Year in Review
Possibilities unlimited, indeed! Nurses are facing COVID-19, racial inequities, financial concerns, and an increasing public mental health crisis. But nurses are prevailing everywhere we look. Engaging with and participating in racial inequity protests, putting their lives on the line with pandemic screening and care, and doing what they do best—promoting wellness, advocating for all (particularly those most at risk), educating the public, healing the sick, delivering babies, and easing patients’ journey from this life to the next.
But all of this comes with a high toll on nurses’ health. That’s where ANA Enterprise’s Healthy Nurse, Healthy Nation™ (HNHN) comes in. As we enter our fourth year, our focus on transforming the health of our nation by first improving the health of its 4 million RNs continues.
HNHN is a free nurse health, safety, and wellness initiative that is open to all. We connect nurses, nursing students, employers of nurses, schools of nursing, universities, healthcare facilities, nursing organizations, and other stakeholders. We concentrate on five domains: physical activity, nutrition, quality of life, safety, and rest.
HNHN operates in many ways. Our main platform, HNHN Connect, is online. Here, participants can set up a home page, similar to other forms of social media. They post a health commitment, take a health risk survey, chat on discussion boards, access wellness resources, read timely blogs, participate in fun health challenges, and engage in contests with prizes. Nurses have the opportunity to be featured in our #healthynurse Spotlights, which are shared in blogs, social media, and other communications. You will see many of these Spotlights throughout this report; all are available at engage.healthynursehealthynation.org/blogs/13.
An additional popular option is our text-to-join campaign. By texting healthynurse to 52-886, you’ll receive our monthly challenge tips by text. Visit our social media platforms, and when you post, use #healthynurse!
Facebook: Healthy Nurse, Healthy Nation
Participants can now take the survey annually and compare results from year to year. Survey respondents can access a heat map graph of their responses, indicating whether they’re at no/low, medium, or high risk for certain health and safety hazards, and they can compare their results to national averages and ideal standards. Participants also can track their own wellness progress over time, making personal adjustments as needed. An Index Score, a numeric representation of responses to specific questions, is also provided. The information in this report is based on data received between May 29, 2019, and May 28, 2020, with 6,142 participant responses analyzed. The data set includes RNs, licensed practical nurses/licensed vocational nurses, advanced practice registered nurses, and nursing students (pre-RN licensure).
Our funders not only provide financial assistance for HNHN, but also make meaningful contributions to content and dissemination of developed resources.
“The nursing community and those of us who depend upon nurses for care must prioritize nurses’ mental and physical well-being as a vital part of the healthcare system. The health of nurses is critical to the health of all of us, which is why HNHN is a priority for the Foundation.” — Kate Judge, executive director, American Nurses Foundation
“Humana’s partnership with HNHN solidifies our focus and commitment to the health and well-being of our nurse community. HNHN provides support and resources for nurses to prioritize their own well-being and model a healthy lifestyle to be able to impact and influence the communities they serve.” — Joanie Howard, BSN, RN, CMCN, chief nursing officer, Humana
“CeraVe values the immeasurable work of nurses and is proud to support the American Nurses Association mission of improving nurses’ quality of life by partnering on the HNHN initiative. CeraVe believes skin health plays an important role in quality of life and recognizes that as nurses are on the frontlines of healthcare, so is their skin, facing irritation from constant hand washing, mask wearing and other factors. CeraVe is committed to giving the nurse community the recognition they deserve and the support they need.” — Caitlin King, marketing director, CeraVe
“The partnership between Compass One Healthcare and HNHN has catalyzed the development of valuable resources that support the health and well-being of all participating nurses. It is very exciting to see both of our organizations’ intellect and spirit come together to create lasting impact.”— Bobby Kutteh, chief executive officer, Compass One Healthcare
Partner organizations can join HNHN at no cost, with varying levels of participation. Our partners include healthcare systems and facilities, schools of nursing, universities, nursing organizations, other employers of nurses, and additional stakeholders. The highest levels are featured as Champion Spotlights in our communications and receive de-identified aggregated data reports quarterly once 25 or more participants take the HealthyNurse Survey and indicate affiliation with their organization. See more about partnership opportunities at hnhn.org. You’ll notice several Champion Spotlights throughout this report; access these and many more at engage.healthynursehealthynation.org/blogs/24.
In April 2020, HNHN began a partnership with Headspace to provide all HNHN participants with a free 1-year subscription to Headspace PLUS. More than 3,800 HNHN participants signed up for an account via the mobile app and have completed over 14,400 meditations for a total of 305,000 minutes. HNHN looks forward to a continued partnership with Headspace to support HNHN participants as they cultivate meditation, mindful eating, gratitude, and healthy sleep with guided exercises, sleepcasts, and more. HNHN participants can sign up here.
On January 23, 2020, the American Nurses Association’s (ANA’s) Board of Directors approved adding “financial health” to ANA’s healthy nurse definition. The definition now reads, “A healthy nurse actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, financial, personal and professional well-being. A healthy nurse lives life to the fullest capacity, across the wellness/illness continuum, as they become stronger role models, advocates, and educators, personally, for their families, their communities and work environments, and ultimately for their patients.”
For ANA Enterprise’s Year of the Nurse, HNHN contributed blogs on meaningful nurse recognition and the importance of nurses prioritizing their own well-being. The first week of ANA’s Nurses Month centered on self-care. For 5 days, a different #healthynurse Spotlight was featured on ANA’s and HNHN’s websites and social media channels.
HNHN and American Association of Colleges of Nursing are continuing their student ambassador program to expand HNHN participation with nursing students. Several of the ambassadors are featured in this report.
The future is looking bright!
COVID-19 and mental health
Past and present findings from the HealthyNurse® Survey and other nurse mental health research have shown that nurses struggle with significant stress, as well as anxiety and depression.
With mental health in mind, the American Nurses Association (ANA), at its 2019 Membership Assembly, moved to examine the issue of nurse suicide in the United States. HNHN was designated to take on this critical work with an emphasis on suicide prevention. In early 2020, with the help of volunteer subject matter experts, psychiatric nurses, researchers, and other interested nurses, HNHN launched the Nurse Suicide Prevention Committee. Bernadette Melnyk, PhD, RN, APRN-CNP, FAANP, FNAP, FAAN, and Judy Davidson, DNP, RN, FCCM, FAAN, cochaired the committee.
Later renamed the Strength through Resiliency Committee, the group took a pivot when COVID-19 struck. They developed and collated mental health resources for nurses in response to the unfathomable stress, anxiety, fear, isolation, depression, anger, and grief nurses were experiencing during the COVID-19 pandemic. A comprehensive blog, Mental Health Help for Nurses was created to assist nurses in crisis, helping to build resiliency, and giving nurses needed mental health resources. The committee is now working on a nurse suicide prevention website, which will be available at nursingworld.org.
Here are a few examples of our participants and partners supporting nurse mental health and fighting COVID-19.
HNHN Student Ambassador Sarah Oerther volunteered for the Missouri Disaster Medical Assistance Team. Subsequently, she was deployed for several weeks at a psychiatric prison that was experiencing a COVID-19 outbreak. Her faith and her family’s love and support, including this beautiful letter from her daughter, are getting her through these tough times.
Frances Akubuilo advises scrupulous self-care during these tough times, including incorporating a mindfulness practice like meditation or prayer into your daily routine. Linda Lowry advocates for lung health, which now has special significance as COVID-19 can damage the lungs. Before the pandemic, Linda Roney assisted her nursing school to stress less by collaborating with other disciplines such as public health, developing a holistic nurses retreat, and providing a laughter yoga session.
Ochsner Health System has been providing staff with meal tickets, emotional and social counseling, dedicated space for staff to decompress and restore during shifts, nurse-led resilience activities, sidewalk chalk messages, and coping resources. Even pre-COVID-19, pet therapy was popular.
The Hospital of the University of Pennsylvania (HUP), through Penn Medicine, launched a digital platform offering behavioral health and well-being resources for employees. Employees can complete targeted assessments that streamline content triaged to the right level and type of support. Resources include videos, meetings with a coach or peer, contact with a psychiatrist, and more.
And finally, North Shore University Hospital, Northwell Health, tells us, “Music has a way of improving our quality of life. For our 2020 Nurses Week, we had a mini concert series featuring our very own team members who performed at change of shift. This band was able to interact with our staff, lift spirits, and bring joy to those walking in and out of work. During a time when we could not be physically together, these performances brought us together in a different way.” Nurses have also taken brief moments to meditate, and staff have created flowers of hope for an art installation on the property.
Results from the HealthyNurse® Survey show that nurses could benefit from increasing their physical activity level.
From the community
Physical activity challenges for Healthy Nurse, Healthy Nation™ included Small Steps = Big Changes and Move More Now. Work (Out) From Home was a particularly important challenge, given the COVID-19 pandemic. All three challenges were powered by Humana. Suggestions from this challenge included using an app from a fitness gym and accessing YouTube fitness videos.
Nurses can be creative in how they keep physically active. Nearly 80 nurses responded to the Facebook post “Fellow nurses, what are your favorite ‘nontraditional’ ways to exercise?” Yoga, housework, and gardening made a strong showing. More unusual answers included trampolining, hula hooping, woodworking, and belly dancing.
Success spotlight #healthynurse spotlight
“The bulk of my patients have issues with something diet-related, like high blood pressure, obesity, or high cholesterol. My motivational strategy is to lead by example as far as what’s possible for them.” — Melvin Viney, APRN, FNP-BC, ENP-C
Mel can empathize with patients. Nine years ago, he was disabled for a year due to obesity, thoracic surgery, and radiation treatments. His health was on a downward slope, and he knew something had to be done. That “something” turned out to be biliopancreatic diversion with duodenal switch surgery. After the surgery, the weight began to fall off, which allowed Melvin to get active. He progressed from walking to biking and started making healthier food choices. Over a year and a half, Mel lost 250 pounds. He works hard to maintain his healthy lifestyle and serves as an inspiration to his colleagues and patients.
“Wellness training can include yoga and other holistic practices that are designed to offer tools that can help you to consistently focus on your physical, mental, emotional, spiritual, and environmental health.” — Frances Akubuilo, DNP, RN
A self-care video, developed as a product of Frances’s doctorate research, starts off with the question, “Nurses, how can we take care of our nation, if we don’t take care of ourselves?” She has dedicated her career to embracing the concept of integrating wholeness—physical, mental, emotional, spiritual, and environmental factors—into everyday nursing practice.
“We have to set the example for our patients and our families. We can’t tell our patients to lose weight when we’re standing in front of them overweight.” — Linda Lowry, RN
Ten years ago, when her son Michael passed away from an asthma attack at the age of 15, Linda used her grief as fuel on her journey to change. Gastric bypass surgery and a new, healthier lifestyle helped her shed more than 100 pounds. Her advocacy for lung health spurred her to complete the American Lung Association’s Fight for Air Climb at Presidential Towers in Chicago, where she climbed 180 floors and 2,340 steps. She supports other nurses in their quest for wellness, noting, “Try to live what you’ve learned as a nurse. Knowledge is power. Don’t give up.”
“People were amazed at my strength during treatment [chemotherapy and multiple surgeries related to breast cancer] and I credit it to starting a healthy life before I was diagnosed.”— Uniqua Smith, PhD, MBA, RN, NE-BC
Uniqua credits her efforts to improve her health before her diagnosis as the reason she avoided complications from her cancer treatments. She and three friends joined a fitness boot camp that consisted of weekly meal preps and at least 5 days of exercise. The friends used a social media app to facilitate accountability, and Uniqua used other apps to track her food intake and miles. She encourages everyone to “get your body in the best shape that you can in order to be strong enough to fight off any illness that may occur in your future.”
“While posting exercise pictures on social media, one of my nursing colleagues, Victoria Randle, sent me a private message. She wanted to discuss an idea. The idea has blossomed into a self-care initiative that we call Nurses 4 Ever Fit™! We host monthly fitness experiences in Atlanta, where our guests participate in fun, fitness, and fellowship!” — Cara Sevier, RN
Cara is committed to self-care and has coauthored articles to help others.
Pumpkin rock and roll
An innovative approach to encourage physical activity comes from the Wyoming Nurses Association (WNA). The association’s “Fall in love with Wyoming Pumpkin Run and Roll” event was designed to counter the effects of Halloween candy and to get nurses, families, friends, and communities to participate in activity, regardless of the weather and location. A live event is held at one location in the state, but those unable to attend are encouraged to log a 5k (treadmill, outdoors, biking, walking, jogging—no limitations) at their place and pace and to share their pictures on WNA’s Facebook page. Members have completed the event on the beaches of Mexico with a group of friends, family members have participated across state lines, and groups of nurses have gathered in other locations for their own live events. Proceeds from the event are used to fund three different scholarships.
Florida Atlantic University (FAU) integrates physical activity into study abroad programs. For example, one physically active component of the program in Guatemala is hiking volcanoes. On the home front, students and faculty engage in charity walks. These are just one component of a robust wellness program that includes an annual health fair that provides free flu shots and birth-control advice among other offerings.
Walking for health
Vanderbilt University Medical Center offers a wealth of wellness opportunities, including walking and step challenges, mindfulness breaks, and healthy food choices. The organization highlights how nurses can improve their health without creating additional burden, such as walking laps around the nurses’ station or outside around the building during patient lulls or downtime. Nurses can also access exercise bands at the stations.
On the road
Northwell Health makes HNHN a driving force to promote wellness across the health system. The organization’s physical activity initiatives include an employee fitness center, a mile-long indoor walking trail for when the weather is inclement, and team-based walking competitions (such as walking the distance from New York to Dublin and from New York to Rome). More than one-third of all employees have participated in a walking competition.
According to the HealthyNurse® Survey, nurses’ average body mass index (BMI) is 27.94, which falls into the overweight category.
From the community
Nutrition challenges for Healthy Nurse, Healthy Nation™ included one on hydration and Healthy Recipe Toolbox powered by support from Compass One Healthcare. The recipes focused on ancient grains, healthy snacks, plant-based foods, nonalcoholic beverages, and sustainability.
Success spotlight #healthynurse spotlight
“Having the structure of being able to log food, re-evaluate, and notice when I’ve done well and could do better is what made Weight Watchers successful for me.” — Jean Ivey, PhD, PNP-PC, FAANP ( Jean has maintained a healthy weight for over 15 years.)
“Educate yourself, especially when it comes to a weight-loss goal. Information is power, and it can help change the way you think and do certain things.” — Nikolay Zuyev, RN (Nikolay’s switch to a vegetarian diet resulted in a 65-pound weight loss over 4 years.)
“Lifestyle changes are not about dieting, but about long-term behavior change. Most people aren’t ready to jump in the deep end—changes should be more mellow over time.” — Aaron Stuber, BSN, RN, DipACLM (Aaron uses Positive Prescriptions to help patients make change. For example, rather than tell patients what they should remove from their diet, he helps them discover healthy options that could be added.)
“I want to get the word out that lifestyle changes students make now will make a difference long-term.” — Susan Indvik, BSN, RN (Susan started the Healthy Lifestyle Change Wellness Profile Check for those on the Dakota College campus, which focuses on lifestyle changes not simply weight loss.)
Northwell Health’s North Shore University Hospital hired Michelin-star chef Bruno Tison to revolutionize the role food plays in healthcare and revamp the hospital cafeteria. He incorporates produce grown at local farms, antibiotic-free chicken, beef, and milk, as well as a number of other changes, including teaching kitchens hosted by the chef to promote healthy eating.
Care for the caregiver
In this Ochsner Health System program, each “campus champion” collaborates with the chief nurse executive to develop events and initiatives that encourage nurse well-being, such as education, a website with health resources, and incorporation of self-care activities into meetings. Employees also can access the Ochsner Eat Fit app, which includes nutrition facts for Eat Fit–approved menu items at local restaurants and Eat Fit–approved recipes.
In response to the COVID-19 pandemic, Hospital of the University of Pennsylvania (HUP) nurses banded together to create a nonperishable food pantry for their fellow essential employees in need. Since its launch in May 2020, initiative has distributed more than 800 bags of food so that HUP employees stay nourished during this unprecedented time.
Quality of life
Most respondents (44%) to the HealthyNurse® Survey, rate their health as good (very good = 25%, fair = 22%), excellent = 5%, poor = 4%).
From the community
Many Healthy Nurse, Healthy Nation™ challenges addressed quality of life, including Mindfulness, Better Work-life Balance, and Screen Time Detox. The Meditate and Recalibrate Challenge, powered by Compass One Healthcare, encourages nurses to carve out some time, even if it’s for 5 minutes, to try one of the six types of meditation: Mindfulness, Spiritual, Focused, Movement, Mantra, and Transcendental.
Success spotlight #healthynurse spotlight
“So many nurses give, give, give but are unable to receive. Only to the measure that we ourselves are healed can we heal others.” — Mary Turner, RN (Mary, who hosts the annual Holistic Playshop & Wellness Retreat for nurses, notes that when you change your mindset, you change your life.)
“Before nursing school, I found that negative conversations were detrimental to my mental health. Now I try to stay as positive as possible.” — Matthew Padgett, student nurse (Matthew says it’s important to know what brings you joy and to make it a priority in your life.)
“Small steps forward can lead to the biggest impacts of your life.” — Adrianne Ewald-Peterson, BSN, RN (Adrianne has taken those small steps. After experiencing serious health problems compounded by childhood trauma and current stress, she replaced toxicity with real meaningful things, revamped her exercise program, and started eating better. She says her journey made her a “better mom and nurse.”)
Supporting students and faculty
School can be stressful. To mitigate the stress, Florida Atlantic University (FAU) has taken a multipronged approach that benefits students—and faculty. FAU has an outdoor labyrinth for walking, and yoga, tai chi, and reiki are offered in an on-site studio. The food court serves up nutritious meals, and a food bank is available for students experiencing food insecurity. Psychiatric services include a university mental health survey and an online class to identify depression and other disorders.
Members of UConn Campuses Chapter of the American Holistic Nurses Association enjoy outdoors options for keeping healthy. Forest bathing is particularly popular: Students use all their senses to truly experience nature. Yoga in the park provides another way to savor the outdoors.
At Ochsner Health System provides multiple ways to ease nurses’ stress, including stress management classes, health and wellness fairs, relaxation rooms, and foot massagers. And a nurse researcher measures nurses’ perceptions of work-related quality of life, which provides valuable insights.
The HealthyNurse® Survey shows that nurses face many hazards at work. Nurses reported they were at “significant level of risk” for the following (respondents could choose more than one):
From the community
As part of the Healthy Nurse, Healthy Nation™ Embracing Caregivers challenge, powered by EMD Serono, nurses shared with other caregivers best practices and resources on the importance of self-care for caregivers. Nurses are well-positioned to help safeguard caregivers against emotional, physical, and financial burdens. Another well-received challenge was Celebrate Civility, which encouraged nurses to take steps to making lasting positive changes in the workplace.
Success spotlight #healthynurse spotlight
“Of course, with certain illnesses like strep throat, an antibiotic is essential, but many times, we can alter our lifestyle to get better while avoiding antibiotics.” — Sarah Oerther, MSN, MEd, RN, FRSPH (Sarah also has a passion for immunization. She and her family celebrate when they get their annual flu vaccine by sharing a treat such as ice cream, while taking the time to discuss the importance of vaccination to keeping their community healthy.)
Preventing workplace violence
No one should feel unsafe at work. Unfortunately, workplace violence is one of the biggest challenges facing nurses working in the emergency department. The Emergency Nurses Association is committed to keeping nurses safe on the job. The association created a Workplace Violence Prevention education program for its members and uses email and social media to spread the message about mitigating violence.
ANA-Illinois set up Healthy Nurse, Healthy Nation-Illinois (HNHN-IL), which includes a private Facebook group and a dedicated committee. Representatives from six regions in the state collaborate to develop strategies for encouraging nurses to adopt healthy habits that lead to lifelong improvements in their health and well-being.
At Florida Atlantic University (FAU), safety is addressed through the distribution of whistles that can be used to call for help and reinforcement of security measures such as exit awareness and what to do in the case of an active shooter.
Adequate sleep is missing for many nurses, according to the HealthyNurse® Survey.
From the community
The Healthy Nurse, Healthy Nation™ Your Best Sleep Yet! Challenge, powered by Compass One Healthcare provided tips on healthy practices to enhance sleep hygiene.
• Eat sleep-friendly foods such as nuts and bananas right before bed.
• Make your bedroom a sleep sanctuary; for example, use room-darkening shades and read a calming book.
• Skip alcoholic beverages close to bedtime.
• Avoid blue light (from TV screens, tablets, and phones) before bedtime; use a filter or wear blue-light–blocking glasses if necessary.
• Meditate or exercise for 30 minutes before bedtime.
Many nurses weighed in, sharing their own tips, such as:
“I tried turmeric tea, stopped looking at my phone screen 2 hours before I went to bed, and I slept through the night.” — JudyAnn
“Even a 15-minute power nap (being sure to set an alarm!) in the middle of the day when I feel overwhelmed, cranky, or plain tired [is helpful].” — Melevine
Success spotlight #healthynurse spotlight
Carol Kight-Dufour, BSN, CCRN, CPAN, understands the role of exercise as it relates to sleep. She participates in endurance riding. It’s not unusual for her to ride anywhere from 25 to 100 miles on her mare, named Dixiegirl. The rides take anywhere from 6 to 24 hours. She says nurses should take breaks when needed and do something physical every day.