Eleanor Feldman Barbera, Ph.D.

In long-term care we spend a lot of time focused on the physical health of those in our care. With increased emphasis on culture change and the update to the MDS (and hopefully as a result of this column), we’ve begun to address the mental health of our residents more adequately.

We do this not only by assessing the needs of individuals, but also by creating a healing emotional environment for all residents. It’s easier for our staff members to create an emotionally healing environment for residents when the work environment is psychologically healthy for them.

What makes a psychologically healthy workplace?

The American Psychological Association (APA) Center for Organizational Excellence recognizes five different elements that contribute to a healthy environment:

  • Employee involvement includes efforts to involve employees in decision-making and give them more opportunity for autonomy.
  • Work-life balance is a recognition that responsibilities outside work can impact on performance on the job, leading to programs that assist workers in managing childcare, eldercare, financial crises, etc.
  • Employee growth and development focuses on offerings that provide employees with the opportunity for new skills and experiences such as coaching or mentoring, continuing education, tuition reimbursement, etc.

  • Health and safety comprises programs that work to maximize employees’ physical and emotional health such as stress management programs, adequate insurance, healthy lifestyle motivators, safe practices training on the job, and Employee Assistance Programs (EAPs).
  • Employee recognition includes ceremonies that acknowledge individual and group contributions to the organization, performance-based bonuses and pay increases, and acknowledgement of milestones.

The benefits of a psychologically healthy workplace 

According to the APA Center for Organizational Excellence, which has been honoring exemplary company practices since 1999, having a healthy workplace isn’t just good for employees. A psychologically healthy environment can reduce staff turnover and absenteeism, improve performance, and enhance the quality of services provided. 

Compare the 2013 award winners with the national average:

  • Turnover: 6% vs. 38%
  • Chronic work stress: 19% vs. 35%
  • Job satisfaction: 84% vs. 67%
  • Intention to seek other work: 11% vs. 31%

Interestingly, three of the four winners this year are healthcare-related employers.  Their award-winning programs included:

  • An annual wellness retreat that appreciably reduced staff conflict and improved communication and group cohesiveness
  • Employee recognition through bonuses and retirement account contributions
  • Flexible scheduling
  • Telework options
  • A wellness website
  • Generous health coverage
  • On-site exercise rooms and fitness programs
  • On-site support programs and medical screenings that saved the company over $381,000 in lost productivity

Where to start in long-term care? 

I’m a big advocate of taking small steps in the direction of change. Perhaps your organization isn’t in the position of being able to upgrade the health insurance package or to install an onsite gymnasium. Here are some manageable actions along the road to a psychologically healthy workplace:

  • As I pointed out in my last post, talking with new hires about the elephant in the living room (the fact that many of our residents die) could reduce absenteeism and turnover. It would undoubtedly make our workers less distressed and our workplaces psychologically healthier.
  • Start customer service training at the management level. Are those in managerial positions speaking to staff members in a manner they’d want the staff members to emulate with residents and families? If not, it’s a great place to begin to change the culture of the facility.
  • Acknowledge successes and efforts on a regular basis. All too often, LTC is a punitive environment where workers are “written up” or facilities are “cited.”  While there are times this is necessary, there are so many more times when people are striving to do their best for residents, even if it doesn’t turn out the way they expected. Make it a point to recognize their efforts regardless of outcome.

  • Include workers in decisions that impact them. Once, I overheard a resident complain to a director of nursing that the nurse wasn’t letting her make a promised phone call at a consistent time. “Okay,” the DON said, “I’ll tell him to do it at 9 a.m.” I was taken aback, knowing that at 9 a.m. the nurse had other daily obligations and that there was no way this “resolution” would be manageable.  Yet versions of this story happen daily, with managers missing out on valuable information from their workers that could create effective solutions to dilemmas. Take the time to solicit feedback from those involved either formally or informally, and create an environment where feedback is a welcome contribution rather than perceived as criticism.
  • Offer stress management training and support through onsite or offsite classes or through EAP services. Long-term care can be a stressful environment with generally low pay and exposure to some of the sadder parts of life. Help your workers cope with their feelings so that they can be their best as they show up for work and for their lives.

Eleanor Feldman Barbera, PhD, the author of The Savvy Resident’s Guide, is an accomplished speaker and consultant with over 16 years of experience as a psychologist in long-term care. A long-time contributor to McKnight’s publications, this blog complements her award-winning website, MyBetterNursingHome.com, which has more on how to create long-term care where EVERYBODY thrives.