Hi everyone, it is a delight to be with you all today to speak a little bit more about leadership within a critical care organization. The objectives are really to discuss the importance of effective leadership and its impact on patient care outcomes. And then certainly to talk about some practical strategies as a leader in critical care from an advanced practice standpoint, but really to just discuss what works and what doesn't work. And I can certainly share many lessons learned. I love this quote by Ray Kroc, who was the founder of McDonald's, certainly a corporation that helps us stay in business as critical care providers, but really profound in what he said, the quality of a leader is reflected in the standards they set for themselves. Here's a picture of many of our critical care team members at Vanderbilt University Medical Center, really have enjoyed working with so many throughout the years. But first, let me share a little bit more about my own critical care journey. I was a critical care nurse in the cardiovascular ICU and then went on to become a nurse practitioner in the same ICU. Really enjoyed working with our team, with our intensivist, our cardiologist, our consultants, the NPs and PAs on the team. We're an academic medical center, so certainly enjoyed working with all the fellows and the residents in cardiovascular ICU. So we were all about transplant, post-cardiac bypass surgery, valve repair, all of the things that you are so familiar with for CBICU. Also worked quite a bit on our thoracic team, but really my heart was with ICU. And I worked there for a few years and then we built a critical care tower at Vanderbilt, which really doubled our numbers of ICU beds. We had a successful program with having NPs and PAs in the ICU, so it just presented a wonderful opportunity for me to step up and lead and help build out the ICU teams, the NP, PA teams in all of our ICUs. So as of today, we have NPs and PAs in all of our adult ICUs and our pediatric ICUs and in the ICUs that are surrounding hospitals. Vanderbilt has over 1,700 beds, I believe seven hospitals and over 200 clinics. So it's a big organization. Lots of amazing people that work here, many of the greatest of the great in terms of minds. So it has been a pleasure to work in this area. So in 2009, that's when our critical care tower was built. That's when I moved into the director position for critical care in PNPA practice. I did realize I needed more formal leadership training. I really needed to better understand finance, needed to better understand macro systems, quality improvements, process improvements, everything that clearly becomes evident when you move into a leadership role. So at that time I also pursued my doctorate in nursing practice. It was a wonderful experience to work with so many on the critical care team, work with the medical directors, with the nursing leaders and all of the many NPs and PAs. I was very involved with the Society of Critical Care Medicine throughout the years and just really appreciated how they also helped to shore up our program as well as my own leadership journey. I really enjoyed all the educational modules, particularly infused the multidisciplinary modules that were offered through SCCM, infused that into our NP and PA orientation program. So really have appreciated the partnership with SCCM throughout the years. In 2014, I moved into a larger role as the associate chief nursing officer for advanced practice for the health system. And that's where I really began to branch out of critical care, out of acute care and beyond to really begin to understand, explore and build NP and PA models of care across the system and also began to really get engaged with our CRNAs, our clinical nurse specialist and our midwives. So again, a very interesting journey but definitely grew as a leader throughout those years and many, many lessons learned as I had mentioned earlier. And then today, over the last two years, I have served as the president of the American Association of Nurse Practitioners. This is an organization with over 121,000 members, the largest member organization for NPs in the country and actually in the world. And so it's been a wonderful opportunity to learn more about how I can support my profession on a broader scale. Learned a lot about interviewing, lots of interviews on TV articles, print. I spent a lot of time traveling to different universities to meet with faculty and students. A lot of times traveling to different hospitals, health systems, academic medical centers to speak with the NP populations there. And so it's just been a wonderful journey. I hosted a series of podcasts, but I'm back now. I'm back home at Vanderbilt. I did move over to the school of nursing where I serve as the associate dean for clinical and community partnerships now. Here are just a few of my favorite pics. Being able to go to the White House and spend time speaking with other healthcare leaders during such a tremendous time of COVID and everything that we've been experiencing over the last couple of years in healthcare. That was such an honor. And it truly exemplified the importance of working together on an interprofessional team and the value that every single person brings to the table. There's a picture of me with one of the university groups, a picture on the Today Show. So just a lot of fun throughout the last couple of years as well as just incredibly humbling to see what people are doing across the country. And in particular, critical care, which of course is my interest. And so seeing what was happening in a lot of the rural and smaller hospitals in terms of being a critical access center. With opportunity, like I said, to lead a podcast series. And on my podcast, I invited different leaders to speak about their journey. So I spoke with NP leaders in the uniform services, with editors of journals, NP leaders that were working in the C-suite with large corporations, NP leaders that were serving in public service roles, in legislative roles. And it was really interesting. I found out more about why they wanted to become a nurse, why they were interested in being a nurse practitioner. But I really started to explore their leadership journey and what kind of led them down the path that they were on. And what I found most interesting is that there was a lot of similarities. Even all of the different pathways they were taking, there were some key similarities. And I found this across many different professions and many different conversations I've had over the years, that there are some similarities in leadership and for effective leaders. And so I'll share those four key themes with you. And that is first, to be authentic, to tell your story. Second, to know your value as a leader and as a contributor to the healthcare team. And then to give back, to give back to the team, to the profession, and certainly more than ever before, to invest in our greatest asset. And that is us as clinicians, as leaders, as educators. We truly need to be working every day to make sure we're taking care of ourselves in order to be able to bring our very best self to our patients and those who we serve. The first is be authentic, to tell your story. I found as a new leader that it was hard for me to tell my story. I didn't think anybody would want to hear my story. But what I realized is people are interested in your journey. And so if you are a medical director, respiratory therapist, pharmacy leader, an NP, a PA, a member of that important critical care team, your story is very important. Your background, your culture, your perspective, your education certainly creates your lens. But what are some successes that you've had? What are some failures throughout your career? And how do you weave your story into those conversations that you're having on a regular basis? Whether that be in rounds, whether that be in team meetings, whether that be in presentations, your story is very important. It really gives light to how you got to where you are today. Many of us have had pivotal moments in our career that really helped us take a turn down a particular pathway. Those are the things that people really want to hear. And I have found that to become more evident as I have journeyed throughout my career. People really want to hear from you. I want to hear from other leaders. I wanna hear my medical director's story. I wanna hear the story of why the anesthesia intensivist decided that they wanted to work in the CBICU that really draws you closer to one another and helps establish you as a leader. So I might ask, what is your story? Here's a story I like to tell. And that's really my journey in the CBICU as an NP. I have told this story often, so please, I apologize if you've already heard it, but several years ago, I've been at the medical center for about 20 years now, but I remember as a new NP in the CBICU, we had 27 beds at that particular time. Coming to work one Saturday morning and getting report and then having the whole unit as an NP and just remembering that day and how difficult it was to get around to all the patients, to get ready, prepare for rounds. You probably know how weekends are. You have to, it's less people there, right? And it was tough. I remember just barely getting around to speak with all the nurses and families, getting ready for rounds, being able to put in orders to get everybody moving along their day, trying to get into getting the procedures done and then putting out fires all across the unit, on the phone with all the consultants, on the phone with the intensivist. And then just well into the night, I was there trying to finish up notes. This is not an atypical day for anyone, but I remember on that day, just really thinking it would be great if there was another NP or PA here with me today, working today. So I began the journey of asking, how do we go about getting more staffing in the ICU? And I remember sitting in front of an administrator for the hospital and that administrator said to me, and it was really hard to hear, but it was important for me to hear. The administrator said, well, what do you do? And like I said, that was hard to hear because as we all know in critical care, we are busy from the minute we walk in the door until late in the evening, we take much of this home with us. And so to be able to have to say, oh, wait, you don't know what I do, that's kind of tough. But I realized at that moment that it was so important for me to be able to speak to my value. And so this is what's really important is to be able to tell your story and know your value. So that day, then and there, I realized how important it was for me to be able to measure everything I did, to speak to the outcomes that I contributed to, certainly our NPPA team, our critical care team. And so that's where we really began to zero in on what is our length of stay? What are our bounce backs to the ICU? What is our CLABSI and CAUTI rate for our ICU? What are our adverse events? Are we putting in those RAS scores? Are we putting in all the things that are necessary for our leapfrog criteria, for our patients who've had a STEMI or a non-STEMI, those types of things, our time from the OR to extubation in the ICU. So it was really important to understand the outcomes related to our unit, but also what are our outcomes and what is that impact to the organization? So resource utilization, the ease of transfer across different areas of the hospital, and beyond to LTACs or rehabs. And then certainly what is our impact to healthcare as a whole? So that was well before we had EMRs. So I was measuring everything, putting everything on a spreadsheet because I thought if anybody ever asked me again, what I do, I wanna be able to speak to those outcomes. Know your value, know the value of your team and its impact on patient care to your organization and to what you do broadly in critical care. Speaking of outcomes, this is a fantastic article that was published in CHEST a few years back, but I always use it as a great example. And this is from one of our fantastic teams here, the medical ICU team at Vanderbilt. And at the time when this was published, the team and the NPs and PAs was led by Dr. Art Wheeler and such an amazing pioneer in critical care. And he was such a supporter of NPs. And I just really enjoyed working with him as a partner, but he was a supporter of teaching NPs about leadership, about research, about all the things that go into critical care and caring for our population. And so this is an article written by Jana Lansberger, who was the team lead at that time and several others in the ICU. And the way the MICU was set up is there were three teams, 34 beds in that unit right now, it's getting ready to expand but 34 beds, three teams, there were two house staff teams and one NP team. And so it created a great scenario for comparison, not that that was the goal to compare house staff teams to NP teams, just that we had that opportunity to really compare so that we could look at the effectiveness of NP teams in the ICU. And so she did exactly that. It was a three year longitudinal study and they looked at over 9,000 patient admissions. They made sure that they were comparing similar acuity across each team. And it was just fantastic what they found in their study. Across all three teams, there was no difference in 90-day survival rate. There was a similar ICU length of stay. There was a lower risk-adjusted hospital length of stay. So the time that the patient spent in the hospital, that was lower. And then a lower ICU mortality rate and lower ICU readmissions. So very interesting. It's been a great study for us to be able to speak to in terms of NPs and our impact in the ICU, but this would not have been possible. The creation of this team, the effectiveness of this team, the success of this team, had it not been for our amazing medical director, Dr. Art Wheeler, the amazing attendings, the house staff, the fellows, the pharmacists, the nursing leaders, everybody that went into supporting the work of this particular unit. Know your values. So many thanks to Jana and Art and all of those that contributed to that study. Really helped me personally to better understand my values and NP on the critical care team, but also greatly appreciate the perspective, the expertise and experience that each person brings to that team. And the more we appreciate that and we communicate and work together, the more reliable we are as a team. So when we're speaking about value, I do wanna draw our attention to Michael Porter's work. I know many of you probably have read his work, The Value Equation. A lot of it was published in Harvard Business Review, but really he talks about shifting our focus from volume, trying to get as many patients through as possible to value and really value from the perspective of the patient and the patient's experience. And that we should be organizing our care around the medical conditions for that patient. One of my wonderful mentors, Dr. Lee Parmley, he's at the VA system in Colorado now, but he was one of our medical directors for many years in the CVICU. He always said, every patient needs a certain compilation of providers around them. So what is the right compilation of providers around the bedside? So maybe today at this particular moment, it's the respiratory therapist, the anesthesiologist and the NP. Maybe tomorrow it's a different compilation. So really what is required for that particular patient? To be able to measure and report outcomes and certainly to align any sort of incentives with value and with quality. So here's the value equation. So what are you willing to invest in order to get the desired quality outcomes? And are you looking at the whole value equation from the perspective of the patient? So what is the perspective of the patient? What did they expect when they came to the ICU? And so I know in some situations they never expected to go to the ICU, right? But for those that are coming to a surgical unit or a cardiac and thoracic unit, what is their anticipated outcome? What are their anticipated activities of daily living after? What is their life going to be like? What is their experience? What are their expectations? How are we really looking at that from an entire team? We often look at value perspective when patients are having an especially challenging time in the ICU. And we speak with families and we have those family meetings and we have those goals of care. So in Porter's work, it's really understanding the value equation from the patient's perspective and really looking at what are the desired outcomes and what are our costs or what are we willing to invest into those outcomes? So the third theme is to give back. How do we build a highly reliable team focused on effective outcomes, on an ideal patient experience? Focused on a team that's satisfied, enjoys what they do, they communicate well, they work together. So this is a great body of work by Dr. Linda Hill, also at Harvard Business School. And if you have an opportunity, please, I've included the link to one of her TED Talks here on the screen. Fantastic speaker, but just so articulate and just a absolute wealth of information. So for many years, she and her team studied effective leaders around the world in different environments. So not just in healthcare, but in banking and engineering firms and software and policy. So she observed leaders to better understand effective leadership styles. And these are four key themes from her work. And that was certainly to foster diversity and inclusion, to really allow for a team that's innovative, to honor everyone's perspective, to know that diversity is absolutely essential to generating new ideas and thinking out of the box. This is how we've gotten to where we are today in terms of our evidence and where we've gotten today in critical care is because we were willing to think out of the box and listen to all ideas and perspectives. So part of that is to be able to promote a safe environment to speak up. I've certainly had those moments when I've been on a critical care team and I have not felt comfortable in speaking up. I thought if I said anything, it's gonna sound silly. They're gonna say that was silly. And we really wanna create an environment where anyone can speak up. So if the nurse wants to speak up and say, hey, by the way, let me tell you what happened overnight with this patient, that nurse should feel very comfortable to do that and not feel that if they spoke up that it would be inappropriate. So creating an atmosphere for psychological safety so people can speak up, so important. To be able to provide structure and support. Do we have clear goals? Do we have clear methods for communication? Does everybody clearly know their role? And then certainly communication and collaboration, so important that we're regularly communicating and collaborating. And this needs to be to a point that it's natural. Certainly I've been in situations where we've tried to structure this. Certainly rounds are structured, but we've tried to say, okay, every day we're gonna have a little teaching moment. Sometimes that works. Sometimes it's better if that happens organically where we have a particular patient and let's talk about this patient. Let's talk about what's happened here, what we've tried. And really wanna hear everybody's perspective on how we could have done things better, how we could do things better going forward. So a debriefing that feels so comfortable and natural, that's where you're really going to provide that ideal teaching atmosphere. So how do we create this communication, this collaboration? And that really comes from listening and mutual respect. And Linda Hill does a great job talking about this concept. Which leads us to the concept of emotional intelligence. And I know a lot of people have different perspectives of just this theory, this concept, emotional intelligence. But at the end of the day, think about any situation, a meeting, rounds, a family meeting, even personal situations, group settings, social situations. What we know is that emotion plays very heavily into decision-making. I, like many others, wish that most of our decisions would be made strictly on data, right? But the truth is data is very important. We're very data-driven. We look at the data, we analyze the data, we talk about it. But emotion is also a key factor. So emotional intelligence is really better understanding your emotions, as well as how to perceive and understand the emotions of others. This is very important in terms of self-awareness, self-management of our own emotions, a social awareness. So knowing that there's something up with this group and we need to explore what that might be. Relationship management, so we can improve relationships. All of this is so important. It cannot be emphasized enough that these factors are important in building a highly reliable team. So when we're talking about emotional intelligence, there's a lot of books out there. There are a lot of different classes and things like that. I've taken many of these classes, but I really appreciate Daniel Goldman's work. So I would draw your attention. He's got an article that just came out, the 25th anniversary edition just published this year. But what he states is emotional intelligence is essential for leadership. It's really a skill to be honed. It doesn't come naturally for everyone. And so how do we hone this skill? How do we hone it in such a way that we're able to motivate and inspire our teams to be able to manage conflict and really make good decisions? It's important for personal success to really be able to manage work like balance, to manage what's happening at home and socially, as well as at work. It can be learned over time. It's a skill. It's like any other skill that we develop. It's not something that you just say, oh, let me read. I'm gonna go out and practice that. It's something that we develop and hone over time. So these are the concepts that he puts in his particular article. And he looks at self-awareness, self-management, social awareness, relationship management, but also he looks at motivation. Empathy, which is a huge skill. This is such a skill that I've had to work on because I am very much a person that comes in. I focus on the work I wanna get in, get the work done, get out. Empathy, understanding where others are coming from, understanding how others are feeling and really empathizing with that and standing in those shoes. This is important as a skill and as a leader of an interprofessional team. And these two quotes from the case for emotional intelligence and healthcare, as nurses, doctors, and staff interact with their patients and each other every day, emotions surface, whether they notice them or not. Emotional intelligence research supported over the last 20 years verifies how contagious the emotions of professionals and positions of power can be for the people around them. And so they go on to say the four emotional intelligence skills enable healthcare professionals to spot and manage these emotions for the benefit of clinical care, patient care outcomes, patient satisfaction, teamwork, and employee health, morale, and retention. Here are two studies related to physicians who have honed their emotional intelligence skills. So it's associated with higher job satisfaction, lower burnout, greater patient satisfaction, and even promotion. So certainly a testament to being emotionally intelligent and understanding the power of emotion, even when you're talking about very data-driven, evidence-based patient care. And two more studies related to nurse leaders and hospital staff, again, demonstrating that it helps in terms of overall job satisfaction for the individual and the team. So I'll finish on this section with this quote that I love. It's by Margaret Wheatley. All change, even very large and powerful change, begins when a few people start talking with one another about something they care about. So the next couple of slides are a video that I recorded with Dr. Ruth Kleinfeld that really emphasized the importance of innovation, psychological safety, leadership, thinking out of the box, and how this can contribute to a stronger team and certainly to patient care outcomes. Hi, everyone. I am here with Dr. Ruth Kleinfeld. She is the past president for the Society of Critical Care Medicine. And I have the wonderful honor of being able to work with her here at Vanderbilt University School of Nursing, where she serves as our associate dean for clinical scholarship. And most importantly, she's an acute care nurse practitioner. She has a wonderful story to tell about leadership in an ICU and its impact on the whole team and certainly the downstream impact on patient care outcomes. Great. Well, thanks so much, April. And the many years that I've been involved in ICU care, I can certainly say that the team, all members of the team play such an important role in terms of leading initiatives in the ICU. I've had several experiences several years ago when SCCM had their PCORI, Patient-Centered Outcomes Research Institute, funded project. We had 63 ICU teams participate in a 10-month national collaborative. And each of the teams identified an individual patient and family-centered care initiative that they would lead. And it really required all members of the team to advocate for implementation and evaluation. At that time, I was at Rush University Medical Center in Chicago and we implemented Families on Rounds. And it was an initiative that at first had some resistance among some of the clinicians, but we highlighted the benefits. And once we started implementation, the clinicians could see the benefits of having Families on Rounds. And it really required all members of the team, physicians, nurses, therapists, pharmacists, and others, that were actually helping to lead this initiative with positive outcomes as well. Here at Vanderbilt, I've had the opportunity to partner with several colleagues to do a couple of different projects in the ICU, ranging from quality improvement to research. And we currently have a therapeutic music program in the intensive care units. I would have never thought that I would be involved in such an endeavor, but one of our 10 schools here at Vanderbilt is Blair School of Music. And so when I came to Vanderbilt, I started networking. I had known some of the ICU colleagues here and we started looking at options for really, I think, enhancing the work environment, making it a healthy work environment, making it more conducive to patients and families. And we actually had a consultation with a medical musician, Andrew Shulman, who came to visit and walked us through sort of the phases of starting up a therapeutic music program. So I can actually share some slides that I have, if that would be of interest with respect to the program. We have a multi-professional team that's involved with the therapeutic music program. I have some slides actually that I can share on our therapeutic music program. We have a multi-professional team that started initiating this initiative. Dr. Todd Rice was involved as director of the medical ICU. We had a number of clinicians involved. Here is the main project team. Miriam closure is was at Blair School of Music, and then myself and Dr. Joe Schlesinger, who's anesthesiologist critical care physician. We helped to lead the program and Joe is actually trained in classical piano jazz music, and has an interest in music and so we joined together with other colleagues Miriam lens and Raina Gordon, who are with our department of otolaryngology music cognition lab, and the Vanderbilt program for music mind and society. And we had a piano that was donated from Nashville piano rescue and we had the piano painted by a local artist, Aaron Graham, who used the studio of Ashley see grows, and this is sort of the whimsical painting of the piano that he made and Andrew Shulman was our medical consultant he's a medical musician in the in New York, and he attributes was actually hospitalized in the ICU and attributes his recovery to his wife bringing in his music so he could listen to it while in the ICU. And so these are some of our volunteer musicians from Blair University they're playing in the hallway. If patients are in isolation, otherwise we have large wheels that are installed on the piano and we wheel it into the patient's room. This was pre pandemic and during the pandemic we transitioned to virtual live, where we have two large iPads on wheels that we go into the patient's room where the musician is live on the other end. And so the musicians play several songs classical music for patients and we've done some research related to it as well. But we have had a doctor of nursing practice, nursing students, help with some of the data collection and analysis we have several of the staff nurses involved, we have had obviously members of the ICU team involved with the initiative in terms of really promoting this for patient use. This is Judy live she's one of the volunteer musicians, but she is playing the piano in the patient's room. And you can see the doors open and it's that's the nurse's station behind but really the staff have enjoyed hearing the music. It's a momentary disruption in their busy day as well. And then this is Sean Yang, he's another one of our musicians and he's also playing in the hallway of a patient who's on ice. Everybody amazing. It just always amazes me at the talent of some of our, you know, musicians here, but that's an ongoing project. We have actually expanded the project where we have we started in the medical ICU. And we're now brought majority of the adults ICUs as well as the step down units several times a week with the music program. And as I said, conducting some research, we all have some residents and fellows that are joining have joined the team as well. So it's been a nice opportunity, but, you know, highlights that leadership within the ICU requires team effort, and every member plays a role in that to really help to improve care in the ICU, and to help enhance patient and family centered care, but ultimately, to improve patient outcomes in the ICU as well. And created such a wonderful space for creativity, innovation out of the box. What a beautiful story. Thank you so much for sharing. Great, thank you. Last theme I want to talk about today is the most important in my mind, is to invest in your greatest asset, and that is you. The years you have put into training and education and everything you've done to get to where you are, at this point, so important, but it's so important that we take care of ourselves, all clinicians, everyone on the healthcare team. Health and well being are essential to maintaining quality of life and quality of care delivery. We know, according to the National Academy of Medicine and studies that we've done here at SCCM, that clinicians, healthcare workers were burned out before the pandemic even began. As much as 35 to 40, 54% of US nurses and physicians had substantial symptoms of burnout before the pandemic. So we only know that that continued to grow as we headed into the tumultuous time that we have all experienced with COVID-19. But then we head into the pandemic, and it is just like nothing ever experienced, especially when everything started moving inpatient and into critical care. The emotional, physical, mental exhaustion was just on overdrive. Everything that was happening and really related to all of the aspects of a pandemic were hitting people from all sides. So the fear, the exhaustion, the emotional, the moral distress, patients, colleagues, passing away, family members passing away, having to come into work, leaving family at home, the isolation that came with it, a very, very different circumstance as we headed into COVID-19. Then, of course, we began to study what was happening within COVID-19 period of time. And this is a study with APRNs. And in this study, the majority indicated that they had signs and symptoms of burnout. And work hours, increased work hours were associated with higher degree of burnout. We also found that the organization can have a tremendous impact on burnout and healthy work environments. And we began to explore what a healthy work environment really looked like. Here's the basic definition for burnout. And certainly, we were seeing these things and even experiencing those ourselves. What were we even doing? Why did we even go down this pathway? And we know that the cost associated with burnout and so many leaving the profession, going to do different things. I saw many colleagues move out of critical care during this time. Tremendous impact to the overall healthcare industry. Here are a few pictures of our providers in the midst of the pandemic in the ICU and our hospital to home and everything we were doing with the emergency department to offload people coming in. It was tremendous, the efforts, the sustained life threatening situation. I love this. This is a study that came out and just kind of really highlighted what goes into working during a pandemic. And then the true spiral that you can head into poor sleep, anxiety, depression, the increased substance use. So what can we do? Burnout is real. It's an injury. It's very much like when we overwork a muscle. Some stress is good, right, but not continued sustained stress. Here are the etiologies of burnout, external. Certainly, we see all of these. Some organizations more than others on the left side, but I would call your attention to the right side and looking introspectively, but also really understanding your team. In critical care, we are high achievers and we are stepping up doing everything we can. We're there till late at night. We're doing for the good of the team, often feel irreplaceable. If I don't go in, no one will. So a lot of these internal etiologies can be really reviewed and are these factors that we could soften up a little bit. So how do we do this? And how do we understand how burnout is impacting our team? In 2019, well before the pandemic, our team here at Vanderbilt conducted a health and well-being study. These are the tools that we used. We pulled together a big task force, not just APRNs, but social workers, physicians, others were on the task force when we launched this study. The interesting thing about this study and what we were really trying to look at is signs and symptoms of burnout. Are you exhibiting signs and symptoms of burnout? Were you formerly burnout and you're not now? Or no signs and symptoms at all or to not do any substantial degree? So great tools were used, but what we really saw here was pretty shocking with our own provider population that 59% of those who responded identified as either being currently burned out or formerly burned out. And this was not what we wanted to hear, but we explored this even deeper. Our task force looked at both organizational recommendations as well as self recommendations that we could offer to our hospital and to our APRNs that worked there. Certainly organizational to prioritize self-care, those working day after day after day, night after night after night, really some limits around that, opportunities for professional growth and development, leadership support, and really creating that sense of community. And this is where leaders in the ICU can really come into play. How do we really buoy up the team and know that we're there for one another, we support one another, we can talk through things, and we create that space for communication. But I think what we learned that was really interesting from those who had been formerly burned out, but not currently. So a lot of free texts came in here, and there was a theme that really crossed all respondents that identified with being formerly burned out. So what was different? What did we learn? And what we learned is that the most common thing that they did was make a change. Now, you might say, what is that change? You know, did they leave the critical care unit? Or what was that big change? And it was across the map. So some became more engaged in a social group. Some started new routines, fitness, nutrition, whatever that might be. Some started doing more for self-care hiking, things like that. Some started to break up their work where they worked some clinically, and then they were an educator some of the time. Some moved to a different unit or a different service, and they found learning the new service gave them a whole new excitement for their career. But it was anything. It was all across the board. Make a change. So this is really important as we're working with our colleagues on our team. How can we offer these opportunities to do things that are different? So maybe you're in charge of the study that we're working on as a group. Maybe you're leading this new project on improving rounds or, you know, why don't you be in charge of the students or, you know, making a change. your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and that's to invest in your community, and

effective leadership

critical care organization

patient care outcomes

practical strategies

authenticity

telling your own story

emotional intelligence

diversity and inclusion

self-care