I'M CAPTAIN ANN MARIE MATLOCK AT THE NATIONAL INSTITUTES OF HEALTH CLINICAL CENTER AND CO-CHAIR OF THE REGIONAL NURSING CONSORTIUM. I'D LIKE TO WELCOME YOU TO OUR WINTER EDUCATIONAL SESSION, JOURNEYS INTO NURSING RESEARCH. THIS WILL SHOWCASE NURSES AND SOME OF THE AMAZING WORK THEY'VE DONE. THE FOCUS OF TODAY'S PRESENTATION IS KNOW THYSELF, NURSES STRIVING TO UNDERSTAND EACH OTHER. THERE'S TWO TOPICS, FATIGUE IN REGISTERED NURSES AND THE IMPORTANCE OF RECOVERY PRESENT DR. ALLISON ROSS AND A TIME TO TALK, A TIME TO LISTEN AND A TIME FOR ACTION. THE FORMATION OF AN EQUITY, DIVERSITY AND INCLUSION COMMITTEE BY MS. CARE LINE FRAZIER AND SAYS EEL YA HENRY AND ALEXIS BRAXTON. THE PRESENTATION ON BEHALF OF THE NATIONAL INSTITUTE OF HEALTH AND THE CCND-WRNRC. FOUR TIMES A YEAR THE WRNRC OFFERS EDUCATIONAL OPPORTUNITIES. THE NEXT OPPORTUNITY AFTER TODAY WILL BE ANOTHER VIRTUAL ONE IN THE AFTERNOON OF FRIDAY, APRIL 16. THIS WILL BE THE DOCTORAL STUDENT RESEARCH CONFERENCE. THE KEY NOTE SPEAKER WILL BE THE DIRECTOR OF THE NATIONAL INSTITUTE OF NURSING RESEARCH. THE CALL FOR ABSTRACTS FOR CURRENT STUDENTS, RECENT GRADUATE WHICH IS IS IN THE LAST THREE YEAR OF NURSING OR HEALTH RELATED DOCTORAL PROGRAMS IS OUT NOW. THE DEADLINE FOR ABSTRACT MARCH 8 AND THREE OF THE ABSTRACTS WILL BE SELECTED FOR AN ORAL PRESENTATION AT THE DOCTORAL CONFERENCE. INFORMATION ABOUT THE ABSTRACTS WERE SENT OUT TODAY VIA E-MAIL. IF YOU HAVE ANY QUESTIONS ABOUT THE ABSTRACTS, YOU CAN CONTACT DR. GAZIO FOR THE DOCTORAL PROGRAM AT THE CATHOLIC UNIVERSITY OF AMERICA'S SCHOOL OF NURSING. HER E-MAIL IS LISTED OR YOU CAN REACH OUT TO ME. OUR CHIEF NURSE OFFICER WAS NOT ABLE TO BE HERE BUT WANTED TO BE SURE I WELCOMED ALL OF YOU. I'D LIKE TO INTRODUCE DR. ALYSON ROSS A NURSE SCIENTIST IN TRANSLATIONAL SCIENCE AT THE NIH CLINICAL CENTER AND GRADUATED FROM VANDERBILT. DR. ROSS RECEIVED A Ph.D. FROM THE UNIVERSITY OF MARYLAND SCHOOL OF NURSING AND AWARDED A PRE -DOCTOR -DOCTORAL INTRAMURAL TRAINING FELLOWSHIP COMPLETE A POST-DOCTORAL FELLOWSHIP IN 2014. HER EXPERIENCE INCLUDES PEDIATRICS, WOMEN'S HEALTH AND MENTAL HEALTH. IN ADDITION TO HER BACKGROUND IN NURSING AND RESEARCH, DR. ROSS RECEIVED A CERTIFICATE IN HEALTH COACHING FROM GEORGETOWN UNIVERSITY AND CERTIFIED AS AN IYENGAR YOGA INSTRUCTOR AND 200IYAT YOGA THERAPIST AND SHE TRESSES CAREGIVERS INCLUDING THE NURSING STAFF AND RESEARCHED AND PUBLISHED WIDELY ON THE IMPORTANCE OF HEALTH PROMOTING BEHAVIORS SUCH AS PROPER NUTRITION, PHYSICAL ACTIVITY, AND SOCIAL SUPPORT AND ALLEVIATING THE STRESS WITH CARE GIVING AND IN PREVENTING LIFESTYLE RELATED DISEASES SUCH AS CARDIOVASCULAR DISEASE AND DIABETES. DR. ROSS IS A MEMBER OF THE AMERICAN HOLISTIC NURSES ASSOCIATION AND THE INTERNATIONAL ASSOCIATION OF YOGA THERAPISTS. THE TITLE OF HER PRESENTATION IS FATIGUE IN REGISTERED NURSES THE IMPORTANCE OF RECOVERY. PLEASE WELCOME DR. ROSS. >> THANK YOU. IT'S AN HONOR TO BE HERE TODAY. I WORK FOR THE DEPARTMENT OF NURSING RESEARCH AND TRANSLATIONAL SCIENCE AND A WORK CLOSELY WITH DR. LAY NA LEE WHERE WE FOCUS ON CANCER CAREGIVERS AND STRESS, COPING AND SYMPTOMS IN CAREGIVERS AND CARDIOVASCULAR DISEASE RISK. FAMILY CAREGIVERS ARE AT INCREASED RISK FOR CARDIOVASCULAR DISEASE AND BECAME INTEREST WHETHER IT WAS A DIRECT RESULT OF THE STRESS OF CARE GIVING OR DID IT HAVE SOMETHING TO DO WITH THE FACT STRESS CAREGIVERS WERE LESS LIKELY TO ENGAGE IN SELF CARE AND THINGS LIKE DIET, EXPERT AND STRESS REDUCING ACTIVITIES AND SUCH. IT WAS NATURAL FOR KNOW SHIFT THE FOCUS FROM FAMILY CAREGIVERS ON TO PROFESSIONAL CAREGIVERS, THE NURSING STAFF BECAUSE NURSES ARE STRESSED, ALL OF US OUT HERE KNOW THIS. THERE'S A LOT OF REASONS AND A LOT OF HAS BEEN WRITTEN ON THIS AND A LOT OF HAS TO DO WITH THE UNFAVORABLE WORK SCHEDULES AND THE SHIFT WORK THAT NEVER ENDS. THERE'S BEEN A LOT OF RESEARCH OUTSIDE OF NURSING TO LOOK AT WHAT MAKES A WORKPLACE STRESSFUL AND I'M GOING TO USE THE TERM STRESS AND STRAIN INTERCHANGEABLY BECAUSE THE TERM THAT'S USED OFTEN WHEN YOU LOOK AT WORKPLACE STRESS IS CALLED WORKPLACE STRAIN. ONE OF THE MOST FAMOUS MODELS THE DEMAND, CONTROL, SUPPORT THEORY OF WORKPLACE STRAIN. IT SAYS ALL THESE THREE FACTORS CONTRIBUTE TO WHETHER OR NOT A WORKPLACE IS HIGH STRAIN OR LOW STRAIN. AND IF YOU LOOK AT THIS DIAGRAM IT'S REALLY NICE, THE FRONT TOP SHOWS HEALTHY WORK WHICH IS HIGH CONTROLLED JOBS WITH EITHER LOW OR HIGH DEMANDS. THE ACTIVE WORK, HIGH DEMANDS, HIGH CONTROL CAN BE STRESSFUL BUT ALSO VERY STIMULATING. AS LONG AS YOU HAVE THE CONTROL IN THERE AND DEMANDS DON'T GET TOO HIGH IT'S ACTUALLY A VERY HEALTHY WORKPLACE. THE REAL DANGER GONE -- ZONE IS WHERE YOU GET HIGH DEMANDS AND LOW CONTROL AND ALL THESE NURSES OU THERE THAT KNOW THAT DEFINES NURSING WORK. THINK OF HOW MANY THINGS DEMANDS WE HAVE ON OUR TIME PARTICULARLY DURING THIS PANDEMIC AND HOW LITTLE WE CAN CONTROL MANY OF THOSE FARCTORS. LATER THE ORIGINAL MODEL HAD JUST DEMAND AND CONTROL AND LATER THEY FOUND SOCIAL SUPPORT PLAYS A KEY ROLE IN THAT IN THAT WE CAN TOLERATE A LOT IF WE DO IT COLLECTIVELY BUT IF INDIVIDUALS FEEL ISOLATED OR MARGINALIZED IT MAKES THE STRAIN OF WORK THAT MUCH MORE DIFFICULT. MY FIRST STUDY THAT I COMPLETED WITH THE NURSES WAS HERE AT THE NIH CLINICAL CENTER. I WAS VERY INTERESTED IN -- WE KNOW THAT THE NURSING WORKPLACE IS STRESSFUL. WE KNOW NURSES HAVE HIGH LEVELS OF OBESITY AND OVERWEIGHT AND KNOW IN WORKPLACES THAT WEIGHT IS CLOSELY TIED WITH STRESS. THE MORE STRESS THE LESS CONTROL YOU HAVE AND HIGHER YOUR WEIGHT IS THIS IS ACROSS MANY EPIDEMIOLOGICAL STUDIES INCLUDING IN ENGLAND. I AGAIN WANTED TO SEE IS IT JUST THE STRESS OR MAYBE THAT NURSES AREN'T PRACTICING HEALTH PROMOTING SELF CARE THOUGH WE HAVE ALL THE KNOWLEDGE IN THE WORLD HOW IMPORTANT THOSE ACTIVITIES ARE. A CROSS-SECTIONAL SURVEY OF NURSES HERE AND INTERESTING FINDINGS AND TWO PUBLICATION US CAN PULL TO READ IN DEPTH. THERE WERE SOME PRETTY HIGH LEVELS OF OVERWEIGHT AND OBESITY IN OUR NURSES AND 80% OF US WERE SEDENTARY MEANING WE SAT FOR THREE OR MORE HOURS PER DAY. SITTING IS THE NEW SMOKING. AND YOU CAN MEETING THE A.H.A. GUIDELINES FOR PHYSICAL ACTIVITY BUT IF YOU SIT THREE OR MORE HOURS PER DAY IT PRETTY MUCH WIPES AWAY THOSE GAINS YOU MAKE. SO IT'S VERY UNHEALTHY AND A LOT OF US DO. ONE OF THE MORE INTERESTING FINDINGS IS NURSES' PROFESSIONAL QUALITY OF LIFE THERE'S A CORRELATION BETWEEN HOW HAPPY THEY WERE IN THEIR JOBS AND SATISFACTION THEY DERIVED THIS IS A MEASURE OF COMPASSION/SATISFACTION WAS RELATED TO THEIR CONSUMPTION OF FRUIT AND VEGETABLES AND PARTICIPATION IN PHYSICAL ACTIVITY. NO THE HAPPIER THEY WERE, THE HEALTHIER THEY ATE, THE MORE THEY EXERCISED. THIS WAS A CROSS-SECTIONAL STUDY. YOU CAN'T SAY THERE'S ANY CAUSATION HERE AND I DON'T THINK IT CAUSES NURSES TO EAT MORE HEALTHY IF THEY LOVE THEIR JOB BUT I THINK NURSES WHO LOVE THEIR JOB VERSUS WHO HATE THEIR JOB GO HOME ENERGIZED AND IF YOU'RE ENERGIZED HAVE YOU THE ENERGY TO GO OUT AND EXERCISE AND PREPARE HEALTHY MEALS. SOME FINDINGS CONCERNED ME. FIRST THERE WAS A HIGH RATE OF SLEEP DISTURBANCES WHICH IS VERY COMMON IN NURSING AND ABOUT A THIRD OF THEM WERE SAYING THEY WERE MODERATELY TO SEVERELY FATIGUED. WE HAD SEVERAL OPEN-ENDED QUESTIONS WHERE WE ASKED NURSE BUR -- BARRIERS FROM HEDGE -- HEALTH PROMOTING ACTIVITIES AND OVER AND OVER WE HEARD I'M SO EXHAUSTED BY THE TIME I GET HOME FROM WORK I'M SO TIRED I CAN LAY DOWN ON THE COUCH AND MAYBE EAT A BOWL OF CEREAL OR BEN & JERRY'S AND WATCH TV AND THAT'S ALL THE ENERGY I HAVE. TOO WEARY FOR WORDS ANYMORE. THOSE FINDINGS LED OUR TEAM TO THE NEXT STUDY WHICH WHICH -- WAS TO LOOK AT FATIGUE IN NURSES AT THE CLINICAL CENTER. HERE WAS A TWO-PHASED STUDY AND THE AIM WAS TO LOOK AT THE LEVEL AND TYPES OF FATIGUE IN NURSE AND THEN AT WHAT FACTORS SEEMED TO CONTRIBUTE CROSS-SECTIONALLY TO FATIGUE. AND THIS IS THE MODEL WE USED. I'VE BEEN TOLD ON THE COMPUTER THIS NOT VERY CLEAR BUT BASICALLY WE USED THERE ARE PHYSIO LOGIC AND PSYCH LOGIC AND SOCIO LOGIC FOR SYMPTOMS OF FATIGUE AND WE RESEARCHED INSIDE AND OUTSIDE OF NURSING WHAT CONTRIBUTE TO FATIGUE. FATIGUE HAS BEEN EXAMINED IN A LOT IN RESEARCH BUT MOST HAS FOCUSSED SPECIFICALLY ON WORKPLACE FARCTS -- FACTORS LIKE HOURS OR SHIFTS AND WE KNOW FROM THAT RESEARCH LONG HOURS AND VARIABLE SHIFT IS THE KISS OF DEATH FOR A LOT OF BAD OUTCOMES SO WE KNEW WE HAD TO INCLUDE THOSE BUT WE KNOW THERE ARE PHYS PHYSIOLOGIC THINGS WITH PHYSICAL HEALTH OR A SLEEP DISTURBANCE THOSE THINGS CONTRIBUTE TO FATIGUE. THERE'S INTERESTINGLY PSYCHOLOGICAL FACTORS LIKE IF YOU'RE DEPRESSED YOU'LL BE MORE FATIGUED. THE WAY YOU COPE AND YOUR OUTLOOK ON THE WORLD IS ASSOCIATED WITH LEVELS OF FATIGUE AND WE INCLUDED THOSE AND NO ONE HAD REALLY LOOKED AT THAT BEFORE IN A NURSING POPULATION AS IT RELATES TO FATIGUE. THEN THERE ARE DOWN STREAM S FROM FATIGUE WE WERE GOING TO GET TO IN PHASE 2 AND WE ALL KNOW WHEN YOU'RE FATIGUED IT'S GOING TO IMPACT YOUR MOOD AND PERFORMANCE. YOU'RE GOING TO HAVE COGNITIVE PROBLEMS. YOU WON'T THINK AS CLEARLY BUT ALSO YOU WON'T BE MOTIVATED. THAT'S WHY THE NURSES WERE SAYING I HAVE TO GO HOME AND GET ON THE COUCH AND A JUST CAN'T GET UP BECAUSE YOU LOSE YOUR MOTIVATION. BUT IF YOU SEE WITH FATIGUE AND LIKE MANY OTHER SYMPTOMS, IT'S NOT A LINEAR RELATIONSHIP. IF YOU GO HOME AND YOU'RE EXHAUSTED AND YOU ARE MORE LIKELY TO SLEEP POORLY IT CIRCLES BACK AND YOU'RE MORE LIKELY TO SLEEP POORLY AND BE DEPRESSED AND COME BACK TO WORK THE NEXT DAY IN A WORSE MOOD, MORE LIKELY TO MAKE ERRORS AND MORE LIKELY TO GET INTO INTERPERSONAL CONFLICTS WITH YOUR PEERS. WE ALL KNOW THAT. IN PHASE 1 THESE ARE THE MEASURES WE LOOKED AT. THERE WERE A FEW OTHERS. BUT WE LOOKED AT ACUTE AND CHRONIC FATIGUE AND FOR FATIGUE WE USED THE MMSI NOT USED MUCH IN NURSING BUT WE LIKE THAT MEASURE BECAUSE IT ALLOWED US TO LOOK AT SUBTYPES OF FATIGUE WHICH HAS NOT BEEN EXAMINED MUCH IN NURSES. BEFORE WE EXAMINED FATIGUE, IF YOU THOUGHT OF THE WORD OF FATIGUE YOU THOUGHT OF PHYSICAL FATIGUE BUT THERE'S MORE AND WE SAW THIS IN OUR FAMILY CAREGIVERS, EMOTIONAL AND MENTAL FATIGUE WERE AS BIG A PROBLEM AS PHYSICAL FATIGUE IN THOSE CAREGIVERS. I WONDERED IF THAT MIGHT ALSO BE THE CASE WITH THE NURSING CAREGIVERS. FOR THE CHRONIC FATIGUE WE USED THE OFFER WHICH HAS BEEN USED A LOT IN NURSING AND THAT ALSO ENABLED US TO COLLECT INTERSHIFT WE COVERY WHICH IS HOW MUCH WE BOUNCE BACK FROM ONE SHIFT TO THE NEXT TIME WE COME INTO WORK. WE LOOKED AT HOURS AND YEARS IN NURSING PRACTICE AND ALL THE OTHER FACTORS THAT LOOKED AT PREVIOUSLY AND LOOKED AT NON-WORK DEMANDS ON OUR TIME BECAUSE WE BELIEVE THOSE THINGS LIKE COPING AND WORKPLACE STRAIN, THAT MODEL I TALKED ABOUT AND DEMANDS, CONTROL AND SUPPORT USING THE JCQ AND HEALTH INCLUDING SLEEP, OUTCOMES AND AND QUALITY OF LIFE USING PROMISE MEASURES. I WANT TO TALK ABOUT THE BRIEF COPE. WE LOOKED AT COPING AS POSSIBLY CONTRIBUTING TO FATIGUE IN NURSES BUT YOU SHOULD ALSO KNOW THAT MAY BE A DOWN STREAM IMPACT OF FATIGUE AND MAY CHANGE THE WAY YOU COPE. THE BRIEF COPE HAS 14 SUBSCALES OF THE WAYS PEOPLE COPE WITH STRESS. THE CREATORS OF THIS SCALE NOT REALLY JUDGE WHETHER THOSE WERE HEALTHY OR UNHEALTHY BECAUSE GIVEN THE CIRCUMSTANCES IT COULD BE BOTH AND LIKE SUBSTANCE ABUSE OR DISENGAGEMENT AND THERE MAY BE TIMES TO CHECK OUT IF YOU'RE UNDERGOING A SEVERE TRAUMA SO THE MAKERS NEVER DELINEATED THEM AS MALADAPTIVE OR ADAPTIVE BUT MANY RESEARCHERS OVER THE YEARS HAVE. SO WE USED THE GROUPING USED BY FURMAN AND THE COPING MECHANISMS ON THE RIGHT ARE CONSIDERED MALADAPTIVE AND THE LEFT CONSIDERED ADAPTIVE. SO WE LOOKED AT ADAPTIVE AND MALADAPTIVE COPING. AND THESE ARE COPING MECHANISMS WHEN STRESSED. I DO THES WHEN I'M SPREAD. I'M STRESSED. HERE'S OUR SAMPLE. IT'S VERY FEMALE, PREDOMINANTLY WHITE, NON HISPANIC AND VERY EDUCATED. THOSE NOT FAMILIAR WITH THE NIH CLINICAL CENTER IT'S A VERY EDUCATED NURSE STAFF. THAT MAKES US DIFFERENT THAN HALF OF THESE THESE HAVING A MASTER'S DEGREE OR HIGHER SO IT'S A UNIQUE PLACE TO WORK. ABOUT 44% IN DIRECT PATIENT CARE NURSES DELIVERING CARE AT THE BEDSIDE. THE OTHER HALF WERE WERE IN RESEARCH GOALS, RESEARCH NURSE COORDINATORS AND RESEARCH NURSES AND A LOT ARE INSTITUTE NURSES AND THEN THE REMINDER OF WHAT WE CALL LEADERSHIP IN ADVANCED PRACTICE TYPE ROLES OR ADMINISTRATION. ANN MARIE IS THE ADMINISTRATOR HERE. THE BEAUTY OF DOING RESEARCH WITH NIH NURSING CLINICAL CENTER IT'S ONE OF THE FEW PLACES I CAN THINK WHERE HALF OF OUR WORK STAFF IS NOT IN DIRECT PATIENT CARE THAT ALLOWS US TO DRAW COMPARISONS TO ALLOW NURSE TO WORK IN ONE TYPE OF ROLE VERSUS ANOTHER AND I DID THAT HERE. THE OTHER INTEREST THINGS ARE TO LOOK AT THE COMMUTE TIME. AN AVERAGE OF 78 MINUTES ROUND TRIP NOT SURPRISING GIVEN WE'RE WASHINGTON, D.C. AND SOME DO COMMUTE 45 MINUTES OR HALF THE NURSES COMMUTE 45 MINUTES EACH WAY EVERY DAY. THEN 50% OF US, ARE DOUBLE-DUTY CAREGIVERS. I ALWAYS WANTED TO IS THIS. PROVIDING CARE TO A CHILD, FAMILY MEMBER OR A SECOND SHIFT THAT STARTS WHEN THEY LEAVE THIS ONE. REMEMBERERING BACK TO OUR JOB STRAIN MODEL HEALTHY WORK VERSUS UNHEALTHY WORK. HERE THE JOBS ON THE BAR THE GREEN AND RED, THE GREEN IS THE ACTIVE JOB THAT'S THE STIMULATING HIGH DEMANDS, HIGH CONTROL. WE HAVE A LOT OF THOSE HERE AND THAT'S THE GOOD NEWS. IT'S A STIMULATING PLACE TO WORK. SO FOR THE MOST PART WELL OVER HALF THE NURSES WORK IN JOBS CONSIDERED HEALTHY SO IT'S A GOOD PLACE TO WORK BUT EVEN THERE LOOK AT THE DIRECT CARE NURSE ON THE BOTTOM ROLE AND THE PERCENTAGES OF HIGH STRAIN JOBS THE ORANGE COMPARED TO THE OTHER ROLES. WE LOOKED AT TOTAL ACUTE FATIGUE IN NURSE. WE LOOKED AT DIRECT CARE AND NON-DIRECT CARE NURSES TO SEE IF THERE ARE DIFFERENCES AND THERE ARE SIGNIFICANT DIFFERENCES. WHAT'S REALLY FASCINATING HERE THE NSFI HAS BEEN USED A LOT IN CLINICAL POPULATIONS AND ALSO IN HEALTHY POPULATIONS. THE MEAN OF OUR NON-DIRECT CARE NURSES IS SIGNIFICANTLY LOWER THAN NURSING PROVIDING DIRECT CARE, HOWEVER, THE MEANS ARE FOURISH AND THE AVERAGE WAS 17 FOR ALL OF OUR NURSES. ALL THE NURSES CLUGSD THE NON-DIRECT -- INCLUDING THE NON-DIRECT CARE HAS SCORES SIMILAR TO THOSE FOUND IN WOMEN UNDERGOING BREAST CANCER TREATMENT. THE NURSES AT THE BEDSIDE HAD TOTAL FATIGUE SCORES THAT WERE ABOUT THE SAME AS INDIVIDUALS UNDERGOING TREATMENT FOR INSOMNIA. THAT'S HOW EXHAUSTED WE ARE, ACUTELY EXHAUSTED. LOOKING AT THE BREAK DOWN OF THE SUBSCALES, YOU'LL SEE A COUPLE INTERESTING THINGS. THERE ARE SIGNIFICANT DIFFERENCES IN PHYSICAL FATIGUE BETWEEN THE NURSES PROVIDING DIRECT CARE AND NOT, THAT'S NOT SURPRISING. THE NURSES AT THE BEDSIDE ARE WORKING PHYSICALLY MORE DEMANDING JOB AND LEVELS OF EMOTIONAL AND MENTAL FATIGUE ARE NO DIFFERENCES AMONG THE NURSES AND EMOTIONAL FATIGUE -- I SAID WHEN I THINK FATIGUE I THINK OF PHYSICAL FATIGUE BUT IT'S NOT THE MOST PROBLEMATIC FATIGUE FOR THE NURSES. IN FACT EMOTIONAL FATIGUE WAS AS PROBLEMATIC FOR BOTH GROUPS AND MORE PROBLEMATIC FOR THE NON-DIRECT CARE NURSES. THIS SANE ISSUE AND NOT ONE I'VE SEEN ADDRESSED MUCH IN THE RESEARCH. THESE ARE LEVELS OF CHRONIC FATIGUE AND HERE'S SIGNIFICANT DIFFERENCES. THE DIRECT CARE NURSES ARE MORE LIKELY TO EXPERIENCE CHRONIC FATIGUE THAN OUTSIDE OF DIRECT PATIENT CARE AND THOSE LEVELS OF FATIGUE IN OUR NURSES LOOK LIKE CHRONIC FATIGUE SEEN IN OTHER NURSE IN OTHER POPULATIONS ALL OVER THE COUNTRY. THOUGH THIS IS A GREAT PLACE TO WORK THERE'S STILL ISSUES WITH CHRONIC FATIGUE. THESE ARE THE RESULTS OF THE REGRESSION MODELS THAT LOOKED AT AND MODELS ASSOCIATED WITH EACH TYPE OF FATIGUE. THERE'S INTERESTING THINGS HERE. IT'S NOT SURPRISING THAT SLEEP WAS ASSOCIATED WITH ALMOST ALL THE TYPES OF FATIGUE EXCEPT CHRONIC FATIGUE INTERESTINGLY. BUT INTERSHIFT RECOVERY BOUNCING BACK FROM ONE SHIFT TO ANOTHER HAD THE BIGGEST EFFECT SIZE ON ALL THE TYPES OF FATIGUE EVEN THAN SLEEP. SO IT WAS REALLY IMPORTANT. MALADAPTIVE COPING KEPT SHOWING UP AGAIN AND AGAIN SOMETIMES AS A BIGGER CONTRIBUTOR THAN SLEEP AND INTERESTINGLY THE MODEL OF WORKPLACE STRAIN, DEMAND, CONTROL, SUPPORT DECISION LATITUDE IS THE MEASURE OF CONTROL THEN PSYCHOLOGICAL DEMAND AND SUPPORT AND ALL THINGS CONTRIBUTED TO CHRONIC FATIGUE AND THEY DIDN'T ALL CONTRIBUTE TO THE SUBTYPES OF ACUTE FATIGUE BUT THAT'S WHAT THE DEMAND, CONTROL, SUPPORT SHOWED IT WAS ASSOCIATED TO BE WITH FATIGUE AND THIS IS ALL CROSS-SECTIONAL SO YOU CAN'T SAY CAUSATION. NOT SURPRISINGLY NURSES WHO WORK HIGHER HOURS HAVE HIGHER LEVELS OF FATIGUE AND HAVE MORE PHYSICALLY TIRED AND THE DOUBLE-DUTY CAREGIVER SHOWED UP WITH TOTAL FATIGUE SCORES AS A CONTRIBUTOR. WHEN WE PLANNED THIS STUDY, WE INCLUDED IN OUR SHIFT RECOVERY BECAUSE WE KNEW WE HAD, TO I THOUGHT OF IT AS ANOTHER LIKE THE FLIP OF FATIGUE JUST THE OPPOSITE OF FATIGUE. BUT RECOVERY IS A REAL THING. THERE'S A WHOLE LINE OF RESEARCH AND THIS TAG IS PROBABLY THE MOST FAMOUS RESEARCHER WHO LOOKS AT THIS TOPIC AND RECOVERY IS THE PROCESS OF REPLENISHING THE DEPLETED RESOURCES SO FATIGUE IS LACK OF RECOVERY AS OPPOSED TO PART OF THE CONCEPT. IT'S A PROCESS WHERE THE SHORT-TERM WORK STRAIN IS ALLEVIATED SO IT DOESN'T BECOME THE DOWN STREAM CHRONIC FATIGUE WHERE THERE WILL BE POSSIBLY LONG-TERM IMPAIRMENTS IN HEALTH AND COGNITION AND MOTIVATION. RECOVERY, IF YOU LOOK AT THE RESEARCH, IT CONSISTS OF RECOVERY EXPERIENCES AND RECOVERY ACTIVITIES. SO RECOVERY ACTIVITY THE THINGS YOU DO, RIGHT, LIKE EXERCISE OR TAKING AN ART CLASS, SOMETHING THAT YOU DO TO RECOVERY. AND RECOVERY EXPERIENCES ARE WHAT YOU'RE EXPERIENCING WHEN YOU DO THE ACTIVITY. SO AN ACTIVITY MIGHT BE RECOVERY ACTIVITY BUT IF YOU'RE NOT NOT THINKING WITH WORK AND SAY YOU'RE WALKING AND RUMINATING ABOUT WORK, IT'S NOT REALLY A RECOVERY EXPERIENCE. THE KEY IS YOU HAVE TO DETACH FROM WORK AND THE WHOLE CONCEPT OF DETACHMENT FROM WORK. SO IT'S INTERESTING, DETACHMENT THERE WORK IS PSYCHOLOGICAL DETACHMENT AND THEY CAN'T DETACH WEN THE WORKPLACE STRAIN GETS SCO HIGH. -- SO HIGH. AND SOMETIMES THEY RETURN E-MAILS ON NIGHTS AND WEEKENDS AND ANOTHER EXAMPLE IS YOUR LUNCH TIME OR BREAKS HOW MUCH DO WORKING LUNCHES WE SIT AT OUR DESK AND WORK. THERE'S NEVER ANY TIME, PHYSICAL TIME AWAY AND IF THERE'S NOT PHYSICAL TIME AWAY THERE'S NOT PSYCHOLOGICAL TIME AWAY. IF YOU WORKED IN A PLACE THAT REALLY AND THERE'S WAYS TO MOVE UP IN THE ORGANIZATION AND RECOGNIZE YOU AND YOU HAVE REALLY GOOD SUPPORT THEN YOU KNOW YOU CAN TAKE A LOT OF STRAIN BUT IF YOU HAVE A LACK OF SUPPORT AT WORK OR WORSE THERE'S ANIMOSITY AND WORKPLACE STRAIN BETWEEN YOU AND ANYONE, DOESN'T MATTER WHETHER IT'S A SUPERVISOR OR PEER, IT JUST MAKES IT SO MUCH WORSE AND SO MUCH HARDER AND THOSE PEM CAN'T LET GO -- PEOPLE CAN'T LET GO WHEN THEY COME HOME. IT'S ALSO KNOWN THERE ARE FACTORS WITHIN THE PERSON THEMSELVES THAT CAN CONTRIBUTE TO YOUR LACK OF ABILITY TO AND IF YOU HAVE NEGATIVE AFFECT AND IN OTHER WAY TO SAY THIS BUT A BAD ATTITUDE YOU'RE LESS LIKELY TO DETACH FROM WORK AND THIS IS INTERESTING RESEARCH IF YOU ARE HEAVILY INVESTED IN YOUR WORK IT'S HARD TO DETACH BECAUSE SO MUCH OF YOUR IDENTITY SO CLINGING ALL THE TIME TO IT IS NOT HEALTHY. AND THE MORE JOB STRAIN YOU HAVE, THE MORE YOU NEED TO RECOVER YET THE LESS YOU WILL RECOVER. SO THERE'S A PARADOX THAT THE HIGHER THE STRESS THE LESS LIKELY YOU ARE TO DETACH FROM WORK. AND YOU WILL NOT SLEEP VERY WELL. YOU MAY COLLAPSE IN BED COMATOSE BUT YOU'LL WAKE UP AT 2:00, 3:00, 4:00 IN THE MORNING AND WILL NOT GO BACK TO SLEEP AND ALL THOSE THINGS HAVE TO DO WITH NOT DETACHING OR RECOVERING. AND ME MORE WE NEED IT THE LESS WE DO. WHAT CAN BE DONE. THERE ARE A LOT OF THINGS WHICH WE CAN DO. -- I WANT TO GO BACK TO ONE THING, WHY? WHY DO WE NOT? WHY DOES THAT HAPPEN? THERE ARE A LOT OF THEORIES ABOUT WHY INDIVIDUALS CAN'T -- DON'T THAT ARE PARTICULARLY STRESSED CAN'T DETACH BUT ONE THAT REALLY RESONATES WITH ME IS THAT IF YOU'RE ALWAYS ON ALERT, YOU'RE ALWAYS IN DANGER SO EITHER BECAUSE OF ALL THE STRESS AT WORK YOU'RE ALWAYS GOING THEN THE PHYSIOLOGY OF YOUR BODY CHANGES AND YOU LITERALLY CAN'T -- IT'S HARD TO TURN THAT OFF PHYSICALLY. THE OTHER THING IS YOU'RE MIND WHEN YOU BECOME STRESSED BECOMES VELCRO TO A STRESSOR. LIKE TEFLON TO LIKE I'M NOT GOING LISTEN TO THAT AND FOCUS JUST ON THE NEGATIVE. WE'LL CLING TO THOSE THINGS AND THERE'S A PHYSIOLOGICAL REASON BECAUSE IF YOU'RE AN DANGER YOU NEED TO FOCUS ON THAT TO GET OUT OF IT AND WE'RE FIGHTING OUR BODIES. OUR BODIES ARE SAYING I DON'T WANT TO STOP THINK THIS BECAUSE I'M IN DANGER AND WE'RE -- COMING OUT OF THAT IS VERY DIFFICULT. SO THERE HAS BEEN RESEARCH. THERE WAS A RECENT REVIE OF THE LITERATURE ON -- RECENT REVIEW OF LITERATURE ON RECOVERING NURSES AND KNOW THERE'S MORE WORK TO BE DONE IN THE AREA FOR RESEARCHERS OUT THERE THAT FIND IT INTERESTING. THERE'S SO MANY AREAS THAT HAVE NOT BEEN LOOKED AT. WE KNOW THE HIGH DEMANDS THAT SHIFT RECOVERIES IF YOU WORK UNTIL MIDNIGHT OONTD -- AND COME BACK AT 7:00 A.M. IS HARD TO RECOVER. AND BREAKS. TAKING BREAKS. AND IT MEANS GETTING OFF THE UNIT AND GETTING AWAY FROM YOUR DESK, NOT WORKING AND EATING EVERY DAY BUT STEPPING AWAY FOR 30 MINUTES AND NOT THINKING ABOUT WORK, GETTING YOUR MIND OFF OF IT AND DOING SOMETHING DIFFERENT. AND THERE'S BEEN THIS VERY GOOD REVIEW BY VERBATE THAT LOOKS AT RECOVERY INTERVENTIONS AND YOU CAN PULL THESE AND LOOK AT WHAT HAS BEEN DONE. SOME ARE SIMPLE. THEY CAN BE INCLUDING SLEEP HIGH HYGIENE AND RELAXATION TRAINING. PHYSICAL ACTIVITY IS A POTENT FATIGUE RECOVERY ENHANCER BECAUSE IT NOT ONLY -- THERE'S SUCH A THING CALLED POSITIVE AND NEGATI NEGATIVE AFFECT. EXERCISE NOT ONLY REDUCES NEGATIVE AFFECT LIKE IT GETS RID OF YOUR BAD MOOD BUT ACTUALLY INCREASES YOUR POSITIVE AND MAKES YOU HAPPIER. IT'S A GOOD RECOVERY STRATEGY AND THAT'S WHY THINGS LIKE LAYING ON THE COUCH AND EATING BEN & JERRY'S ARE PASSIVE RECOVERIES DON'T WORK WELL. YOU'RE NUMBING BUT NOT PSYCH PSYCHOLOGICALLY DETACHING AND NOT UPPING THE ENDORPHINS AND GIVING YOURSELF A MORE POSITIVE AFFECT. RECOVERY TRAINING, STRESS MANAGEMENT. YOGA. I'M GOING TO GET MY PLUG IN FOR YOGA. PHYSICAL YOGA. MINDFULNESS PRACTICE HAS RECEIVED SOME ATTENTION WHEN IT COMES TO RECOVERY OUTSIDE OF NURSING. WE'VE NOT REALLY DONE THIS MUCH FOR NURSING AND INDEED THEY CAN WORK BECAUSE WHAT THEY DO IS THOUGHT SUBSTITUTE. IF YOU'RE THINKING A NEGATIVE WORK THOUGHT WHICH A LOT OF US DO AND THEN IF YOU CAN SUBSTITUTE ANY THOUGHT THAT CAPTURES YOUR ATTENTION, YOU GET THAT PSYCHOLOGICAL DETACHMENT AND SO MINDFULNESS WILL DO THAT SO YOU CAN FOCUS ON YOUR BREATHE AND BODY SENSATION AND FOCUS ON WASHING YOUR HANDS. THAT HASN'T BEEN LOOKED AT IN NURSING AS IT HER PAINS TO RECOVERY -- PERTAINS TO RECOVERY SO IT'S AN INTERESTING AREA FOR RESEARCH. AND THEN MORE ACTIVE FORMS OF YOGA WHICH WOULD ACT AS NOT ONLY A STRESS REDUCER BUT ALSO AS EXERCISE IT'S GOING TO RELEASE ENDORPHINS AND INCREASE YOUR POSITIVE AFFECT. THERE ARE ORGANIZATIONAL CHANGES THAT CAN HAPPEN, PARTICIPATORY CHANGES, BREAKS. REAL BREAKS NOT JUST GOING OFF THE UNIT AND HAVING A PHONE WHERE THEY CAN REACH YOU AND THAT TYPE OF THING AND CHANGES IN WORK LOAD, THOSE THINGS CAN ENHANCE RECOVERY. SO IN CLOSING I WANT TO SAY I'M SURE YOU ALL HAVE QUESTIONS SO FEEL FREE TO E-MAIL ME HERE IF YOU HAVE QUESTIONS OR COMMENTS OR THOUGHTS. I WANT TO THANK MY RESEARCH TEAM, OUR RESEARCH TEAM WHO WORKED VERY HARD. IT'S QUITE A CHALLENGE THAT WE REALLY ENJOY EACH OTHER AND THERE'S A LOT OF WORK PLIS SOCIAL SUPPORT THERE. AND THANKS TO DOCTORS AND NURSES AT THE NIH CLINICAL CENTER WHO TOOK THE TIME TO TAKE THIS SURVEY EVEN WHEN THEY'RE TIRED. THANK YOU. >> THANK YOU VERY MUCH, DR. ROSS. OUR NEXT SPEAKERS ARE MS. FRAZER, MS. HENRY, AND MS. BRAXTON. CAR CAROLINE FRAZIER IS A NURSE CONSULTANT FOR THE NURSING OPERATION SERVICE AT THE NATIONAL INSTITUTE OF HEALTH CLINIC CENTER AND CO-CHAIR OF THE NURSING DEPARTMENT FOR EQUITY, DIVERSE COUNCIL AND HAS 13 YEARS IN DIRECT-PATIENT CARE AND CARE COORDINATION AND QUALITY IMPROVEMENT AND PATIENT SAFETY. IN HER LEADERSHIP ROLE AT THE NIH, SHE WORKS TO LINK DATA TO THE BEDSIDE BY EMPOWERING NURSES AND LEADERSHIP TO UTILIZE DATA TO IMPROVE NURSING PRACTICE. SHE HAS TRAINING FOR HEALTH CARE AND CAROLINE IS PASSIONATE ABOUT IMPROVING THE QUALITY, DELIVERY AND ACCEPTABLE OF HEALTH CARE FOR MARGINALIZED POPULATIONS. AT THE YALE SCHOOL OF NURSING HER PROJECT HAS FOCUSSED ON DEVELOPING A DIDACTIC AND EXPERIENTIAL NURSING AND HOLDS A MASTER HES OF SCIENCE FROM THE UNDERSTAND OF BALTIMORE. SHE IS A MEMBER HONOR SOCIETY, AMERICAN NURSE'S ASSOCIATION, AND THE MARYLAND ASSOCIATION OF HEALTH CARE EXECUTIVES. CECILIA HENRY SAY SERVICE EDUCATOR FOR THE ONCOLOGY AND CRITICAL CARE SERVICE AT THE NIH WHERE ALONG WITH HER EDUCATION, LEADERSHIP RESPONSIBILITIES SHE SERVES AS CO-CHAIR OF THE NIH NURSING DEPARTMENT EQUITY AND DIVERSITY COUNCIL AND PART OF THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES AND THE AMERICAN NURSES ASSOCIATION WHERE SHE SERVED IN THE DEPARTMENT OF GOVERNMENT AFFAIRS AND THE MARYLAND NURSING ASSOCIATION WHERE WHERE SHE SERVED AS A MEMBER OF THE LEGISLATIVE COMMITTEE WITH EXPERIENCE IN EDUCATION, LEADERSHIP AND CLINICAL NURSING SHE BRINGS SEASONED INSIGHT FROM HER PRACTICE IN DIVERSE SETTING AND INTERESTS INCLUDE CRITICAL CARE, HEALTH PROMOTION, HEALTH POLICY AS IT RELATES TO HEALTH DISPARITIES. SHE OLDS A BSN FROM SOUTHERN ADD VEN TEST UNIVERSITY AND MANAGEMENT FROM THE UNIVERSITY OF MARYLAND. HER ACADEMIC HONORS INCLUDE MEMBERSHIP IN PHI KAPPA PHI HONOR SOCIETIES. ALEX IS A BRAXTON IS WITH THE NIH CLINICAL CENTER. SHE HAS A CLINIC BACKGROUND IN EMERGENCY NURSING HAVING SERVED AS AN EMERGENCY NURSE AT THE WALTER REED NATIONAL MILITARY MEDICAL CENTER AND VARIOUS DEPARTMENTS. FROM 2011 TO 2016 SHE WAS THE NURSE EDUCATOR FOR MED STAR GOOD SAMARITAN HOSPITAL AND WORKED AT THE NOTRE DAME OF MARYLAND UNIVERSITY. CURRENTLY COORDINATOR FOR THE NURSING DEPARTMENT BASIC LIFE SUPPORT RENEWAL AND ORIENTATION PROGRAMS IN ADDITION TO VARIOUS NURSING EDUCATION AND PROFESSIONAL DEVELOPMENT ACTIVITIES. MS. BRAXTON EARNED HER SCIENCE OF NURSING FROM THE MARYLAND SCHOOL OF NURSING IN 2006 AND MASTER'S OF SCIENCE AND NURSING WITH A FOCUS IN NURSING EDUCATION FROM THE NOTRE DAME OF MARYLAND UNIVERSITY IN 2014. SHE'S A CERTIFIED EMERGENCY NURSE AND MEMBER OF THE ASSOCIATION FOR NURSES AND PROFESSIONAL DEVELOPMENT AND THE MARYLAND ORGANIZATION OF NURSE LEADERS. MS. BRAXTON IS THE 2021 PLEASE WELCOME MS. FRAZIER, MS. HENRY AND MS. BRAXTON. >> THANK YOU FOR THE KIND INVITATION HERE TODAY. A TIME TO TALK, A TIME TO LISTEN, AND A TIME FOR ACTION. THE FORMATION OF EQUITY, DIVERSITY AND INCLUSION COMMITTEE. OUR PRESENTATION OBJECTIVES TODAY ARE TO DESCRIBE HOW THE HISTORY OF RACIAL INEQUITIES IN HEALTH CARE CONTRIBUTES TO HEALTH CARE DISPARITIES AND DESCRIBE HOW SOCIAL UNREST DURING THE SUMMER OF 2020 OPENED CONVERSATIONS ABOUT EQUITY, DIVERSITY AND INCLUSION, EDI AT THE NATIONAL STAT INSTITUTES OF HEALTH AND IMPORTANCE OF EDI COUNCILS WITHIN HEALTH CARE ORGANIZATIONS AND YOU'LL BE ABLE TO PROVIDE A FRAMEWORK FOR LEARNERS TO IMPLEMENT AN EDI COMMITTEE IN YOUR WORK ENVIRONMENT. WE HAVE A PAINTING OF WHAT IS THE FATHER OF MODERN GYNECOLOGY AND IT'S THE ONLY KNOWN REPRESENTATION OF THREE ENSLAVED WOMEN WHO SIMS OPERATED ON ACCORDING TO THE AMERICAN HISTORICAL ASSOCIATION. WE'LL DISCUSS MORE ABOUT DR. SIMS LATER IN THE PRESENTATION. I'D LIKE TO SAR A QUOTE WITH YOU FROM BIRD AND CLAYTON FROM 2001. RACISM IN MEDICINE, A PROBLEM WITH ROOTS OVER 2,500 YEARS OLD SAY HISTORICAL CONTINUUM THAT CONTINUALLY AFFECTS AFRICAN AMERICAN HEALTH AND THE WAY THEY RECEIVE HEALTH CARE. RACISM IS AT LEAST IN PART RESPONSIBLE FOR THE FACT THAT AFRICAN AMERICANS SINCE ARRIVING AS SLAVES HAVE HAD THE WORSE HEALTH CARE, THE WORSE HEALTH STATUS AND THE WORSE HEALTH OUTCOMES OF ANY RACIAL OR ETHNIC GROUP IN THE UNITED STATES. MANY FAMOUS DOCTORS, PHILOSOPHERS AND SICIENTISTS OF EACH HISTORICAL ERA WERE INVOLVED IN CREATING AND PERPETUATING INFERIORITY IN STEREOTYPES AND SUCH THEORIES WERE ROUTINELY TAUGHT IN MEDICAL SCHOOLS IN THE FIRST HALF OF THE 20th CENTURY. THAT'S A QUOTE FROM BIRD AND CLAYTON FROM 2001. LET'S REVIEW A BIT WITH THE PAST. AS NURSES IN RESEARCH WE'RE ALL FAMILIAR WITH THE INFAMOUS TUSKEGEE EXPERIMENT. IT WAS ORIGINALLY PROJECTED TO LAST ONLY SIX MONTHS WENT ON FOR 40 YEARS ENDING IN 1972 WHICH IS WELL WITHIN THE LIFE SPAN OF A LOT OF YOU LISTENING TODAY. CONDUCTED BY THE U.S. PUBLIC HEALTH SERVICE TREATMENT WAS WITHHELD FROM AFRICAN AMERICAN MEN FROM SYPHILIS AND BLAKE WOMEN WERE RECRUIT -- BLACK NURSES WERE RECRUITED TO EN GENDER TRUST AND THESE MEN WENT ON TO SPREAD SYPHILIS THROUGHOUT THEIR COMMUNITIES LEFT UNTREAT AND WE'RE FAMILIAR WITH THE CASE OF HENRIETTA LAKS PIECES OF THE TUMOR OF HER CERVIX WERE GIVEN TO A DOCTOR FOR CANCER RESEARCH. HELA CELLS WERE THE FIRST HUMAN CELLS TO SURVIVE AND THRIVE OUTSIDE THE BODY IN A TEST TUBE AND ARE USED IN LABS ALL OVER THE WORLD UNTIL TODAY PLAYING A ROLE IN NUMEROUS SCIENTIFIC DISCOVERIES INCLUDING THE DEVELOPMENT OF CORONAVIRUS VACCINES. NEITHER SHE NOR HER FAMILY WERE EVER COMPENSATED FOR HER CELLS. AND LAST, DR. JAMES SIMS WHO WE MENTIONED EARLIER. DR. SIMS HERALDED AS THE FATHER OF MODERN GIYNECOLOGY BUT WHAT MANY DO NOT KNOW IS HE PERFECTED HIS SURGICAL TECHNIQUE BY PERFORMING COUNTLESS OPERATIONS ON ENSLAVED AND WOMEN. THE WOMEN HAVE BEEN DESCRIBED AS SCREAMING AND CRYING AS A TEAM OF PHYSICIANS STOOD BY OBSERVING AND LEARNING MANY WOULD ANESTHETICS ONE WOMAN OPERATED ON BY SIMS OVER A DOZEN TIMES. THERE WAS A STATUE OF DR. SIMS RECENTLY REMOVED FROM CENTRAL PARK IN NEW YORK CITY AFTER PROTESTS. ONE SUCH PROTEST WITH TWO YOUNG WOMEN IN BLOOD STAINED GOWNS IS DEPICTED HERE. THEY STATED THEY WERE REPRESENTING LUCY, ANARCA AND BETSY. THAT BRINGS US TO THE PRESENT DAY. WHAT THINGS DO WE EXPERIENCE TODAY THAT HAD THEIR ROOTS IN HISTORY? THIS PAST JANUARY MR. DAVID BELL, 39 YEARS OLD THE DIRECT OF CENTRAL COUNTY FIRE AND RESCUE, DIED IN THE PARKING LOT OF A ST. LOUIS HOSPITAL. HE ALLEGEDLY WAS REFUSED TREATMENT THREE TIMES, THREE SEPARATE TIMES AND HAD RETURNED ONCE AGAIN FOR TREATMENT. HE COLLAPSED IN FRONT OF HIS WIFE FROM A HEART ATTACK. THE FAMILY IS ALLEGING AND SUING THE HOSPITAL FOR RACIALLY BASED LACK OF TREATMENT. ANOTHER SAD EXAMPLE WAS DR. SUSAN MOORE. SHE WAS A MEDICAL DOCTOR THAT ALLEGED LIVE ON SOCIAL MEDIA SHE RECEIVED INADEQUATE TREATMENT FOR COVID-19 BASED ON HER RACE IN AN INDIANA HOSPITAL AND DISCHARGED HOME WITHOUT PROPER TREATMENT AND LATER DIED OF COVID-19 COMPLICATIONS. THEN WE TALK A LITTLE BIT ABOUT OUR CORONAVIRUS PANDEMIC. DATA SHOWS COVID-19 IMPACTS BLACK, HISPANIC, LATINO AND NATIVE-AMERICAN POPULATIONS AT MUCH HIGHER RATES THAN THOSE OF THE WHITE POPULATION. HEALTH CARE PRACTITIONERS HAVE TO OVERCOME SEVERAL HURDLE INS HIGH RISK POPULATIONS. MISINFORMATION, DECADES OF MISTRUST OF HEALTH CARE AND GOVERNMENT INSTITUTIONS THAT WE HAVE PREVIOUSLY DISCUSSED HERE AND THEN FRESH TENSIONS AROUND DISCRIMINATION IN THE UNITED STATES. SO THIS BRINGS US TO THE SUMMER OF 2020 THAT WE JUST HAVE LIVED THROUGH. WITH THE DEATH OF MR. GEORGE FLOYD, THE ENTIRE WORLD WATCHED FOR 8:46 SECONDS AS THE LIVE DRAINED OUT OF THIS MAN. THIS DEATH AND OTHERS SPARK SOCIAL UNREST THROUGHOUT THE COUNTRY AND SOCIAL PROTESTS ALL THROUGHOUT THE WORLD. RECOGNIZING THE STRESS AND STRAIN AND TOLL IT WAS HAVING ON HER DEPARTMENT THE CNO OF THE CLINICAL NURSING DEPARTMENT HERE AT NATIONAL INSTITUTES OF HEALTH CLINICAL CENTER CLEARED HER SCHEDULE FOR SEVERAL DAYS TO HAVE FRANK TALK SESSIONS WITH ALL MEMBERS WITH THE NURSING DEPARTMENT OF WHAT WAS HAPPENING BOTH OUTSIDE AND INSIDE THE ORGANIZATION. AND TO HAVE SUGGESTIONS ON HOW TO HELP AMELIORATE THE AFFECTS OF RACISM ON HER SALVE AND SHE SAID, AND I QUOTE, I WANT YOU TO KNOW IMPLICIT BIAS AND EXPLICIT BIAS AND RACISM OF ANY KIND ARE NOT ACCEPTABLE IN OUR DEPARTMENT AND WE NEED TO HELP EACH OTHER FEEL SAFE IN VOICING CONCERNS AND EACH COMES FROM A DIFFERENT LIFE EXPERIENCE AND WE KNOW LITTLE ABOUT EACH OTHER. OUT OF THESE TALKS IT BECAME APPARENT THERE WAS AN YOU ARE GENT NEED FOR A CONDUIT TO ADDRESS EQUITY, DIVERSITY AND INCLUSION CONCERNS WITHIN THE CCND AND THE IDEA OF THE COUNCIL WAS BORN. ITS MISSION IS TO SERVE THE NIH CCND AS ACTION-ORIENTED CHANGE AGENT DEDICATED THE EQUITABLE TREATMENT, DIVERSITY AND INCLUSIVENESS. LET'S REVEAL A LITTLE BIT ABOUT THE SOCIAL DETERMINATES OF HEALTH AND MAKE SURE THERE'S HEALTH AND SOME DETERMINATES ARE DEPICTED HERE, ENVIRONMENT, ECONOMICS, SOCIAL RELATIONSHIPS, FOOD, EDUCATION, AND THEN HEALTH CARE. ALL AFFECT THE PATIENT AND HEALTH CARE PROVIDER AND WE'LL TALK ABOUT DEFINITIONS FOR CLARITY GOING FORWARD. THE FIRST FOR EQUITY. FOR THE PURPOSES OF THIS PRESENTATION IT'S RESOURCES AND THE NEED TO PROVIDER ADDITIONAL OR ALTERNATIVE RESOURCES SO ALL GROUPS CAN REACH COMPARABLE, FAVORABLE OUTCOMES. IN THE ILLUSTRATION IN THE SLIDE YOU SEE WITH EQUALITY ALL THE KIDS HAVE THE SAME RESOURCES TO BE ABLE TO LOOK OVER THE FENCE INTO THE PLAYGROUND HOWEVER, NOT ALL THE CHILDREN ARE ABLE TO SEE AND ONE IS DISABLED AND ALL THEY CAN LOOK AT IS THE FENCE. HOUR WITH EQUITY -- HOWEVER, WITH EQUITY ALL THE CHILDREN ARE GIVEN THE AS IT -- TOOLS THEY NEED TO SEE THE PLAYGROUND IN THE SAME WAY. DIVERSITY, DIVERSITY REFERS TO DIFFERENCE OR VARIETY OF A PARTICULAR IDENTITY. THE FRAMEWORK FOCUSES ON RACE. OTHER MARKERS LIKE GENDER OR SEXUAL ORIENTATION CAN BE ADDRESSED AS WELL. DIVERSITY MEASURES AT ENTITIES COMPOSITION. YOU SEE A BEAUTIFUL RAINBOW OF COLORS OF ALL TYPES. FINALLY INCLUSION. INCLUSION REFERS TO INTERNAL, PRACTICES AND POLICIES THAT SHAPE AN ORGANIZATION'S CULTURE AND SPEAKS HOW TO COMMUNITY MEMBERS OF A SHARED IDENTIFY EXPERIENCE AND YOU CAN SEE THE DIVERSITY YOU SEE MANY DIFFERENT COLORS AND SHAPES, PIECE OF A PUZZLE. INCLUSION OR INCLUSIVENESS IS BRINGING THOSE DIVERSE PIECES TOGETHER TO MAKE A BEAUTIFUL PICTURE. INCLUSION BENEFITS POPULATIONS REPRESENTED WITHIN AN ORGANIZATION. SPACES CAN BE INCLUSIVE OF PARTICULAR GROUPS WHILE STILL LACKING DIVERSITY OF OTHERS. MY COLLEAGUE WILL FURTHER DISCUSS I'LL PROVIDE AN OVERVIEW WHY EQUITY, DIVERSITY AND INCLUSION MATTER. ACCORDING TO THE PUGH RESEARCH CENTER BY 2040, 40% WILL BE NON HISPANIC WHITE. IT'S PROJECTED THE HISPANIC POPULATION WILL TRIPLE IN SIZE. LATINOS WILL ACCOUNT FOR 29% OF THE POPULATION AND BLACKS 13.4% AND ASIAN 9%. THIS CALLS FOR ORGANIZATIONS TO ENSURE DIVERSITY AND INCLUSION ARE ORGANIZATIONAL PRIORITIES. THE MEDICAL AND BIOMEDICAL AND NURSING COMMUNITY HAVE RESPONDED TO THE POPULATION BECOMING MORE DIVERSE. FOCUSSING ON INCREASING RACIAL AND ETHNIC GROUPS. RESEARCH DEMONSTRATE THE WORKFORCE MUST BE REFLECTIVE OF THE PATIENT POPULATION THEY'RE SURVEYING. -- SERVING. THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES IN THE AMERICAN MEDICAL ASSOCIATION MANDATED DIVERSITY TO ATTRACT STUDENTS FROM DIVERSE BACKGROUNDS AND RESULTED IN AN INCREASE IN FEMALE, BLACK AND HISPANIC STUDENTS. THE INSTITUTE OF MEDICINE'S LANDMARK REPORT CALLED FOR MORE RACIAL, ETHNIC AND GENDER DIVERSITY TO IMPROVE THE QUALITY OF CARE AND REDUCE HEALTH DISPARITY. AS A RESULT OF NATIONAL AND STATE LEVEL EFFORTS THERE'S BEEN AN INCREASE IN THE PERCENTAGE OF MEN IN NURSING. THIS ALSO PRESENTS NEW CHALLENGES AND OPPORTUNITIES FOR HEALTH CARE ORGANIZATIONS. IN ORDER FOR ORGANIZATIONS TO TRULY EMBRACE KEY PRINCIPLES OF EDI WORK THERE MUST BE A LEVEL OF INFORMATION OF BARRIERS. AS MY COLLEAGUE DESCRIBED BECAUSE OF THE HISTORICAL MISTREATMENT OF RACIAL MINORITIES THERE'S A LACK OF MISTRUST AMONG THE MEDICAL COMMUNITY WHICH MAKES THE STARTING POINT FOR CARE FOR MINORITY PATIENTS NOT THE SAME. IT IS ALSO IMPORTANT TO NOTE THAT EMPLOYEE AND STAFF WHO ARE ALSO MEMBERS OF MARGINALIZED POPULATIONS MAY ALSO EXPERIENCE BIAS AND MICROIMMIGRATIONS WITHIN THEIR WORK ENVIRONMENT. THERE'S ALSO LESS OPPORTUNITIES FOR PROFESSIONAL DEVELOPMENT AND MENTORING AND COACHING FROM MARGINALIZED POPULATIONS. IT'S ESSENTIAL THESE BARRIERS ARE ADDRESSED. HEALTH CARE ORGANIZATIONS MUST ALSO UNDERSTAND HOW EDI WORK IS VALUE ADDED RESEARCH FOUND HAVING DIVERSE TEAMS IN THOUGHTS, SKILLS, EXPERIENCES, RACIAL AND ETHNIC BACKGROUND CAN IMPROVE PROBLEM SOLVING AND INCREASE INNOVATION AND DIVERSITY SPECIFICALLY CAN ADDRESS HEALTH IN THE INEQUITIES AND ADVANCE SCIENTIFIC RESEARCH. HAVING AN INCLUSIVE ENVIRONMENT FOSTERS AN OPPORTUNITY FOR INDIVIDUALS TO BE WELCOME, RESPECT AND EMPOWERED HELPING TO ADVANCE THE MISSION AND ALSO MAXIMIZES EMPLOYEE ENGAGEMENT. THE KEY TENETS OF EDI LITERATURE INCLUDE DIVERSIFYING THE WORKFORCE AND ENSURING PRACTICES AND POLICIES TO ALLOW EMPLOYEE TO DO THEIR JOBS AND BELONGINGNESS. I'D LIKE TO SHARE OBJECTIVES OF THE COUNCIL. WE ESTABLISHED THESE OBJECTIVES BASED ON THE EDI PRINCIPLES. OUR FIRST IS TO FOCUS ON DIVERSIFYING THE WORKFORCE TO FOSTER SAFE ENVIRONMENT OF INCLUSION AND BELONGINGNESS AND TO ENHANCE AND PROMOTE PROFESSIONAL DEVELOPMENT OPPORTUNITIES TO ENGAGE STAFF IN EXISTING RESOURCES, TO CREATE SOCIAL ENVIRONMENTS TO LEARN ABOUT LIVED EXPERIENCES OF CCND STAFF MEMBERS AND TO PROMOTE AND CELEBRATE DIVERSITY WITHIN THE DEPARTMENT. THE MAJOR TAKEAWAYS IS HEALTH CARE ORGANIZERS MUST RESPONSE TO BECAUSE OF THE INCREASE IN DIVERSE POPULATIONS TO EDI WORK MUST ADDRESS BARRIERS EXPERIENCED BY PATIENTS AND BY STAFF AND EMPLOYEES. MOST IMPORTANTLY THEY MUST SEEK OUT LEADERS INTERESTED IN CHAMPIONING THE WORK. MS. BRAXTON WILL NEXT DISCUSS HOW TO FRAME YOUR COUNCIL. >> GOOD AFTERNOON AND THANK YOU. I'M GOING TO TALK ABOUT FRAMING YOUR COUNCIL, THEY'VE DISCUSSED HOW A HISTORY OF RACIAL INEQUITIES IN HEALTH CARE CONTRIBUTE TO HEALTH CARE DISPARITIES FOR MARGINALIZED COMMUNITY. THEY'VE DESCRIBED HOW SOCIAL UNREST DURING THE SUMMER OF 2020 OPENED CONVERSATIONS ABOUT EDI AT THE NIH CLINICAL CENTER NURSING DEPARTMENT AND THE IMPORTANCE OF EDI COUNCILS WITHIN HEALTH CARE ORGANIZATIONS. IN OUR EXPERIENCE, THERE'S CERTAIN KEY ELEMENTS TO SUCCESS. THEY ARE SECURING LEADERSHIP SUPPORT, PERFORMING A CURRENT STATE OF ANALYSIS AND PLANNING THE STRUCTURE OF YOUR COUNCIL, CREATE PROPOSAL TO PITCH TO STAFF AND KEY STAKEHOLDERS AND TAKING ACTION AND FINALLY ROUNDING EVERYTHING OFF WITH EVALUATION. OF IMPORTANCE TO NOTE, WHILE I'LL TALK ABOUT EACH STEP IN A CERTAIN ORDER THERE'S REALLY NO SPECIFIC ORDER. OUR BEGINNING STEPS WERE FLUID AND WE GAINED LEADERSHIP SUPPORT FIRST IN OUR CONVERSATIONS WITH DR. WALLIN AND THEN CREATE OUR PROPOSAL AND PLANNED THE STRUCTURE WE MET WITH DIFFERENT LEADERSHIP TEAMS AT DIFFERENT POINTS AND ALL VERY ORGANIC AND FLUID. WHEN STARTING YOUR COUNCIL OR COMMITTEE, ONE FIRST PRIORITY IS TO GAIN SUPPORT OF YOUR LEADERSHIP TEAM. WITHOUT LEADERSHIP SUPPORT, YOUR COUNCIL MAY NOT HAVE THE POWER TO ENACT THE CHANGE YOU WANT TO SEE. WE BELIEVE WHOLEHEARTEDLY THAT THE COUNCIL SHOULD BE A GRASS-ROOTS MOVEMENT EXACTING THE CULTURE CHANGE IS BEST ACCOMPLISHED WHEN THE PEOPLE WHO WILL BENEFIT THE MOST ARE ACTIVELY INVOLVED. HOWEVER, LEADERSHIP HAS A KEY ROLE IN ENSURING COUNCIL MEMBERS ARE SUPPORTED TO ATTEND MEETINGS, HAVE WORK TIME TO ACCOMPLISH ACTION ITEMS OF THE COUNCIL AND WOULD LIKE IT IF THE LEADERSHIP TEAMS WOULD SPREAD THE WORD ABOUT THE COUNCIL. HOW DID OURS FORM? OUR FIRST CONVERSATIONS WERE WITH OUR CNO, DR. GLEN WALLIN. HE SHARED OUR INITIAL PROPOSAL WITH THE CEO OF THE CLINIC CENTER R. GILLMAN AND CONNECTED US WITH OTHER IMPORTANT STAKEHOLDERS IN OUR CLINICAL CENTER SUCH AS OUR DEPUTY EXECUTIVE OFFICER. THIS ENHANCED OUR COUNCIL'S VISIBILITY AND FORMED RELAIONSHIPS WITH THE NIH OFF OF EQUITY, DIVERSITY AND INCLUSION AND THE AT THE DEPARTMENT OF HEALTH AND HUME ANSERVICES OF WHICH NIH IS ONE AGENCY. ONCE THE GENERAL IDEA OF THE COUNCIL WAS FORMED, WE PRESENTED TO OUR EXECUTIVE TEAM INCLUDING OUR SERVICE CHIEFS, SPECIAL ASSISTANT TO THE CNO AND CONSULTANT FOR EXTRAMURAL COLLABORATIONS. AFTER CONSIDERATION OF FEEDBACK PROVIDE THE EXEC TEAM, WE PRESENTED TO OUR NURSING LEADERSHIP TEAM WHICH CONSISTS OF NURSE MANAGERS, CONSULTANTS, EDUCATORS AND PROGRAM DIRECTORS AND RESEARCH TEAM MEMBERS. OUR NEXT STEP IS TO PRESENT TO OUR STAFF. AND THIS WILL TAKE PLACE DURING OUR MONTHLY NURSING PRACTICE COUNCIL IN JUST A FEW DAYS. SO CREATION OF OUR PROPOSAL AND CONVERSATION WITH OUR CNO. WE TALKED, WE ID ITTED, WE -- EDITED AND TALKED MORE AND EDITED AGAIN. ONCE WE HAD A FINAL PRODUCT IT WAS SHARED WITH OUR CLINICAL CENTER LEADERS. OUR PROPOSAL INCLUDING THE FOLLOWING ELEMENTS. THE BACKGROUND IS YOUR WHY. WHY WHAT IS BRINGING US TO THIS PLACE AT THIS TIME? YOUR OBJECTIVES, WHAT DO YOU PLAN TO ACCOMPLISH? STRUCTURE IS THE WHO. WHO ARE YOUR KEY STAKEHOLDERS? AND THE LEADS? DO YOU HAVE A STEERING COMMITTEE? WHAT DOES GENERAL MEMBERSHIP LOOK LIKE? AT THIS POINT YOU CAN INCLUDE THE RESPONSIBILITIES AND EXPECTATIONS OF THE DIFFERENT PEOPLE. ACTION ITEMS ARE THE HOW. MANY INITIATIVES -- EXCUSE ME, HOW WILL WE ACCOMPLISH THE OBJECTIVES. BUDGET IS ALSO A PART OF THE HOW. MANY INITIATIVES WILL NEED MONEY TO ACCOMPLISH. SOME CAN BE MINOR SUCH AS SENDING E-MAILS TO THE STAFF ON INTERESTING HISTORY MONTH FACTS AND THAT'S FREE BUT IT'S IMPORTANT. SENDING SOMEONE TO A CONFERENCE ON THE OTHER HAND ON EDI TOPICS IS ALSO IMPORTANT BUT WILL NEED FUNDING. YOUR EVALUATION METRICS WILL DETERMINE THE SUCCESS OF YOUR COUNCIL BUT CHOOSE WISELY BECAUSE YOU WILL NEED TO PLAN ACTION ITEMS IN BUDGET PLACED ON YOUR EVALUATION METRICS. BEST BUSINESS PRACTICES INDICATE THE NEED TO PERFORM A CURRENT STATE ANALYSIS OR CSA. A CSA IS A SNAPSHOT OF WHERE YOUR ORGANIZATION IS AT THE PRESENT TIME. IT CAN BE PERFORMED BY A VARIETY OF METHODS AND CAN HAVE SURVEYS, LISTENING SESSIONS, FACILITATE A DIALOGUE. FUTURE STATE PLANNING IS DETERMINING WHERE YOU WANT TO BE. FOR US, THIS IS REFLECTED IN OUR MISSION AND VISION. ONCE YOUR CSA IS COMPLETE YOU'LL NEED TO ANALYZE THE DATA AND COMPARE IT TO YOUR FUTURE STATE. CAREFUL REVIEW OF THE DIFFERENCES BETWEEN THE TWO IS CONSIDERED TO BE A GAP ANALYSIS. THAT GAP ANALYSIS WILL HELP PRI PRIORITIZATION AND BUDGETARY NEEDS AND WE PERFORMED AN INFORMAL CSA AND RELIED HEAVILY ON OUR OWN LIVED EXPERIENCES AND SUGGESTIONS FROM DR. WALLIN AS RESULT OF HER LISTENING SESSIONS FOR OUR DELIVERABLE. SOME CONSIDER BENCHMARKING WITH LOCAL ORGANIZATIONS WHEN DECIDING HOW BEST TO PROCEED. WITHIN HHS AND NIH WE HAVE PEOPLE ALREADY IMMERSED THIN THIS WORK AND WE DE TESTIFY TO THEIR EXPERT EASE. -- EXPERTISE. YOU PITCHED YOUR IDEAS AND ASSESSED YOUR SITUATION AND BEGUN ACTION ITEMS BUT THERE'S NO WAY YOU CAN MOVE THIS ALONE NOR SHOULD YOU TRY. WHO ARE THE PEOPLE TO CREATE CHANGE IN YOUR ORGANIZATION? THIS IS WHERE THE CHANGE MAKERS AND CHANGE AGENTS COME IN. A CHANGE MAKER MEANS ONE WHO DESIRES CHANGE IN THE WORLD AND BY GATHERING KNOWLEDGE AND RESOURCES, MAKES THAT CHANGE HAPPEN. A CHANGE AGENT IS DEFINED AS AN INDIVIDUAL WHO PROMOTES AND SUPPORTS A NEW WAY OF DOING SOMETHING WITHIN THE COMPANY. I THINK OF CHANGE AGENTS AS THE EARLY ADOPTERS. THE PEOPLE WHO EMBRACE CHANGES AND CHAMPION IT FOR STAFF MEMBERS. I THINK OF OUR STEERING COMMITTEE AS A CHANGE MAKER AND THE AGENTS AS THE CHANGE AGENT. THE COMMITTEE STEERING MEMBERS WERE CHOSEN FROM A VARIETY OF METHODS. SOME SUGGESTED BY OUR CNO, SOME SELECTED BASED ON OUR KNOWLEDGE OF THEIR WORK ETHIC AND BELIEF SYSTEMS. SOME WERE CHOSEN BECAUSE OF THEIR ROLES IN CCND. YOU'LL NEED TO HAVE THE RIGHT PEOPLE AT THE FABLE TO ACCOMPLISH THE GOALS OF YOUR COUNCIL. FOR EXAMPLE, ONE OF OUR GOALS IS TO SUPPORT RECRUITMENT AND RETENTION OF POPULATIONS AND HOWEVER, YOU DECIDE ON THE MEMBERS OF YOUR STEERING COMMITTEE, REMEMBER, OF UTMOST IMPORTANCE IS ENSURING ALL THESE PEOPLE HAVE THE PASSION TO DO THIS WORK. EDI CAN BE AN EMOTIONAL JOURNEY AND VERY TOUCHY SUBJECT FOR MANY PEOPLE. YOUR STEERING COMMITTEE MEMBERS WILL NEED TO DISPLAY COURAGE, THEY'LL NEED TO BE RESILIENT AND NEED TO BE APPROACHABLE AND GENUINELY INTERESTED IN DETERMINING ROOT CAUSES OF BEHAVIORS IN YOUR ORGANIZATION. VERY SIMILAR TO YOUR STEERING COMMITTEE MEMBERS THE GENERAL MEMBERSHIP SHOULD CONSISTENT OF PEOPLE PASSION NAL ABOUT THIS WORK -- PASSIONATE WITH ABOUT THIS WORK AND IMPACT THE LACK OF EQUITY, DIVERSITY AND INCLUSION. AGAIN, FEEL FREE TO FORMULATE THE EXACT STRUCTURE AS BEST FITS YOUR ORGANIZATION. AS A GRASSROOTS MOVEMENT, YOUR ENTIRE STAFF SHOULD BE INVITED TO ATTEND IN SOME MANNER. STAFF WHO ARE NOT ACTIVE MEMBERS MUST BE SUPPORTED IN THE PLACE WHERE THEY ARE. ALL STAFF SHOULD BE ENCOURAGED TO PARTICIPATE AND LEAD FROM WHERE THEY ARE. REMEMBER TOO THAT WHEN IT COMES TIME FOR INVITATION TO GENERAL MEMBERSHIP, LEADERSHIP SUPPORT AGAIN PLAYS A KEY ROLE. YOUR LEADERSHIP MUST BE ONBOARD TO ENCOURAGE STAFF TO PARTICIPATE AND BE SUPPORTIVE IN THEIR ENDEAVORS. NOW, LET'S THINK ABOUT PARTNERSHIPS. WHEN YOU THINK ABOUT PARTNERSHIPS YOU HAVE TO TAKE A BROADER LOOK AT YOUR ORGANIZATION. ARE THERE ANY EXISTING EDI STRUCTURES. IF SO, REACH OUT TO THEM, REQUEST MEETINGS, HAVE BRAIN STORMING SESSIONS TO DETERMINE HOW RELATIONSHIPS CAN BE MUTUALLY BENEFICIAL. AT NIH, WE HAVE AN OFFICE OF EQUITY, DIVERSITY AND INCLUSION. THERE ARE STRATEGIES FOR SPECIAL EMPHASIS PORTFOLIOS. WE LY HAVE AN ASIAN -- CURRENTLY HAVE AN ASIAN AMERICAN AND BLACK PORTFOLIO AND HISPANICS AND SEXUAL AND GENDER MINORITIES AND A WOMEN'S PORTFOLIO AMONG OTHERS. THROUGHOUT THE GOVERNMENT THERE'S ALSO EMPLOYEE RESOURCE GROUPS AND AFFINITY GROUPS WHICH WITH TO PARTNER THERE'S FEDERALLY EMPLOYED WOMEN AND ABILITIES PEOPLE WITH DISABILITIES OF ANY FORM, THERE'S BLACKS IN GOVERNMENT OF WHICH I'M A PROUD MEMBER AND GAY, LESBIAN AND OTHERS KNOWN AS GLOBE. THIS IS A SMALL AMOUNT OF THE GROUPS AVAILABLE FOR US TO PARTNER WITH. SO FIGURE OUT WHO ARE YOUR EXISTING POWER PLAYERS AND MEET UP WITH THEM. TALK, SHARE IDEAS, HAVE JOINT SPEAKERS AND ACTIVITIES. THE BIGGER FISH WILL USUALLY MAKE A GREATER IMPACT AND INCREASE THE VISIBILITY OF YOUR ACTION AND ACTION ITEMS ARE E-MAILS TO STAFF WITH INTERESTING HISTORY FACTS BASED ON MONTHLY OBSERVE ANSWERS, A BOOK CLUB AND JOURNAL CLUB AND RECRUITME RECRUITMENT FAIRES AND AN IMPORTANT PIECE IS DOING WHAT YOU SAY YOU WILL DO. PEOPLE WILL BASE THEIR EXPECTATIONS AND OPINIONS ON WHAT YOU SAY AND IF IT'S FOLLOWED UP WITH ACTION. YOUR EVALUATION. AT SOME POINT AFTER IMPLEMENTATION, YOU WILL NEED TO EVALUATE YOUR PROGRAM. LET'S THINK BACK FOR JUST A MINUTE. MAYBE IN YOUR GAP ANALYSIS YOU NOTICED RETENTION OF CERTAIN GROUPS IS LOW. YOUR OBJECTIVES AND ACTIONS WILL BE AIMED AT RETENTION RATES AMONG THAT GROUP. A METRIC WOULD BE TO INCREASE RETENTION OF SAY NATIVE AMERICANS BY 10% FOR A GIVEN YEAR. THE METRICS CAN BE VARIED. THEY CAN BE BASED ON EMPLOYEE RETENTION RATES. THEY CAN BE BASED ON STAFF SATISFACTION SCORES. MANY OF US IN NURSING ARE VERY FAMILIAR WITH THE NATIONAL DATABASE OF NURSING QUALITY INDICATORS. IN THE FEDERAL GOVERNMENT WE HAVE A SPECIFIC SURVEY FOR US IT'S CALLED FEVS, THE FEDERAL EMPLOYEE VIEW POINT SURVEY BUT USE WHAT MAKES SENSE FOR YOUR ORGANIZATION AND LOOK AT YOUR INTERVENTIONS. DOES ANYTHING NODE TO -- NEED TO BE TWEAKED OR CHANGED OR HOLD STEADY OR NEED SOMETHING NEW? TO SUSTAIN YOUR PROGRAM, EVALUATION AND INTERVENTIONS WILL NEED TO BE CONSTANTLY REVIEWED TO ENSURE YOUR COUNCIL IS MEETING THE NEEDS OF YOUR STAFF OR ELSE YOU'LL BE RIGHT BACK WHERE YOU STARTED. SO IN CONCLUSION, I'D LIKE TO LEAVE YOU WITH A QUOTE FROM THE LATE FRED HAMPTON. HE SAID, POWER ANYWHERE THERE'S PEOPLE. WHILE YOU MAY NOT AGREE WITH MANY HAMPTON'S POLITICS, I URGE YOU TO BE INSPIRED BY HIS WORDS. GAIN THE SUPPORT OF YOUR LEADERSHIP AND RALLY YOUR PEOPLE AND EXERCISE YOUR POWER TO EXACT CHANGE IN YOUR ORGANIZATION. HAVE A PLAN FOR SUCCESS AND DO WHAT YOU SAY YOU WILL. OUR CONTACT INFORMATION FOR ANY QUESTIONS IS HERE. IT'S CCND COUNCIL AND YOU CAN REACH US AT THAT EMAIL ADDRESS. THANK YOU AGAIN SO VERY MUCH FOR SPENDING TIME WITH US