unsupportive environment. So it's not a deficiency of an individual to feel burnout. There's lots of factors that go in to when someone might feel burnt out, and our environment and our teams are a big part of that. On the other side that I mentioned, which is more when an event happens, this is what we call secondary traumatic stress, or synonymously vicarious trauma. Some of you may have heard of that term before. And it's where an event happens, that an event that's highly stressful, and an individual may feel distress as a result of that. This can include things such as individuals feeling fear, difficulty sleeping, constant unwanted thoughts about that event that happened. I'll give you an example. On our campus, a number of years ago, we had one of our advanced practice providers, not in the trauma program, but in a different program in the hospital who was leaving work late at night and she was attacked. And they found her hours later in the cold. It was the middle of winter. She was brought into our trauma center and ultimately she died in our trauma center. And we had some individuals that were caring for that coworker, that colleague in our trauma center who experienced this. And it hit home even harder because it was a colleague. And she was a known person for some of the individuals that were caring for her. There were some people that were fine. They treated her. They gave her the best care possible and they moved on. And that goes back to my earlier point that for some, a stressful event is that, a stressful event, and they can move on. And for some others, for whatever reason, that event hits home and can cause distress. So secondary traumatic stress, vicarious trauma, secondary exposure, these are real. And they happen to individuals who provide even the best level of trauma care. So what is a second victim? This is any provider who is involved in a patient safety event. Maybe there was a medical error and subsequently becomes traumatized by that event. These are critical because in hospitals and trauma care, when a medical error happens, for example, or an adverse outcome occurs, we have to review it. We have to figure out what happened and how do we move forward in a different way or provide care in a different way. But for some individuals, this can also be extremely stressful and traumatizing. And these are clinicians who are providing care who may be a part of these events can start to feel a strong sense of isolation, limited communication, because things might be looked at or investigated, a PI process might have been initiated. There could be then as a result negative impact on work, low morale. You can see the spiral happening, right? Impaired job performance, prolonged suffering. And for some, it leads to people dropping out of the profession. We're all human. People make mistakes. There are errors that occur. And for some, if a mistake happens or an error occurs, to them, it's impossible to get back to work. So this is what the trajectory of recovery looks like for second victims. And it's really about this critical phase in the moments after of really trying to figure out what happened. Oftentimes, the providers I work with at our medical center where medical errors have occurred, there is a tremendous sense of isolation. I'm not sure who to talk to. I feel like I'm the only one that's been through a medical error. And in a little bit, I'm gonna talk about a program that we've established at our medical center with Dr. Alicia Polarski, who's our chief wellness officer, to really support individuals who've experienced secondary traumatic stress as well as have experienced more of the second victim experience. Because it is tremendously isolating for providers, especially for providers that are used to being a part of a team. So what are the personal consequences of burnout, experiencing high rates of adverse events at work, or experiencing secondary traumatic stress? They can be really categorized by being behavioral, physical, spiritual, cognitive, and even emotional. And I'm gonna give some examples here. If you think about not only ourselves, but our teams, and if you might see some of this in some of your team members, or even yourself, as you think about where you fall on the spectrum of thriving at work versus feeling maybe a sense of being overwhelmed to the other end of the spectrum, which is burnout. So behavioral factors look like isolation, people all of a sudden not being a part of maybe some meetings or events that they normally are a part of, avoiding people and duties, or extending time at work, even though they don't need to. Inability to separate work from personal life. This is a hard one in trauma care, I get that. But also having a planned way to remove oneself from work when there is a boundary that work is over is extremely important. Increased alcohol intake, engaging in other risky behaviors, difficulty sleeping, and changed eating habits are all signs of distress. Physical can look psychosomatic in a lot of ways, such as headaches, individuals experiencing breakout in hives, heartburn, migraines that are occurring more often, anxiety, weight gain, stomach ulcers, and so on. These physical ramifications of stress. Changed in beliefs about meaning and hope, a lack of sense of purpose, again, not feeling like one is connected to their purpose in life. Decreased sense of agency or control, feeling as though one has really no control over what's happening at work, where they did before. Reduced sense of connection to others. Challenging belief in self-worth. And this goes back to that feeling and sense of like, I just don't think that I'm making any difference anymore. I don't feel like I'm moving the needle. On the other hand, inflated savior complex. This can be really a defense mechanism for some to really inflate their own self-worth, to really try to hide some of the distress that they're experiencing. Increased cynicism, negativity, constantly thinking about patients and not being able to let go of those patients and move on. Difficulty gaining clarity. Difficulty concentrating, problem solving, engaging in those important cognitive skills, particularly as leaders in the work that we do. Difficulty with those day-to-day decisions, not being able to find a path to a problem. Decreased reasoning and even memory changes, all of these things can be the result of stress. And finally, emotional. Prolonged grief, anxiety, sadness. We all know that sometimes things happen at work. And when they happen at work, sometimes we just need to take a moment and really think about the impact that that's had on us. But if that sticks with us and it sticks with us day after day after day, that is a sign of stress. Irritability, depression symptoms, agitation, a change in sense of humor, and feeling less safe than we did before. So these are all the consequences of stress. They can be varied and occur in different aspects of our lives. And it's important to think again about how they might impact us, but also how our teams might be impacted by stress, and if you've seen any of the changes in your team members. This is important now more than ever because of the stress that we are under. I, as many of you, we all went through the period of COVID, of civil unrest. We've now gone into a period of global unrest. And now we're talking about our economy and inflation. And if you look at the research that's done on stress in America, stress is unfortunately only increasing. So for those of us that have jobs that may present itself as stressful initially, it's compounded by also what's going on around us. And so there's a lot of concern, particularly about different groups in the U.S., about are we going to be able to move forward and engage in the workforce in the way that we normally have, and how are we going to address the effects of stress? And in particular, the younger generations are feeling the stress the most. And if we think about it, who are those younger generations? It's those trainees that we have coming through. It's those junior team members that are coming up. I don't know about all of you, but we've also been dealing with trying to figure out, can we provide services in our trauma center and support the trauma center in a way where we can support a hybrid workforce? As many individuals feel like they can't come to work on a daily basis and are asking for hybrid workflows. And so we need to be thinking about, well, what is this a result of? And a lot of this is a result of this cumulative stress. So let's talk about the impact of secondary trauma on a team. If we know that there's a stressor that's occurred for a team, it's important to address that stressor and address how everybody is doing. I know there's some programs and hospitals across the country that do things like critical incidents, stress debriefing. I want to call out that while it's important to make sure to provide support to team members when a critical event occurs, I would not advocate for any sort of stress debriefing in a group setting. And the research supports this, that a lot of people can become distressed as a result of a critical event, and also a lot of people are fine after a critical event. So not everybody needs stress debriefing after a critical event occurs at a hospital. And in fact, controlled clinical trial studies have shown that if you do critical stress debriefing with everybody who is exposed to the same critical event, you can actually increase symptoms in those that previously didn't have any. What I'm talking about here is thinking about how the critical event affects the team. Sure, certain individuals can have an impact which might affect the team, but we need to be thinking about the team dynamic, if you will, as the focus. And so what we can see when we see stress impacting team functioning, it's reduced productivity and reduced quality of work. And increased absenteeism, people taking a lot of time off. Impaired judgment and changes in decision-making, that's not characteristic. Staff turnover and staff friction. All of these things can be impacted because of a critical event. And so we need to think about individual-level coping, and then we need to think about team coping, right? And so if we think about individual-level coping, I think the best analogy that I can come up with is, where's your fuel tank at? You can ask your team members this. Where's their fuel tank at today? I start meetings sometimes with this. All right, let's just do a check. Where is your fuel tank at today? Are you running on empty? You're running on fumes? Are you somewhere in the middle? Are you coming in today and you're ready to go and you have a full tank of gas? Or a full charge, for those of you that drive electric vehicles. I should change this. I just got one. So where is your battery at? Where is your fuel tank at? Sometimes it's important just for us to hear not only for ourselves and have a chance to reflect on ourselves and where we're at, but where are our colleagues at? If I'm coming in and I'm raring to go today and my battery is full and my teammate says that they're at 50%, okay, that's going to help me understand where they're at today and how we might need to move forward as a team and even expectations of that team member as we are trying to accomplish whatever we're trying to accomplish today. We really need to be thinking about coping for ourselves in order to help others, right, in the acute moments of stress, but then also for the long term. I don't know about you all, but I work with a team who's highly effective. They're amazing at what they do, from our advanced practice providers to our trauma program manager to our surgeons to our other psychologists to the nurses we work with, physical therapists, occupational therapists, social workers, everybody is amazing at what they do, and they are all extremely passionate about the trauma population. Yet I've seen colleagues burn out, and I've also seen people pivot and make change in order to prevent that burnout from continuing and really engage in new levels of coping so that they have well-being at work. So there's the ABCs of managing stress. I'm sure a lot of you have heard of this before, but the first thing is awareness. If we don't acknowledge our level of stress, then we can't do something about it. There's no action to be taken. Balance is knowing yourself and your limits and understand what you're doing and what helps you to manage stress most effectively. The third, the C, is control. Managing stress is all about taking control, and this is hard because a lot of you are used to probably taking a lot of control in your lives, and sometimes we are trying to affect change in something that we don't have control over. So I want to focus on controllability for a minute. I'm the type of person who, if I see something that is wrong and that shouldn't be happening, I feel like I have to go 100 miles an hour until that thing is changed. There was a wise mentor of mine who pointed out to me at one point, well, can you affect change in that regard? So it's really important that we think about our locus of control. When you are presented with a stressor, when you're presented with a problem, do you have control in that situation? Do you have influence maybe? Maybe you don't have full control in changing that stressor, but maybe you have influence over that stressor, or is this completely out of your control? When you're presented with a stressor that you cannot let go of or your team cannot let go of, you have to think about where that locus of control is because then that helps to dictate how much energy you put into something. I presented something like this a couple years ago for TCAA and the brick wall analogy. You might want something to change, but you have zero control over that thing. It's like trying to push a brick wall. You can put all the energy you want in pushing that wall, but ultimately the only thing you're going to do is what? Waste your own energy, right? Waste your own time and really deplete your own resources. Again, thinking about controllability and agency is extremely important. Sometimes when you're coaching team members, sometimes team members might say, well, I really care about this. You're not asking individuals to not care about something, but maybe if there is no control that can be taken, we're asking team members to set it aside for the time being until there is a way to influence change or until there is a way to have more agency or control over the situation. That's a hard thing to do but an important thing to do when we think about coping with stress because if there are 50 wildfires in front of us, we cannot attend to all 50 at the same time, and we really need to engage in a sense of understanding what we have control over in order to make decisions about moving forward. Coping really comes down to learning when to walk away or set something aside if that's a better way to think about it for people. Letting emotions out when necessary and then setting those emotions aside and moving on. We have emotions for a reason or evolutionarily, we would have gotten rid of emotions a long time ago. They give us information. They tell us what we think about something and how important something is to us. Letting others offer you empathy because it also helps others provide a sense of support and coping. Engaging in mindfulness. If any of you engage in mindfulness yourselves, it can be a great way to manage acute stress in particular. Finding sources of inspiration for work. Let others live their own stories and not be judgmental of that, and finding outlets for processing what you are experiencing. We only have a few minutes left, but I encourage people to think about looking up trauma stewardship. It's a really great way for individuals to think, and their team members in particular, to think about grounding themselves in reminding them why they're doing the work, where they feel like they are in the work that they're doing, and how do they recenter themselves and find their true north when they need to. At the organizational level, what does organizational level coping look like? By this, I mean your teams. Team level coping when stress occurs. Creating an organizational culture. By that, I mean sometimes I know people can feel overwhelmed. Well, I can't influence the entire enterprise, the entire healthcare system. Maybe not, but you can certainly affect change on your team. You can set a culture of support that normalizes that stress occurs, that we all have reactions to stress, and then we also need to acknowledge that stress and find ways to move forward with it in a way that's supportive for individuals and nonjudgmental. Adopting policies that promote and support self-care. Allow diversified workloads and encourage professional development. When people feel like they're on a path towards growth, that is incredibly beneficial, especially if all the team members feel like they're on a path for growth. Creating opportunities for individuals to engage in values-based outreach. For some, this may be extremely important, and so helping to facilitate that outreach is critical. Ensure a safe work environment, and by that I just don't mean physical safety, but also emotional safety. For those of you that have or are working on implementing trauma-informed care and education into your hospital systems, I know this is a big initiative of the Committee on Trauma, the ACSCOT. Really encourage education and discussion around trauma-informed care because trauma-informed care is not just about how we care for our patients, it's also about how we care for ourselves in caring for patients. And counseling resources and next steps should be available to those in need. I am going to skip ahead. I included something called radical empathy, and it's really coming from a place of being nonjudgmental when we have team members going through stress. But I want to talk about some nontraditional ways of helping the team that we're doing and have implemented at our medical center. The one that I want to really highlight is called the SOS program, or supporting our staff. This is the one that I referenced in the beginning of my talk, that Dr. Alicia Polarski implemented. She's our chief wellness officer. And coincidentally, she previously was our associate CMO, and she implemented this right before COVID. So we had about six months of getting this off the ground before COVID hit, and it came in really handy to be able to provide tiered support services to anybody in the hospital. And what this program looks like briefly is that we have individuals in every clinical department at our hospital, in every profession, from nursing to social work to our surgeons to our internal medicine docs and so on, trained in how to give peer support through our SOS program. So if something happens, let's say an adverse event occurs in the OR, one of our surgeons or one of our surgical residents can go to an SOS peer supporter in our department and talk through that situation and what occurred. And they'll help them to kind of navigate, because who best knows what it's like to have the responsibility of being a surgeon, another surgeon. And so what they do is they provide peer support, and then, if necessary, escalate the support if there's significant levels of distress, and they are trained in identifying what those levels of distress are. And then there's a group of us that are tier three supporters where we are brought into the situation if there is a higher level of distress and, again, very informally meet with that provider and then help them navigate how to find well-being back in the workplace and how to move forward and provide formal treatment if possible. These are just some other examples. And to summarize, self-care is important. It's not only important to ourselves, but it's important to our team, and it really can impact how we lead and how we maximize the wellness of our team members in our trauma centers. Thank you.

self-care

team well-being

stress management

burnout

compassion fatigue

organizational coping

Supporting Our Staff (SOS)