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Mindfulness Training: A Case of Misplaced Effort by Nurses for Nurses

Writer's picture: Bruce CummingsBruce Cummings

Change the work environment; don’t blame its victims.


Nurses for Nurses

The current issue of the Journal of Healthcare Management features a well-written, reasonably researched article with supported findings. Journal of Healthcare Management 70(1):p 16-31, January/February 2025. | DOI: 10.1097/JHM-D-23-00123 Unfortunately, the article's premise misses the mark.  


Co-authored by 9 nurses and nursing researchers, “Correlation of Mindfulness Practices, Resilience, and Compassion Satisfaction in Hospital-Based Healthcare Workers: A Randomized Controlled Trial”, does a credible job of showing that exposure to, training in, and practicing mindfulness 10 minutes a day, 3 times a week resulted in somewhat higher self-reported levels of resilience and compassion satisfaction among frontline staff when compared to a control group that did not receive such coaching.  The authors opine: “Readily available, low-cost mindfulness practices may be introduced to hospital staff to build resilience and improve compassion satisfaction. In turn, this may help support hospital efforts to reduce turnover in the healthcare workforce.”


I strongly disagree — not with the hopeful sentiment expressed per se but rather by the failure of the authors to recognize WHY clinicians need this support in the first place.  


Nurses and physicians do not lack resilience or compassion.  They come to their professions already predisposed to have these qualities. Their respective rigorous training regimens and professional ethics further burnish and reinforce resilience and compassion as hallmarks of being clinicians.


Unfortunately, the hospital or medical group practice work environment into which these resilient clinicians go are often replete with toxicity, bad or at least unnecessarily complex processes, outdated policies and practices, balky time-consuming EHR’s, constraints on being able to practice at the top of one’s license, work-life imbalance, and other stressors that continually wear down front-line clinicians.  


Against this backdrop, providing mindfulness training to clinicians is a little bit like applying antiseptic ointment to the wound of a patient with sepsis or affixing band-aids to someone with arterial bleeding:  whatever the fractional benefit, it doesn’t change the circumstances that caused the problem and won’t change the patient’s prognosis.


If clinicians need palliative measures like resilience training, it’s a sign of chronic, systemic occupational issues. In short, the workplace, not the clinician, needs to be made more responsive and resilient. Indeed, that’s why the World Health Organization classifies burnout as an occupational phenomenon.


There are evidence-based interventions that can address dysfunctions in the workplace. Mindfulness training, yoga, gym memberships, recharge rooms, time management courses, and the like are not among them.


Solutions for Hospitals, Health Systems, and Medical Group Practices:  Leadership-Driven Changes


The locus for curing clinician burnout and staffing challenges runs through the C-suite.  Here are examples of leadership-driven changes to the workplace that my colleague Paul DeChant, MD, MBA and I often recommend:


> Regard clinicians as knowledge workers who are given significant latitude to make clinical decisions without unnecessary administrative encumbrances or delays

> Consistently apply one or more of the improvement sciences (Lean, Six Sigma, operations research, agile, design thinking) in consultation with front-line staff to improve workflow and reduce delays, waste, inefficiency, and job skill mismatches

> Expect all leaders, but especially senior executives, to do periodic job shadowing of front-line staff (where observing and deep listening are emphasized) in lieu of "rounding" (a largely ineffectual, if widely practiced activity)

> Create and require leader standard work (LSW).

> Develop and deploy a sophisticated, deeply ingrained, and rigorous daily management system (DMS) supported by visual display boards or monitors

> Judiciously invest in AI/ML solutions -- selected, tested, and endorsed by front-line staff -- that eliminate or at least markedly reduce data entry, administrative requirements, and/or repetitive tasks that are non-value add

> Support near-continuous optimization and remediation of the EHR (there's no such thing as "it's all set")

> Get rid of superfluous or outdated policies, procedures, redundant approvals, and other stupid stuff (GROSS)


Ready to transform your hospital or workplace?


Are you frustrated by mistrust or even adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation Clinicians feel toward the C-Suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.

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