For 16 years, Kerry Appleton held her dream job as a pediatric ICU nurse, but the stress the work created eventually became too much to bear.
“I was crying at random moments,” Appleton said. “I’d be at an elementary school choir concert for one of my children and I’d start crying. I’d think of the parents I’d worked with who’d lost a child and would never be able to experience this kind of joy.” The trauma of working in a high-stress hospital environment wound her tighter than a spring. “If you’d tap me on the shoulder,” Appleton said, “ I’d go through the roof. I was just that tense.”
Appleton, who’d dreamed of being a nurse since she was a child, never thought that her work would one day take over her life in such a negative way.
“I decided when I was 6 that I wanted to be a nurse or a ballerina,” Appleton said with a laugh. “My ballet career ended early, so I was set on being a nurse from a young age. My grandmother, mom and several aunts were nurses. It made sense for me to do that, too.”
But her dream career came with nearly daily traumas, like the sudden death of a young patient during a summer internship when she was still in nursing school. Living through the aftermath of that incident — which included discovering her young patient in full cardiac arrest and profusely bleeding from a tracheotomy tube — was emotionally difficult, but Appleton figured that she had to tough it out if she was going to be a nurse.
“I decided I had survived his death,” she said. Though it hurt emotionally, Appleton recalled, “It didn’t kill me. I had endured this so early in my career, so surely I could endure whatever came my way.”
As the years went on, Appleton’s work-related traumas started to add up and her endurance faltered. And though she believed — along with most of her hospital colleagues — that trauma just came with the job, it eventually became too much. By the time her youngest child turned 3, Appleton realized that she needed to step away from the work that had defined her life for so long.
With a goal of putting “a little distance between the patient and myself,” Appleton enrolled in a graduate program in nursing leadership. When she finished, she was back at her hospital as an education specialist, helping new ICU nurses through the onboarding process. This close work with other health care professionals was a revelation: “It wasn’t just me,” she said. “I started recognizing how burned out all of our team members were, how much they were hurting.”
During a weekend course in critical incident stress management taught at a Bloomington firehouse, Appleton learned a difficult truth: First responders like EMTs and firefighters were much more sophisticated than health care workers in their response to work-related trauma. Staff at the firehouse offered more emotional support for their colleagues than anything she’d ever seen in her own workplace.
“I recognized that not only had I not been OK for several years, there was nothing wrong with me for not being OK,” Appleton said. “I was having normal reactions to the intense things I was seeing. No one at the hospital told me I was normal. I had sold myself on the idea that I was just broken. It was a pretty liberating experience to go through that course at the firehouse and see that I was never broken.”
Fired up from that workshop, Appleton created critical incident stress management programming for nurses at her hospital.
She wanted to bring stress reduction techniques like allowing teams to diffuse after a critical event to hospitals. “Hospitals need to be doing this work,” Appleton said. “Who’s taking care of us? Nobody’s taking care of us. We have to take care of ourselves.”
Building a ‘resiliency muscle’
Once she realized the emotional support gap that existed for health care workers, Appleton decided to make reducing that gap her life’s work. When she wasn’t working with nurses at her hospital, she started contracting with other health facilities, hosting listening sessions around the impact of COVID and what health care organizations could do to help their workers.
Health care workers and managers aren’t always easily convinced of the importance of this kind of work, Appleton said. And it requires a clear commitment to the process to make change stick.
“It’s not always easy to choose to eat salad. Picking the macaroni and cheese sometimes seems easier. It is hard to create new habits, even ones that are better for you, especially when you are feeling strained and tired.”
North Memorial Health Hospital, one of the hospitals that Appleton had contracted with, was particularly enthusiastic about her work. The large Minneapolis-based care provider had been focused on worker burnout even before the pandemic hit the state, and once COVID’s full impact was felt in their facilities, it became clear that a serious attitude shift needed to happen, said Chief Administrative Officer Samantha Hanson.
“We’re turning the idea that taking care of yourself is a sign of weakness in a health care setting on its head. The thinking is: You take care of yourself so you can take care of others.”
For too long, health care workers at all levels have been taking on stress without finding a release valve, Hanson said. This can only go on for so long until something breaks down.
“A caregiver just keeps putting little stones in their backpack and before they know it that backpack is weighing them down. Those terrible traumas, like the pandemic, those are boulders, but those little rocks, the ones that you pick up every day, people weren’t paying attention to. They were just carrying them around and they were becoming a terrible weight.”
Hanson said that she and her colleagues at North Memorial decided that they didn’t want to wait until every worker in their system was lugging around heavily laden backpacks. Something needed to be done to lighten their load.
“We realized we need to strengthen our resiliency muscle,” Hanson said. In June 2021, they created a new “resiliency coach” position, with a goal of leading up North Memorial’s efforts to create a culture focused on the mental health needs of all of the hospital’s workers as well as creating programming that supported the resilience of the system’s 6,400 employees.
When Appleton heard about the position, she didn’t feel daunted by it at all. In fact, she decided this could be her new dream job.
“The forethought around this position and the willingness to try something new was exciting,” she said. “North Memorial made a decision that they wanted to do something different and that really appealed to me.”
Hanson said that at North, the systemwide commitment to change is permanent. She and her colleagues decided to hire Appleton because of her demonstrated commitment, combined with the street cred earned from over a decade of work as a nurse in one of the most stressful areas of any hospital.
In her new role, Appleton oversees two programs. The first is HeartMath. She went through HeartMath-certified training with nine other employees. This group teaches their coworkers a series of mindfulness techniques that help provide emotional regulation by calming the heart. “Boiled down, it’s emotional regulation on the go,” Appleton explained.
The other program is North’s peer resilience program, a peer-support model where trained staff members meet with their colleagues to discuss stress, anxiety and resilience. It’s a win-win situation, Appleton explained: Volunteers “learn how to support a peer, but through the training they also get more in their toolbox for helping themselves and others.”
She also works with teams throughout the hospital and with individual employees to offer tips and trainings for reducing stress and building resilience. The one-on-one meetings are confidential and time in the sessions is paid.
Appleton freely acknowledges that she is not a mental health provider, but her years of experience help give her credibility with her peers. “I can say, ‘I’ve worked in some pretty tough spaces. That’s what drives me.’ When people build up a wall or say, ‘What you do is a bunch of crap,’ that doesn’t bother me at all.”
Even before COVID, Hanson said that North Memorial was working toward designing a benefits program that supported wellness. The pandemic threw fuel on the fire of what already was a highly stressful work culture, and she said that now having a role like Appleton’s in place is essential to a healthier future for everyone connected to the system.
“We are living through a time that has had an incredible impact to our health system,” Hanson said. “It’s not just COVID. It’s the increase in gun violence, the health-equity crisis that we have. We find ourselves in a community-focused health care system smack dab in the middle of all of that.”
Moving forward in a healthy manner requires bravery and true commitment to change, Hanson added. Health care workers have to take a different approach to self-care if they want to stay on the job and feel healthy. “There is no going back to a ‘Stuff it down’ culture. There is no way we’re going to undo the impact of these resiliency skills and what it has done for the mental health of our workforce.”
Appleton believes that for health care workers, making these kinds of changes and paying closer attention to their own overall health while at the same time caring for others is not only possible, it is essential.
“I don’t like to tease out mental health from physical health,” Appleton said. “I believe in ‘head-to-toe’ health and getting people in touch with their bodies. When people come to work they tend to check out of that awareness of their bodies as they are caring for other people. I’m trying to let them know we don’t have to make that sacrifice.”