Honoring the Heart of Care: Nurse Well-Being in Action

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In this special Nurses Week episode, Chief Well-Being Officer Elizabeth Harry, M.D., chats with nurse leaders Denise Ervin, D.N.P., R.N., NC-BC, and Tonie Owens, M.S.N., R.N., about resilience, teamwork and the evolving future of nursing. They share personal stories, “sacred moments” in care and practical ways teams support well-being on the front lines. The conversation highlights both the challenges nurses face and the culture of connection that helps them thrive.

Guests:

• Denise Ervin, D.N.P., R.N., NC-BC
• Tonie Owens, M.S.N., R.N.

Transcript

Liz:

Welcome to the Well-Being at Michigan Medicine podcast. This is a special edition, our Nurses Week episode for Nurses Week, which is May 6th through 12th. I'm so excited to have Dr. Denise Ervin and Tonie Owens joining us today to talk about nurse well-being. Dr. Denise Ervin is our Nurse Leader for Resilience and Well-being at Michigan Medicine with over 26 years of nursing experience across oncology, cardiology, critical care, a DNP from University of Minnesota, and Michigan first certified Integrative Nurse Coach. Welcome, Denise.

Dr. Denise Ervin:

Thank you so much, Liz, for having me.

Liz:

And Tonie Owens is a Clinical Nurse Specialist at C.S. Mott Children's Hospital with 35 years in nursing and over 31 years of TNS practice. She's published, presented, and taught at the U of M School of Nursing. But if you ask her what she's most proud of, she'll tell you it's standing shoulder to shoulder with front-running nurses at the bedside. Welcome, Tonie.

Tonie Owens:

Hi, Liz. Hi, Denise. It's nice to be here.

Liz:

So excited to have both of you here, so excited to be celebrating Nurses Week, and so I just want to talk a little bit so that people can get to know who you are and how you came to nursing. And so, I'm curious if each one of you would share the moment when you knew nursing was it for you. This is the way you want to spend your time. This is the career path that you love and that you want to pursue.

Tonie Owens:

I think for me, growing up, my mom was a big influence in my life. She fundamentally taught me about compassion, and kindness, and inclusion, and so watching her really care for others in our family and our community led me to a path of nursing. She wasn't a nurse herself, but she just embraced the qualities of caring. She did not go to college, and she had some learning differences, so she really couldn't guide me in decision-making around a career choice, but two of my cousins, who were role models as I was younger than them, were nurses. And so, I took the leap of faith and applied to college and nursing school.

During nursing school, though... or during college, I decided to transfer to Michigan State University, and I think that really... I was accepted right into the School of Nursing. Getting into the School of Nursing can be pretty competitive, and so I think that was my sign that I was supposed to be a nurse because I was accepted right there. So, I entered MSU and went to nursing school, and finished, and then did my graduate studies at Wayne State University. So I just have to shout out, "Go green."

Liz:

Yeah, we won't harbor on that point too much.

Tonie Owens:

But I did say, "Go blue," this week when Michigan won the national championship.

Liz:

Well, that's wonderful. Denise, how about for you?

Dr. Denise Ervin:

Yeah. So, it's an interesting story because, when I was in high school, my father was diagnosed with leukemia and we were told he had two weeks to live. I'm very grateful to say he's still alive today at 70-some years old, so I'm very blessed for that, but I always knew I wanted to be in the hospital. So I thought I wanted to be a biomedical engineer, following daddy's footsteps of the engineer. But honestly, when my dad got through his experience and I really saw the impact that the nurses had on my father and us as a family, it actually... I can feel the emotions today, I said, "I want to deal with caregiving," and that really is what carved my... bring back tears.

Liz:

Denise, can you think of a specific moment with one of those nurses that was caring for your dad that was particularly impactful?

Dr. Denise Ervin:

I can. My dad went through a bone marrow transplant at that time. This was in the '90s, so bone marrow transplants were not what they are today. And he was having a fever and needing a little transfusion, and was very obviously scared. And the man was strict, the clothes and everything that we do in healthcare, and that nurse sat next to him and talked him through it. And at that time, I was in 10th grade, so I was observing this and I was like, "Wow." That moment, that was really one of the moments. And then my dad would always say, "It was your mom and the nurses that saved my life."

Liz:

Wow. Wow. And that's just that human connection in those moments that can feel dehumanized, when where patients can certainly really take away some of that dignity and pieces that we're really used to, and it is the humanity around us that really helps reanchor us in that we had Dr. Sanjay Saint on the podcast a while ago talking about this concept of sacred moments. You're describing one of these. These are these brief flashes where everything else seems to dissolve away and we really are able to focus on that humanity and we remember why you're here. Do either of you have a moment recently that felt like one of those sacred moments that really sticks with you and rekindles that why?

Dr. Denise Ervin:

I actually do. So, one thing when I think about nursing... I call it nursing magic, and it's that moment when it really is that nursing presence that art and the science come together. And just a couple of weeks ago, I was facilitating a retreat and we were doing Stress First Aid. And in that moment, I saw the nursing leader and the staff nurse really come together and say, "Yeah, this is the human experience, and how do we bring that back?" And it brought tears in all of our eyes. And so, those moments, again, whether it's in my experience, whether it's with the patients, or now when the nurses... when they see that moment of... that sacred moment, that moment of, "Ah, yes, we are human doing human work," or, "We are patients, and we're serving these patients as the wounds," I think that's always a sweet spot, and I call it nursing magic. It's an energy that comes.

Liz:

Yeah, it's amazing how deeply human healthcare is and where we can remember that and keep that at the center, and that technology can help us connect more with that humanity because it brings up space. But really, it's a really human experience for the people receiving the care and the people delivering the care. How about you, Tonie?

Tonie Owens:

Yeah. Recently, I came into my office and opened email, and there was a patient safety report regarding a patient who has sickle cell and was being admitted on a different unit, not the typical unit that the nurses know that patient population know how to manage the care in a different way because they have more experience with it. So, for me as a leader, it's about supporting our teams in those really difficult moments. So I asked the nurse and the team if I could round with them, and it was in the moment to say to the teams, "I'm here to help you. I'm here to support you. I'm here to ensure that that patient gets what they need and that you get what you need, and that we do it in a way that supports each other."

Liz:

Yeah. And what I love about what you're saying is really that we want people filling out patient safety reports because it demonstrates a really high psychological safety in our culture that we're always striving for the best care. We always want to make sure that we are looking for any opportunity to make things better.

Tonie Owens:

And I would just say the team really did come together, right? The patient got the care they needed. They created a collaborative plan. Everybody knew the plan. We had a plan for overnight. The next day we rounded, everybody was still on the same page, and it felt good to everybody, including the patient and family.

Liz:

I love that, and that's what we do because we are humans where mistakes are going to happen. They're going to happen regardless, or a risk. That's what I love about the patient safety reports, and it could just be something that puts people at risk, right? And so, we're constantly trying to identify where are there opportunities and where are there risks, and creating that culture where it's not punitive, where it brings the team together. We do it to really explore how we can do our best.

So what I love about this conversation so far is it's really anchored us in our why. Why did you [inaudible 00:09:17] nursing? Why do you do what you do, a recent moment that has really been impactful? And we all know that healthcare is going through a lot of changes, and everything is going through a lot of changes. It's a very dynamic time. And so, Denise, I'm curious if you could give us sort of a weather report on nursing, in medicine in general right now, not necessarily specific to Michigan Medicine, but just the field of nursing. What's the forecast? How are people doing?

Dr. Denise Ervin:

So the interesting thing is, the weather report in nursing right now, I think there is a lot of opportunity for nursing as a profession right now. There has been a lot of change and a lot of growth within the profession. And so, though it is a scary time in nursing, I think there is enormous amount of growth in nursing, and it really makes me think of a quote that I ground myself in, a Florence Nightingale. And Florence Nightingale said around 1870, I think it was. She said it will take 150 years for nursing and the world to see all of nursing potential.

And the beauty of that quote that I think about then and I think about now is 2020 was Florence's 200th birthday, and it would've been around 150 years from that quote. So I don't think nursing... we can truly conceptualize right now. I think we're in between the old and the new, and I don't think we really have grasp who we are as a collective in healthcare and the opportunities that really do exist within the nursing profession, which is very exciting. And also, it's very scary because there's a lot of uncertainty, right? So, grounding us in being why we're here and are treating.

Tonie Owens:

Denise, that quote gave me chills and gave a good perspective of we're still growing and evolving and we have a lot of work to do.

Liz:

And what I love about the comments you made is you could take them and apply them to anything right now. I think that so much healthcare, higher education of the way that we do your things in general, the way that we've always done them is at the tipping point, right? And on the one hand, there's this anxiety if you look at it because change is scary and because there's disruption. And with disruption, there's uncertainty, but there's also all this opportunity of, "Well, what does that mean, and what's possible?" And I love your focus on the possibility of what does it [inaudible 00:12:09] of what could be possible and how could we be an example of what's possible. So, Tonie, thinking about how this actually comes to play in the day-to-day, what are you seeing? In your world, things move fast. What does well-being actually look like on a Tuesday afternoon with the nurses that you're seeing?

Tonie Owens:

Yeah. In our unit and with the nurses and our interdisciplinary colleagues, what it looks like is the friendly hello, the smile, the gesture of, "We've got this. Regardless of what the day brings, we're here for each other." In our DMS huddle, we always do a joke. What it looks like daily for us is our commitment from our nurse leaders and our physician leaders to be present on the unit. I think our teams know we're here for them. We try to let them know which one of us is more available on the unit that day, but we are always rounding. We're always checking in. We have committed, as a nursing leadership team, that any nursing meeting, one of us will be at. There's never a meeting that we're not at to support them, to connect the dots in terms of how does that work align with work that other work within the unit, or how does that work align with other work in the organization.

We have a really strong MPLAN team that helps... that has presence. Because our workflow is a little different, we don't have... There's people busy in and out of the operating room and getting patients discharged, but our MPLAN team has designated... comes meet us, come talk to us, tell us what you need, and we do that once or twice a month. And it's in our conference room and we open the doors, and most of us are there, and we sit down and have the conversation with whoever wants to talk to us.

Liz:

Tonie, that's amazing. I'm hearing showing up is a really big part of this, right? It's being present, physically present, maybe bringing a little levity with a joke, and keeping that connectivity amongst the team members seems to be really important to what you're saying.

Tonie Owens:

Yeah, that's how we lead and that's how we collaborate, and I think it is vital to building the teamwork. It's vital for our safety and patient safety, right? I heard a quote many years ago, "Kinder cultures are safer cultures," and I really believe that to be the truth, like saying, "Hello. How are you doing?" connecting on the personal level so that, when the challenges do arise, because they arise every day, almost moment by moment, that we are connected and that we know we are there for each other.

Liz:

It's so interesting you say that. Someone recently was asking me, it was someone who works at another organization, and they were aware of some of our patient satisfaction scores, which are very high in the industry, and they said, "Well, how do you train folks there around how to communicate with patients and how to be kind, and things like that?" And that is training. I don't want to take away from that, but I said, "It's not really needed. People are just really nice here." I feel like it's part of the culture. There is this inherent friendliness, inherent nice that people want to take a little bit of extra time to have that conversation with you. They want to understand about your family. They want to understand how your weekend was. It's just those extra little moments that really still build the team and build a sense of belonging, which is one of our four strategic priorities as an organization.

And so, part of this episode is really about what keeps you here in terms of nursing. And specifically for both of you, what are some of these emotional and cultural anchors that really make you feel like you belong at Michigan Medicine? Denise, we'll start with you.

Dr. Denise Ervin:

Yeah. So, Liz, you actually just illuminated part of what I was thinking around this. I've worked at many healthcare organizations in my years of nursing, and I will say relationships, hands down, Michigan Medicine has shown me a different level of relationship. There has not been one single person in my time here that I haven't reached out, and they're happy to meet, they're happy to share, they're happy to connect, and that hasn't been seen or felt in other places that I've worked at. And I think it's very strong and that does keep me. That is one thing that got [inaudible 00:17:02].

Tonie Owens:

I'm going to try not to cry. What keeps me at Michigan Medicine is our legacy at Michigan, and our legacy is to transform, which is not a little word, patient care through the art and science in nursing practice. We have generations of nurses here who carry that legacy, and their generation, they carry the generation of their family nursing legacy. The nurses I have worked alongside here are brilliant, brave, and steady in the moments that demand everything of them, clinical expertise, compassion, and superhuman strength. The nurses and the patients are what keep me here.

Liz:

Getting goosebumps. That was beautiful. That was literally getting goosebumps, and you're absolutely right. And I think we're really lucky to have these communities and to have these legacies. It's funny, someone asked me the other day, "So how long have you been here now?" And it's been over two and a half years, and I said, "But only here when I say that I still feel very new," and it is because, Tonie, you run into people that are like, "Oh, I'm the fifth generation here and I've been here for 35..." You two are great and try think I'll feel new until the day I retire. And I do think it's that community and those pieces that really help meet people here and help get through those hard moments. And this is why all of us think about well-being and our in well-being, we know there are real challenges and we know there are opportunities.

And, Tonie, I'll start with you. I know that nurses have things that drain their energy or drain their cognitive load before they even touch a patient. There's all the emotional pieces. It is hard to be with people on their hardest day of their life, there's that, and that is really hard, too. And there is also structural and administrative things that we're always working on and we're always working on to improve that are inherent in healthcare across the country, which is why there are these well-being roles and positions across the country to address this. Tonie, when you and your team think about this, what are you all working on together to try to reduce some of those administrative frictions or reduce some of those workflow hiccups?

Tonie Owens:

Yeah, no, definitely the inefficiencies, the daily frustrations can wear a team down. I think what we have done is we have built different teams to work on some of those inefficiencies. So we have a pre-op lean team and a PACU lean team, and we meet monthly, and it's staff nurses who do it every day. It's myself, some of the supervisor, the clinical nursing director, and we look to say, "What can we improve? How do we improve it? And what's in our control? What can we, at our unit level, improve?" And we really take those steps within a month to implement it, within a week to implement it. It is fast cycle change, right? We're there. We round every day. If that process improvement is working, then we adjust in the moment. I think the teams have come to know that we're going to do the work with them, and so our teams continue to do that kind of work.

Liz:

Yeah. And the amazing piece about what you're saying is nothing is too much, but getting five minutes back is a big deal because those things add up. And so, Denise, how do we make sure that our frontline teams, as you're having these discussions and you're learning about... People give you these examples. They say, "Well, here would be an example here." How do we ensure that they have a voice in operational decisions before they're being made, not after, and in a way that really creates that sense of empowerment around your day-to-day workflow?

Dr. Denise Ervin:

Yeah, I would say, really, that piece is 100% why my role exists within the organization. So, I meet regularly with the nursing leadership and then the CNDs, and also the rounding. I round on the nursing units, I meet with UBC, and we are having these meaningful conversations literally on weekly basis across different segments, depending on which segment is the focus at that time or whoever reaches out, but it's real conversations of how can we embed well-being into our workflows and it not be a checkbox outside of the work that we do. So, it really is my day in and day out all the time. And I think we are working on some system level things right now within nursing and the Department of Nursing of how do we do this again at that unit level, in a leadership level. So we can have some systems in place, such as Stress First Aid, and these tools that we have so we can have these conversations around that, our stress response, and identifying those small little things that can... we do have locus of control to make change of them.

Tonie Owens:

I think that the important point is, when we work in teams, we have to really think about what we can impact. We had a lot of conversations about, "The system needs to fix this, the system needs to do that," and that is probably true and we can work on that, but what can we do? What can we improve for our own colleagues in the moment so that we can remove the smaller frustrations? And if we remove one small frustration, what's the next thing and what's the next thing? And so, really keeping it focused and local has been some of our success.

Liz:

Tonie, thank you for highlighting that. I think this idea of locus of control is so important and it is really easy, because things feel big and complex to look outside and say, "What are they going to do? How are they," the royal they, "going to fix this?" And there's so much that we can do, and so this idea of like, "What's one thing we can do to make this process just a little bit easier?" And when teams work together and innovate, particularly the people that are closest to the work, the people that know the work, that are doing the work, they know the workflows, that's when we get brilliance, right? That's when we get the really best stuff because these are the people that really know how the work goes. And so, I love that ingenuity, that scrappiness, if you will, of like, "Pull up our bootstraps, we're just going to do this and we're going to test things out, and we're going to see how we can make this better."

And one thing I just want to name for those that are listening is that this is a both/and approach, right? We are going to get into... There's a lot of support for individuals that you both offer to help an individual with their personal resilience. And if you put a really resilient person in a system that's got a bunch of friction, they're going to be at risk of burnout. And so, we really wanted to start with this system level focus of trying to address those points of friction, and there's all this personal support, so just really, really naming that that's why we started there. And now, coming to that personal support, Denise, could you walk us through some of the things that are available if the nurse finds themselves struggling, programs that you mentioned, like the COMPASS Peer Support or the Stress First Aid, and share with us a little bit about what you hear from nurses about, when they do reach out, when would you like to see them reach out and what their experience is with these programs?

Dr. Denise Ervin:

Yeah. COMPASS Peer Support is one very large and robust program for those encounters. And what I hear from nurses a lot around that is just connecting with another nurse that has that lived experience, whether it's workplace violence, whether it's adverse event, whether it's imposter syndrome. As a new nurse, any transition, I think, in nursing, we have imposter syndrome, whether we're new, whether we're moving to a different unit, whether we're moving to a leadership. And I hear a lot around when they're able to connect with those peers and normalize, if you will, or recognize that, "Oh, okay, this is part of the experience," because we can't always talk about our families and friends. They don't understand the work we do.

And also, there's a lot of stigma like, "I don't want to look weak. I don't want to think I don't know what I need to know after nursing school," or after grad school, or in those transitions. What I would love all the nurses to know, no matter if you were in a workplace violence, no matter if it was adverse event, no matter if you are questioning your clinical skills or imposter syndrome, please reach out to [email protected]. We will connect you with another peer supporter, or you can go to the front-facing and connect yourself.

The other thing I want to say related to support, early on in my career, we weren't trained to take care of ourselves. We didn't even know how to do that. We were trained to care for others. And about a year and a half, I was feeling my first layer of burnout and our first time of being burned out, and I didn't have healthy coping. After a code, I'd jump in that break room and I'd eat a lot of food, didn't know really what I was doing at that time. And so, the other resource that is available is the counseling. Whether it is a one-minute brief session through the counselors at OCWR or six-session, to gain perspective, to gain coping strategies to stress management is really, really beneficial. I did that outside of the organization I was at. But to normalize that, that is okay.

Liz:

And to ask early. No one is going to be too early or be turned away to say, "This isn't a big enough issue."

Dr. Denise Ervin:

Absolutely, absolutely. There is no big enough issue because it gets [inaudible 00:27:39] and we don't know how to explain.

Liz:

Yeah, absolutely. So, Tonie, psychological safety is one of those phrases that can sound abstract until you're one that's feeling maybe afraid to speak up, and you're in on a very high stakes unit. How do you make it real, make that psychological safety something that people on your unit feel? And how do you track and have a sense of it if they feel that they're really able to speak up?

Tonie Owens:

Yeah. Psychological safety, to me, is not a buzzword. It's a core value, and we try to live it every day. We talk about, for me as a leader, it is my responsibility to ensure that we have a culture where everybody can learn, grow, and thrive. And we talk about it in our staff meetings. We talk about it when we train new nurses. We talk about it... how we show up for each other. What does that mean? And how do you ensure psychological safety for another person that's working next to you? Just recently in one of our staff meetings, there's always teams within teams, right? And we talk about, "We understand you want to work alongside your peer, your friend, the person you know there's clinical skills in case you get into a situation. You know how to lean on them." And so, those micro teams within the larger team are important, but we also, those micro teams, have to be open enough to ensure that everybody can be supported to learn and grow and deliver safe patient care.

So, we create it by being present. We create it by saying, "I have your back. I've been a nurse for a really long time and I've done a lot of things, and I don't know everything, and I'm still going to have hard days and I might have not done that task in a year, but I'm going to step in with you and I'm going to support you. And we're going to grab our resources, we're going to pause, we're going to get our brains going that we understand what the interventions we need to do for that patient, and we're going to do it together so that we are all safe and the patient is safe," and then that's how we create psychological safety.

Liz:

It's such an amazing... It just keeps coming back to the theme as a team and really the people behind the work, being together and working together as one. And so, we're thinking about these exciting future times. Denise, you talked about the possibilities, and we're thinking about Nurses Week. And so, Denise, I want to turn this to you for a second. And if you and I are having a chat two or three years from now and we're reflecting back on where we've been and everything that's happened, what do you hope has changed? What do you hope we will have seen? What are you excited to have potentially seen? What will things look like if everything goes as you hope?

Dr. Denise Ervin:

So, honestly, Liz, it really is... I really envision a healthcare... I envision our day in and day out where it's not only our patients, it is us and it is that paradigm shift of how do we hold both. And if I was to wave a magic wand and hope for the future, I would hope that we will get there and we will be able to have a thriving environment in spite the change, in spite the heard, in spite the trauma, all of that where we can hold both. We can hold not only our patients, but our safety and that human experience. I dream about that often.

Liz:

Denise, thank you for naming that because I have heard people describe it as mutually [inaudible 00:31:38]. We can either deliver excellent care and have great throughput or we can have thriving teams, and we know that's not actually true. We know that the data suggests very strongly that thriving teams provide better care, and that is where we are really able to deliver what we all hope to deliver to our patients. And so, really getting to this... What I'm hearing you say is getting to this mindset where it's super clear that not only can we hold both, but we must in order to be able to deliver the kind of care that we want, that we don't do it at the expense of our teams, but we do it while supporting it and really lifting up everybody. So, Tonie, a brand new nurse is listening to this on their drive home from orientation. What's one thing you want them to know about staying grounded in this work?

Tonie Owens:

My advice would be that my journey has shown me that, even in the face of profound struggles and trauma, actively practicing bravery, compassion, and kindness can foster cultures where we can grow, learn, and thrive. I believe that a young nurse needs to learn great clinical skills, but it's not just our clinical skills, it's our ability to care for ourselves and our communities that keep us grounded in what we need to do.

Liz:

Wow, that's beautiful. And so, to both of you, as we celebrate Nurses Week, what's the message you want the thousands of nurses across our institution, other institutions to hear and really believe? What's your take home for them? I'll ask you first, Denise.

Dr. Denise Ervin:

So, my take home is I see you all, I hear you all every day in the work that you do. Just this week, just this day, give yourself permission to honor yourself. And there was a quote that came out around COVID that has really stuck with me, and I just would like to read it, "You may not have signed up for the nurse's journey, but the second you fall, got your butt kicked, suffered a disappointment, screwed up, or felt that heartbreak started, no matter whether you are ready for the emotional adventure, the hurt happened. It happens to every single one without exception. The only decision we get to make is what role will play in our own life. Will you write your own story, or will you have someone like that wrote you? Please give yourself permission to honor yourself."

Tonie Owens:

Again, I'm going to try not to cry. I would say to every nurse in our community, thank you. Thank you for showing up shift after shift with compassion, skill, and grace. Thank you for holding the hands of patients who are scared. Thank you for comforting families during their hardest moments. Thank you for staying, even when the work is heavy and the days are long. You are the heart of healthcare, not the building, not the technology, not the systems. The people, the nurses. I've been honored and humbled to walk alongside this community. I carry every experience, every lesson, every person I've worked with deeply in my heart. My message of hope is simple, you matter. The work you do matters, and it is our responsibility as leaders to invest in your well-being with the same dedication that you pour into your patients every single day. Thank you. This week and every week, I see you, I appreciate you, and I will always support you.

Liz:

Tonie, thank you, that was beautiful. And that's our show. So, to every nurse listening, whether you're mid-shift, post-shift, or on your day off, thank you. Not the generic poster in the break room kind of thank you, but the real kind, the kind that Denise and Tonie have said. We see the weight you carry, and we're working to make it lighter. If anything in this conversation resonated, share it with a colleague who needs to hear it. And if you have someone you know could use support, please reach out to OCWR. The link and information will be in the show notes. You don't have to be in craziness to ask for help. Happy Nurses Week. We'll see you next time on Well-Being at Michigan Medicine.