On May 1, 2017, ANA Enterprise launched a bold initiative—Healthy Nurse, Healthy NationTM (HNHN) Grand Challenge—to transform the health of our nation by first improving the health of its 4 million RNs. As we go to press, more than 117,000 individuals and 510 partner organizations have joined this exciting movement.
Year in Review
What is HNHN?
This grand challenge focuses on improving the health, safety, and wellness of nurses and nursing students, leading them to be more effective role models, advocates, and educators.
- connects and engages individuals and organizations to act within five domains: physical activity, rest, nutrition, quality of life, and safety
- provides a web platform to inspire action, cultivate friendly competition, provide content and resources, gather data, and connect nurses, nursing students, employers, and organizations.
When participants join, they create a profile page, make a health commitment, join challenges, engage in discussion, access resources and blogs, and take a health-risk appraisal (HealthyNurse® Survey)—all available on the interactive HNHN Connect platform. A private Facebook community and text-to-join option are also available. Nurses and nursing students can be chosen or nominated for #healthynurse spotlights that showcase their wellness journey in blog, social media, and newsletter content. Contests for health and wellness prizes are offered.
Newsletters go out monthly in two groups, one for HNHN partners and another for HNHN individual participants. Newsletters emphasize hot topics in HNHN social media and discussion boards. Relevant wellness news stories and announcements are shared. Nurses’ and nursing students’ stories are showcased, as well as the health initiatives offered by their employers, organizations, and schools.
This second annual report summarizes HNHN’s activities as well as statistical analyses of nurse and nursing student respondents’ data related to the five domains as part of the HealthyNurse Survey. Partners’ and participants’ stories are highlighted, and specific features of HNHN, such as awards, challenges, and new offerings are featured.
The electronic HealthyNurse Survey focuses on nurses’ health, safety, and wellness risks. Question categories include demographics, occupational health, employee and personal wellness, individual safety, and overall health. This institutional review board-reviewed survey takes about 15 minutes to complete. Participants receive their confidential results immediately in the form of an interactive heat map and link to the national average, ideal standard, and resources for most survey questions.
The HealthyNurse Index Score is a numeric representation of the heat map, based on the individual’s answers to specific questions. Since the survey is slated to reset later in 2019, this Index Score will allow for ease in comparing survey scores year to year. In the past 2 years, over 20,000 participants have taken the survey. The results in this report are based on data received between February 2, 2017, and May 28, 2019, for a total of 18,537 completed survey responses, with invalid responses removed. (Note: Participants could skip several of the questions.)
Most organizations can join HNHN at three different partnership levels: Connector, Collaborator, and Champion. All levels agree to share information about HNHN with their employees and encourage nurses to join; in return, organizations are recognized on hnhn.org. A fourth category, Catalyst, is available by invitation only. At the highest level of engagement, Champions are asked to make a specific commitment to their nurses and to set metrics for success. They submit quarterly progress reports and engage in the web platform. As an example, Integris Southwest Medical Center reports, “Integris is initiating an employee resiliency training program in 2019. We expect to see improvement in multiple domains of self-care including nutrition, physical activity, rest, safety, and quality of life. Our goal for 2019 is to increase the number of employees who complete the [HealthyNurse] survey.”
Champions’ successes are highlighted in blogs, social media, and the HNHN newsletter. Collaborators and Champions can receive quarterly organization-specific data reports. These data are pulled from participants’ HealthyNurse Survey results (de-identified) that are affiliated with their organization. At least 25 participants from the affiliated organization must take the survey to ensure anonymity of the aggregated, de-identified data before a report is issued. Partners find this data vital—Mayo Clinic Arizona (MCA) notes, “Being a Champion with ANA Enterprise in regards to HNHN gives MCA access to the health survey data from our own staff. We use this data to help focus future seminars on areas where we have seen a need for change. The survey data shows how the health of MCA nurses is compared to the health of the nation’s nurses. On future surveys we can use the data to see improvements in the health of MCA nurses.”
During late 2018, HNHN held the Partners All In Awards, made possible, in part, by Stryker. The winners, the Medical University of South Carolina and the New Jersey State Nurses Association, were those organizations that had the most employees and/or members join HNHN from July 16 through December 15, 2018. Honorable mentions included CarolinaEast and the Texas NursesAssociation.
In 2019, a half-day HNHN workshop was held at Emporia State University, Emporia, Kansas, for the university’s
nursing students and other local nurses. Participants learned about HNHN and put together their own self-care plan.
In addition, they shared their thoughts on what HNHN’s future direction and offerings should be.
Also in 2019, ANA Enterprise partnered with the American Association of Colleges of Nursing (an HNHN Catalyst partner) to launch the HNHN Student Ambassador program. This program is designed to increase nursing student and school of nursing participation in HNHN, to improve nursing student health, safety, and wellness.
Everyone’s a winner!
ANA Enterprise won the 2018 ASAE “Power of A” Silver Award for HNHN, recognizing the organizational work being done to advance the health of the nursing profession. Later that year, HNHN hosted the Join the Movement contest, which encouraged nurses to enroll in HNHN. The grand prize winner won an exercise bike. Hundreds of other HNHN participants won gift cards, delivery meal subscriptions, and other prizes. The HNHN e-store opened in 2018. It offers reasonably priced, attractive fitness wear and accessories, with bulk pricing available.
Although HNHN is designed predominately for nurses, it’s open to everyone and is free of charge. HNHN can be found on social media, including:
Join us at hnhn.org and text healthynurse to 52-886 to get challenge tips today. HNHN is an ongoing initiative of ANA Enterprise.
From the community
Physical activity remains the most popular commitment domain for Healthy Nurse, Healthy NationTM (HNHN), with nurses pledging to increase the amount and duration of their exercise. Several challenges, supported by Humana, addressed physical activity, including Move More! (focused on tips for boosting daily activity), Move 4 a Cause (participants used activity to support causes they felt passionate about), and the Renew Challenge (designed to renew both mind and body). Nurses’ comments on the Move More! Challenge included:
- “I feel great, exercise is medicine.” — CEM
- “Patients are encouraged and inspired when they see wellness in action.” — JS
- “So I did it!!!! The goal was 750,000 steps from Oct 1, 2018, to January 31, 2019. I made 751,904!!!!! GOAL!!!!!!!!” — RR
Here are suggestions from experts and your nurse colleagues to boost your physical activity.
- Strengthen your muscles and prevent bone and muscle loss with resistance training. Consider resistance bands, free weights, weight machines, and classes. Learn more here.
- Get out into nature by taking up the Japanese practice of forest bathing. Turn off your phone and tune into the views, sounds, scents, and feel of nature.
- Start a wellness team at your organization. In addition to helping you be more active, you’ll build connections that can enhance your mental health.
“Currently, I have a goal to run a half marathon in all 50 states, and I have 18 more states to complete. You do not have to be a runner, but I encourage everyone I encounter to pick one activity and just do it. A mantra I say daily is ‘move something.’ As a result of my passion for physical activity, I became a group fitness instructor in June 2018, taught myself how to swim in December 2018, and started studying aqua fitness and body pump. I would like to bring others on this journey”
– Latonia Ford, MBA, BSN, RN (https://engage.healthynursehealthynation.org/blogs/13/3060)
“I paddleboard at least once or twice a week. It makes me want to see how much more I can push myself to go
faster and farther.”
– Lauren Rodriguez, RN (https://engage.healthynursehealthynation.org/blogs/13/3279)
Lauren has completed the longest nonstop paddling race in the world—more than once. Participants are allotted 88 hours to cover 340 miles.
“I was a bookish kid and not into sports. As I became an adult, I discovered I enjoyed exercising, biking, and swimming and incorporated those activities into raising young children. I became a nurse at 36 years old, and 2 years of night shift found me 25 pounds heavier and less active. A divorce became the impetus to hike, after trying alcohol and crying. My therapy of hiking a mountain became a love and now a necessity of life. Age 44 gave me a new love in my life and along with him, I discovered my passion for skiing! The message is it’s never too late to bloom!”
– Dionne Allen, BSN, RN (engage.healthynursehealthynation.org/blogs/13/2023)
Champion Partner spotlight
Stepping up for heart health
UT Southwestern Medical Center employees shattered their goal of the Heart Month 2 Million-Step Challenge. Not only did they hit the 2 million-step goal—they walked right past it to collectively walk an impressive 3,122,017 steps. More than 600 employees also participated in a 10-minute walk, held during a heart healthy fair, and over 3,275 employees actively participated in the 2018 Dallas Heart Walk. Read more at engage.healthynursehealthynation.org/blogs/24/3243.
University of Mississippi Medical Center (UMMC) nurses can take advantage of healthier lunch/vending options, discounted membership to several locally owned UMMC gyms, a local farmers market, and an employee health-improvement program. Learn more at engage.healthynursehealthynation.org/blogs/24/3059.
INTEGRIS Southwest Medical Center offers unique options in its reward-based wellness program, including a rowing team, couch to 5K, mind/body therapies, volunteering opportunities, and on-site fitness coaching. Employees also receive a 40% discount on all foods designated as Eat Well options and can access a Facebook page for employees to communicate, inspire, and strategize in their pursuit of health and wellness. Read more at engage.healthynursehealthynation.org/blogs/24/1922.
On the go
NewYork-Presbyterian/Weill Cornell Medical Center (NYP-WC) nurses Elizabeth Laporte, MPS, BSN, RN, NE-BC, and Shirley Ames, MS, RN, served as volunteers at the 2018 New York City Marathon. They provided crowd and runner control during the event and ensured that everyone was safe. Read more about NYP-WC activities at engage.healthynursehealthynation.org/blogs/24/3061.
Putting nurses’ health first
Humana is supporting three 2019 HNHN Challenges as it also supports its employees’ health, including the Go365 wellness and rewards program where members earn points for completing healthy lifestyle activities like preventive screenings and fitness activities. Other initiatives include earning WOW (Work On Well-Being) points, and Take 10 (10-minute activities sent during the workday to remind associates to take a break and work on some physical activity, mindfulness, meditation, or other health-related activity.) The company also has an annual 100 Day Dash Step Challenge, where associates across the enterprise work on increasing steps for 100 days. Find out more about Humana’s HNHN and wellness programs at engage.healthynursehealthynation.org/blogs/24/3275.
Quality of Life
From the community
Many Healthy Nurse, Healthy NationTM challenges focused on growing resiliency, including Stress Less, Renew, Get Your Gratitude On, and Bring in the Joy! Participants committed to making more time for themselves and doing those things that bring them happiness. Leaving work on time and taking breaks were key.
Participant suggestions for growing resiliency included, playing with children, spending time on enjoyable hobbies, and talking with trusted mentors, coworkers, friends, or family. Others noted that if the environment is too toxic, it’s time to move on.
A game changer
“Over the years, I would discover that health was more than the physical, it involved the emotional, the psychological, and the spiritual. I eventually decided to take my educational journey in nursing in a different direction when I enrolled in a master’s degree in narrative medicine at Columbia University. This program was a game changer, transforming the way I approached my life and my patients…. It allowed me to see parts of myself that had shaped my journey and showed me the qualities that made me unique.”
– Kimberly La Force, RN (engage.healthynursehealthynation.org/blogs/13/3254)
Art of nursing
“I took the HNHN challenge further by creating an HNHN Mosaic. This was an original life-size oeuvre measuring 18 feet by 7 feet. The artwork showcased favorite exercises and sporting activities of our Philippine Nurses Association of New Jersey Bergen Passaic Subchapter Executive Board (EB). Mindful words that resonate for each EB [member] were outlined along the shape of each person. The mosaic was displayed in the Philippine Nurses Association National Conference.”
– Jocelyn Espejo, BSN, RN, CCRN-CMC (engage.healthynursehealthynation.org/blogs/13/2425)
Champion Partner spotlight
Walking for wellness
The University of Texas MD Anderson Cancer Center tackles quality of life from a variety of perspectives through its WellNurse Program, including employee assistance, wellness-themed self-care baskets, and tranquility rooms with chair massages and mindfulness resources. These efforts have reduced staff call-off hours, and 80% of participants said the
program influenced them to make healthy lifestyle changes. Other activities include group walks. Read more at engage.healthynursehealthynation.org/blogs/24/3262.
Renewing for health
In the Renewal Center at the Hospital of the University of Pennsylvania, nurses can take a breather and recharge. Over a year, there were 22,000 visits by nearly 3,000 individuals to the center; most were for respite, meditation, computer use, and lactation. Read more at engage.healthynursehealthynation.org/blogs/24/2974.
At Northwell Health’s North Shore University Hospital, the interdisciplinary Team Lavender provides staff an opportunity for timely emotional, spiritual, and physical support. The team also can explore coping mechanisms and offer additional mental well-being resources as needed. Strategies were used to increase the use of Team Lavender over two quarters, doubling on five.
According to the HealthyNurse® Survey, the nurses’ average body mass index (BMI) is 28.5, which falls into the overweight category.
From the community
Nutrition is a popular commitment domain for Healthy Nurse, Healthy NationTM , with top pledges including controlling portions; reducing intake of nutrition-poor foods such as processed foods, sugar, and soda; ensuring adequate hydration; and embracing a plant-based or vegan diet. A popular challenge was Curb Your Sweet Tooth.
“I believe that each of us must pursue our own plan to lose weight and be healthier. What worked best for me was to journal my daily food intake and try to do some type of exercise 5 days a week. I use MyFitnessPal, which is a free app that allows me to track my food. For exercise regimen, I alternate between exercise videos and just plain walking. I lost 30 pounds in a year’s time and have managed to keep most of it off.”
– Pamela Cipriano, PhD, RN, NEA-BC, FAAN (engage.healthynursehealthynation.org/blogs/13/3179)
“We [my wife and I] always give ourselves a little treat at the end of the day. We know our bodies crave sugar, and we’ve never cut it out completely. We found options, like an 80-calorie ice cream treat, that fit… Anyone can do this.”
– Danny Jimenez, BSN, RN, CNRN, SCRN (engage.healthynursehealthynation.org/blogs/24/3218)
Danny lost more than 80 pounds on his weight-loss journey, which included a food diary and portion control.
“I had to learn to be happy in my journey, to be happy along the way, instead of only finding happiness in the end goal.”
– Denise Norris, RN (engage.healthynursehealthynation.org/blogs/13/3280)
Denise lost 235 pounds over 8 years; she now eats a plant-based diet.
Champion Partner spotlight
More fruits and vegetables
When the Medical University of South Carolina (MUSC) decided to focus on nurses’ nutritional health, they started offering takeaway, fresh, seasonal, locally sourced food items through its Simply-to-Go program (supported by Sodexo). The organization’s efforts paid off. Nurses tripled their daily consumption of fruits and vegetables, with 17% now consuming the recommended five servings and 72% consuming three or more servings. Read more at engage.healthynursehealthynation.org/blogs/24/2053 and engage.healthynursehealthynation.org/blogs/13/2225.
Innovative diet approach
The Kentucky Nurses Association offered conference attendees the opportunity to have APOE gene testing at a significant discount so they could receive a diet based on their genetics; 75 took up the offer. When a person fuels the body with the right combination of healthy fats, carbohydrates, and proteins based on APOE, inflammation is reduced, reversed, and prevented. Read more at engage.healthynursehealthynation.org/blogs/24/3151.
The HealthyNurse® Survey reveals a significant number of hazards for nurses at work.
Top 10 work hazards
Nurses reported they were at “significant level of risk” for the following (respondents could choose more than one):
Fortunately, those threats apparently don’t always result in action; 12% of respondents had been assaulted by a patient or a patient’s family member in the past year.
From the community
A popular safety challenge for Healthy Nurse, Healthy NationTM (HNHN) was No More Distracted Driving, with an emphasis on no more texting behind the wheel. Although 40% of HNHN respondents said they never text while driving, and 38% said they seldom do it, 19% admitted that they sometimes text while driving, and 3% said they nearly always or always do it. Avoid the temptation by turning off cell phone notifications and being prepared (for example, begin your playlist before starting to drive).
The challenge Don’t Get Stuck focused on avoiding sharps injuries. In all, 13% of HealthyNurse Survey respondents had sustained one or more sharps injuries within the last 5 years.
Other challenges included Celebrate Civility and #EndNurseAbuse. Access nurses’ thoughts on bullying here and review tips for addressing nurse abuse here. Remember to be aware of your surroundings at all times, and proactively diffuse or remove yourself from a situation that could become violent. Employers should implement and enforce a zero-tolerance policy for violence.
Leading in health
Peter Stoffan is a trained Pilates instructor, so it’s not surprising that he’s incorporated health into his leadership role as patient care director of the preop and postanesthesia care units at New York-Presbyterian/Weill Cornell Medical Center. Peter started Wellness Wednesdays, which have included nutrition, meditation, and aromatherapy, and launched Holiday Health Reset for a full week after Thanksgiving, which helps staff recharge for the continued holiday season. Most, if not all, of Peter’s health initiatives are easy, cost little to nothing, require minimal planning, and can be incorporated into any unit.
– Peter Stoffan, MPA, BSN, RN, CCRN,NEA-B (engge.healthynursehealthynation.org/blogs/13/3063)
Champion Partner spotlight
Building healthy communities
Greater Baltimore Medical Center (GBMC) recognizes that building a healthier community starts with building their own employees’ health. As part of its Greater Wellness programs, it provides a fitness center for staff and offers many community wellness initiatives such as a flu shot drive and skin checks. Read more at engage.healthynursehealthynation.org/blogs/24/2377.
Keeping staff safe includes safeguarding their health at Regional Health in South Dakota. The organization makes it
easy for staff to engage in well-being activities by offering comprehensive resources that include an online portal and provides support for stopping unhealthy habits such as smoking. Caregivers can earn a Well-Being Contribution Credit after completing a series of voluntary steps. In addition, Regional Health has a robust, interdisciplinary network of approximately 85 Well-Being Champions from all five of their markets. The champions are an integral part in increasing participation, motivation, and visibility of the organization’s LiveWell programming. Read more at engage.healthynursehealthynation.org/blogs/24/1320.
Supporting nurses’ safety
The Maryland Nurses Association (MNA) has a practice and education committee workgroup that focuses on workforce issues. These issues can include, but aren’t limited to, nurse staffing, the work environment, and occupational safety and health. The committee collaborates with appropriate stakeholders, identifies and enlists subject matter experts, and analyzes current data trends on these topics. Read more at engage.healthynursehealthynation.org/blogs/24/2222.
The International Nurse Coach Association (INCA) has incorporated the HNHN mission into its strategic vision. The organization states that the five domains challenge integrative nurse coaches to engage in deeper self-reflection, self-assessment, self-evaluation, and self-care, and to embrace personal responsibility, integral to enhancing personal growth, overall health, and well-being. In addition, INCA points out that the domains lead to wholeness and healing, noting that healing is a lifelong journey of seeking harmony and balance. Read more at engage.healthynursehealthynation.org/blogs/24/2180.
From the community
The Healthy Nurse, Healthy NationTM Healthy Sleep Challenge encouraged nurses to get the rest they need, with increasing sleep hours topping the list of commitments related to rest. Visit the discussion on “What helps you get quality sleep” (engage.healthynursehealthynation.org/discuss/viewtopic/35/12) for ideas that can help you improve your resting potential.
You can use an action plan to help you start (or continue!) your own journey to health. Here’s an example of an action plan worksheet filled out for physical activity. Download a blank worksheet here.
“Healthy Nurse, Healthy NationTM started around the time when I started lifting weights. Because of my trainer and a new online nursing support system, I didn’t feel alone. Suddenly I had people around me who were dedicated to living a healthy lifestyle. I felt a new responsibility to myself—I need to eat right, work out, and sleep well to feel healthy.”
– Mary Alice Anderson, MS, RN, CNOR (engage.healthynursehealthynation.org/blogs/13/1771)
Champion Partner spotlight
Staying healthy under stress
In preparation for Hurricane Florence, the Pathway Taskforce at CarolinaEast Health System prepared goody bags for the nursing staff who would be staying in the facility throughout the storm. The goody bags contained treats such as fuzzy bedroom slippers, toiletries, and snacks. Each bag came with a handwritten note thanking the nursing recipient for his or her commitment to the health and safety of the New Bern community. The bags
were placed in the nurse sleeping quarters along with a mint on each pillow. Read more at engage.healthynursehealthynation.org/blogs/24/2684.