Welcome everyone to today's Luminary Lounge. Thank you for joining. My name is Amy Zerva, and I'm a pharmacist at New York Presbyterian Hospital. And I have the distinct honor and pleasure to get to spend the next 45 minutes talking with Dr. Ruth Kleinpell. I'm going to start off by providing a brief introduction. Dr. Ruth Kleinpell is Associate Dean for Clinical Scholarship, Independence Foundation Chair of Nursing Education, and Professor at Vanderbilt University School of Nursing. She is certified as an acute care nurse practitioner and is known nationally for her work on advanced ACNP role development. She has conducted research related to patient outcomes in hospitalized older adults, post-discharge follow-up interventions using telehealth, and patient and family-centered care in the ICU, as well as a number of other funded studies. She served as the 2017 President of the Society of Critical Care Medicine, the third nurse to serve in this role in the organization's 50-year history. Additionally, she served two terms as President of the World Federation of Critical Care Nurses. She's a board member of the World Federation of Intensive and Critical Care, the American Nurses Credentialing Center, and the Tennessee Board of Nursing's Political Action Campaign. And finally, Dr. Ruth Kleinpell is a fellow in the American Academy of Nursing, the American College of Critical Care Medicine, the American Association of Nurse Practitioners, the National Academies of Practice, and the Institute of Medicine of Chicago. Welcome, Dr. Kleinpell. Great, thank you so much. So I thought we would start off with a topic that's pretty much on everybody's minds these days, including burnout and resilience. I know that you served as co-author on several publications addressing ICU clinician burnout, including the Critical Care Society's collaborative call to action. You served as the lead for the National Summit held to gather experts to address mitigating burnout in the ICU. So I'm wondering if you can start off by telling the audience a little bit about maybe some lessons that you learned on how health care workers can rejuvenate and sustain themselves in the sense that when they're burnt out. Yeah, well, you know, it's certainly an appropriate topic because the ongoing pandemic has certainly impacted health care clinicians, especially those in intensive and critical care settings. You mentioned the work that the Society of Critical Care Medicine had done in conjunction with the Critical Care Society's collaborative, which is our national partners, American Thoracic Society, the American Association of Critical Care Nurses, along with the Society of Critical Care Medicine and CHEST. We looked really at the literature, did a review and published a call to action in 2016, which was published in all four of our journals. And we really looked at the research literature with a particular focus on critical care clinicians and identified that the research and literature that had been done highlighted that burnout is really a health system issue. It's not an individual clinician. Weakness or character flaw or anything related to that. And following that call to action, we really worked to disseminate strategies. So we had sessions at each of our annual meetings. And then we also, as you mentioned, held the National Summit in 2017, where we brought together 50 experts in many different fields, psychology, sociology, suicide prevention, experts in mindfulness. And they really reiterated what we had identified in the call to action. And we see it today that health systems are really attuned to how can they make the work environment one that's more conducive? How can they promote a healthy work environment? How can they really help clinicians to have a healthy well-being in the work setting? And so we're seeing it really culminated because of the pandemic. So many organizations are outreaching to clinicians to have varied work schedules, different roles and responsibilities on certain days, if at all possible, respite days, healthy choices, food choices in the cafeteria, making sure that people know the importance of adequate sleep and rest and nutrition, having people just, we actually learned through some of our work that we all have worked in the ICU setting on days when it's so busy, you don't even have time to take a meal break or let alone to go to the bathroom and having a clear understanding that those are so important for clinicians is to make sure that they're getting breaks when they're at work, as well as having a buddy system for social support. Many units have formed wellness committees over the years, especially now during the pandemic, that really focus on having social activities for clinicians, or again, having opportunities to get days off when you need it. It really needs to be a system approach. And we see that reflected in the literature, particularly the work of the National Academy of Medicine and their ongoing clinician collaborative, addressing clinician resilience and their action collaborative. So, you know, I think that we need to make sure that from the administrative support on to leadership support of the intensive care unit, that there's keen awareness as to the importance of fostering a healthy work environment, and that, you know, can help clinicians, especially during these challenging times. Thank you for all your work with that. You know, as you mentioned, I think this all existed pre-pandemic, and it only magnified everything with the pandemic. And the work that you've done has served as, you know, a foundation for folks to springboard off of and develop individualized programs for the needs of their healthcare workers. So thank you for that. I'm sure the audience would be interested, out of those that you listed, on a personal note, what do you do to rejuvenate yourself or sustain yourself when your workload becomes a little too heavy? I think we're all challenged. We're all trying to juggle the balls in the head and not get hit, you know, but it certainly requires focused efforts at really taking time out from work. You know, I think with the combination of the challenges with staffing, as well as remote work, that there really is no on-off switch anymore in terms of when do you work and when do you take time for family life. So I find that, you know, hobbies are a key pastime. I enjoy going for walks. I enjoy taking time to bake and cook, and luckily my husband and son pull me away when I'm getting too entrenched with work, because I would work seven days a week, you know, on project work and such. But it is important, so important, that we have, you know, that social support and that we know when we need to take boundaries with work. Great, thank you for sharing. Kind of one more topic related to this that's germane to this is that we've had a lot of turnover within our clinical staff, and since you've been involved with a lot of education, how do you think we should adapt our educational practices to account for this high turnover? Yes, you know, it's something that I think has reached a critical state in terms of the staffing shortages and the staffing turnover. We need to really ensure that we're testing new models of care. You know, nothing says that we all need to be working, you know, the schedules that we have, whether it's 12-hour shifts or a week on call, you know, that was models of the past that I think were constructed at a time when we thought those were best, you know, for consistency to be present, you know, for a certain number of days for consistency and follow-through, but is that really the best for the clinicians? So, I think we're going to see a testing of new models where we may vary the roles, you know, on a certain day that a clinician comes in, and I've shared this at a couple of Congresses and some talks, you know, I really feel that the future will hold that when we present to work, we will get our, you know, biometric assessment, our stress level, our cortisol levels, and then we'll be designated what to do that day, you know, should we be working with the patient that's on ECMO? Should we be helping, rather, with the rapid response team that day? Should we be really the clinical lead, or should we, you know, defer that to someone else? Should we be working on quality improvement and research that day? So, what is best for not only the clinician, but also for patient safety? We're not there yet, you know, but certainly I believe that we will not see the current models that we have today, and I know that hospitals are actually looking at new models of care to have different levels of support so that it's not the same, perhaps, staffing ratios that we've always had, maybe having additional individuals work that maybe don't have patient care assignments so they can float and help others who may, whose, you know, schedule may get more hectic during the day, because we can never predict when we come on shift how the day's going to unfold, you know, admissions, discharges, critically ill patients changing constantly. So, I think we will have to test out new models and use technology, you know, in ways that we haven't used it before as well. Well, thank you for sharing your thoughts. Certainly, the pandemic has unfolded a lot of our vulnerabilities, and restructuring and rethinking is going to be key for the future, not only of critical care, but of health care. So, taking a little bit of a pivot, I want to talk specifically about your involvement with PCORI, where you promoted patient and family-centered care in the ICU. I want to just highlight that you wrote the proposal and served as the principal investigator for the PCORI-funded national collaborative, which brought together 63 ICUs nationally, and they implemented patient and family-centered engagement. And so, I'm just wondering, do you want to just talk a little bit, how did that develop over time, how it morphed, and, you know, what were some of the exciting points of doing all of that research? Sure. We had the opportunity to apply for funding from the Patient-Centered Outcomes Research Institute, or PCORI. It was actually a special call to health professional associations. And so, we were lucky enough to be funded, and as you indicated, it supported a national collaborative of 63 intensive care units, and they each identified what patient and family-centered care initiative they were going to implement during the collaborative timeline. So, some chose to implement open visitation, some chose to implement family care conferences, some did pet therapy or music therapy, and so, really, a learning opportunity for not only the individual organizations, but also collectively for the collaborative as well. So, we really have received a lot of responses from units that participated in that. Of course, we know that the pandemic challenged patient and family-centered care with changes in visitation practices that still exist today. So, I think, you know, refocusing on how to engage patients and families post-pandemic is definitely a priority area. One of the things that I will share personally from the collaborative at the facility I was at previously, Rush University, we had targeted open visitation and had implemented that as well. And initially, you know, there was a lot of concern about changes, you know, having open visitation for patients, family members, and they saw with changes over time that it really was valuable, you know, to family members were actually helping staff with information they didn't even know. So, there's so many benefits. So, I'm hopeful that we can return to those times when there are not restrictions on family members to be in the intensive care unit. One of the, I think it was two of the teams implemented music in the intensive care unit, and that really piqued my interest in terms of having, you know, music as a healing part of the environment. And so, when I transitioned here to Vanderbilt University Medical Center, we actually have a school of music here at Vanderbilt, the Blair School of Music. And so, with colleagues here, Dr. Joel Schlesinger and Dr. Todd Rice and others, we've actually implemented a therapeutic music program in the intensive care unit. So, we have virtual musicians who play classical music and go throughout the intensive care unit. So, we've actually converted it now to virtual. So, we have two large iPads on wheels that the musicians can play from. But we really have seen not only benefit for patients and families, but also the staff. You know, it gives them a momentary welcomed interruption in their day to hear some of this beautiful music that the students can play. So, I personally benefited from some of the lessons that we learned in that national collaborative work. That's neat. I know some institutions have it as an orderable item in their physician order entry, or their... And is that something you guys also have? Or is this just the music plays at a set time and you roll the iPads on wheels into the patient rooms? Or can you order this up? Well, it's actually dependent on the musician's schedule. So, we have found it beneficial to have it later afternoon time. So, right now, we don't have it as something that, you know, is in the order set. I know other intensive care units do try and integrate either musical therapists, the actual therapists that do music therapy as something as well. So, other units have, you know, music that patients can choose from with headsets. And so, I think even using such things as virtual reality, which we have not done a lot in the intensive care unit, I think we could look to modify the environment and make it more therapeutic for patients overall. And just to stay on the topic of research, you've been involved in so much that it's phenomenal to look at your CV and see all the facets of critical care that you touch. Can you just talk a little bit about the role of the critical care nurse in research? Sure. Well, I actually, you know, grew up in the intensive care unit doing 15 years as a staff nurse before getting my advanced degrees. And I always welcome the opportunity to look at either quality improvement, how can we improve things, or opportunities to conduct research. So, I've been involved with a lot of clinical studies and continue to do that here as well. I think looking at, you know, how can we make the ICU environment better for patients, better for clinicians. And so, research is always, you know, a part of that as well. One opportunity here at Vanderbilt is that we have a learning healthcare system. And I know other centers are looking at that concept of really testing things clinically to improve care. And so, that's also benefited nurses. We have our nurses actively engaged in research. And, you know, they see the ways that we can use research to improve care outcomes for patients. And so, that's always, I think, sometimes it's a challenge to get some of our staff interested in research. You say the word research and, you know, their eyes sort of gloss over. So, I've come accustomed to using terms such as, well, we have an opportunity for a project. And sometimes, if you couch it, you know, that way, there's more acceptance to it as well. But I think, you know, introducing the clinical staff to the value of research is important. We have a current project in our medical ICU. And we actually discovered this. We were looking at ways in the literature that were being used to help give information to family members, especially during the pandemic. Our COVID ICU clinicians were reporting that they were very challenged at the time to communicate updates and ongoing explanations of the bedside equipment because families weren't present. So, we actually found an article that was published. And a picture happened to be posted on Twitter from the UK of a wall map that they had designed for their waiting room. And this wall map had a depiction of a patient, an icon, and different icons around the bedside explaining the equipment. So, we actually corresponded with them. They gave us approval to replicate it. They had conducted a study related to it. They allowed us to replicate the tool. And so, we have an ongoing project for getting feedback from family members with respect to how helpful is the ICU wall map. So, that's one example. But I think as an outcome of that, it really helps to show staff the value of having ongoing research to improve. You know, we can do randomized controlled trials. And we see that a lot, you know, in critical care. But not everyone is able to do that type of research. So, I really love the clinical research and process improvement projects as well. Because it really does make a difference. Yeah. Well, thank you for sharing your ongoing research. You're always so involved in the cutting edge. And it's so great for the bedside nurses or other advanced nurses to be involved. They have some ownership then. And it feeds right back into the quality improvement within the unit that they're working in. So, I fully believe in that also. And thank you for all the work that you've done. So, let's take a minute now and talk about your involvement in SCCM. I'm sure folks are very interested for you to talk about a little bit how you originally got involved in SCCM and then your path to presidency within the society. Yeah. Well, I worked in a surgical intensive care unit. And at the time, they were looking at having FCCS. And so, I had been a member of, you know, the fundamentals of critical care support course. And so I was a member of the SCCM, but not really active up until that point. So that, you know, really gave me an eye in terms of the resources that SCCM has for ICU clinicians. I was a member of the nursing section and had attended those meetings, but, you know, really started to outreach. I joined one committee through the nursing section and then several and got to become involved that way. And then one thing led to another and I was on the research committee and the membership committee and the program committee. I really enjoyed the program committee. And I think each opportunity led to me needing more people, learning more about the society. And I think because I was active, I would get tapped into a lot. Well, would you do this? And would you do that? And so, you know, I just became involved, but really enjoyed the networking. I will say that that, you know, and we're missing a live Congress this year, but I thoroughly have enjoyed all the activities throughout the years in terms of the Congress meetings, because the committees actually meet then. And so that was another source of engagement that you were actually working with people and getting to meet more people and professional, you know, enjoyments. And so that was one of the reasons that I became more active and had the opportunity then. Based on, I think serving as program co-chair with Nick Ward that year gave me really an insight because we had a report to council, you know, in terms of the program itself. And just really, it gave me an eye as to, maybe I'll seek, you know, a leadership position after serving on council for several years. So it is quite a trajectory. So I'm hopeful that individuals that may be listening in on this, you know, have a focused interest. There are many, many opportunities to get involved with SBCM and it only takes that first step, whether it's through one of the knowledge education groups or whether it's one of the sections or whether it's, you know, volunteering, everyone should be going on the website and checking off the committees they have interest in because every year the president elect goes through that database and that is how they designate individuals to serve on those committees. Those are always used, those profiles. So I will encourage people to consider doing that and getting involved. I have founded professional reboarding, but again, the networking and the people that you meet is just so valuable as well. You may be able to share with us one of your favorite moments while you were president or maybe you had several moments. Yes, I think definitely the opportunities to attend our collaborative meetings. So it was the critical care society's collaborative, it was our international partner meetings, just being able to represent SCCM at the different levels. You know, not all critical care organizations, especially internationally, are as multi-professional as we are. So that was always a point of interest from other societies that are not as diverse in terms of membership. And I think that is certainly an asset because it truly represents how we practice in critical care is with the multi-professional team. And so having an organization that represents that, having a council that represents that, having committees that represent that, it really benefits us because that's how we practice. So I think that's another asset of SCCM involvement as well. And certainly this was pre-pandemic, so you got to do a lot more traveling than perhaps some of our current society's presidents. Did that put the travel bug in you? Did you already have the travel bug? I had actually traveled internationally a fair bit amounts through my work with the World Federation of Critical Care Nurses. And then over the years, I've been active with the World Federation of Intensive and Critical Care. And so they had a Congress every four years, it's now every two years. And so I had actually started going to those and meeting colleagues internationally. So I had traveled before, but I will say that it's not always glamorous. Those travels are a bit taxing. Not only is it the time change, but usually you're landing, you're presenting the next day. Oftentimes they're adding on more talks or visits during your visits. And then you're back on a plane to either come back home or go to work or go someplace else. But it really was a great opportunity to represent the organization as well. But I also enjoyed the council meetings, leading the council meetings and really seeing the progress that we have made over the years. And the SCCM staff is just so great to work with. That was another memorable part of the presidency is just really seeing all the behind the scenes work that our staff do and appreciating what they do for the organization as well. There was one thing that you think about that you might have done differently over that time. What might be something that you can pinpoint? Well, I think I was moving at such a fast pace that I couldn't take it all in. So I think as we all say, I wish I would have taken some time to enjoy it. But at the time you were just going and doing things so quickly. It was passing by so quickly. But one of the things that I'll always treasure is that when I was handing over the torch to Dr. Jerry Zimmerman, traditionally every year, the presidents have gotten a gift from the organization. And it had been for many years, this round Tiffany platter. And I think it was engraved. So I asked David Martin, the CEO, I said, David, I said, instead of a platter, can I have like Tiffany jewelry? I would love to have that as a remembrance. And he's like, well, we can't have personal gifts. You know, it has to be business oriented. So I thought, okay, I'm gonna get a Tiffany platters. So they surprised me with this very unique, it's a pyramid shaped, an artist actually developed it. It's a pyramid shaped container and glass on the outside and on the inside, it has mementos of my nearest presidents. So the different things, different areas I traveled to, photos that they had collected and mementos throughout the years. So I have it in my office. It's actually in my window here. And that's a daily reminder of my time with the society. Oh, that's so very special. So we've talked a little bit about your pathway within the society. And as you evolved and growing, starting off at a committee level, but let's go back even further in time and what propelled you into nursing? Yeah, well, I actually had in high school, I had volunteered as a candy striper at a local hospital, community hospital. And my position was to sit at the information desk and hand out visitor passes. And then one day they said, well, we need more help on the clinical floors. Would you consider passing water? So I thought, oh, all right, I'll go and pass water. So they set me up and showed me how to do it on the clinical floor. And I did that. And seeing, I think that piqued my interest on the clinical floor to seeing the healthcare team and the nurses in action. And I think my mother was also behind my choice of nursing as a career as well. She was very encouraging of not only doing the volunteer work, but considering nursing after high school. So I originally went to a three-year diploma school, Lutheran Medical Center School of Nursing, which is no longer there. It's in Cleveland, Ohio. But one thing about the three-year training is that they really immerse you in the clinical setting. You are doing weekends, doing shifts, right? With the nurses volunteering. And so that gave me a really strong skillset with bedside nursing. I remember one licensed practical nurse when I was in nursing school, that actually taught me to do tray care and on the clinical floor. And so I think I always had an interest in the intensive care unit. So when I graduated, I worked at a community hospital on their step-down unit. And the step-down unit was located right outside the intensive care unit. And the doors would open and you'd peek in or you'd get a patient out sometimes, or I'd go in just to see what's going on. And I always wanted to go inside. So after I had worked for two years on the step-down unit as a new grad, then I was able to transfer in the intensive care unit and just really never looked back after that. It was a mixed adult medical surgical ICU, and I had great experience in that community hospital. And then had the opportunity to relocate to Chicago and started working at the University of Illinois Hospital on the night shift, mind you, in the surgical ICU and worked there for over 15 years. And they had a great package where as long as you worked 50%, you got 100% tuition reimbursement. And so I was able to take advantage of that and go to University of Illinois at Chicago and get my BSN and then stayed on and got my master's degree in three years. And then they convinced me to stay on and go through what was called a bypass program that as long as you were in the master's program, you could start taking courses in the PhD program. Well, I never intended to continue on, but I ended up finishing the PhD program as well and thoroughly enjoyed that opportunity. And then I worked at Rush University in Chicago and they were opening up their first acute care nurse practitioner program. And so I was able to go through that in order to teach in the program and get certified. And so that's sort of my pathway into how I became a nurse practitioner then, but having that experience as a staff nurse in the ICU was so beneficial as well. I think probably a lot of us can pinpoint to that we volunteered or we had a family member or some sort in healthcare that probably has propelled our career. But I think what you alluded to and I think what's so important is remembering our roots, remembering what it's like to be at the bedside or what it's like to be that technician, delivering the water or handing out passes because we are all a team and we all have to work together for the good of the patient. Sometimes as we progress up, we forget and it's good to, like I said, go back and remember your roots. That's right. So as you've climbed up the ladder within nursing, how have you seen nursing evolve over the years and how has bedside nursing changed? Yeah, I will say, definitely have seen changes and I think we're gonna see ongoing ones in the future for the betterment of the whole healthcare team. Certainly there's more collaborativeness, I will say, back when I worked in the intensive care unit at that community hospital in Cleveland, they had an ICU team, but it wasn't really the team models that I have seen work well over the years. So I think enhanced teamwork, enhanced collaboration, definitely more attention and focus on each member of the ICU team and the benefits that they bring, looking at collaborative projects. When I was first in the intensive care units, we didn't really work together on quality improvement initiatives or things such as that. And so that I think has really evolved as well. More professional opportunities that didn't exist previously when I was first in my nursing career. So that certainly has evolved. And as I mentioned, I think we're gonna see new, even more new models of care as the future unfolds and as we use more technology, especially in the ICU setting too. Well, thank you for that. And to date, you've done so much. What's been the most highlight of your career? Obviously being the president of the society was very high up in a multidisciplinary group, but maybe one piece of literature, what are you most proud of? Well, I will definitely say that the things I have been active as a collaborator within the society, serving on several guidelines. I'm currently now on the family center care guidelines. I've served on the sepsis guidelines. Those have always been great experiences. I learned from those opportunities each time. I think the one thing that really was quite enjoyable was when a group within SCCM collaborated to, it's now in its second edition, but we did the first edition of integrating nurse practitioners and physician assistants in the ICU, which was really the first book of its kind to really help new intensive care units that were onboarding nurse practitioners and physician assistants really learn how to best structure that. It's not just about hiring several and them following what a resident would do. It really requires a focused effort on having processes in place for orientation, for support, for clinical privileging, having structures within an organization. And I will say that that, I think, has really had increased recognition nationally. We now see centers of advanced practice that exist that did not exist 15 years ago. So we're seeing that that has really helped. I think ICU practice as well. We have dedicated teams here at Vanderbilt. I was always so amazed at Vanderbilt that all of their intensive care units have 24 seven coverage of advanced practice providers. And we're seeing more settings like that as well. And that probably is going to be the future where we have intensivist led teams, but they're responsible for other areas beyond perhaps the ICU, so. And something you touched on that I have a curiosity on, you've probably seen different models of integration of acute care nurse practitioners. So for example, one model might be integrating within let's say medical residents or medical interns. And then another model might be a complete unit dedicated to acute care nurse practitioners where there are no other types of learners in that setting. Have you seen one work better than the other or do you feel that they're about the same? Yeah, it really is site dependent because there are some community settings that do not have, they're not affiliated with a medical school. So they don't have residents and fellows and they have acute care nurse practitioners that are in those models of care. And then in an academic medical center, which I have tended to work at throughout my career, it's just normal to have members of the team be learners as part of medical residents as well as other fellows and students. And I think both models work equally well. It's not one over another, but I think it's how you integrate the model that makes it most successful. So having every member of the team be recognized for their skillset and optimizing them to work to the full scope of practice based on their education and training. And we're not there yet. We see a lot of different regulations from state to state and hopefully one day those barriers, unnecessary barriers will be removed to practice for all the team members. Well, thank you for sharing all your insights. I'm certainly have some folks that have listened to you that have been inspired by your words. And so maybe we can end by, maybe you can give three pieces of advice to somebody who's just joined the society or just starting off their career in leadership roles and maybe sharing with them, what do you think is the best paths or things that they should do now moving forward? Sure. Well, I think it takes some reflection individually to identify what might be your professional goals. Do you see yourself evolving and wanting to conduct research? Do you see yourself wanting to publish? Do you see yourself wanting to run for office within the organization? Serving on a guideline committee, there are so many opportunities. So I would say number one is get involved. So filling out that volunteer form online is one way that you can start to serve on committees or whatnot. I would say number two is network. The value of networking I have found is just so valuable. I have met people at SCCM meetings or conferences that I end up co-publishing with them or presenting with them the next year or getting involved with an initiative. So that's been so very valuable as well. And I think the third thing is to not only get involved but seek ways that you can get recognition. Obviously SCCM has fellowship that you can become involved in by being a fellow. There's awards, there's recognition. So it really is beneficial for your career. It's not all about you just volunteering. It's about how can the offerings of the organization help to advance your career as well? And so there are many win-wins to being involved with the society. Well, it's really been my pleasure getting to know you. Thank you for sharing all your wisdom and your thoughts during Congress. And I hope you have a great rest of the Congress. Great, well, thank you so much. I've enjoyed this time dialoguing. And even though we're in our virtual worlds, this year again for Congress, that is one of the things that is really probably a little advantage of having it virtual is that everyone can participate. I know even our organization, it was like, okay, who can attend this year? Because everyone can go. But by having it virtual, more people can participate by having an extended time that the sessions are open. It enables other people to get engaged as well. We may see the day that all of our conferences are hybrid because optimally that would be most beneficial because we know someone's got to stay behind and take care of patients. And so who knows, but hybrid may be the new way of the future for conferences as well. Well, thank you for your time. Great, thanks so much. Thank you.

burnout

resilience

healthcare workers

work environment

patient-centered care

career advancement

hybrid conferences