Shireen: Dr. Tamara Kear talks to us about the American Nephrology Nurses Association’s recent research into the mental health and wellbeing of nephrology nurses and the effects of the COVID 19 pandemic on nurses. She also discusses what workplaces, and the nursing industry can do to alleviate this serious problem.

Podcasting from Dallas, Texas, I am Shireen. And this is a Yumlish Podcast.

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Dr. Tamara Kear is the Executive Director of the American Nephrology Nurses Association and a tenured associate professor at Villanova University. She was a 2019 national president for the American Nephrology Nurses Association, during which time she directed the association’s response and actions related to the advancing American kidney health initiative.

Welcome Dr. Kear.

Tamara: Thank you, Shireen.

Shireen: So, Dr. Kear, can you talk to us about why you were drawn to the field of nephrology nursing and your career journey toward becoming a professor researcher and nurse executive?

Tamara: Certainly, I'll be happy to explain that. So, I was one of those individuals that I knew from the earliest age, that nursing was going to be my career. In high school, I prepared myself with the classes to prepare me to go to college, to study nursing. Uh, I did, I took the track that most nurses take. I got out of school. I took a position on a medical surgical unit and a telemetry unit. And interestingly, our unit happened to be the unit that took care of the patients that required kidney dialysis or had kidney disorders.

And I would see the nurse come in in the morning and prepare the patient for the dialysis treatment. And it was very interesting to me because I got to see that nurse sit with that patient for three or four hours, provide the care, get to know the patient really well. And so, I decided to leave the hospital setting and move to work in an outpatient dialysis facility.

And immediately I knew, I had my bachelor's degree at that point, that this was the career path I was going to take. I was able to work with patients who required chemo dialysis, patients who required peritoneal dialysis in the home. And it was also able to work outside of our dialysis program in the hospital, providing acute chemo dialysis treatments.

Quickly within two years, I realized I would follow this career path. And I enrolled in a clinical nurse specialist program that allowed me to study chronic illness, specifically chronic kidney disease and rehabilitation. And from that point on my career moved forward, I left the small dialysis study, and I went to an academic medical institution, received my master's degree, and during that period of time actually had some great internships working with patients on transplant. And was able to be hired as a clinical nurse specialist, where I worked in the program for 13 years, covering two outpatient and one inpatient dialysis unit, and also some therapies in the ICU. I continued to expand my career from there and it was a perfect position because it allowed me to take clinical practice, my interest in research and education and blend it together.

And as I said, I stayed in that position for 13 years. I then decided I want to do something a little different and went towards academia but continued to practice in the dialysis settings because I wanted to make sure that it was clinically relevant, and actually in touch with what was happening, kind of boots on the ground as many people describe it, so that it could inform my education personally. And I went on for my PhD, but it also allowed me to be informed so that I could teach my students. I could write, um, I could publish and again, continue my research in this particular direction.

I've been in academia for over 20 years, I continue to research, write, publish, um, and fortunately I've had the opportunity to move into a role as the Nurse Executive or the Executive Director for the American Nephrology Nurses Association that I've been part of for over 30 years and have held leadership roles within.

So, it's very interesting. I would have never guessed my career path would have led me to this position. But opportunities along the way during my PhD program and also within leadership opportunities have led me to this position. So, I think the moral of my professional and personal journey is, opportunities presented themselves and I took the opportunities when they were there. But one part that has always been a constant is I've never strayed far from nephrology nursing because it has been my love. And so, I'll just say for a few minutes, why I've not strayed from nephrology nursing and that's because this particular area of nursing practice allows us to practice as I’ve described.

In the community setting, in the home setting, and the outpatient setting, in the acute setting. There's really no specialty area I can think of that really allowed and individual to practice in so many areas. We also have the opportunity to get to know our patients because we see them, whether they've been transplanted, whether they're receiving dialysis treatment or we're training them for a home therapy that they will do on their own at home, we see our patients sometimes three or four times a week, if not, at least once a month.

And so, we develop these long-term relationships with our patients. And with their families. And I think that's the part when you speak to a nephrology nurse that keeps us in this area of practice because of the relationship and also the autonomy that we have in practice, too.

Shireen: Thank you for sharing that. You were recently involved in the association’s, a recent study, in fact about mental health and wellbeing of nephrology nurses during the COVID-19 pandemic.

How did the team realize that this was an important area to research at this time?

Tamara: Yeah, that's a fantastic question. And it's kind of interesting.

In 2019, I was not sitting in the position as the Executive Director of the American Nephrology Nurses Association. Actually, I was the president of the association at that time and, um, myself and the president elect had a meeting with a group of individuals, a consulting company, a pharmaceutical company. And they said, you know, what's one of the challenges that nephrology nursing is facing right now. Um, certainly we are all facing workforce issues and we were, we were facing that before the pandemic, but in late 2019, myself and the president elect, we said to this group, our nurses develop these long-term relationships with their patients.

That can last for years, if not decades, if they stay in the same practice setting. And it's very difficult for nephrology nurses when they lose a patient and ANNA has done some focus groups and research in this area. So, in January of 2020 and ANNA embarked upon with a pharmaceutical company, as well as a consulting company, we embarked upon putting together a survey to look at the mental health and wellbeing.

Little did ANNA know that four to eight weeks later, the pandemic would be facing the world and the importance of the study grew and the direction and aim of the study changed. So, in summer of 2020, the study was actually conducted. And now if I take you back to summer of 2020, when we collected the data, we had not gone through the Delta surge, we were kind of on the verge of it. We had not gone through the Omicron surge, and nurses were still being looked at as heroes, for lack of better words, and important part of the healthcare team. But we knew that collecting that data then was absolutely critical. I do believe that, and it's been published, the data's been published, and it's been presented numerous times. I do believe if we collected the data today, it would reflect what we found within the study, but it might even be more grim because we've gone through the Delta surge. We've gone through the Omicron surge, and we continue to have a nursing workforce challenge in all areas of practice.

Shireen: What were the results of the study concerning the general mental health and wellbeing of nurses.

Tamara: Absolutely. So, as I said, the survey was conducted in the summer of 2020, actually, between the dates of July 24th and August 17th. So, we were starting, you know, we were on the cusp where we were starting to move into, into Delta.

We had 393 respondents to the study, and they reported, again, as I mentioned, I think the findings would be the same today. If not a little more dramatic. They reported feeling burned out from the work. And that was 62% of our respondents said, I feel burned out. 47% said they were experiencing anxiety. And 16% of our population had major depressive episodes, pretty grand data.

It really is. And is that what we were expecting to find with the tools and the measures that we use? We were, I don't, I'm not sure we were expecting to find those dramatic high numbers, particularly in regard to burnout and anxiety, but they were there. We know with our nephrology nursing population; they provide a lot of technical care and highly skilled care to complex patient populations.

And during the pandemic, they were caring for these complex patients and situations in outpatient settings and in inpatient settings. And it was physically and psychologically demanding upon them. We looked at the number of hours that the nurses had been working and about one month prior to the conducting of the survey and on average, they were working 35 and a half hours, plus or minus 13.

So, we had some who were working less than full-time, and we had some nurses who were working up to 48, 50 hours a week during that period of time. And workload was the main driver for the anxiety and the feelings of burnout that the nurses were experiencing. So again, and also getting back to work hours, 51% of the population expressed in that month prior, they'd worked more than 40 hours.

So, what do we do with this information? I mean, that's really the question, where do we go with this information? ANNA has worked to put together webinars. A resource pages. We've also folded the need to, for nurses to understand that they are burned out and they need to pay attention to themselves.

We fold this, folded this into our national meetings, which are now in Harvard fashion, for example, ANNA national meeting, which is coming up in May or national symposium. We have corporate sponsorship for a relaxation station where the nurses are going to be able to go to the station and get actual massages.

It's not just massage chairs, massage therapists are coming in. We're going to have the opportunity for them to sit in this quiet spot, like space to be calm, to, to try to, to relax and ease their mind. We also know in our current setting that nurses want education when they come to our meetings, but we're also looking at trying to provide quiet times and downtimes for them. And that the education they receive is just as important as the opportunity to go to someplace and take care of themselves while they get the education. We're working on trying to provide healthier meals and just giving them a space to step away from what they're doing every day.

Shireen: Did you see any, and you talked about burnout already, but did you see any other psychological burden as a result of this COVID-19 pandemic through this study?

Tamara: Well, I mean, we also had conducted this study in July of 2020 around the time that, you know, the, the United States was going through some internal struggles in regard to racism. And so, we did look at, look at some of these demographics in regard to race, ethnicity, and our study did show that those populations expressed greater anxiety, greater stress and greater burnout regarding COVID-19 and what it meant to that particular population. So, we did section that out, um, and that nurses were experiencing symptoms of stress, inability to eat, inability to sleep.

And again, just the worry and anxiety that comes along with that entire phenomenon. And I think we have to be attentive moving forward to what's the long-term impact on the profession, not just nursing, but on healthcare that they're going to be carrying forward. Our seasoned nurses, our novice nurses, and any healthcare professional in those areas and anywhere between, because the impact is going to be there, and we need to pay attention to that.

Shireen: I love that you talked about that. Can you expand on that to tell us when did respondents really report the effects of these issues on their work and their relationship with patients?

Tamara: Yeah, so I mean, one of the things that that's been well-documented is when nurses feel safe, when nurses feel that their work environment supports them, that translates over to patient care and patient safety.

So, if the nurse feels supported, safe, psychologically, physically and their environment, research has long shown that provides a safer work environment. The same is also true when the patients are provided that safe patient care environment, it impacts the nurse safety as well because the patients are less likely to show behaviors when they're trying to get care centered upon them.

So, there's this direct correlation between a safe work environment for the healthcare provider and providing a safe environment for the patient and a safe environment for the patient provides a safe work, supportive environment for the healthcare provider. So again, I think the long-term implication on this is if the nurses are not feeling supported, safe, taken care of, given the resources that they need, the time off that they need.

That's going to have a direct impact on the patient.

Um, and I think one of the things that we see with the pandemic is it's been hard for healthcare providers to take their much-needed time off. They were told, okay, you're having symptoms of COVID you come to work. If you're still testing negative, you come to work.

But yet you're ill that doesn't serve anyone well, because in the end, the patient may be exposed to, COVID not COVID doesn't matter what it is. They've been exposed to something and that much needed relaxation time in the end provides a more positive environment for not only the care provider, but the patient in the end as well.

Shireen: What can be done in the nursing industry and by workplaces to help alleviate some of that burnout in anxiety, depression that many nurses have felt over the pandemic?

Tamara: Yeah, that's an excellent question. And I have to say that's a question that nursing associations, colleges of nursing, the profession in general is really grappling with and it's kind of acquired changes and we've started to move into the space.

It's going to require changes at the federal level, changes in providing the correct salaries, for nurses, so that nurses stay in the profession so that nurses can hold one job and not a full-time job. And maybe another job on the side to get themselves through paying off some of their loans. We are starting to see some programs come out at the state level to assist nurses with loans they may have, which again may allow them to work one job and not a job, and then something else on the side. So again, it's going to come at the federal level. There's been talk about staffing mandates and there's pros and cons related to staffing mandate. It's very difficult to look at a staffing mandate across nursing, because an area of critical, such as critical care nursing, it's going to have different staffing needs than perhaps someone that's working in and outpatient setting. So, it becomes very difficult when you want to put a mandate for all nursing, and you don't pay attention to the idiosyncrasies of a particular specialty or area of practice.  But certainly, loan forgiveness, looking at the work environment that nurses are in coming up with legislation that protects nurses because unfortunately healthcare has become more violent and again, for a variety of different reasons, but protecting the health care providers who are in the settings working to provide care.

And then also making sure that the resources are there, whether it's protective equipment, you know, the personal protective equipment. Whether it's providing the resources for nurses to advance their education, to have the time off, to advance their education, to have the time off as I spoke about to take their personal time off and not feel guilty for it.

So, it's reinforcing so that we can bring more nurses into the profession. And when we do that, we strengthen the workforce, and we don't continue to burden and stress those who are in the profession right now. It is a big goal, but it is going to take federal focus and dollars to move in that direction. And I do have to say that HERSA, for example, has looked at and listened to nurses and they've invited nurses onto webinars to hear what they're facing on the front lines so that they will hopefully start to address some of these challenges.

And we look at it as providing opportunities for our current and future.

Shireen: And so, how is the, um, how was the association involved in moving some of those regulatory changes?

Tamara: Yeah, absolutely. So, the American Nephrology Nurses Association is part of a larger group and a couple of ways of, uh, coalitions of nurses who come together.

So, we've been on the HERSA calls. We have collaborated with the American Nurses Association and the nursing community, in general to write letters at the federal level and multiple nursing associations sign on to these letters to say, uh, you know, that we wrote letters about personal protective equipment.

We wrote letters about COVID vaccine. Now we're writing letters about supporting the nursing workforce, putting money, not only into the workforce, but into research. For the workforce and providing loan forgiveness. So, we we've written those letters. We sign on to anything related to any appropriation at the federal level to fund these kinds of projects.

And we don't do it solo. We do it as a group.

Shireen: With that Dr. Kear, we’re to the end of the episode, how can our listeners connect with you and really learn more about your work?

Tamara: Absolutely. So, uh, you can find me on LinkedIn. I've shared my LinkedIn address with Yumlish. And again, I'm delighted to be here to speak with Yumlish.

Uh, you also can learn more about nephrology nursing. If you're interested in learning about what it means to work with patients who have kidney failure again, and the variety of practice settings I've described by going to ANNAnurse.org. That is our website. I also have a Facebook page that I have an Instagram page and I do spend time on Twitter.

So, if I had to think about social media, my two favorite social media is our Twitter and LinkedIn. So, I would love for you to join me there. I'd love for you to shout out and say hello, I found you through Yumlish.

Shireen: Awesome. That's lovely. And we're going to link all of the social media in our show notes. So, listeners can click on there and get connected over to you.

Thank you so much again, Dr. Kear for your time, and for telling us all of these interesting things that are happening. I’m so glad to hear that things are moving in a positive direction and then there's lobbying and efforts being done to try to help our nurses who’ve given so much of their time during this pandemic and even beyond that.

So, I really appreciate you sharing all the work that has been done.

Tamara: Thank you, Shireen. It's been my absolute pleasure.

Shireen: And to our listeners, head over to our social media pages on Facebook on Instagram and answer this quick question. What do you do to combat burnout, anxiety and depression in your life?

Whatever quite tips you have to share, send those over on our Facebook page again on our Instagram page @Yumlish_ and answer this question under this, uh, social media posts for the podcast. What do you do to combat burnout, anxiety, and depression in your life?

We will see you there after this episode, Dr. Kear, thank you again.

Tamara: Thank you so much. It was a lot of fun.

Shireen: Thank you for listening to the Yumlish podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and at @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective.

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