By James Shea

For years, VCU Medical Center and other hospitals around the country have used a stress control model that involves nurses sitting in a room and talking about a traumatic event. But forcing nurses to relive their trauma generally doesn’t help much, says Kelley Rumsey, pediatric trauma program manager at Children’s Hospital of Richmond at VCU.  She felt there had to be a better way.

“In my work, I have witnessed many times the sadness among our providers after we have had a terrible tragedy,” Rumsey said. “You might have a child who has died because they have a terrible trauma, and the mental health and well-being of our team members around that began to concern me.”

The burnout rate for nurses has always been high — even before the pandemic. One study showed that 15% of nurses experienced burnout and considered leaving the field. An environment like that creates problems not only for nurses, but for the patients, too, Rumsey noted. Stressed, burned out nurses are more likely to make a mistake, which could negatively impact patient care.

Inspired by a Navy protocol

In addition to her work at the hospital, Rumsey serves on a regional peer support team for paramedics, firefighters and other emergency responders. She deploys with the team during emotionally difficult cases, particularly those involving children.

While embedded within the Chesterfield County Fire and EMS a few years ago, she encountered a different means of stress control in use among responders. The “Stress First Aid” (SFA) protocol used a peer-to-peer approach to help team members better understand and confront their trauma.

“Stress First Aid is not practiced widely within hospitals,” Rumsey said. “It’s mostly practiced in pre-hospital environments.”

The model was developed by the Navy to help health care workers who incurred post-traumatic stress disorder while serving in Iraq or Afghanistan. With that in mind, Rumsey reached out to Richard J. Westphal, Ph.D., co-director of the Wisdom and Wellbeing Program at the University of Virginia, for advice on how to bring SFA to VCU Health. Westphal had worked for the Navy and has helped deploy the protocol across the United States.

With Westphal’s help, Rumsey initiated SFA at CHoR in 2018 — teaching 20 PICU team members the technique in a pilot project. In 2020, the program expanded across CHoR, and by 2021, SFA training had begun across the health system.

Colors as cues

Stress First Aid is a highly visual system that uses the colors green, yellow, orange and red to express emotional state. The process starts when one nurse asks another how he or she is feeling.

“It’s intended to be a natural conversation,” Rumsey said. “It is not intended to look like a mental health intervention, because we know there is a lot of stigma around mental health. If someone thinks you are not ok, that could be the end of your career. SFA is really just a skillset for team members to begin that conversation.”

The person identifies where on the color spectrum they reside. Green means healthy. Yellow means stressed and irritated. Orange means something in particular is causing distress. Red signifies a mental disorder, like PTSD.

Red is rare, Rumsey said. Health care professionals often reside in yellow and orange during the workday. SFA helps move them toward green. The process might involve taking a walk around the block or speaking with the hospital chaplain.

“The key to the interventions is recognizing somebody is struggling and connecting with them human-to-human, peer-to-peer, on a one-on-one basis. Then they connect that person with the right resources.”

It works

Data collected after the pilot project showed decreased burnout and reduced turnover among nursing staff. The data also showed a decline in absenteeism, with fewer nurses calling in sick.

“We heard from the team members, and we heard from staff that the culture has shifted,” Rumsey said. “It is a much more caring and supportive environment.”

Westphal said VCU’s experience of using team members to train other people is unique and could set an example for other organizations. SFA was readily accepted here and supported because units were given the freedom to implement SFA in a way that matched the team’s needs rather than being prescribed a one-size-fits-all approach.

“The implementation at VCU, from my perspective, in many ways has been ideal,” Westphal stated. “They started with a small group of individuals that had a passion about helping their colleagues. They were trained with a set of tools they could use. They were able to use those tools in a way that worked in their individual units and cultures.”

SFA particularly relevant during COVID

Because the pandemic has been challenging for everyone in health care, Rumsey has been teaching SFA across the health system so nurses from other units could benefit. SFA took on added momentum as pediatric nurses deployed to other areas of the health system introduced the toolkit to their new teams, helping those teams better handle the stress of tending COVID-19 patients.

“I’m not gonna lie. COVID was stressful even within a functioning team,” Rumsey said. “But what we heard anecdotally was that as those team members got redeployed, they were able to dual purpose their nursing skills by being caring and supportive in their new units. They were able to understand the stress that those COVID units were experiencing.”

Rumsey’s goal is to see the protocol implemented across the health system. SFA can make a huge difference at VCU, she said. With their stress under control, VCU employees can continue to provide the best health care possible to their patients.

Kelley Rumsey is but one of the many VCU Health nurses who make our campus special. May is National Nurses Month. We would like to take this moment to express our appreciation to Rumsey as well as all of our nurses. Thank you for your skills, talents, caring and compassion. We couldn’t do our jobs without you.

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