As we begin 2022 and enter the third year of the COVID-19 pandemic, care teams are responding to the pandemic amid cases of the new Omicron variant surging, flu cases rising, and millions of people still unvaccinated. Health center teams who may have been stressed, strained, and burned out before, are now experiencing emotional exhaustion. They are also experiencing moral injury and distress. These are emotions and bodily changes that accompany a disconnect between what you believe is right and good, and what you are able to do or what you see happening around you.

"At this point in the pandemic we are tired, not even physically tired, but we are mentally exhausted, so trying to give our employees an outlet to be verbal about what they are experiencing with that burden is critical," says Ronda Arline, Director of Nursing, Albany Area Primary Health Care, Albany, GA. "With this pandemic, our employees have lost parents, siblings, and even children so in order to help them, you have to consider their personal lives on top of things constantly changing in the clinics which are busy outside of COVID."

NACHC is addressing moral injury and distress with health centers to strengthen their workplace culture. In the NACHC presentation, "A Path to Healing for the Workforce," Senior Fellows Jennie McLaurin, MD, MPH, FAAP, Wanda Montalvo, PhD, RN, FAAN, and Grace Wang, MD, MPH, FAAFP discussed the impact and trauma on the workforce resulting from the pandemic. The presentation illustrated staff resources to assist healing, including poetry exercises, and examples of grief walking methods.

"As our health care teams continue to push through this pandemic response, we must acknowledge and meet our provider teams where they are."

Dr. Wanda Montalvo, Phd, RN, FAAN

The Therapeutic Power of Poetry

Functional MRI studies show poetry composition provides an opportunity to rest the parts of the brain that are used for planning and priority setting. Research also shows writing poetry increases activity in areas of the brain associated with motivation, drive, and intentional self-generated action. According to Dr. Wang, "Poetryis a narrative medicine tool that helps staff process and channel intense emotions, give perspective to their worries and foster a sense of calm and peace."

Writing short poems like Haikus are ways that care teams can gather to express their reality and their hopes for the future.

Haiku Poetry Technique	Examples
Contains 17 syllables, arranged in 3 lines Lines 1 and 3 - 5 syllables Line 2 - 7 syllables Does not rhyme or have titles Is not a reflective or finished poem The verb "to be" shouldn't be included, it is already implied Should be kept simple Tends to include a reference to nature or to the current season	Too many thoughts abound I long for peace and quiet Too much to be done Toward better health Respect for healthcare workers Listen to the science

Reflecting on Loss Through Grief Walking

Health center staff are experiencing griefs both large and small. One intervention that safely assists staff to collectively process and validate their grief is Grief Walking, developed by Joanna Macy, PhD, author, teacher, and Buddhist scholar. "This structured, safe and short (1 hour) method helps people share and process "small griefs" that compound greater griefs. It's perfect for the many pandemic losses felt in the workplace," says Dr. McLaurin.

Creating a Forum for Open Communication and Connection with a Nurse Leaders Boot Camp

Creating opportunities for care teams to come together to help share and connect about the burnout and stress they are experience personally can also assist with their individual healing process and build resilience. Rhonda Arline of Albany Area Primary Health Care recently led her nurse leaders from different clinic locations through a half-day "Nurse Leaders Boot Camp."

Held at a partner's auditorium (donated space), the session gave nurse leaders the opportunity to decompress and have open communication with each other and leadership about their experiences of stress and burnout. They were given the opportunity to share what is and is not working in their clinics and what leadership can do to better support them. The opportunity to come together helped forge connections and new support systems among these nurse leaders who all worked at different clinic locations.

Discussion topics and role play activities focused on a range of stress, burnout and communication issues including:

• compassion fatigue
• putting the fun back into the workplace
• adapting to change
• conflict resolution
• crucial conversations
• generational diversity
• mindfulness and self-care

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