The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Communication Strategies & HIPPA
July 28, 2022
Special Considerations Related to Vulnerable Populations
July 28, 2022

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021)

466 pages | 6 x 9 | PAPERBACK

ISBN 978-0-309-68506-1 | DOI 10.17226/25982

Mary K. Wakefield, David R. Williams, Suzanne Le Menestrel, and Jennifer Lalitha Flaubert, Editors; Committee on the Future of Nursing 2020 2030; National Academy of Medicine; National Academies of Sciences, Engineering, and Medicine

National Academies of Sciences, Engineering, and Medicine 2021. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington, DC: The National Academies Press. https://doi.org/10.17226/25982.

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I believe that everything affecting our society affects nurses and that eventually will hemorrhage over

to the nursing profession.

³’HQHWUD�+DPSWRQ��51��GRFXPHQWDU\�ÀOPPDNHU�RI�Racism: The African American Nursing Experience Short Film

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Nurses’ health and well-being are affected by the demands of their work- place, and in turn, their well-being affects their work and the people they care for. As it has in so many other areas, COVID-19 has imposed new challenges for the well-being of nurses. But it also has offered opportunities to give nurses’ well-being the attention it deserves and to address the systems, structures, and policies that create workplace hazards and stresses that lead to burnout, fatigue, and poor physical and mental health. This issue will take on even greater urgency over the coming years as nurses are asked to assume a more prominent role in advancing health equity. For nurses to address the many social GHWHUPLQDQWV�WKDW�LQÁXHQFH�KHDOWK³IURP�KRXVLQJ��WR�YLROHQFH��WR�SRRU� DLU�TXDOLW\³WKH\�PXVW�ÀUVW�IHHO�KHDOWK\��ZHOO��DQG�VXSSRUWHG�WKHPVHOYHV�� Policy makers, employers of nurses, nursing schools, nurse leaders, pro- fessional associations, and nurses themselves all have a role in ensuring the well-being of the nursing workforce.

301

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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302 THE FUTURE OF NURSING 2020–2030

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THE FAR-REACHING IMPACT OF NURSE WELL-BEING

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 303

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A FRAMEWORK FOR WELL-BEING

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

304 THE FUTURE OF NURSING 2020–2030

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 305

THE STATE OF NURSES’ HEALTH AND WELL-BEING

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The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

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HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 309

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BOX 10-3 &29,’����DQG�1XUVHV·�+HDOWK�DQG�:HOO�%HLQJ

Nurses can struggle with determining how to uphold their professional ethical YDOXHV�LQ�WKH�FRQWH[W�RI�FRPSHWLQJ�REOLJDWLRQV�WR�SDWLHQWV��WKHLU�RZQ�IDPLOLHV��DQG� WKHLU�KHDOWK��0DQ\�FOLQLFLDQV�DOUHDG\�IDFHG�DQ[LHW\��EXUQRXW��GHSUHVVLRQ��VWUHVV�� and risk of suicide prior to the pandemic, but the COVID-19 crisis has presented DQ�HYHQ�JUHDWHU�KDUGVKLS�WKDW�FDQ�H[DFHUEDWH�H[LVWLQJ�OHYHOV�RI�EXUQRXW�DQG�PHQ- WDO�KHDOWK�VWUHVVRUV��6TXLUHV�HW�DO���������8OULFK�HW�DO����������6RXUFHV�RI�VWUHVV� LGHQWLÀHG� LQ�D�UHFHQW�TXDOLWDWLYH�VWXG\�RI�QXUVHV�FDULQJ� IRU�&29,’����SDWLHQWV� EHWZHHQ�0D\�DQG�-XO\������LQFOXGHG�SHUVRQDO�H[SHULHQFHV�RI�VRFLDO� LVRODWLRQ�� witnessing large numbers of deaths, increased patient acuity, caring for families, WKH�XQFHUWDLQW\�RI�KRZ�WR�FDUH�IRU�SDWLHQWV��DQG�VHYHUH�VWDIÀQJ�VKRUWDJHV�DQG� RUJDQL]DWLRQDO�LVVXHV��6TXLUHV�HW�DO����������1XUVHV�PD\�H[SHULHQFH�YDU\LQJ�GH- grees of moral suffering that result in moral residue and fatigue as they respond WR� FRPSOH[� DQG� RIWHQ� XQVROYDEOH� HWKLFDO� WUDGH�RIIV� LQ� FDULQJ� IRU� SDWLHQWV� ZLWK� &29,’�����5RVD�HW�DO����������$GGLQJ�WR�WKHVH�VWUHVVRUV��QXUVHV�DUH�DFWLQJ�DV� GH�IDFWR�VRFLDO� LQWHUPHGLDULHV�IRU�SDWLHQWV�ZKR�DUH�LVRODWHG�IURP�WKHLU�IDPLOLHV�� )RU�H[DPSOH��QXUVHV�DUH�XVLQJ�WHFKQRORJ\�WR�KHOS�SDWLHQWV�VWD\�FRQQHFWHG�ZLWK� WKHLU�IDPLOLHV�ZKHQ�YLVLWRUV�DUH�QRW�SHUPLWWHG��6KDSLUR���������&29,’����LV�DOVR� highlighting the challenges that nurses and nurse leaders have in reporting staff VDIHW\�LVVXHV�DQG�HTXLW\�LVVXHV��5DQJFKDUL�DQG�:RRGV�������� � 7KH�GLVSURSRUWLRQDWH�LPSDFW�RI�&29,’����RQ�SHRSOH�RI�FRORU��VHH�&KDSWHU���� has highlighted the need for nurses to focus on caring for the underserved and DGGUHVVLQJ�VRFLDO�DQG�VWUXFWXUDO�EDUULHUV�WR�KHDOWK��1XUVHV�DW�WKH�IURQW�OLQHV�VHH� ÀUVWKDQG�WKH�FRQVHTXHQFHV�RI�VRFLDO�DQG�HFRQRPLF� LQMXVWLFH�ZKHQ�WKH�SHRSOH� most negatively affected by the disease are people of color, immigrants, and other vulnerable groups who are providing essential services often without needed pro- tections, who lack basic access to health services, and who live in overcrowded FRPPXQLWLHV��$EVHQW�LQWHUYHQWLRQV��DV�&29,’����UDWHV�HEE�DQG�SHDN�DURXQG�WKH� 8QLWHG�6WDWHV��WKH�LPSDFW�RQ�QXUVHV�LV�OLNHO\�WR�EH�ORQJ�ODVWLQJ��1HOVRQ�DQG�/HH� :LQQ��������

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310 THE FUTURE OF NURSING 2020–2030

mismatch between the skills and preparation of workers and the jobs that they DUH�H[SHFWHG�WR�SHUIRUP��0DVODFK���������

1XUVHV�LQ�DOO�UROHV�DQG�VHWWLQJV�FDQ�H[SHULHQFH�EXUQRXW��1XUVLQJ�VWXGHQWV�PD\� H[SHULHQFH�DFDGHPLF�DQG�HPRWLRQDO�EXUQRXW�EHIRUH�WKH\�HYHQ�HQWHU�WKH�ZRUNIRUFH� �5tRV�5LVTXH]�HW�DO����������$�VKLIW�WRZDUG�SUHYHQWLYH�FDUH�DQG�FDUH�PDQDJHPHQW� EDVHG�LQ�SULPDU\�FDUH�RU�SDWLHQW�FHQWHUHG�PHGLFDO�KRPHV�PHDQV�WKHUH�LV�D�JURZ- LQJ�GHPDQG�RQ�QXUVHV�WR�WDNH�RQ�PRUH�FRPSOH[�SDWLHQWV�DQG�DVVRFLDWHG�WDVNV�� LQFUHDVLQJ�EXUQRXW�DPRQJ�QXUVHV�LQ�SULPDU\�FDUH��’XKRX[�HW�DO����������1XUVHV� LQ�RWKHU�VHWWLQJV�WKDW�HQWDLO�SURORQJHG�FRQWDFW�ZLWK�SDWLHQWV�VXFK�DV�FULWLFDO�FDUH�� RQFRORJ\��DQG�SV\FKLDWULF�QXUVLQJ�H[SHULHQFH�EXUQRXW�DV�ZHOO��&DxDGDV�’H�OD� )XHQWH�HW�DO���������-DFNVRQ�HW�DO����������:KLOH�GDWD�DUH� ODFNLQJ�RQ�EXUQRXW� DPRQJ�QXUVH�SUDFWLWLRQHUV��VRPH�HYLGHQFH�VKRZV�WKH\�FDQ�H[SHULHQFH�EXUQRXW� FRPSDUDEOH� WR� WKDW�H[SHULHQFHG�E\�QXUVHV�DQG�SK\VLFLDQV��+RII�HW�DO���������� 1XUVHV�ZKR�ZRUN�LQ�ORQJ�WHUP�FDUH�VHWWLQJV�IDFH�SDUWLFXODU�RFFXSDWLRQDO�VWUHVVRUV�� VXFK�DV�SK\VLFDO�RU�YHUEDO�DEXVH�IURP�UHVLGHQWV�ZLWK�GHPHQWLD��IUHTXHQW�SK\VLFDO� WUDQVIHUV�RI�UHVLGHQWV��H[SRVXUH�WR�GHDWK�DQG�GHFOLQLQJ�KHDOWK�DPRQJ�UHVLGHQWV�� DQG�FDULQJ�IRU�LQGLYLGXDOV�ZLWK�YHU\�GLIIHUHQW�FDUH�QHHGV��:RRGZDUG�HW�DO����������

Compassion Fatigue

&RPSDVVLRQ�IDWLJXH��FRQVLGHUHG�GLVWLQFW�IURP�EXUQRXW��LV�GHÀQHG�DV�´D�KHDOWK� FDUH� SUDFWLWLRQHU·V� GLPLQLVKHG� FDSDFLW\� WR� FDUH� DV� D� FRQVHTXHQFH� RI� UHSHDWHG� H[SRVXUH�WR�WKH�VXIIHULQJ�RI�SDWLHQWV��DQG�IURP�WKH�NQRZOHGJH�RI�WKHLU�SDWLHQWV·� WUDXPDWLF� H[SHULHQFHVµ� �&DYDQDJK� HW� DO��� ������ S�� ������ &RPSDVVLRQ� IDWLJXH� RFFXUV�ZKHQ�D�QXUVH·V�DELOLW\�WR�HPSDWKL]H�ZLWK�SHRSOH�LV�UHGXFHG�DV�D�UHVXOW�RI� UHSHDWHG�H[SRVXUH�WR�RWKHUV·�VXIIHULQJ��3HWHUV���������5HVHDUFK�VXJJHVWV�D�QXPEHU� RI�IDFWRUV�WKDW�FDQ�OHDG�WR�FRPSDVVLRQ�IDWLJXH��VRPH�RI�ZKLFK�DUH�RUJDQL]DWLRQDO� DQG�VRPH�RI�ZKLFK�DUH�LQGLYLGXDO��2UJDQL]DWLRQDO�IDFWRUV�LQFOXGH�FKURQLF�DQG� LQWHQVH�SDWLHQW�FRQWDFW��SURORQJHG�VWUHVV��D�ODFN�RI�VXSSRUW��KLJK�ZRUNORDG��KRXUV� SHU�VKLIW��DQG�WLPH�FRQVWUDLQWV�WKDW�KLQGHU�TXDOLW\�FDUH��3HWHUV���������,QGLYLGXDO� factors include a personal history of trauma, a lack of awareness about compas- VLRQ�IDWLJXH��DQ�LQDELOLW\�WR�PDLQWDLQ�SURIHVVLRQDO�ERXQGDULHV��H�J���WDNLQJ�RQ�H[WUD� VKLIWV���DQG�D�ODFN�RI�VHOI�FDUH��3HWHUV���������

Suicide

1XUVHV��OLNH�SK\VLFLDQV��DUH�DW�KLJKHU�ULVN�WKDQ�WKH�JHQHUDO�SRSXODWLRQ�IRU� VXLFLGH��’DYLGVRQ�HW�DO�������D��1$6(0������D���/RQJLWXGLQDO�GDWD�IURP������ WKURXJK������VKRZHG�WKDW�QXUVHV�FRPPLWWHG�VXLFLGH�DW�D�KLJKHU�UDWH�UHODWLYH�WR�WKH� JHQHUDO�SRSXODWLRQ��%RWK�IHPDOH�DQG�PDOH�QXUVHV�ZHUH�DW�JUHDWHU�ULVN�RI�VXLFLGH� �IHPDOH�LQFLGHQW�UDWH�UDWLR�>,55@� ������������FRQÀGHQFH�LQWHUYDO�>&,@������² �������S��������PDOH�,55� ������������&,���������������S���������’DYLGVRQ�HW�

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DO�������D���’HVSLWH�WKLV�LQFUHDVHG�ULVN��UHODWLYHO\�OLWWOH�DWWHQWLRQ�KDV�EHHQ�SDLG�WR� XQGHUVWDQGLQJ�DQG�SUHYHQWLQJ�QXUVH�VXLFLGH��’DYLGVRQ�HW�DO�������D���

Behavioral Health

(VWLPDWHV�LQGLFDWH�WKDW�QXUVHV�KDYH�WKH�VDPH�UDWH�RI�VXEVWDQFH�XVH�GLVRUGHUV� �68’V��DV�WKH�JHQHUDO�SRSXODWLRQ��6WUREEH�DQG�&URZOH\��������:RUOH\��������� ZLWK�DSSUR[LPDWHO\����SHUFHQW�RI�WKH�QXUVLQJ�SRSXODWLRQ�KDYLQJ�DQ�68’��:RUOH\�� �������,Q�DGGLWLRQ�WR�WKH�JHQHUDO�ULVN�IDFWRUV�WKDW�DUH�DVVRFLDWHG�ZLWK�68’��LQFOXG- LQJ�JHQHWLF�SUHGLVSRVLWLRQ��KLVWRU\�RI�WUDXPD�RU�DEXVH��HDUO\�DJH�DW�ÀUVW�XVH�RI�D� VXEVWDQFH��DQG�FRPRUELG�PHQWDO�KHDOWK�GLVRUGHUV��QXUVHV�PD\�DOVR�KDYH�XQLTXH� risk factors that include access to controlled substances, workplace stress, and ODFN�RI�HGXFDWLRQ�DERXW�68’V��:RUOH\���������1XUVLQJ�VWXGHQWV�DUH�DOVR�DW�ULVN� RI�68’V��$1$��������6WUREEH�DQG�&URZOH\��������

Moral Well-Being

1XUVHV�LQ�DOO�UROHV�DQG�VHWWLQJV�DUH�FRQIURQWHG�ZLWK�HWKLFDO�FKDOOHQJHV�WKDW� KDYH�WKH�SRWHQWLDO�WR�FDXVH�PRUDO�VXIIHULQJ��$1$���������LQFOXGLQJ�PRUDO�GLVWUHVV� RU�PRUDO�LQMXU\��5XVKWRQ���������:KHQ�QXUVHV�DUH�XQDEOH�WR�FRQYHUW�WKHLU�PRUDO� FKRLFHV� LQWR� DFWLRQ� EHFDXVH� RI� LQWHUQDO� RU� H[WHUQDO� FRQVWUDLQWV�� PRUDO� GLVWUHVV� HQVXHV� DQG� WKUHDWHQV� WKHLU� LQWHJULW\� �8OULFK� DQG� *UDG\�� ������� 0RUDO� GLVWUHVV� DOVR�DULVHV�WR�YDU\LQJ�GHJUHHV�LQ�UHVSRQVH�WR�PRUDO�XQFHUWDLQW\��PRUDO�FRQÁLFWV� RU� GLOHPPDV� LQYROYLQJ� FRPSHWLQJ� HWKLFDO� YDOXHV� RU� FRPPLWPHQWV�� RU� WHQVLRQV� UHVXOWLQJ�IURP�QRW�EHLQJ�DEOH�WR�VKDUH�PRUDO�FRQFHUQV�ZLWK�RWKHUV��0RUOH\�HW�DO��� �������0RUDO�GLVWUHVV��WKH�PRVW�ZHOO�UHVHDUFKHG�IRUP�RI�PRUDO�VXIIHULQJ��RFFXUV�LQ� response to moral adversity that threatens or violates an individual’s professional YDOXHV�DQG�LQWHJULW\��DQG�LV�DVVRFLDWHG�ZLWK�P\ULDG�QHJDWLYH�FRQVHTXHQFHV��%XU- VWRQ�DQG�7XFNHWW��������(SVWHLQ�DQG�’HOJDGR��������0RUOH\�HW�DO���������5XVKWRQ� HW�DO����������1XUVHV�FDQ�H[SHULHQFH�PRUDO�GLVWUHVV�ZKHQ�WKH\�IHHO�LQDGHTXDWHO\� supported, when health care resources are inappropriately used, and when there LV�GLVDJUHHPHQW�EHWZHHQ�WKH�SDWLHQW·V�FDUH�SODQ�DQG�WKH�SDWLHQW·V�IDPLO\·V�ZLVKHV� �%XUVWRQ�DQG�7XFNHWW��������(SVWHLQ�HW�DO����������)RU�H[DPSOH��QXUVHV�PD\�H[SH- rience moral distress when asked to provide life support care that is not in the best LQWHUHVW�RI�WKH�SDWLHQW��.DVPDQ���������0RUDO�LQMXU\��D�PRUH�H[WUHPH�IRUP�RI�PRUDO� VXIIHULQJ��RFFXUV�ZKHQ�WKHUH�LV�´D�EHWUD\DO�RI�ZKDW·V�ULJKW��E\�VRPHRQH�ZKR�KROGV� OHJLWLPDWH�DXWKRULW\�«�LQ�D�KLJK�VWDNHV�VLWXDWLRQµ��6KD\��������S��������,W�LQYROYHV� D�YLRODWLRQ�RI�RQH·V�PRUDO�FRGH�E\�ZLWQHVVLQJ��SDUWLFLSDWLQJ�LQ��RU�SUHFLSLWDWLQJ�D� YDULHW\�RI�PRUDO�KDUPV��:KLOH�WKH�URRWV�RI�WKH�FRQFHSW�EHJDQ�LQ�WKH�PLOLWDU\��QXUVHV� DQG�RWKHU�FOLQLFLDQV�LQFUHDVLQJO\�DUH�H[SORULQJ�LWV�DSSOLFDWLRQ�LQ�KHDOWK�FDUH��

Nurses can suffer from moral distress when they lack the resources or capac- LW\�WR�KHOS�WKHLU�SDWLHQWV��.HOO\�DQG�3RUU��������RU�DUH�XQDEOH�WR�WDNH�WKH�HWKLFDOO\�

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312 THE FUTURE OF NURSING 2020–2030

appropriate action because of constraints or moral adversities (Ulrich et al., �������1XUVHV�ZRUNLQJ�LQ�FRPPXQLWLHV�RU�ZLWK�SHRSOH�ZLWK�FRPSOH[�KHDOWK�QHHGV� DQG�VRFLDO�ULVNV��VXFK�DV�68’V�DQG�SV\FKRORJLFDO�DQG�EHKDYLRUDO�GLVRUGHUV��DQG� WKRVH�ZRUNLQJ�LQ�KLJK�LQWHQVLW\�VHWWLQJV�RU�SDOOLDWLYH�FDUH�FDQ�H[SHULHQFH�PRUDO� GLVWUHVV�GXH�WR�WKH�FRPSOH[�PRUDO�DQG�HWKLFDO�LVVXHV�WKH\�FRQIURQW��(QJODQGHU�HW� DO���������6$0+6$��������:HONHU�+RRG��������:ROI�HW�DO����������1XUVHV�ZKR� work in clinical care often lose contact with patients when they leave the clinical VHWWLQJ��:ROI�HW�DO����������ZKLFK�PDNHV�LW�GLIÀFXOW�WR�KHOS�WKHVH�SDWLHQWV�ZLWK� WKHLU�QRQFOLQLFDO�QHHGV��VXFK�DV�IRRG��VDIH�KRXVLQJ��DQG�D�VXSSRUW�QHWZRUN��7KLV� FDQ�OHDYH�QXUVHV�IHHOLQJ�WKDW�WKHLU�HIIRUWV�DUH�IXWLOH�ZLWKRXW�VRFLHWDO�FRPPLWPHQW� to systemic reforms.

$GGUHVVLQJ�LVVXHV�RI�KHDOWK�HTXLW\�FDQ�LQYROYH�FRQIURQWLQJ�VH[LVP��UDFLVP�� DEOHLVP��[HQRSKRELD��DQG�WUDXPD��ZKLFK�FDQ�EH�XQFRPIRUWDEOH�DQG�FKDOOHQJLQJ� IRU� DOO� LQYROYHG� �0XQQDQJL� HW� DO��� ������� ,Q� DGGLWLRQ�� WKH� KLVWRULFDO� URRWV� RI� WUDXPD�DUH�RIWHQ�´LQYLVLEOHµ��&RPDV�’tD]�HW�DO���������+HOPV�HW�DO����������ZLWK� LQGLYLGXDOV�RI�FRORU�VXIIHULQJ�IURP�UDFH�EDVHG�VWUHVV��&RPDV�’tD]�HW�DO���������� 0RUHRYHU��QXUVHV�PD\�QRW�IHHO�HPSRZHUHG�WR�UDLVH�WKHLU�FRQFHUQV�DERXW�WKHVH� LQHTXLWLHV�EHFDXVH�RI�IHDU�RI�UHWDOLDWLRQ�RU�FRPSURPLVHG�UHODWLRQVKLSV��8OULFK� HW� DO��� ������� :KHQ� WKH� FODLPV� RU� YRLFHV� RI� QXUVHV� DQG� RWKHU� FOLQLFLDQV� DUH� GLVFRXQWHG��WKHLU�VWUHVV�LV�KHLJKWHQHG��+XUVW���������

,Q�WKH�FRQWH[W�RI�&29,’�����VHH�%R[��������HYLGHQFH�LV�HPHUJLQJ�WKDW� QXUVHV�KDYH�H[SHULHQFHG�PRUDO�GLVWUHVV�DV�WKH\�KDYH�DGGUHVVHG�WKH�VWDUN�HWKLFDO� WHQVLRQV��0RUOH\�HW�DO���������8OULFK�HW�DO���������FUHDWHG�E\�WKH�SDQGHPLF�� IDFLQJ�D�JDS�EHWZHHQ�´ZKDW�WKH\�FDQ�GR�DQG�ZKDW�WKH\�EHOLHYH�WKH\�VKRXOG� GRµ��3HDUFH��������5RVD�HW�DO����������7KLV�VLWXDWLRQ�OHG�WKH�$PHULFDQ�1XUVHV� $VVRFLDWLRQ��$1$��WR�GHYHORS�JXLGDQFH�WR�KHOS�QXUVHV�XQGHUVWDQG�WKHLU�HWKLFDO� REOLJDWLRQV� GXULQJ� D� SDQGHPLF�� SDUWLFXODUO\� ZLWK� UHVSHFW� WR� SUHVHUYLQJ� WKHLU� LQWHJULW\�DQG�ZHOO�EHLQJ��$1$������D�E���8SKROGLQJ�WKH�HWKLFDO�PDQGDWH�RI� QXUVHV�WR�SURYLGH�UHVSHFWIXO��HTXLWDEOH�FDUH�IRU�DOO�SHUVRQV�DQG�WKH�UHVSRQVLELOLW\� WR�DGGUHVV�LVVXHV�RI�VRFLDO�MXVWLFH�FDQ�EH�HVSHFLDOO\�FKDOOHQJLQJ�GXULQJ�D�SDQ- GHPLF��$1$��������$1$�DQG�$$1���������0RUDO�LQMXU\�KDV�EHFRPH�D�IRFXV� RI�LQTXLU\�ERWK�SULRU�WR�DQG�GXULQJ�WKH�SDQGHPLF��’HDQ�HW�DO���������.RSDF]�HW� DO���������0DJXHQ�DQG�3ULFH��������5XVKWRQ�HW�DO����������DQG�HDUO\�GDWD�VXJJHVW� WKDW�LW� LV�HPHUJLQJ�DV�D�IDFWRU�DVVRFLDWHG�ZLWK�WKH�GLIÀFXOW�HWKLFDO�WUDGH�RIIV� H[SHULHQFHG�E\�FOLQLFLDQV�LQ�WKH�FRQWH[W�RI�WKH�SDQGHPLF��+LQHV�HW�DO��������� :LOOLDPV�HW�DO���������DQG�LQ�UHVSRQVH�WR�WKH�GHDWKV�RI�%ODFN�LQGLYLGXDOV�DW�WKH� KDQGV�RI�SROLFH��%DUERW���������7KH�SUDFWLFH�VHWWLQJ�DQG�HWKLFDO�FOLPDWH�RI�WKH� KHDOWK�FDUH�RUJDQL]DWLRQ�DUH�SRVWXODWHG�DV�IDFWRUV�WKDW�LQÁXHQFH�WKH�SUHYDOHQFH� RI�PRUDO�GLVWUHVV��5DWKHUW�HW�DO���������6DXHUODQG�HW�DO����������0RUH�UHVHDUFK� LV�QHHGHG�WR�XQGHUVWDQG�WKH�UHOHYDQFH�RI�PRUDO�LQMXU\�DPRQJ�KHDOWK�FDUH�SUR- IHVVLRQDOV�DQG�WR�VWXG\�LWV�UHODWLRQVKLS�WR�YDULRXV�PHDVXUHV�RI�ZHOO�EHLQJ�DQG� PRUDO�UHVLOLHQFH��5XVKWRQ��������

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Social Health and Well-Being

7KH�QDWXUH�RI�QXUVLQJ�ZRUN�PHDQV�WKDW�QXUVHV�DUH�FRQVWDQWO\�LQWHUDFWLQJ�ZLWK� RWKHU�SHRSOH��LQFOXGLQJ�LQGLYLGXDOV��IDPLOLHV��FRPPXQLWLHV��SK\VLFLDQV�DQG�RWKHU� providers, administrators, staff, and other nurses. While these social interactions DUH�HVVHQWLDO�WR�WKH�ZRUN�RI�FDULQJ�IRU�LQGLYLGXDOV�DQG�FRPPXQLWLHV��WKH\�FDQ�DOVR� EH�D�VRXUFH�RI�VWUHVV�DQG�DGYHUVHO\�LPSDFW�QXUVH�ZHOO�EHLQJ��7KLV�VHFWLRQ�H[SORUHV� WKUHH� W\SHV� RI� QHJDWLYH� VRFLDO� LQWHUDFWLRQV�� EXOO\LQJ� DQG� LQFLYLOLW\�� ZRUNSODFH� violence, and racism and discrimination.

Bullying and Incivility

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http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

314 THE FUTURE OF NURSING 2020–2030

Workplace Violence

,Q� WKH�8QLWHG�6WDWHV��KHDOWK�FDUH�ZRUNHUV�H[SHULHQFH� WKH�KLJKHVW� OHYHO�RI� DVVDXOW�RI�DOO�RFFXSDWLRQV��DQG�DPRQJ�KHDOWK�FDUH�ZRUNHUV��QXUVHV�DQG�SDWLHQW� FDUH�DVVLVWDQWV�H[SHULHQFH�WKH�KLJKHVW�UDWHV�RI�YLROHQFH��*URHQHZROG�HW�DO��������� 26+$���������$JJUHVVLRQ�DQG�DVVDXOW�FDQ�UHVXOW�LQ�ORQJ�WHUP�HIIHFWV�RQ�QXUVHV� that include posttraumatic stress and lower levels of productivity (Gates et al., ������� 1XUVHV� HQGXUH� ERWK� HPRWLRQDO� DQG� SK\VLFDO� DEXVH� IURP� SDWLHQWV� �*D- EURYHF��������*DWHV�HW�DO����������$Q�$1$�KHDOWK�ULVN�DVVHVVPHQW�RI�QXUVHV�GXULQJ� ����²�����LQGLFDWHG�WKDW����SHUFHQW�RI�QXUVHV�KDG�H[SHULHQFHG�YLROHQFH�DW�WKH� KDQGV�RI�SDWLHQWV�RU�WKHLU�IDPLO\�PHPEHUV��$1$���������+RZHYHU��LQFLGHQWV�RI� assault are substantially underreported by as much as 50 percent because of a lack RI�ZRUNSODFH�UHSRUWLQJ�SROLFLHV��D�ODFN�RI�FRQÀGHQFH�LQ�WKH�UHSRUWLQJ�V\VWHP��DQG� IHDU�RI�UHWDOLDWLRQ��26+$���������

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While much of the research on workplace violence focuses on hospital set- WLQJV��QXUVHV�ZRUNLQJ�LQ�RWKHU�VHWWLQJV�DUH�DOVR�DW�ULVN�RI�YLROHQFH�DQG�DJJUHVVLRQ�� +RPH�YLVLWLQJ�QXUVHV��ZKR�RIWHQ�ZRUN�DORQH�LQ�G\QDPLF�HQYLURQPHQWV�FKDUDFWHU- L]HG�E\�SRWHQWLDOO\�KLJK�ULVN�VLWXDWLRQV��DUH�DW�ULVN�RI�YHUEDO�DQG�SK\VLFDO�DVVDXOW� ZKLOH�LQ�WKH�FRPPXQLW\�RU�SHRSOH·V�KRPHV��0DWKLHZV�DQG�6DOPRQG���������7KH� LQFLGHQFH�RI�ZRUNSODFH�YLROHQFH�LQ�KRPH�QXUVLQJ�LV�OLNHO\�XQGHUUHSRUWHG�EHFDXVH� RI�IDFWRUV�LQFOXGLQJ�WKH�SHUFHSWLRQ�WKDW�YLROHQFH�LV�SDUW�RI�WKH�MRE�DQG�WKH�PRUDO� FRQÁLFW�QXUVHV�IDFH�EHWZHHQ�GXW\�WR�WKHLU�SDWLHQWV�DQG�GXW\�WR�UHSRUW�DQ�LQFLGHQW�RI� YLROHQFH��0DWKLHZV�DQG�6DOPRQG���������:KLOH�PDQ\�RUJDQL]DWLRQV�DUH�DWWHPSW- LQJ�WR�UHVSRQG�WR�WKHVH�FKDOOHQJHV��HGXFDWLRQ�DQG�WUDLQLQJ�DORQH�DUH�OLNHO\�LQVXI- ÀFLHQW�WR�DGGUHVV�WKH�URRW�IDFWRUV�WKDW�FRQWULEXWH�WR�WKHP��*HRIIULRQ�HW�DO���������

Racism and Discrimination

$V�GLVFXVVHG�LQ�&KDSWHU����UDFLVP�FDQ�VLJQLÀFDQWO\�LPSDFW�WKH�SK\VLFDO�DQG� mental health of individuals. Health can be affected by structural racism (poli- cies and systems), cultural racism (stereotypes, beliefs, and implicit biases), and GLVFULPLQDWLRQ��EHLQJ�WUHDWHG�GLIIHUHQWO\�EDVHG�RQ�UDFH���:LOOLDPV�HW�DO���������� 0LFURDJJUHVVLRQV��ZKLFK�DUH�EULHI�DQG�FRPPRQSODFH�GDLO\�LQGLJQLWLHV��DUH�DOVR�

http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 315

correlated with poor health (&UX]�HW�DO���������1DGDO�HW�DO���������2QJ�DQG�%XU- URZ��������6XH�HW�DO����������1XUVHV�PD\�HQFRXQWHU�UDFLVP��GLVFULPLQDWLRQ��DQG� PLFURDJJUHVVLRQV� IURP� D� QXPEHU� RI� VRXUFHV�� LQFOXGLQJ� HPSOR\HUV�� HGXFDWRUV�� PDQDJHUV�� FROOHDJXHV�� DQG� SDWLHQWV�� 1XUVHV� DQG� RWKHU� FOLQLFLDQV� RI� FRORU� FDQ� H[SHULHQFH�KDUGVKLS��EXUQRXW��DQG�WKH�LQFUHDVHG�HPRWLRQDO�ODERU�DQG�EXUGHQ�RI� DQ�DOUHDG\�HPRWLRQDOO\�GHPDQGLQJ�MRE�ZKLOH�GHDOLQJ�ZLWK�WKH�SHUVRQDO�QHJDWLYH� FRQVHTXHQFHV�RI�UDFLVP�IURP�SDWLHQWV��&RWWLQJKDP�HW�DO���������3DXO�(PLOH�HW� DO����������$FFRPPRGDWLQJ�SDWLHQWV·�SUHIHUHQFHV�UHJDUGLQJ�WKH�UDFH��JHQGHU��RU� UHOLJLRQ�RI�WKHLU�SURYLGHUV�KDV�EHHQ�FRPPRQ�SUDFWLFH�LQ�WKH�8QLWHG�6WDWHV��RIWHQ� LQ�D�FRQWH[W�RI�OLWWOH�JXLGDQFH�RQ�KRZ�WR�DSSURDFK�WKHVH�VLWXDWLRQV��3DXO�(PLOH�� �������7KLV�SUDFWLFH�FDQ�KDYH�DGYHUVH�HIIHFWV�RQ�FOLQLFLDQV��HVSHFLDOO\�ZKHQ�WKH\� are rejected by patients or subject to abuse because of their race. However, nurses’ H[SHULHQFHV�RI�UDFLVP�DUH�QRW�OLPLWHG�WR�WKHVH�W\SHV�RI�GLVFUHWH�HYHQWV�EXW�DUH�SDUW� RI�WKH�ODUJHU�V\VWHP�RI�VWUXFWXUDO�UDFLVP�LQ�WKH�8QLWHG�6WDWHV��:DLWH�DQG�1DUGL�� ��������

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http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 317

7KHUH�LV�HPHUJLQJ�HYLGHQFH�WKDW�GHVSLWH�WKH�FRQVWUDLQWV�LPSRVHG�E\�WKH�V\VWHP�� VRPH�QXUVHV�DUH�DEOH�WR�UHPDLQ�KHDOWK\�DQG�ZKROH�DQG�JURZ�LQ�UHVSRQVH�WR�DGYHU- VLW\��&XL�HW�DO���������,W]KDNL�HW�DO���������2NROL�HW�DO���������7UDXGW�HW�DO���������� 1XUVHV�QHHG�WKH�VNLOOV�DQG�WRROV�WKDW�HQDEOH�WKHP�WR�H[HUFLVH�WKHLU�DXWRQRP\�� DJHQF\��DQG�FRPSHWHQFH�ZLWKLQ�WKHVH�V\VWHPV��)XUWKHU�LQYHVWLJDWLRQ�LV�QHHGHG� to understand the individual and system characteristics that create the conditions IRU�QXUVHV�WR�WKULYH�LQ�WKH�PLGVW�RI�FRPSOH[LW\��XQFHUWDLQW\��DQG�XQSUHGLFWDELOLW\��

7KLV�VHFWLRQ�ÀUVW�H[DPLQHV�LQGLYLGXDO�OHYHO�DSSURDFKHV�WR�ZHOO�EHLQJ�DQG� then turns to a review of approaches at the systems level. The committee notes WKDW�DOWKRXJK�WKHUH�H[LVWV�QR�PHQX�RI�UHDG\�WR�LPSOHPHQW��HYLGHQFH�EDVHG�LQWHU- YHQWLRQV�IRU�LPSURYLQJ�QXUVH�ZHOO�EHLQJ��1$6(0������D���D�JUHDW�QXPEHU�RI� HIIRUWV�FXUUHQWO\�EHLQJ�SXUVXHG�FDQ�RIIHU�LQVSLUDWLRQ�DQG�RSSRUWXQLWLHV�IRU�HYDOX- DWLRQ��UHSOLFDWLRQ��DQG�VFDODELOLW\��+RZHYHU��DV�QRWHG�E\�0HOQ\N�DQG�FROOHDJXHV� �������LQ�D�UHFHQW�V\VWHPDWLF�UHYLHZ�RI�LQWHUYHQWLRQV�IRFXVHG�RQ�LPSURYLQJ�SK\- VLFLDQV·�DQG�QXUVHV·�SK\VLFDO�DQG�PHQWDO�ZHOO�EHLQJ��PRUH�UDQGRPL]HG�FRQWUROOHG� WULDOV��5&7V��DUH�QHHGHG�WR�H[DPLQH�WKH�HIÀFDF\�RI�VXFK�LQWHUYHQWLRQV�DV�PDQ\�RI� WKH�DYDLODEOH�VWXGLHV�KDYH�ZHDNQHVVHV�LQ�WKHLU�PHWKRGRORJLHV��

Individual-Level Interventions

:KLOH�KHDOWK�FDUH�RUJDQL]DWLRQV�PXVW�FUHDWH�WKH�ZRUNSODFH�FRQGLWLRQV�IRU� ZHOO�EHLQJ�DQG�LQWHJULW\�WR�WKULYH��QXUVHV�DUH�DOVR�UHVSRQVLEOH�IRU�LGHQWLI\LQJ�WKHLU� RZQ�QHHGV�DQG�LQYHVWLQJ�LQ�WKHLU�ZHOO�EHLQJ��5RVV�HW�DO����������7KLV�UHVSRQ- VLELOLW\�DULVHV�IURP�WKHLU�LQKHUHQW�KXPDQ�GLJQLW\�DQG�WKHLU�SURIHVVLRQDO�HWKLFDO� PDQGDWH�WR�LQYHVW�LQ�WKHLU�RZQ�LQWHJULW\�DQG�ZHOO�EHLQJ�VR�WKH\�FDQ�H[HFXWH�WKH� UHVSRQVLELOLWLHV�RI�WKHLU�QXUVLQJ�UROH��$1$���������3URYLVLRQ���RI�WKH�$1$�&RGH� RI�(WKLFV�VWDWHV�WKDW�QXUVHV�VKRXOG�´HDW�D�KHDOWK\�GLHW��H[HUFLVH��JHW�VXIÀFLHQW�UHVW�� PDLQWDLQ�IDPLO\�DQG�SHUVRQDO�UHODWLRQVKLSV��HQJDJH�LQ�DGHTXDWH�OHLVXUH�DQG�UHFUH- DWLRQDO�DFWLYLWLHV��DQG�DWWHQG�WR�VSLULWXDO�RU�UHOLJLRXV�QHHGVµ��$1$��������S�������

$OWKRXJK� QXUVHV� DUH� RIWHQ� NQRZOHGJHDEOH� DERXW� WKH� LPSRUWDQFH� RI� WKHVH� LVVXHV��WKDW�NQRZOHGJH�GRHV�QRW�DOZD\V�WUDQVODWH�LQWR�DFWLRQ��5RVV�HW�DO���������� 5RVV�DQG�FROOHDJXHV��������LGHQWLI\�D�QXPEHU�RI�LQWULQVLF�DQG�H[WULQVLF�IDFWRUV� WKDW� DIIHFW� QXUVHV·� SDUWLFLSDWLRQ� LQ� KHDOWK�SURPRWLQJ� EHKDYLRUV�� ,QWULQVLF� IDF- WRUV�LQFOXGH�SHUVRQDO�FKDUDFWHULVWLFV�DQG�EHOLHIV��SHUFHLYHG�EHQHÀWV�DQG�EDUULHUV�� VHOI�HIÀFDF\��JHQGHU�DQG�DJH��IDWLJXH��GHSUHVVLRQ��DQG�DQ[LHW\��([WULQVLF�IDFWRUV� LQFOXGH� QRUPV�� VRFLDO� VXSSRUW�� UROH� PRGHOLQJ�� ÀQDQFLDO� DQG� WLPH� FRQVWUDLQWV�� DQG�LQVWLWXWLRQDO�VXSSRUW��6KLIW�ZRUN�DQG�ZRUN�VFKHGXOHV��DV�ZHOO�DV�FRPSHWLQJ� GHPDQGV�RXWVLGH�RI�ZRUN��VXFK�DV�FDULQJ�IRU�DGXOW�RU�FKLOG�GHSHQGHQWV��DUH�DGGL- WLRQDO�EDUULHUV�WR�SDUWLFLSDWLRQ��5RVV�HW�DO���������

%HORZ��WKH�FRPPLWWHH�H[DPLQHV�LQWHUYHQWLRQV�DQG�LQLWLDWLYHV�GLUHFWHG�DW�LP- SURYLQJ�LQGLYLGXDO�QXUVHV·�KHDOWK�DQG�ZHOO�EHLQJ�LQ�D�QXPEHU�RI�DUHDV��0DQ\�VXFK� LQLWLDWLYHV�DGGUHVV�PXOWLSOH�DUHDV�RI�ZHOO�EHLQJ�DQG�XVH�PXOWLSOH�DSSURDFKHV��)RU� H[DPSOH��WKH�+HDOWK\�1XUVH��+HDOWK\�1DWLRQ��+1+1��*UDQG�&KDOOHQJH��DQ�HIIRUW�

http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

318 THE FUTURE OF NURSING 2020–2030

RI�$1$�DQG�LWV�SDUWQHUV��VHHNV�WR�WUDQVIRUP�WKH�KHDOWK�RI���PLOOLRQ�51V�WKURXJK�D� IRFXV�RQ�SK\VLFDO�DFWLYLW\��QXWULWLRQ��UHVW��TXDOLW\�RI�OLIH��DQG�VDIHW\��$1$�(QWHU- SULVH���������2UJDQL]DWLRQV�WKDW�SDUWLFLSDWH�LQ�+1+1�KDYH�GHYHORSHG�D�QXPEHU� RI� LQGLYLGXDO�IRFXVHG� LQLWLDWLYHV�� VXFK� DV� RIIHULQJ� RQVLWH� ÀWQHVV� RSSRUWXQLWLHV�� ZDONLQJ�SURJUDPV��LQFUHDVHG�DFFHVV�WR�KHDOWK\�IRRG��PLQGIXOQHVV�UHVRXUFHV��DQG� GHGLFDWHG�URRPV�IRU�QXUVHV�WR�UHVHW�DQG�UHOD[��$1$�(QWHUSULVH��������������-DUUtn HW�DO����������2WKHU�ZHOO�EHLQJ�LQLWLDWLYHV�DUH�IRFXVHG�RQ�D�VSHFLÀF�EHKDYLRU�RU� KHDOWK�FKDUDFWHULVWLF��EXW�RQH�WKDW�PD\�KDYH�FRQVHTXHQFHV�IRU�PXOWLSOH�DUHDV�RI� ZHOO�EHLQJ��)RU�H[DPSOH��SRRU�VOHHS�SDWWHUQV�DUH�DVVRFLDWHG�ZLWK�SRRU�SK\VLFDO� and mental health, an increased risk of obesity, and an increased risk of accidents ERWK�LQ�DQG�RXWVLGH�RI�WKH�ZRUNSODFH��,20���������

7KH�LQLWLDWLYHV�DQG�LGHDV�GHVFULEHG�EHORZ�DUH�GHVLJQHG�WR�LPSURYH�WKH�KHDOWK� RI�QXUVHV�E\�DGGUHVVLQJ�D�ZLGH�YDULHW\�RI�WDUJHWV��

�� SK\VLFDO�DFWLYLW\��GLHW��DQG�VOHHS�� �� VXEVWDQFH�XVH� �� UHVLOLHQFH� �� PHQWDO�KHDOWK� �� HWKLFDO�FRPSHWHQFH� �� LQFLYLOLW\��EXOO\LQJ��DQG�ZRUNSODFH�YLROHQFH��DQG • racism, prejudice, and discrimination.

Physical Activity, Diet, and Sleep

A recent systematic review of workplace interventions to address obesity in nurses found limited evidence of successful interventions. The authors rec- RPPHQG�WKDW�LQWHUYHQWLRQV�EH�WDLORUHG�WR�WKH�XQLTXH�DVSHFWV�RI�QXUVHV·�ZRUNLQJ� OLYHV��.HOO\�DQG�:LOOV��������DQG�WKDW�LQWHUYHQWLRQV�QRW�EH�XQLYHUVDO�EXW�WDUJHWHG� WRZDUG�WKRVH�ZKR�DUH�REHVH��,Q�WKHLU�V\VWHPDWLF�UHYLHZ��0HOQ\N�DQG�FROOHDJXHV� �������IRXQG�WKDW�YLVXDO�WULJJHUV��SHGRPHWHUV��DQG�KHDOWK�FRDFKLQJ�FDQ�LQFUHDVH� SDUWLFLSDWLRQ�LQ�SK\VLFDO�DFWLYLW\��7KH�1XUVHV�/LYLQJ�)LW�SURJUDP�ZDV�HIIHFWLYH� LQ�UHGXFLQJ�QXUVHV·�ERG\�PDVV�LQGH[��%0,��RYHU�D����ZHHN�LQWHUYHQWLRQ�SHULRG�� KRZHYHU��WKH�HIIHFWV�RI�WKH�SURJUDP�RQ�%0,�ZHUH�QRW�VXVWDLQHG��6SHURQL�HW�DO��� �������

$�UHFHQW�VFRSLQJ�UHYLHZ�RI�VWXGLHV�ORRNHG�DW�LQWHUYHQWLRQV�WDUJHWHG�DW�QXUVHV� ZKR� ZRUN� VKLIWV� DQG� DLPHG� DW� LPSURYLQJ� VOHHS� SDWWHUQV� RU� PDQDJLQJ� IDWLJXH� �4XHUVWUHW�HW�DO����������,Q�WKHVH�VWXGLHV��PRVW�RI�ZKLFK�ZHUH�FRQGXFWHG�LQ�,WDO\�� 7DLZDQ��DQG�WKH�8QLWHG�6WDWHV�LQWHUYHQWLRQV�IHOO�LQWR�WKUHH�SULPDU\�FDWHJRULHV�� QDSSLQJ��ZRUNLQJ�GLIIHUHQW�VKLIW�SDWWHUQV��DQG�H[SRVXUH�WR�OLJKW�RU�OLJKW�DWWHQ- XDWLRQ��:LWK�UHJDUG�WR�QDSSLQJ�LQWHUYHQWLRQV��WKH�DXWKRUV�IRXQG�PL[HG�UHVXOWV�� For studies that measured performance at work as an outcome, there was im- SURYHPHQW�RQ�VRPH�PHDVXUHV��H�J��� LQIRUPDWLRQ�SURFHVVLQJ�LPSURYLQJ�DIWHU�D� ���PLQXWH�QDS���6WXGLHV�WKDW�H[DPLQHG�VKLIW�SDWWHUQV��H�J���URWDWLQJ�VKLIW�SDWWHUQV��

http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 319

À[HG�QLJKW�YHUVXV�GD\�VKLIWV����KRXU�YHUVXV����KRXU�URWDWLQJ�VKLIWV��IRXQG�WKDW� VKLIW�SDWWHUQV�LQFOXGLQJ�QLJKW�VKLIWV�ZHUH�DVVRFLDWHG�ZLWK�SRRUHU�VOHHS�TXDOLW\�DQG� LQFUHDVHG�IDWLJXH��5HVXOWV�RI�OLJKW�H[SRVXUH�VWXGLHV�ZHUH�VLPLODUO\�PL[HG��)RXU� VWXGLHV�IRXQG�WKDW�VHOI�UHSRUWHG�HQHUJ\�OHYHOV�LQFUHDVHG�ZLWK�H[SRVXUH�WR�EULJKW� OLJKW��$QRWKHU�VWXG\��KRZHYHU��IRXQG�QR�HIIHFW�RI�DQ�LQWHUYHQWLRQ�LQYROYLQJ�OLJKW� YLVRUV�RQ�IDWLJXH�RU�VOHHS��7KH�VFRSLQJ�UHYLHZ�IRXQG�QR�VWXGLHV�FRQGXFWHG�RQ� VDPSOHV� LQYROYLQJ�QXUVH�PLGZLYHV��4XHUVWUHW�DQG�FROOHDJXHV��������FRQFOXGH� WKDW�WKH�OLWHUDWXUH�LV�LQFRQVLVWHQW�UHJDUGLQJ�KRZ�WR�LQWHUYHQH�WR�LPSURYH�VOHHS� DQG�UHGXFH�IDWLJXH�IRU�QXUVHV�ZKR�ZRUN�VKLIWV��DQG�WKDW�WKH�LQWHUYHQWLRQV�DQG� measures used in these studies were disparate in nature.

Substance Use

$�UHFHQW�SRVLWLRQ�VWDWHPHQW�IURP�WKH�(PHUJHQF\�1XUVHV�$VVRFLDWLRQ�DQG� the International Nurses Society on Addictions called for four primary actions to DGGUHVV�QXUVHV�ZLWK�68’V��6WUREEH�DQG�&URZOH\���������SURYLGLQJ�HGXFDWLRQ�WR� QXUVHV�DQG�RWKHU�HPSOR\HHV��DGRSWLQJ�DOWHUQDWLYH�WR�GLVFLSOLQH��$7’��DSSURDFKHV�� FRQVLGHULQJ�GUXJ�GLYHUVLRQ�LQ�WKH�FRQWH[W�RI�SHUVRQDO�XVH�DV�D�V\PSWRP�DQG�QRW�D� FULPLQDO�RIIHQVH��DQG�HQVXULQJ�WKDW�QXUVHV�DQG�QXUVLQJ�VWXGHQWV�DUH�DZDUH�RI�WKH� risks associated with SUDs and have a way to report concerns safely. The two pri- PDU\�DSSURDFKHV�WR�WUHDWLQJ�QXUVHV�ZLWK�68’V�KDYH�EHHQ�HLWKHU�D�GLVFLSOLQDU\�DS- SURDFK�RU�DQ�$7’�SURJUDP��0RQURH�HW�DO���������1&6%1��������5XVVHOO��������� 0RQURH�DQG�FROOHDJXHV��������FRQFOXGH�WKDW�$7’�SURJUDPV�KDYH�D�JUHDWHU�LPSDFW� WKDQ�GLVFLSOLQDU\�SURJUDPV�RQ�SURWHFWLQJ�WKH�KHDOWK�DQG�VDIHW\�RI�WKH�SXEOLF��DV� they identify and enroll more nurses and in turn remove more nurses with SUDs IURP�GLUHFW�SDWLHQW�FDUH��7KHVH�SURJUDPV�KDYH�EHHQ�DGRSWHG�E\�PDQ\�VWDWH�ERDUGV� RI�QXUVLQJ��5XVVHOO���������,Q�DQ�DQDO\VLV�RI����VWDWH�ERDUG�RI�QXUVLQJ�SURJUDPV�� 5XVVHOO��������IRXQG�D�ODFN�RI�FRQVLVWHQF\�DPRQJ�WKHP�DQG�VXJJHVWV�WKDW�PRUH� UHVHDUFK�LV�QHHGHG�WR�LGHQWLI\�WKH�HVVHQWLDO�FRPSRQHQWV�RI�VXFK�SURJUDPV��&RP- PRQ�FRPSRQHQWV�LGHQWLÀHG�LQ�DW�OHDVW�KDOI�RI�WKH�SURJUDPV�LQFOXGHG�DQ�DOFRKRO� GUXJ�DEVWLQHQFH�UHTXLUHPHQW��XVH�RI�PRRG�DOWHULQJ�PHGLFDWLRQV�IRU�SV\FKLDWULF� PHGLFDO�FRQGLWLRQV��DQ�$OFRKROLFV�$QRQ\PRXV�RU�1DUFRWLFV�$QRQ\PRXV�SURJUDP�� DQG�UHVWULFWHG�KRXUV�RU�VKLIWV��5XVVHOO���������

,Q�D�UHWURVSHFWLYH�VWXG\�RI�������QXUVHV�SDUWLFLSDWLQJ�LQ�68’�SURJUDPV�EH- WZHHQ������DQG�������6PLOH\�DQG�5HQHDX��������IRXQG�WKDW�ELPRQWKO\�UDQGRP� GUXJ�WHVWV��D�PLQLPXP�RI���\HDUV�LQ�D�SURJUDP��DQG�GDLO\�FKHFN�LQV�ZHUH�DVVRFL- DWHG�ZLWK�VXFFHVVIXO�SURJUDP�FRPSOHWLRQ��7KH\�DOVR�IRXQG�WKDW�VWUXFWXUHG�JURXS� PHHWLQJV�ZHUH�KHOSIXO��7KH�EHVW�UHVXOWV�ZHUH�IRU�WKRVH�QXUVHV�ZKR�VWD\HG�LQ�D� SURJUDP�DW�OHDVW���\HDUV�DQG�ZHUH�WHVWHG�WZLFH�SHU�PRQWK��7KH�DXWKRUV�UHFRP- PHQG�WKDW�DQ�H[SHUW�SDQHO�UHYLHZ�WKHVH�UHVXOWV�DQG�GHYHORS�IRUPDO�JXLGHOLQHV�IRU� VXFK�SURJUDPV��DQG�WKDW�ERDUGV�RI�QXUVLQJ�WHVW�WKHVH�JXLGHOLQHV�LQ�WKHLU�$7’�SUR- JUDPV��,Q�DGGLWLRQ��KHDOWK�FDUH�RUJDQL]DWLRQV�DQG�HPSOR\HUV�KDYH�D�UHVSRQVLELOLW\�

http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

320 THE FUTURE OF NURSING 2020–2030

WR�GHWHFW�HDUO\�SDWWHUQV�RI�GUXJ�GLYHUVLRQ7 proactively before they become severe. 7R�WKLV�HQG��RUJDQL]DWLRQV�DUH�XVLQJ�VXFK�WHFKQRORJLHV�DV�DXWRPDWHG�GLVSHQVLQJ� FDELQHWV��DGYDQFHG�DQDO\WLFV��DQG�PDFKLQH�OHDUQLQJ�8

Resilience

7UDLQLQJ�IRFXVHG�RQ�EXLOGLQJ�LQGLYLGXDO�UHVLOLHQFH�LV�RIWHQ�RIIHUHG�WR�SUHSDUH� QXUVHV�IRU�WKH�IDWLJXH��VWUHVV��ZRUNORDG��DQG�EXUQRXW�WKH\�PD\�IDFH��7D\ORU��������� 5HVLOLHQFH�UHIHUV�WR�´WKH�FDSDFLW\�RI�G\QDPLF�V\VWHPV�WR�ZLWKVWDQG�RU�UHFRYHU� IURP�VLJQLÀFDQW�GLVWXUEDQFHVµ��0DVWHQ��������S��������+XPDQV�DUH�WKRXJKW�WR� KDYH�DQ�LQQDWH�UHVLOLHQFH�SRWHQWLDO�WKDW�HYROYHV�RYHU�WLPH�DQG�ÁXFWXDWHV�GHSHQG- LQJ�RQ�WKH�FRQWH[W��WKH�LQWHUSOD\�RI�LQGLYLGXDO�IDFWRUV��VRFLDO��FRPPXQLW\��HQYL- URQPHQWDO��DQG�VRFLHWDO�FRQGLWLRQV��DQG�PRUDO�HWKLFDO�YDOXHV�DQG�FRPPLWPHQWV� �5XVKWRQ��������6]DQWRQ�HW�DO����������5HVLOLHQFH�LQFOXGHV�´WKH�DELOLW\�WR�IDFH� DGYHUVH�VLWXDWLRQV��UHPDLQ�IRFXVHG��DQG�FRQWLQXH�WR�EH�RSWLPLVWLF�IRU�WKH�IXWXUH�µ� DQG�LW�LV�GHVFULEHG�DV�D�´YLWDO�FKDUDFWHULVWLFµ�IRU�QXUVHV�LQ�WKH�FRPSOH[�KHDOWK�FDUH� system. Resilience is associated with reduced symptoms of burnout, improved PHQWDO�KHDOWK��DQG�UHGXFHG�WXUQRYHU��5XVKWRQ�HW�DO����������

7D\ORU��������VXJJHVWV�RIIHULQJ�UHVLOLHQFH�LQWHUYHQWLRQV�DW�WKH�SULPDU\��VHF- ondary, and tertiary levels. At the primary level, such interventions would focus RQ� EXLOGLQJ� VHOI�DZDUHQHVV�� FRSLQJ� VNLOOV�� DQG� FRPPXQLFDWLRQV� VNLOOV��$W� WKH� VHFRQGDU\� OHYHO�� WKH\� PLJKW� LQFOXGH� VFUHHQLQJ� IRU� EXUQRXW� DQG� SURYLGLQJ� WKH� associated resources and supports nurses will need. Finally, at the tertiary level, LQWHUYHQWLRQV�ZRXOG�WDUJHW�QXUVHV�ZKRVH�UHVLOLHQFH�WKUHVKROG�KDG�EHHQ�EUHDFKHG� DQG� VXSSRUW� WKHLU� KHDOLQJ� DQG� UHWXUQ� WR� ZRUN�� 8QGHUVWDQGLQJ� DQG� DGGUHVVLQJ� UHVLOLHQFH�DPRQJ�QXUVHV�KROGV�SURPLVH�IRU�DWWHQXDWLQJ�WKH�HIIHFWV�RI�ZRUNSODFH� GHPDQGV�WKDW�H[FHHG�SHUVRQDO�UHVRXUFHV��DFFHVVHG�$SULO���������@���

8 6HH� KWWSV���ZZZ�ÀHUFHKHDOWKFDUH�FRP�KRVSLWDOV�LQGXVWU\�YRLFHV�DV�FRYLG����ÁDUH�XSV�FRQWLQXH� KHDOWKFDUH�RUJDQL]DWLRQV�PXVW�GRXEOH�GRZQ��DFFHVVHG�$SULO�����������

9 6HH� KWWSV���ZZZ�QXUVLQJZRUOG�RUJ�JHW�LQYROYHG�VKDUH�\RXU�H[SHUWLVH�SUR�LVVXHV�SDQHO�PRUDO� UHVLOLHQFH�SDQHO��DFFHVVHG�$SULO�����������

http://nap.nationalacademies.org/25982
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity

Copyright National Academy of Sciences. All rights reserved.

HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 321

VXSSRUW�KXPDQ�V\VWHPV��WHDPV��DQG�RUJDQL]DWLRQV�LQ�DGDSWLQJ�KHDOWKIXOO\�WR�WKH� DGYHUVLWLHV�WKH\�LQHYLWDEO\�HQFRXQWHU�E\�PRGLI\LQJ�WKRVH�FKDUDFWHULVWLFV�WKDW�DUH� DPHQDEOH�WR�LQWHUYHQWLRQ��0RVV�HW�DO����������,Q�DGGLWLRQ�WR�LPSURYLQJ�WKH�UHVLO- LHQFH�RI�LQGLYLGXDOV��RUJDQL]DWLRQV�FDQ�VHHN�WR�LGHQWLI\�DQG�DPHOLRUDWH�WKH�QHJD- WLYH�FRQGLWLRQV�WKDW�V\VWHPDWLFDOO\�XQGHUPLQH�KHDOWK�DQG�ZHOO�EHLQJ��*UHJRU\�HW� DO����������%DUUDWW��������VXJJHVWV�WKDW�HIIRUWV�WR�LPSURYH�LQGLYLGXDO�UHVLOLHQFH� IRFXV�RQ�EXLOGLQJ�WKH�UHVLOLHQFH�RI�WHDPV�DQG�RUJDQL]DWLRQV�WR�JLYH�LQGLYLGXDOV� the support and resources they need. Resilience is discussed further in the section on system-level approaches later in this chapter.

Mental Health

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All rights reserved.322 THE FUTURE OF NURSING 2020–2030SUDFWLFH�DW�KRPH��KRZHYHU��WKH�DXWKRUV�FRQFOXGH�WKDW�WKHVH�SURJUDPV�ZHUH�SR- tentially too time-intensive for clinicians to accommodate within their schedules. They also note that many hospitals do not have mindfulness trainers available to LPSOHPHQW�WKHVH�SURJUDPV��*LYHQ� WKH� FKDOOHQJHV� RI� LPSOHPHQWLQJ� WLPH�LQWHQVLYH� LQWHUYHQWLRQV� KLJK- OLJKWHG� E\� 0HOQ\N� DQG� FROOHDJXHV� �������� WKHUH� LV� DOVR� SURPLVLQJ� HYLGHQFH� that brief mindfulness interventions may have positive impacts on compassion, DOWKRXJK�+RIPDQQ�DQG�*RPH]��������REVHUYH�WKDW�LW�LV�XQFOHDU�ZKHWKHU�EULHI� LQWHUYHQWLRQV�FDQ�KDYH�WKH�VDPH�NLQG�RI�LPSDFW�RQ�DQ[LHW\�DQG�GHSUHVVLRQ�DV�WKDW� RI�WKH�ORQJHU�LQWHUYHQWLRQV��%R[������GHVFULEHV�SURPLVLQJ�LQWHUYHQWLRQV�WKDW�XVH� PRELOH�WHFKQRORJLHV�WR�VXSSRUW�PLQGIXOQHVV�DQG�RWKHU�ZHOO�EHLQJ�VNLOOV��$QRWKHU�SURPLVLQJ�DSSURDFK�WR�HDUO\�VFUHHQLQJ�DQG�WUHDWPHQW�LV�WKH�+HDOHU� (YDOXDWLRQ�$VVHVVPHQW�DQG�5HIHUUDO��+($5��SURJUDP��ÀUVW�SLORWHG�ZLWK�QXUVHV� LQ�������'DYLGVRQ�HW�DO�������E������E���7KLV�SURJUDP��D�FROODERUDWLRQ�EHWZHHQ� WKH�8QLYHUVLW\�RI�&DOLIRUQLD��6DQ�'LHJR��DQG�WKH�$PHULFDQ�)RXQGDWLRQ�IRU�6XL- cide Prevention, includes a set of educational presentations focused on burnout, GHSUHVVLRQ�� DQG� VXLFLGH�� DV� ZHOO� DV� DQ� HQFU\SWHG� DQG� FRQÀGHQWLDO� ZHE�EDVHG� DVVHVVPHQW�WRRO�GHVLJQHG�WR�LGHQWLI\�DQG�UHIHU�LQGLYLGXDOV�DW�ULVN�IRU�GHSUHVVLRQ� DQG�VXLFLGH��7KH�SLORW�DVVHVVPHQW�VKRZHG�LW�WR�EH�DQ�HIIHFWLYH�VFUHHQLQJ�WRRO��'D- YLGVRQ�HW�DO�������E���7KUHH�\HDUV�DIWHU�WKH�SLORW������QXUVHV�KDYH�EHHQ�VFUHHQHG�� ZLWK���SHUFHQW�RI�WKRVH�VFUHHQHG�H[SUHVVLQJ�WKRXJKWV�RI�WDNLQJ�WKHLU�RZQ�OLIH�� 176 nurses have received treatment, and 98 have accepted referrals for treatment.Ethical Competence2UJDQL]DWLRQV� DUH� LQYHVWLQJ� LQ� SURJUDPV� DLPHG� DW� EXLOGLQJ� PLQGIXOQHVV�� HWKLFDO�FRPSHWHQFH��DQG�UHVLOLHQFH�WKURXJK�H[SHULHQWLDO�DQG�GLVFRYHU\�OHDUQLQJ�� VLPXODWLRQ��DQG�FRPPXQLWLHV�RI�SUDFWLFH��%URZQ�DQG�5\DQ��������*URVVPDQ�HW� DO���������5XVKWRQ�HW�DO���������6KDSLUR�HW�DO���������6LQJOHWRQ�HW�DO����������7KHVH� SURJUDPV��FRXSOHG�ZLWK�SURJUDPV�DLPHG�DW�FXOWLYDWLQJ�QXUVHV·�FRPSHWHQFLHV�WR� DGGUHVV�HWKLFDO�FRQFHUQV�WKURXJK�V\VWHPDWLF�SURFHVVHV�WKDW�HQJDJH�WKH�YRLFH�RI� WKH�IURQW�OLQH�DQG�SURYLGH�QXUVHV�ZLWK�VNLOOV�IRU�FRQVWUXFWLYHO\�DQG�FRQÀGHQWO\� UDLVLQJ� WKHLU� FRQFHUQV�� DUH� LPSRUWDQW� OHYHUDJH� SRLQWV� IRU� FUHDWLQJ� ZRUNSODFHV� where moral resilience is fostered and ethical practice is routine (Grace et al., ������+DPULF�DQG�(SVWHLQ��������5RELQVRQ�HW�DO���������5XVKWRQ�HW�DO��������� 7URWRFKDXG�HW�DO���������:RFLDO�HW�DO����������7KHVH�UHVRXUFHV�DOVR�QHHG�WR�EH� DOLJQHG�ZLWK�V\VWHP�FKDQJHV�WKDW�UHPRYH�WKH�LPSHGLPHQWV�WR�QXUVHV·�ZHOO�EHLQJ� DQG�LQWHJULW\�DQG�EXLOG�PRUDO�FRPPXQLW\��+DPULF�DQG�:RFLDO��������/LDVFKHQNR� DQG�3HWHU��������7UDXGW�HW�DO����������$GRSWLQJ�V\VWHPDWLF�PHWKRGV�IRU�EXLOGLQJ� D� FXOWXUH� WKDW� IRVWHUV� HWKLFDO� SUDFWLFH� DQG� LQWHJULW\� E\� LQYHVWLQJ� LQ� VWUXFWXUDO� HOHPHQWV�DQG�SURFHVVHV�LQ�KHDOWK�FDUH�RUJDQL]DWLRQV�ZLOO�EH�HVVHQWLDO�WR�DPSOLI\� LQWHUYHQWLRQV�DLPHG�DW�EXLOGLQJ�LQGLYLGXDO�FDSDFLWLHV��1HOVRQ�HW�DO���������3DYOLVK�http://nap.nationalacademies.org/25982 The Future of Nursing 2020-2030: Charting a Path to Achieve Health EquityCopyright National Academy of Sciences. All rights reserved.HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 323BOX 10-4 Mobile Technology and Mental Health Interventions� 0RELOH� WHFKQRORJ\�DQG�P+HDOWK�KDV�EHFRPH�D�JURZLQJ�ÀHOG�RI� LQQRYDWLRQ�� VWXG\��DQG�UHVHDUFK��3DUN���������DQG�KDV�WKH�SRWHQWLDO�WR�KHOS�QXUVHV�DQG�RWKHU� FOLQLFLDQV�PDLQWDLQ�WKHLU�ZHOO�EHLQJ��P+HDOWK�LV�D�FRPELQDWLRQ�RI�H+HDOWK�RU�WHOH- health service delivery, health care tracking, mobile computing, medical sensor, DQG�FRPPXQLFDWLRQ� WHFKQRORJLHV��,VWHSDQLDQ�HW�DO����������P+HDOWK�KDV�PDQ\� advantages, it allows users to access services in most places, at any time, and bypasses traditional barriers created by infrastructure, such as roads and trans- SRUWDWLRQ��:+2��������� � 7KHUH�KDV�EHHQ�D�VWHDG\�LQFUHDVH�LQ�WKH�XVH�RI�VPDUWSKRQHV�DQG�WKH�HPHU- JHQFH�RI�VHYHUDO�PHQWDO�KHDOWK²IRFXVHG�DSSV��'RQNHU�HW�DO����������6\VWHPDWLF� reviews have shown that these apps, including those focused on mindfulness DQG�PHGLWDWLRQ��+XEHUW\�HW�DO���������DQG�RQ�EHKDYLRU�FKDQJH��+DQ�DQG�/HH�� ������/\]ZLQVNL�HW�DO����������KROG�SURPLVH�IRU�UHGXFLQJ�V\PSWRPV�RI�PHQWDO�LOO- QHVV�DQG�PDQDJLQJ�V\PSWRPV�RI�RWKHU�FKURQLF�LOOQHVV��+RZHYHU��UHVHDUFK�LQ�WKLV� area is growing, and studies have found that many apps lack clinical evidence or PHDQLQJIXO�LQSXW�IURP�XVHUV��6XEKL�HW�DO����������RU�KDYH�EHHQ�VWXGLHG�ZLWK�VPDOO� VDPSOH�VL]HV��*RRGZLQ�HW�DO���������5DWKERQH�DQG�3UHVFRWW��������:DQJ�HW�DO��� ������:RRG�HW�DO����������2WKHU�FKDOOHQJHV�LQFOXGH�OLPLWHG�DGRSWLRQ�RI�QHZ�DSS� based health interventions because of age or access to traditional health care VHUYLFHV��$OVVZH\�DQG�$O�6DPDUUDLH��������6XEKL�HW�DO����������7KH�QHDU�XELTXLW\� and adoption of information technology and data systems in health care and the steady growth of younger nurses entering the workforce means that nurses, espe- cially during periods of public health emergencies and crises, provide an optimal SRRO�RI�SRWHQWLDO�XVHUV�IRU�HYLGHQFH�EDVHG�PHQWDO�KHDOWK�DSSV� � ,Q�WKH�FRPLQJ�\HDUV�DQG�ZLWK�KLJKHU�PRELOH�XVDJH�LQ�SODFH��$OH[RSRXORV�HW� DO����������DGGLWLRQDO�UHVHDUFK�ZLOO�VXSSRUW�WKH�GHWHUPLQDWLRQ�RI�EHVW�SUDFWLFHV�IRU� helping nurses maintain their mental health or access mental health resources WKURXJK�WKH�XVH�RI�PRELOH�WHFKQRORJ\��,Q�WKH�PHDQWLPH��VHYHUDO�UHVRXUFHV�KDYH� EHHQ�ODXQFKHG�ZLWK�D�IRFXV�RQ�KHDOWK�FDUH�ZRUNHUV��$�PHQWDO�KHDOWK�SDUWQHU�LQLWLD- WLYH�EHWZHHQ�WKH�8QLYHUVLW\�RI�1RUWK�&DUROLQD�DW�&KDSHO�+LOO�DQG�&RRSHU�8QLYHUVLW\� +HDOWK�&DUH�FUHDWHG�DQ�DSS�FDOOHG�+HURHV�+HDOWK��ODXQFKHG�LQ�-XO\������WKDW�LV� DLPHG�DW�ÀUVW�UHVSRQGHUV�DQG�KHDOWK�FDUH�ZRUNHUV��7KH�DSS�DOORZV�WKHP�WR�DQVZHU� weekly questions that assess their mental health, and users are connected to UHVRXUFHV�EDVHG�RQ�WKHLU�DQVZHUV��+HURHV�+HDOWK���������$Q�DGGLWLRQDO�IHDWXUH� WR�ZKLFK�D�KHDOWK�FDUH�RUJDQL]DWLRQ�FDQ�VXEVFULEH�DOORZV�LWV�HPSOR\HHV�WR�JLYH� IHHGEDFN�WKURXJK�DQ�DJJUHJDWH�GDVKERDUG��%ULJKDP�DQG�:RPHQ·V�+RVSLWDO� LQ� %RVWRQ�UHOHDVHG�DQ�DSS�IRU�HPHUJHQF\�SURYLGHUV�FDOOHG�´5RVHµ�WKDW�FROOHFWV�GDWD� IURP�XVHUV�WKURXJK�D� MRXUQDO� IHDWXUH�DQG�TXHVWLRQQDLUHV��7KH�DSS·V�EXLOW� LQ�$,� platform then uses these data to identify trends in stress and burnout, allowing the RUJDQL]DWLRQ�WR�ÀQG�ZDUQLQJ�SDWWHUQV�RU�WULJJHUV�WKDW�PDUN�DGYHUVH�PHQWDO�KHDOWK� V\PSWRPV�LQ�VWDII��'UHHV��������/DQGL���������$UWLÀFLDO�LQWHOOLJHQFH�WHFKQRORJ\�LQ� the app is equipped to read key words and phrases and detect signs of mental KHDOWK�SUREOHPV��LQFOXGLQJ�WUDXPD��0LOLDUG��������http://nap.nationalacademies.org/25982 The Future of Nursing 2020-2030: Charting a Path to Achieve Health EquityCopyright National Academy of Sciences. All rights reserved.324 THE FUTURE OF NURSING 2020–2030HW�DO����������7KHVH�HIIRUWV�DUH�V\QHUJLVWLF�ZLWK�WKRVH�DLPHG�DW�EXLOGLQJ�SV\FKRORJ- LFDO�VDIHW\��1HOVRQ�HW�DO���������DQG�PRGHOV�RI�MXVW�FXOWXUH�IRU�VDIH��TXDOLW\�FDUH�Incivility, Bullying, and Workplace Violence,Q�LWV������SRVLWLRQ�VWDWHPHQW��$1$���������$1$�DUWLFXODWHG�WKH�UHVSRQVL- ELOLWLHV�RI�ERWK�LQGLYLGXDO�QXUVHV�DQG�HPSOR\HUV�LQ�HQGLQJ�ZRUNSODFH�EXOO\LQJ�� LQFLYLOLW\��DQG�ZRUNSODFH�YLROHQFH��:LWK�UHJDUG�WR�EXOO\LQJ��5XWKHUIRUG�DQG�FRO- OHDJXHV��������FRQGXFWHG�DQ�LQWHJUDWLYH�UHYLHZ�RI�VWXGLHV�RI�LQWHUYHQWLRQV�DG- GUHVVLQJ�WKH�EXOO\LQJ�RI�SUHOLFHQVXUH�QXUVLQJ�VWXGHQWV�DQG�QXUVLQJ�SURIHVVLRQDOV�� ÀQGLQJ�WKDW�WKRVH�LQWHUYHQWLRQV�IHOO�LQWR�WKUHH�PDLQ�FDWHJRULHV��HGXFDWLRQ��QXUVHV� DV�OHDGHUV��DQG�SROLF\�FKDQJHV��7KH�DXWKRUV�FRQFOXGH�WKDW�HGXFDWLRQDO�LQWHUYHQ- WLRQV�DUH�LPSRUWDQW�WR�UHGXFLQJ�RU�HOLPLQDWLQJ�EXOO\LQJ�EHKDYLRU�DQG�PD\�EH�RI� WKH�PRVW�EHQHÀW�WR�VWXGHQWV��7KHVH�W\SHV�RI�LQWHUYHQWLRQV�UDQJH�IURP�MRXUQDOLQJ� WR�WHDFKLQJ�QXUVHV�KRZ�WR�DGGUHVV�EHLQJ�D�WDUJHW�RI�EXOO\LQJ�RU�LQFLYLOLW\��2QH�LQWHUYHQWLRQ��GHVFULEHG�E\�$HEHUVROG�DQG�6FKRYLOOH���������XVHG�UROH� SOD\�VLPXODWLRQV�ZLWK�GHEULHÀQJ�VHVVLRQV�DQG�DQ�HGXFDWLRQDO�FRPSRQHQW�ZLWK� VHQLRU�OHYHO� XQGHUJUDGXDWH� QXUVLQJ� VWXGHQWV�� 3UHOLPLQDU\� TXDOLWDWLYH� HYLGHQFH� IURP�WKLV�LQWHUYHQWLRQ�LQGLFDWHG�WKDW�VLPXODWLRQ�FDQ�EH�DQ�HIIHFWLYH�VWUDWHJ\�IRU� DGGUHVVLQJ�LQFLYLOLW\�DQG�EXOO\LQJ�LQ�WKH�ZRUNSODFH��DOWKRXJK�WKLV�ZDV�D�VPDOO� SLORW�VWXG\�ZLWK�D�FRQYHQLHQFH�VDPSOH�RI�QXUVLQJ�VWXGHQWV��3IHLIIHU�DQG�9HVVH\� �������FRQGXFWHG�DQ�LQWHJUDWLYH�UHYLHZ�RI�EXOO\LQJ�DQG�ODWHUDO�YLROHQFH��%/9�� DPRQJ�QXUVHV� LQ�0DJQHW® DFFUHGLWHG�KHDOWK�FDUH�RUJDQL]DWLRQV�10 The authors IRXQG�WKDW�D�YDULHW\�RI�WHUPV�ZHUH�XVHG�WR�GHVFULEH�%/9��PDNLQJ�LW�GLIÀFXOW�WR� V\QWKHVL]H�DQG�FRPSDUH�ÀQGLQJV�DFURVV�VWXGLHV��$OWKRXJK�0DJQHW�DFFUHGLWDWLRQ� VWDQGDUGV�SURPRWH�D�PRGHO�RI�FROOHJLDOLW\�DQG�WHDPZRUN��%/9�UHPDLQV�SUHYDOHQW� DQG�H[LVWV�LQ�ERWK�0DJQHW�DQG�QRQ�0DJQHW�RUJDQL]DWLRQV��3IHLIIHU�DQG�9HVVH\� �������FDOO�IRU�PRUH�VWXGLHV�H[DPLQLQJ�WKH�SUHYDOHQFH�RI�%/9�LQ�WKHVH�DFFUHGLWHG� RUJDQL]DWLRQV�DQG�DOVR�PRUH�UHVHDUFK�DLPHG�DW�EHWWHU�XQGHUVWDQGLQJ�IDFWRUV�ZLWKLQ� RUJDQL]DWLRQV� DQG� LQWHUYHQWLRQV� WKDW� FDQ� HIIHFWLYHO\� UHGXFH� WKH� RFFXUUHQFH� RI� %/9��,Q�VXP��WKH�OHYHO�RI�HYLGHQFH�IRU�WKH�HIIHFWLYHQHVV�RI�EXOO\LQJ�LQWHUYHQWLRQV� DPRQJ�QXUVHV�LV�OLPLWHG�DQG�WKHUH�LV�D�QHHG�IRU�ULJRURXV��ZHOO�GHVLJQHG�5&7V� WR� EXLOG� WKLV� HYLGHQFH� EDVH�� PXOWLSOH�� VWUDWLÀHG� LQWHUYHQWLRQV� PD\� EH� QHHGHG� �5XWKHUIRUG�HW�DO����������As mentioned previously, workplace violence is also a concern for nurses, SDUWLFXODUO\�WKRVH�ZKR�ZRUN�LQ�HPHUJHQF\�GHSDUWPHQW�VHWWLQJV��*LOOHVSLH�HW�DO��� ����D�E���,QWHUYHQWLRQV�WKDW�KDYH�EHHQ�GHYHORSHG�WR�DGGUHVV�ZRUNSODFH�YLROHQFH� include a hybrid educational intervention with online and classroom components �*LOOHVSLH�HW�DO�������D��DQG�D�PXOWLFRPSRQHQW�LQWHUYHQWLRQ�WKDW�LQFOXGHV�HQYL- URQPHQWDO�FKDQJHV��HGXFDWLRQ��WUDLQLQJ��DQG�FKDQJHV�LQ�SROLFLHV�DQG�SURFHGXUHV�10 7KHVH�DUH�KHDOWK�FDUH�RUJDQL]DWLRQV�WKDW�DUH�DFFUHGLWHG�WKURXJK�WKH�$PHULFDQ�1XUVHV�&UHGHQWLDO- LQJ�&HQWHU��7KLV�PRGHO�LV�FRQVLGHUHG�WR�EH�WKH�JROG�VWDQGDUG�IRU�QXUVLQJ��3IHLIIHU�DQG�9HVVH\���������http://nap.nationalacademies.org/25982 The Future of Nursing 2020-2030: Charting a Path to Achieve Health EquityCopyright National Academy of Sciences. All rights reserved.HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 325�*LOOHVSLH�HW�DO�������E���DOWKRXJK�WKHVH�DUH�QRW�VWULFWO\�IRFXVHG�RQ�QXUVHV��7KH� hybrid educational intervention showed promise with a small sample of employ- HHV�IURP�D�SHGLDWULF�HPHUJHQF\�GHSDUWPHQW��ZLWK�WKH�UHVHDUFK�WHDP�FRQFOXGLQJ� WKDW�WR�DFKLHYH�VLJQLÀFDQW�OHDUQLQJ�DQG�UHWHQWLRQ��WKH�K\EULG�PRGHO�LV�SUHIHUUHG�� 7KH�PXOWLFRPSRQHQW�LQWHUYHQWLRQ�ZDV�SURPLVLQJ��EXW�RQO\�WZR�RI�VL[�VLWHV�UH- SRUWHG�VLJQLÀFDQW�GHFUHDVHV�LQ�YLROHQW�HYHQWV��7KH�DXWKRUV�DOVR�QRWH�WKDW�HPHU- JHQF\�GHSDUWPHQW�ZRUNHUV�GLG�QRW�UHSRUW�PRVW�RI�WKH�YLROHQW�HYHQWV�WKDW�RFFXUUHG� EHFDXVH�RI�VXFK�IDFWRUV�DV�WLPH�FRQVWUDLQWV�DQG�IHDU�RI�EHLQJ�EODPHG��*LOOHVSLH� HW�DO�������E���7KHUH�LV�D�QHHG�IRU�PRUH�UHVHDUFK�WR�H[DPLQH�KRZ�WR�DPHOLRUDWH� ZRUNSODFH�YLROHQFH�DPRQJ�KHDOWK�FDUH�ZRUNHUV��DQG�IRU�UHSOLFDWLRQ�DQG�ULJRURXV� 5&7V�RI�SURPLVLQJ�LQWHUYHQWLRQV��Racism, Prejudice, and Discrimination$V�GLVFXVVHG�LQ�&KDSWHU����WKHUH�KDV�EHHQ�D�VKLIW�LQ�SDWLHQW�FDUH�VHWWLQJV� away from cultural competency toward cultural humility, and toward a focus RQ�D�OLIHORQJ�DSSURDFK�WR�OHDUQLQJ�DERXW�GLYHUVLW\�DQG�WKH�UROH�RI� LQGLYLGXDO� ELDV� DQG� V\VWHPLF� SRZHU� LQ� KHDOWK� FDUH� LQWHUDFWLRQV�� 6SHFLÀF� DSSURDFKHV� WR� ZHDYLQJ�FXOWXUDO�KXPLOLW\�FRQFHSWV�LQWR�QXUVLQJ�DQG�LQWHUSURIHVVLRQDO�HGXFDWLRQ� are discussed in Chapter 7. 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All rights reserved.HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 333of community nurses means that employers have less opportunity to observe WKHLU�ZHOO�EHLQJ�DQG�OHVV�FRQWURO�RYHU�WKH�ZRUN�HQYLURQPHQW��0RUH�UHVHDUFK�LV� QHHGHG�RQ�LPSURYLQJ�WKH�ZHOO�EHLQJ�RI�QRQFOLQLFDO�QXUVHV��LQ�WKH�LQWHULP��JLYHQ� the lack of evidence, employers need to think creatively and communicate with nurses about their needs.7KHUH�DUH�D�YDULHW\�RI�H[LVWLQJ�RUJDQL]DWLRQDO�LQLWLDWLYHV�WR�LPSURYH�QXUVH� ZHOO�EHLQJ�WKURXJK�FKDQJHV�WR�WKH�ZRUN�HQYLURQPHQW��DV�GHVFULEHG�EHORZ��7KH� SUHYLRXVO\�GLVFXVVHG�0DJQHW�5HFRJQLWLRQ�SURJUDP�RI�WKH�$PHULFDQ�1XUVHV�&UH- GHQWLDOLQJ�&HQWHU��$1&&��LV�DQ�RUJDQL]DWLRQDO�PRGHO�GHVLJQHG�WR�LPSURYH�WKH� ZRUN�HQYLURQPHQW�IRU�QXUVHV�LQ�D�KRVSLWDO�VHWWLQJ��7KH�PRGHO�LV�IRFXVHG�RQ�LPSUR- YLQJ�WKRVH�FRPSRQHQWV�RI�D�QXUVH·V�ZRUN�HQYLURQPHQW�WKDW�FDQ�EH�DGMXVWHG��VXFK� DV�VXIÀFLHQW�VWDIÀQJ��OHDGHUVKLS��FOLQLFDO�DXWRQRP\��LQWHUGLVFLSOLQDU\�FROODERUD- WLRQ��DQG�VKDUHG�JRYHUQDQFH��7KH�FRPPLWWHH�QRWHV�WKDW�WKHVH�FRPSRQHQWV�PDWFK� PDQ\�RI�WKH�ZRUN�V\VWHP�IDFWRUV�WKDW�FRQWULEXWH�WR�EXUQRXW��1$6(0������D��� $V�RI�������DERXW����SHUFHQW�RI�8�6��KRVSLWDOV�KDG�DFKLHYHG�0DJQHW�GHVLJQDWLRQ� �$1&&���������$QRWKHU�$1&&�LQLWLDWLYH��WKH�3DWKZD\�WR�([FHOOHQFH�SURJUDP�� UHFRJQL]HV�KHDOWK�FDUH�RUJDQL]DWLRQV�WKDW�GHPRQVWUDWH�D�FXOWXUH�LQ�ZKLFK�D�ZRUN� HQYLURQPHQW�WKDW�HQJDJHV�DQG�HPSRZHUV�LWV�ZRUNHUV�LV�IRVWHUHG��0HHWLQJ�WKH���� VWDQGDUGV�IRFXVHG�RQ�ZRUNSODFH�H[FHOOHQFH� LV�DVVRFLDWHG�ZLWK�SURPLVLQJ�GDWD� VXJJHVWLQJ�LPSURYHG�SDWLHQW�FDUH��GHFUHDVHG�HPRWLRQDO�H[KDXVWLRQ��DQG�KLJKHU� job satisfaction (JarrtQ�HW�DO����������3URJUDPV�VXFK�DV�6FKZDUW]�&HQWHU�5RXQGV�RIIHU�LQWHUSURIHVVLRQDO�RSSRUWX- QLWLHV�WR�H[SORUH�WKH�SV\FKRORJLFDO��VSLULWXDO��DQG�PRUDO�DVSHFWV�RI�FOLQLFDO�ZRUN� LQ�D�IDFLOLWDWHG�IRUPDW��7KH�FUHDWLRQ�RI�ZHOO�EHLQJ�DQG�D�IHHOLQJ�RI�SV\FKRORJLFDO� VDIHW\�DPRQJ�WHDPV�LV�HQDEOHG�E\�D�FXOWXUH�RI�VDIHW\��QRUPV�RI�SURIHVVLRQDO�UH- sponsibility to speak up, leadership, support from peers and leaders, familiarity ZLWK�WHDP�PHPEHUV��DQG�LQFOXVLYHQHVV��2·'RQRYDQ�DQG�0F$XOLIIH���������(YL- GHQFH�VXJJHVWV�WKDW�VXFK�SURJUDPV�IRVWHU�FRPPXQLFDWLRQ��WHDPZRUN�DQG�VXSSRUW� �/RZQ�DQG�0DQQLQJ���������DQG�SV\FKRORJLFDO�ZHOO�EHLQJ��0DEHQ�HW�DO���������� )XUWKHU�UHVHDUFK�LV�QHHGHG�WR�VXSSRUW�WKH�GHVLJQ��LPSOHPHQWDWLRQ��DQG�HYDOXDWLRQ� RI�LQWHUYHQWLRQV�DLPHG�DW�EXLOGLQJ�SV\FKRORJLFDO�VDIHW\�ZLWKLQ�KHDOWK�FDUH�WHDPV� �2·'RQRYDQ�DQG�0F$XOLIIH���������The American Association of Critical-Care Nurses (AACN) has developed a VHW�RI�VWDQGDUGV�IRU�HVWDEOLVKLQJ�DQG�VXVWDLQLQJ�KHDOWK\�ZRUN�HQYLURQPHQW��+:(�� VWDQGDUGV��,QLWLDOO\�UHOHDVHG�LQ������DQG�UHYLVHG�LQ�������WKH�+:(�VWDQGDUGV�KDYH� EHHQ�ZLGHO\�DGRSWHG�QDWLRQDOO\�DQG�LQ�VHYHUDO�RWKHU�FRXQWULHV��7KH�VL[�HVVHQ- WLDO�VWDQGDUGV�DUH�´VNLOOHG�FRPPXQLFDWLRQ��WUXH�FROODERUDWLRQ��HIIHFWLYH�GHFLVLRQ� PDNLQJ��DSSURSULDWH�VWDIÀQJ��PHDQLQJIXO�UHFRJQLWLRQ��DQG�DXWKHQWLF�OHDGHUVKLSµ� �$$&1��������S�������2XWFRPHV�IRU�RUJDQL]DWLRQV�LPSURYH�ZKHQ�WKH\�DFWLYHO\� LPSOHPHQW�WKHVH�VWDQGDUGV��$$&1���������$�VXUYH\�RI�PRUH�WKDQ�������DFXWH�DQG� FULWLFDO�FDUH�QXUVHV��8OULFK�HW�DO���������GHPRQVWUDWHG�WKDW�XQLWV�WKDW�LQWHQWLRQDOO\� DGGUHVV�ZRUN�HQYLURQPHQW�LVVXHV�VFRUHG�EHWWHU�RQ�HYHU\�LQGLFDWRU�RI�+:(�VWDQ- GDUGV��LQFOXGLQJ�FROODERUDWLRQ��OHDGHUVKLS��VWDIÀQJ��LQWHQW�WR�OHDYH��DQG�GHFLVLRQ�http://nap.nationalacademies.org/25982 The Future of Nursing 2020-2030: Charting a Path to Achieve Health EquityCopyright National Academy of Sciences. 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All rights reserved.HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 335$GPLQLVWUDWLYH�%XUGHQ�5HODWLQJ�WR�WKH�8VH�RI�+HDOWK�,7�DQG�(+5��21&��������� 3ROLF\�PDNHUV�FDQ�ZRUN�WRJHWKHU�ZLWK�QXUVHV��RWKHU�FOLQLFLDQV��ZRUNSODFHV��DQG� SDWLHQWV�WR�GHYHORS�SROLFLHV�WKDW�PHHW�WKH�QHHGV�RI�KHDOWK�FDUH�ZKLOH�SURPRWLQJ� WKH�ZHOO�EHLQJ�RI�QXUVHV.'XULQJ� WKH� &29,'���� SDQGHPLF�� &06� DQG� RWKHU� UHJXODWRUV� DQG� SD\HUV� KDYH�PDGH�FKDQJHV�WR�SROLFLHV�WR�OLIW�RU�OHVVHQ�DGPLQLVWUDWLYH�DQG�WHFKQRORJLFDO� EXUGHQV�RQ�FOLQLFLDQV��LQFOXGLQJ�QXUVHV��7KHUH�KDYH�EHHQ�FDOOV�WR�PDNH�PDQ\�RI� WKHVH�FKDQJHV�SHUPDQHQW�WR�WUDQVIRUP�KHDOWK�FDUH��ZLWK�WKH�JRDO�RI�DFKLHYLQJ�WKH� 4XDGUXSOH�$LP�RXWFRPHV�RI�EHWWHU�FDUH�IRU�LQGLYLGXDOV��EHWWHU�KHDOWK�IRU�WKH�SRSX- ODWLRQ��ORZHU�FRVWV��DQG�EHWWHU�H[SHULHQFH�IRU�FOLQLFLDQV��%RGHQKHLPHU�DQG�6LQVN\�� ������6LQVN\�DQG�/LQ]HU���������)RU�LQVWDQFH��LQ�D�UHFHQW�FRPPHQWDU\��6LQVN\� DQG�/LQ]HU��������FDOO�IRU�D�UHFRQVLGHUDWLRQ�RI�WKH�SUH�&29,'����VWDWXV�TXR�DQG� UHFRPPHQG�WKDW�FHUWDLQ�SROLF\�DQG�SUDFWLFH�FKDQJHV�UHODWHG�WR�&29,'����UHPDLQ� LQ�SODFH��H�J���SHUPLWWLQJ�YHUEDO�RUGHUV��DOORZLQJ�FOLQLFLDQV�WR�SURYLGH�WHOHKHDOWK� VHUYLFHV�IURP�WKHLU�KRPHV���$V�QRWHG�LQ�&KDSWHU����WKH�7ULSOH�$LP�LV�IRFXVHG� SULPDULO\�RQ�RSWLPL]LQJ�WKH�KHDOWK�V\VWHP·V�SHUIRUPDQFH��VHH�%RGHQKHLPHU�DQG� 6LQVN\���������7KH�´IRXUWK�DLP�µ�DGGUHVVLQJ�FOLQLFLDQV·�ZHOO�EHLQJ�DQG�LPSURYLQJ� WKHLU�ZRUN�OLIH��DOVR�WDUJHWV�LPSURYLQJ�WKH�TXDOLW\�RI�SDWLHQW�FHQWHUHG�FDUH��DQG� these two need to be in balance so one or the other is not compromised (Boden- KHLPHU�DQG�6LQVN\���������Nursing Associations and Organizations1XUVLQJ�DVVRFLDWLRQV�DQG�RUJDQL]DWLRQV��LQGLYLGXDOO\�DQG�FROOHFWLYHO\��KDYH� D�SLYRWDO�UROH�LQ�VXSSRUWLQJ�QXUVH�ZHOO�EHLQJ��3URIHVVLRQDO�RUJDQL]DWLRQV�VXFK� DV�$1$��$$&1��DQG�RWKHUV�KDYH�OHYHUDJHG�WKHLU�RUJDQL]DWLRQDO�LQIUDVWUXFWXUH� WR�FXUDWH�UHVRXUFHV��RIIHU�SURJUDPV��DQG�LQWHUSUHW�DQG�GLVVHPLQDWH�UHSRUWV��UH- VHDUFK��DQG�EHVW�SUDFWLFHV��,Q�0D\�������WKH�$PHULFDQ�1XUVHV�)RXQGDWLRQ��WKH� SKLODQWKURSLF�DUP�RI�$1$��ODXQFKHG�D�QDWLRQDO�ZHOO�EHLQJ�LQLWLDWLYH18 for nurses WR�DGGUHVV�WKH�LQFUHDVHG�VWUHVV�RQ�QXUVHV�GXH�WR�WKH�&29,'����SDQGHPLF��7KLV� LQLWLDWLYH�LV�D�FROODERUDWLRQ�DPRQJ�$1$��$$&1��WKH�(PHUJHQF\�1XUVHV�$VVRFL- DWLRQ��WKH�(1$���DQG�WKH�$PHULFDQ�3V\FKLDWULF�1XUVHV�$VVRFLDWLRQ��$31$���DQG� LQFOXGHV�SHHU�WR�SHHU�FRQYHUVDWLRQV��KRWOLQHV��FRJQLWLYH�SURFHVVLQJ�WHFKQLTXHV�� and other preventive approaches, such as apps for stress reduction. The National %ODFN�1XUVHV�$VVRFLDWLRQ��1%1$��KDV�DQ�1%1$�$IÀUPDWLRQV�ZHESDJH�LQ�ZKLFK� QXUVHV�FDQ�VXEPLW�WKHLU�IDYRULWH�TXRWHV�RU�SRVLWLYH�DIÀUPDWLRQV�19 and also has a 7ZLWWHU�FDPSDLJQ�FDOOHG��1%1$5HVLOLHQW��7KH�1DWLRQDO�$VVRFLDWLRQ�RI�+LVSDQLF�18����� �)RU� PRUH� LQIRUPDWLRQ�� VHH� �KWWSV���ZZZ�QXUVLQJZRUOG�RUJ�QHZV�QHZV�UHOHDVHV������DPHULFDQ� QXUVHV�IRXQGDWLRQ�ODXQFKHV�QDWLRQDO�ZHOO�EHLQJ�LQLWLDWLYH�IRU�QXUVHV��DFFHVVHG�$SULO�����������19 6HH�KWWSV���ZZZ�QEQD�RUJ�DIÀUPDWLRQV��DFFHVVHG�$SULO�����������http://nap.nationalacademies.org/25982 The Future of Nursing 2020-2030: Charting a Path to Achieve Health EquityCopyright National Academy of Sciences. All rights reserved.336 THE FUTURE OF NURSING 2020–20301XUVHV��1$+1��FRQGXFWV�HGXFDWLRQDO�SURJUDPPLQJ�WKDW�LQFOXGHV�ZHELQDUV�IR- FXVHG�RQ�VWUHVV�DQG�FRPSDVVLRQ�IDWLJXH���1XUVLQJ�RUJDQL]DWLRQV�DUH�SRLVHG�WR�EH�WKH�FROOHFWLYH�YRLFH�RI�WKHLU�PHPEHUV� RQ�FULWLFDOO\�LPSRUWDQW�LVVXHV�LQFOXGLQJ�QXUVH�ZHOO�EHLQJ�E\�QDPLQJ�WKH�SUREOHP� DQG�DGYRFDWLQJ�IRU�VROXWLRQV��7KH\�KDYH�D�YLWDO�UROH�LQ�VKDSLQJ�WKH�QDUUDWLYH�DERXW� WKH�FKDOOHQJHV�QXUVHV�IDFH�WR�DYRLG�UHLQIRUFLQJ�D�YLFWLP�SHUVSHFWLYH�E\�RIIHULQJ� DQ�HYLGHQFH�LQIRUPHG�DUUD\�RI�VROXWLRQV�WKDW�FDQ�EH�FXVWRPL]HG�IRU�WKH�XQLTXH� QHHGV� RI� PHPEHUV� ZLWKLQ� WKHLU� RUJDQL]DWLRQV�� 7KH\� KDYH� UHSUHVHQWHG� YDULRXV� QXUVLQJ� VSHFLDOWLHV� LQ� VXFK� LQWHUSURIHVVLRQDO� LQLWLDWLYHV� DV� WKH� 1$0·V�$FWLRQ� &ROODERUDWLYH�WR�EULQJ�WKH�YRLFH�RI�QXUVHV�WR�WKH�WDEOH��3URIHVVLRQDO�RUJDQL]DWLRQV� DOVR�SURYLGH�V\VWHPV�RI�VXSSRUW��EXLOG�FRPPXQLW\�DQG�FRQQHFWLRQ�DPRQJ�WKHLU� PHPEHUV��DQG�LQVSLUH�HQJDJHPHQW� LQ�DGGUHVVLQJ�WKH�V\VWHPLF�LPSHGLPHQWV� WR� QXUVH�ZHOO�EHLQJ��3URIHVVLRQDO�RUJDQL]DWLRQV�KDYH�D�SLYRWDO�UROH�LQ�HGXFDWLQJ�WKHLU� FRPPXQLWLHV�DERXW�WKH�IDFWRUV�WKDW�GHJUDGH�WKHLU�ZHOO�EHLQJ��VXFK�DV�EXUQRXW��DQG� LQ�GLVVHPLQDWLQJ�UHVRXUFHV�WR�DGGUHVV�WKHP��&RFKUDQ�HW�DO����������CONCLUSIONS7R�FDUH�UHVSRQVLEO\�IRU�SHRSOH³HVSHFLDOO\�DV�WKH\�SUDFWLFH�LQ�PRUH�VHWWLQJV� ZLWK�PRUH�GLYHUVH�SHRSOH�ZLWK�FRPSOH[�QHHGV³QXUVHV�QHHG�WR�IHHO�KHDOWK\��ZHOO�� and supported. The systems that educate and employ nurses have a duty to fully VXSSRUW�WKHP�DV�WKH\�WDNH�RQ�QHZ�UROHV�WR�DGYDQFH�KHDOWK�HTXLW\��:KLOH�QXUVHV� KDYH�H[SHULHQFHG�URDGEORFNV�WR�ZHOO�EHLQJ�EHIRUH³IURP�EXUQRXW��WR�FRPSDVVLRQ� IDWLJXH��WR�LQMXULHV�DQG�LQIHFWLRQ³&29,'����KDV�LQWHQVLÀHG�WKHLU�VWUHVV�DQG�OHIW� WKHP�IHHOLQJ�XQSURWHFWHG�DQG�XQVXSSRUWHG��Conclusion 10-1: All environments in which nurses work affect the health and well-being of the nursing workforce. Ultimately, the health DQG�ZHOO�EHLQJ�RI�QXUVHV�LQÁXHQFH�WKH�TXDOLW\��VDIHW\��DQG�FRVW�RI�WKH� care they provide, as well as organizations and systems of care. The COVID-19 crisis has highlighted the shortcomings of historical efforts to address nurses’ health and well-being.1XUVH�ZHOO�EHLQJ�LV�LPSDFWHG�E\�SK\VLFDO��PHQWDO��PRUDO��DQG�VRFLDO�IDFWRUV� RULJLQDWLQJ�LQ�D�UDQJH�RI�VRXUFHV�IURP�WKH�LQGLYLGXDO�WR�WKH�V\VWHP�OHYHO��,PSURY- LQJ�WKH�ZHOO�EHLQJ�RI�QXUVHV�ZLOO�WKHUHIRUH�UHTXLUH�PXOWLOHYHO�DQG�PXOWLIDFHWHG� approaches that address their physical, mental, moral, and social health and cre- DWH�VDIH��VXSSRUWLYH��DQG�HWKLFDOO\�JURXQGHG�HQYLURQPHQWV��2FFXSDWLRQDO�KHDOWK� KD]DUGV��ZRUNSODFH�YLROHQFH��VWUHVV�DQG�PHQWDO�KHDOWK�LVVXHV��PRUDO�VXIIHULQJ�� FRPSDVVLRQ�IDWLJXH��EXUQRXW��DQG�EXOO\LQJ�DQG�LQFLYLOLW\�DOO�QHHG�WR�EH�DGGUHVVHG���� 6HH� KWWS���ZZZ�QDKQQHW�RUJ�1$+1�(YHQWV�:HELQDUV�1$+1�&RQWHQW�:HELQDUV�DVS["KNH\ �F����G��D�H���HD���E�I�GD�I���EI�GF��DFFHVVHG�$SULO������������http://nap.nationalacademies.org/25982 The Future of Nursing 2020-2030: Charting a Path to Achieve Health EquityCopyright National Academy of Sciences. All rights reserved.HEALTH AND PROFESSIONAL WELL-BEING OF NURSES 337WKURXJK�UHIRUP�DLPHG�DW�FKDQJLQJ�ZRUNSODFH�SROLFLHV�DQG�FXOWXUH�WR�VXSSRUW�WKH� ZHOO�EHLQJ�RI�QXUVHV�DQG�HQVXUH�WKHLU�FDSDFLW\�DQG�DELOLW\�WR�SURYLGH�TXDOLW\�FDUH� for people, families, and communities.&RQFOXVLRQ�������7KH�ODFN�RI�VXIÀFLHQW�GDWD�DQG�HYLGHQFH�DERXW�WKH� negative impacts of burnout, fatigue, and stressful work environments on nurses’ health and well-being hinders understanding of the severity of these issues and limits the ability to address them appropriately. Many programs and initiatives seek to improve nurses’ health and well-being; however, the translation of effective evidence-based in- terventions into practice, further research, and rigorous studies are needed to understand the impact of these programs and initiatives and their relationship to system factors.Conclusion 10-3: Structural racism, cultural racism, and discrimi- nation exist within nursing as in other professions. Nurses of color experience discrimination and bias within the workplace and educa- tional systems, compounded by the lack of diversity among the nursing workforce and faculty. Nurses, educators, and health care leaders have a responsibility to address structural racism, cultural racism, and discrimination within the nursing profession across educational and practice settings, and to build structures and systems that promote in- clusivity and health equity.$V�WKH�IXWXUH�RI�QXUVLQJ�GHPDQGV� WKDW�QXUVHV� LQFUHDVLQJO\�DGGUHVV�VRFLDO� QHHGV�DQG�6'2+��DWWHQWLRQ�WR�QXUVH�ZHOO�EHLQJ�ZLOO�EH�FULWLFDO��$GGUHVVLQJ�VR- FLDO�QHHGV�DQG�6'2+�UHTXLUHV�LQ�WXUQ�FRJQLWLYH��HPRWLRQDO��DQG�PRUDO�ZRUN�WKDW� LV�QRW�FXUUHQWO\�VXSSRUWHG��WKDW�LV��WLPH�DQG�SD\PHQW�IRU�WKLV�ZRUN�DUH�ODUJHO\� QRW�DYDLODEOH��,I�QXUVHV�DQG�RWKHU�FOLQLFLDQV�DUH�H[SHFWHG�WR�IXOÀOO�WKHLU�SURIHV- VLRQDO�PDQGDWHV�IRU�VRFLDO� MXVWLFH�� LQFOXGLQJ�DGGUHVVLQJ�FRPSOH[�VRFLDO�QHHGV� DQG�6'2+��DQG�WR�VSHQG�WKH�WLPH�DQG�FRJQLWLYH�HIIRUW�WR�DGGUHVV�ERWK�KHDOWK�DQG� VRFLDO�LVVXHV��V\VWHP�ZLGH�FKDQJHV�ZLOO�EH�QHHGHG�WR�SURYLGH�VSDFH�DQG�VXSSRUW� IRU�WKDW�VKLIW��0RUH�ZHOO�GHVLJQHG��PHWKRGRORJLFDOO\�VRXQG�UHVHDUFK�VWXGLHV�DUH� QHHGHG�WR�GHYHORS�DGGLWLRQDO�NQRZOHGJH�LQ�WKLV�DUHD�Conclusion 10-4: Coordinated and collaborative action at the individ- ual and systems levels, encompassing individual nurses, educators, employers, health systems, professional organizations, and govern- ment agencies, is needed to promote nurses’ health and well-being.(QVXULQJ�QXUVH�ZHOO�EHLQJ�QHFHVVLWDWHV�DQ�LQYHVWPHQW�LQ�LQGLYLGXDO�VWUDWHJLHV� within a systems approach that addresses the structures and policies responsible IRU�WKH�ZRUNSODFH�KD]DUGV�DQG�VWUHVVHV�WKDW�OHDG�WR�SRRU�KHDOWK��7KLV�LQYHVWPHQW�http://nap.nationalacademies.org/25982