Supporting Nurses Who Experience Second Victim Phenomenon

Podcast Transcript

Carol Pehotsky (00:05):

As a new nurse and caregiver, I was so excited to be someone who could bring and joy and healing and relief to patients. But with a little more years and road under my tires, it's impossible to ignore the fact that sometimes the nursing care we give ends in an unexpected outcome, whether there's cause or not. We bare witness to tragedy every day, and yet we come back the next day and the next day. But what are we doing to take care of ourselves and to really process that emotion? I'm joined today by Dr. Diana Copley to talk more about second victim phenomenon and the Emerged Stronger program.

(00:43):

Hi, and welcome to Nurse Essentials, a Cleveland Clinic podcast where we discuss all things nursing, from patient care, to advancing your career, to navigating tough on the job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

(01:04):

Welcome back, everyone. When I first started nursing, I think I've shared with you that I started on a med surge floor, and really everything from somebody who had had a really successful surgery and needed a couple days on a tally floor before they went home, to, to folks who had some pretty complicated medical journeys that didn't necessarily require an ICU stay but needed advanced treatment and care. And I think about the day that I took care of one gentleman, and he'd had a colostomy that had been reversed, great. And so he was with us to, to, for that to heal, to make sure that everything was working probably and that he could go home. And the day before he was discharged, and I worked nights, so of course, when did it happen, like, right 5 or 6 AM he started deteriorating out of nowhere. So we called the physician, you know, we help- we helped clean him up, some things were going on, the physician came, and it was time for me to go home.

(01:53):

And so the next night, I came back, and it was like there was a whole new patient in his bed. He was confused, he was combative, his vitals were fine, his labs were fine, but he just wasn't the same individual. And certainly, those were the [inaudible 00:02:06] days when we talked about delirium, so we started wondering, you know, what is this? As the nursing team on that night shift, I was new, but the nurse I was working with had years and years of experience. We brought in fellows and residents, and no one could really figure out what was happening other than he was acutely confused. And unfortunately, right as I was leaving the hospital for the day, he coded, and unfortunately he passed away.

(02:27):

And you might... maybe you can hear my voice 20 years later, it still effects me. The full RCA was done, the full investigation was done, there was nothing we could've done. This, this was something that happened. So the physicians, the nurses, everybody did what they needed to do, and, and sometimes patients have untoward outcomes that are not necessarily related to the care we provide. But that didn't make a difference to me. Probably two weeks I didn't sleep, which is, which is already hard enough, but as night shift, that really bordered on that's un- unsafe even getting to and from work.

(02:59):

And I just wanted to talk to somebody. And I went to my leadership just to try to talk to them, and, and at the time, what they could offer me was an appointment with our employee assistance program. And that really wasn't what I was looking for. What I didn't know at the time was that the concept of the second victim phenomenon was just starting to be researched and written about, and boy, could I have used it back then. (laughs) And thankfully, I'm obviously in a much better place and I have plenty of peers to support me now, and I'm thrilled to introduce to you all Dr. Diana Copley. Diana is a Clinical Nurse Specialist for our surgical ECU at Cleveland Clinic Main Campus and is the Associate Director of the Nursing Ethics program and an expert and committed to the concept of second victim phenomenon and how we can support our caregivers. Diana, thank you so much for joining me today.

Dr. Diana Copley (03:44):

Thank you so much for having me. I'm very excited to be here.

Carol Pehotsky (03:46):

So you have a great career and a great story, so I hope you'll start us off by sharing with our audience your career thus far and what brought you into this space.

Dr. Diana Copley (03:54):

Yeah. So I started as a nurse in 2009.

Carol Pehotsky (03:54):

Mm-hmm.

Dr. Diana Copley (03:57):

I came as an associate degree nurse, actually,-

Carol Pehotsky (04:00):

Very good. Good. Woo!.

Dr. Diana Copley (04:00):

... it was very excited.

Carol Pehotsky (04:00):

(laughs)

Dr. Diana Copley (04:01):

Was really committed to advancing my education.

Carol Pehotsky (04:02):

Mm-hmm.

Dr. Diana Copley (04:04):

Got my bachelors right away. I actually started my bachelor program the same day I started my career here at the Cleveland Clinic.

Carol Pehotsky (04:10):

Oh, that's impressive. Good for you. (laughs)

Dr. Diana Copley (04:11):

And I absolutely loved the unit I started in.

Carol Pehotsky (04:11):

Mm-hmm.

Dr. Diana Copley (04:13):

I actually started in the same unit I now support today as a...

Carol Pehotsky (04:16):

Oh, I didn't know that. That's so cool.

Dr. Diana Copley (04:18):

Yeah. I started as a clinical nurse in the surgical intensive care unit, and I was just so drawn to ICU-

Carol Pehotsky (04:18):

Mm-hmm.

Dr. Diana Copley (04:23):

... and I was so excited to be able to h- make a positive impact for patients.

Carol Pehotsky (04:23):

Yeah.

Dr. Diana Copley (04:28):

And I was really passionate about where I was. Like a lotta new nurses, I was very nervous,-

Carol Pehotsky (04:32):

Yeah.

Dr. Diana Copley (04:32):

... I was very, very careful, I tried to be very mindful all the time that I was doing the best care, I was providing really safe care.

Carol Pehotsky (04:38):

Mm-hmm.

Dr. Diana Copley (04:39):

But like a lotta nurses in my first few years of practice, I did make a medication error.

Carol Pehotsky (04:43):

Oh, gosh.

Dr. Diana Copley (04:44):

And just like your story,-

Carol Pehotsky (04:45):

Mm-hmm. Mm-hmm.

Dr. Diana Copley (04:45):

... it was devastating to me. It was a busy night shift. I worked straight nights.

Carol Pehotsky (04:49):

Sure.

Dr. Diana Copley (04:50):

The patient came up from the OR. We were all admitting the patient.

Carol Pehotsky (04:54):

Mm-hmm.

Dr. Diana Copley (04:54):

And unfortunately, I had an oversight which led to the medication error.

Carol Pehotsky (04:57):

Oh, gosh.

Dr. Diana Copley (04:57):

As soon as I knew the patient was safe,-

Carol Pehotsky (04:57):

Mm-hmm.

Dr. Diana Copley (04:59):

... I stepped out of that room and I started crying.

Carol Pehotsky (05:02):

Oh, of course.

Dr. Diana Copley (05:03):

Which my coworkers didn't know what to do with me because-

Carol Pehotsky (05:05):

Oh, sure.

Dr. Diana Copley (05:06):

... I was pretty stoic at baseline.

Carol Pehotsky (05:07):

Yeah.

Dr. Diana Copley (05:07):

And so they did allow me space, which was so important.

Carol Pehotsky (05:11):

Mm-hmm.

Dr. Diana Copley (05:11):

And I stepped in the hallway, and the fellow came out to check on me,-

Carol Pehotsky (05:11):

Mm-hmm.

Dr. Diana Copley (05:14):

... which is, I think, shows even back then-

Carol Pehotsky (05:17):

Yeah.

Dr. Diana Copley (05:17):

... how important teamwork was.

Carol Pehotsky (05:18):

Mm-hmm.

Dr. Diana Copley (05:19):

They were going to support me. I talked to my manager the next morning. I filled out the incident report. My manager was so supportive.

Carol Pehotsky (05:27):

Wonderful.

Dr. Diana Copley (05:27):

I never felt blamed. I felt like, you know, I'm going to grow from this, I'm going to learn.

Carol Pehotsky (05:31):

Mm-hmm.

Dr. Diana Copley (05:31):

But while everybody else was supporting me, I wasn't supporting myself, and I couldn't forgive myself.

Carol Pehotsky (05:36):

Mm. Sure.

Dr. Diana Copley (05:36):

For the next few nights, I couldn't sleep,-

Carol Pehotsky (05:38):

Yeah.

Dr. Diana Copley (05:39):

... couldn't eat, was really doubting myself, had been considering going back to grad school, actually stopped the application.

Carol Pehotsky (05:45):

Oh no.

Dr. Diana Copley (05:46):

My brother who was in nursing school said, "You know, I think I want to be an ICU nurse," and all I wanted to tell him was, "Don't do it. I don't want you to ever feel like this."

Carol Pehotsky (05:53):

Oh, gosh. Oh.

Dr. Diana Copley (05:54):

And so I finally, after a few weeks, did the things that we always tell patients not to do, I got on the internet and started searching-

Carol Pehotsky (06:00):

Oh, no. (laughs)

Dr. Diana Copley (06:01):

... about what I was experiencing. And about that same time, there was a nursing story hitting the headlines-

Carol Pehotsky (06:07):

Mm-hmm. Yeah.

Dr. Diana Copley (06:07):

... about a nurse who had experienced something called second victim phenomenon.

Carol Pehotsky (06:11):

Yeah.

Dr. Diana Copley (06:11):

Our stories were so different though because she didn't have support-

Carol Pehotsky (06:11):

Right. Yeah.

Dr. Diana Copley (06:14):

... and she ultimately died by suicide.

Carol Pehotsky (06:17):

I remember what you're talking about, yep.

Dr. Diana Copley (06:19):

And so as my career advanced, I really loved clinical nursing.

Carol Pehotsky (06:19):

Mm-hmm.

Dr. Diana Copley (06:23):

I still love clinical nursing to this day, and I think it is the most important part of nursing. But I wanted to be able to support nurses more.

Carol Pehotsky (06:23):

Mm-hmm.

Dr. Diana Copley (06:29):

I wanted to be able to put more evidence into practice. So I did eventually apply to graduate school, pursued a master's degree as a clinical nurse specialist,-

Carol Pehotsky (06:38):

Mm-hmm.

Dr. Diana Copley (06:38):

... and then began that practice. And then continuing advancing our education, as we do as nurses,-

Carol Pehotsky (06:38):

(laughs)

Dr. Diana Copley (06:43):

... I pursued a doctoral degree.

Carol Pehotsky (06:45):

Mm-hmm.

Dr. Diana Copley (06:45):

And when you pursue a doctoral degree, one of the questions they ask you is, "What are you passionate about? What do you want to bring to your workplace?"

Carol Pehotsky (06:52):

Mm. Yeah. Mm-hmm.

Dr. Diana Copley (06:52):

Because you're going to spend the next three to four years studying it. (laughs)

Carol Pehotsky (06:55):

Right. You better be passionate. (laughs)

Dr. Diana Copley (06:56):

And so as I was reflecting on what is important to me, what was important to my career, I kept going back to the event-

Carol Pehotsky (06:57):

Mm-hmm.

Dr. Diana Copley (07:03):

... and remembering the support I felt and remember how hard I was being on myself-

Carol Pehotsky (07:03):

Mm.

Dr. Diana Copley (07:08):

... and how I wish I would've known it was okay to have some self forgiveness.

Carol Pehotsky (07:12):

Sure.

Dr. Diana Copley (07:12):

And so I decided I wanted to further explore second victim phenomenon.

Carol Pehotsky (07:16):

Yeah.

Dr. Diana Copley (07:16):

For our listeners who are not familiar with what second victim phenomenon is, it's the distress caregivers feel following an adverse or unanticipated clinical event or healthcare error.

Carol Pehotsky (07:27):

Mm.

Dr. Diana Copley (07:27):

And as those feelings can be really pervasive. We used to think it was all about errors. When the literature first started coming out,-

Carol Pehotsky (07:28):

Right. Yeah.

Dr. Diana Copley (07:34):

... it was all errors and errors and errors.

Carol Pehotsky (07:36):

Absolutely. Yeah.

Dr. Diana Copley (07:36):

But we've really learned, like, your experience-

Carol Pehotsky (07:36):

Right. Mm-hmm.

Dr. Diana Copley (07:38):

... that it's not just errors, that caregivers can experience this even in the absence of a mistake. If there's a patient who reminds them of a, one of their family members.

Carol Pehotsky (07:47):

Oh, sure. Yeah, had that too. Yep. (laughs)

Dr. Diana Copley (07:48):

Maybe it's been a hard month on the unit and there's been-

Carol Pehotsky (07:51):

Sure.

Dr. Diana Copley (07:51):

... multiple outcomes-

Carol Pehotsky (07:51):

Yeah.

Dr. Diana Copley (07:52):

... that weren't what we hoped for.

Carol Pehotsky (07:52):

Mm-hmm.

Dr. Diana Copley (07:54):

Those really have an emotional toll on us as caregivers, and what tends to happen is caregivers suffer in silence-

Carol Pehotsky (08:00):

For sure.

Dr. Diana Copley (08:00):

... and they suffer alone.

Carol Pehotsky (08:00):

Mm-hmm.

Dr. Diana Copley (08:01):

And really hoping to change that culture of what caregivers are experience so that they feel empowered to say, "You know what? I really need help after this event."

Carol Pehotsky (08:09):

Fantastic. Much needed. So we're so fortunate here at Cleveland Clinic that we have a program that really helps individuals who are going through something like this. So you tell us a little bit more about the Emerge Stronger program, please.

Dr. Diana Copley (08:21):

Yeah. The Emerge Stronger program is led by Dr. Laura Hoeksema-

Carol Pehotsky (08:21):

Mm-hmm.

Dr. Diana Copley (08:25):

... who is one of my collaborators. And I would be remiss if I didn't acknowledge that while Laura and I have contributed to this program, there are so many nurses, so many caregivers who have been leading efforts across the Cleveland Clinic healthcare system for years.

Carol Pehotsky (08:39):

Mm-hmm. Amazing.

Dr. Diana Copley (08:39):

While we didn't have a formalized program until-

Carol Pehotsky (08:41):

Sure.

Dr. Diana Copley (08:41):

... 2020, there's been a lotta work in this field, and all of those experiences have led us to where we're at today.

Carol Pehotsky (08:48):

Absolutely.

Dr. Diana Copley (08:48):

So Laura brought together a group in January of 2020, which was not the most ideal timing. (laughs)

Carol Pehotsky (08:49):

Oh. (laughs)

Dr. Diana Copley (08:54):

Or it was psychic.

Carol Pehotsky (08:56):

(laughs)

Dr. Diana Copley (08:56):

And we really started talking about what would support look like at the Cleveland Clinic?

Carol Pehotsky (09:00):

Sure.

Dr. Diana Copley (09:00):

How can we ensure that nobody suffers alone? And so we had a group of caregivers from every facet you can think of.

Carol Pehotsky (09:01):

Mm-hmm.

Dr. Diana Copley (09:09):

We had nurses, we had physicians, we got feedback from our environmental service colleagues. Really looking-

Carol Pehotsky (09:09):

Oh, wonderful, not all clinical, everybody, yeah.

Dr. Diana Copley (09:15):

... at the Cleveland Clinic, yep, both clinical and what's called nonclinical roles.

Carol Pehotsky (09:19):

Mm-hmm.

Dr. Diana Copley (09:19):

We wanted to include everybody. We started with a needs assessment.

Carol Pehotsky (09:22):

Okay.

Dr. Diana Copley (09:23):

What are Cleveland Clinic caregivers experiences? And not surprisingly, most caregivers, in line with national and international literature, they want to talk to a peer after one of these events.

Carol Pehotsky (09:32):

Yeah. Yep.

Dr. Diana Copley (09:33):

But we know that sometimes, and I think of our newer nurses who maybe haven't identified-

Carol Pehotsky (09:37):

Yeah.

Dr. Diana Copley (09:37):

... who that peer is yet.

Carol Pehotsky (09:38):

Sure.

Dr. Diana Copley (09:39):

Or maybe they feel like the team is judging them, even if the team's not,-

Carol Pehotsky (09:43):

Mm-hmm.

Dr. Diana Copley (09:43):

... it sometimes is really hard to-

Carol Pehotsky (09:43):

The story.

Dr. Diana Copley (09:44):

... go to a new group of people and say, "I need help."

Carol Pehotsky (09:46):

Yeah, we... the story we tell ourselves, yeah.

Dr. Diana Copley (09:46):

Yeah.

Carol Pehotsky (09:46):

Mm-hmm.

Dr. Diana Copley (09:48):

So we wanted to make sure that every caregiver felt supported. Our needs assessment said they wanted peer support.

Carol Pehotsky (09:53):

Hm. All right.

Dr. Diana Copley (09:54):

And then we started training individuals.

Carol Pehotsky (09:56):

Okay.

Dr. Diana Copley (09:57):

So we had a couple brave individuals that first year-

Carol Pehotsky (10:00):

(laughs) Yeah.

Dr. Diana Copley (10:00):

... in the middle of the pandemic who (laughs) came to our training. It allowed us the opportunity to refine and really make sure we were giving them the communication skills they were going to need-

Carol Pehotsky (10:09):

Okay.

Dr. Diana Copley (10:09):

... to talk to their peers.

Carol Pehotsky (10:11):

Yeah.

Dr. Diana Copley (10:11):

Because they're talking to their peers about something that's really traumatic to them,-

Carol Pehotsky (10:12):

Yes.

Dr. Diana Copley (10:15):

... something that's really haunting them, and we want to make sure that communication we recognize is a skill like anything else.

Carol Pehotsky (10:21):

Mm.

Dr. Diana Copley (10:21):

You are not great at IVs on your first start.

Carol Pehotsky (10:23):

That's okay, keep trying. (laughs)

Dr. Diana Copley (10:24):

The first time you talk to a peer who's experiencing second victim phenomenon,-

Carol Pehotsky (10:28):

Mm.

Dr. Diana Copley (10:28):

... we want them to feel comfortable and confident.

Carol Pehotsky (10:30):

Yes.

Dr. Diana Copley (10:30):

So our training involves a lotta role play.

Carol Pehotsky (10:32):

Oh, that's good. Yeah, because I can imagine somebody is, yes, I'm reaching out for this experience, and if they're getting somebody who doesn't seem very confident, you'd hate or them to overreact to that and not try again. Yeah.

Dr. Diana Copley (10:45):

Mm-hmm. Yeah. So one of the benefits of the pandemic in a way was that we got very good at virtual very fast.

Carol Pehotsky (10:50):

Sure.

Dr. Diana Copley (10:51):

Because one of our initial concerns is, what happens if we have a Cleveland Clinic caregiver who says, "I want support"? We try to get them connected to a peer within 24 hours-

Carol Pehotsky (10:59):

Oh, wow. Mm-hmm.

Dr. Diana Copley (10:59):

... if it's a business day, so really quickly.

Carol Pehotsky (11:01):

Mm-hmm.

Dr. Diana Copley (11:02):

What if there's nobody at their hospital who's available?

Carol Pehotsky (11:04):

Sure.

Dr. Diana Copley (11:04):

So we were able to leverage technology,-

Carol Pehotsky (11:06):

Okay.

Dr. Diana Copley (11:07):

... whether that's phone calls,-

Carol Pehotsky (11:08):

Mm-hmm.

Dr. Diana Copley (11:08):

... whether that's a virtual platform that we use to do video conferencing.

Carol Pehotsky (11:12):

Mm-hmm.

Dr. Diana Copley (11:12):

We were able to leverage technology very quickly to be able to connect them with peers. So that was one of the benefits.

Carol Pehotsky (11:17):

That's fantastic.

Dr. Diana Copley (11:18):

Yeah.

Carol Pehotsky (11:19):

So in a way, maybe the timing actually worked out really well because it (laughs) put technology in your lap. So in current state, how often would you say these consultations are virtual versus in person? Do we see caregivers leaning one way or the other? Do they have a preference?

Dr. Diana Copley (11:34):

When people reach out for formal peer support, meaning-

Carol Pehotsky (11:36):

Mm-hmm.

Dr. Diana Copley (11:36):

... they go to our website or they send us an email saying, "I need peer support,"-

Carol Pehotsky (11:36):

Mm-hmm.

Dr. Diana Copley (11:40):

... those tend to end up being a virtual meeting. And the reason for that is we want to match caregivers with the closest caregiver possible.

Carol Pehotsky (11:48):

Mm-hmm.

Dr. Diana Copley (11:48):

So if I have an ICU nurse submit a request saying, you know, "I had a healthcare error happen in my area,"-

Carol Pehotsky (11:53):

Mm-hmm.

Dr. Diana Copley (11:53):

... "I'm feeling distressed by it. I would like to talk to a peer," our goal is to connect them with an ICU nurse-

Carol Pehotsky (11:59):

Sure.

Dr. Diana Copley (11:59):

... or the closest role possible.

Carol Pehotsky (12:01):

Yeah.

Dr. Diana Copley (12:01):

So one of the benefits of working at a large organization-

Carol Pehotsky (12:01):

Mm-hmm.

Dr. Diana Copley (12:04):

... is we're able to connect peers across different hospital systems. And as the program has grown, we're now not only in Ohio, but Nevada, Florida, Abu Dhabi and London.

Carol Pehotsky (12:14):

Oh, that's fantastic. It's like you've gone international.

Dr. Diana Copley (12:15):

We haven't done any...

Carol Pehotsky (12:15):

(laughs)

Dr. Diana Copley (12:17):

Yeah. We haven't done any international connections that I'm aware of,-

Carol Pehotsky (12:17):

Mm-hmm.

Dr. Diana Copley (12:20):

... but it's nice to know that we have that ability.

Carol Pehotsky (12:22):

Right.

Dr. Diana Copley (12:23):

Because as a large organization, and like most healthcare settings,-

Carol Pehotsky (12:27):

Mm-hmm.

Dr. Diana Copley (12:27):

... there's a lotta different roles. And so trying to find that best match-

Carol Pehotsky (12:29):

Sure.

Dr. Diana Copley (12:30):

... is sometimes challenging.

Carol Pehotsky (12:30):

Yeah. And a true peer, not-

Dr. Diana Copley (12:33):

Mm-hmm.

Carol Pehotsky (12:33):

... I'm talking to somebody, they're a peer in the spirit of we both work for this organization,-

Dr. Diana Copley (12:38):

Yeah.

Carol Pehotsky (12:38):

... but truly the, they've walked in my shoes.

Dr. Diana Copley (12:39):

Yeah. We want EVS workers to talk to EVS workers,-

Carol Pehotsky (12:39):

Absolutely.

Dr. Diana Copley (12:42):

... physicians to talk to physicians.

Carol Pehotsky (12:44):

So what techniques do you work with peer supporters with to really help them get somebody to feel comfortable enough to open up? Or do they ever experience the, "Well, I don't want to get in trouble, but..."? How do they help the person get sort of past some of that?

Dr. Diana Copley (12:57):

Yeah. One of the things we train our peer supporters on, and I think it's hard for caregivers to recognize that when they're coming to peer support, we are here to talk about them, how they're feeling.

Carol Pehotsky (13:07):

Oh, not the event. Sure, yeah.

Dr. Diana Copley (13:08):

What their coping strategies are.

Carol Pehotsky (13:08):

Mm-hmm. Mm-hmm.

Dr. Diana Copley (13:10):

As a just culture organization, we-

Carol Pehotsky (13:10):

Mm-hmm.

Dr. Diana Copley (13:12):

... absolutely have a lot of individuals, if the caregiver wants to talk about the event itself, we have individuals-

Carol Pehotsky (13:12):

Sure.

Dr. Diana Copley (13:17):

... who can walk them through every step of it.

Carol Pehotsky (13:19):

Mm-hmm. Mm-hmm.

Dr. Diana Copley (13:19):

But our peer supporters are truly there to support them as a caregivers.

Carol Pehotsky (13:22):

Mm.

Dr. Diana Copley (13:23):

Have you been sleeping?

Carol Pehotsky (13:24):

Sure.

Dr. Diana Copley (13:24):

Have you been eating?

Carol Pehotsky (13:26):

Mm-hmm.

Dr. Diana Copley (13:26):

What do you find joy in? You know, sometimes we have a habit of depriving ourselves of the things we find joy in when we're feeling hard and down on ourselves.

Carol Pehotsky (13:33):

Sure. Yeah.

Dr. Diana Copley (13:33):

So it's encouraging them to seek those items. And our peer supporters get training on how to have those conversations.

Carol Pehotsky (13:39):

Oh, that's fantastic. So they're probably in receipt of some pretty heavy stories.

Dr. Diana Copley (13:43):

Mm-hmm.

Carol Pehotsky (13:44):

So how do we best support those individuals who are peer supporters?

Dr. Diana Copley (13:47):

Thank you so much for asking that, because we always say, you know, "One day I could be the peer supporter, tomorrow I might need peer supporter myself.

Carol Pehotsky (13:48):

Absolutely. Yeah, for sure. Mm-hmm.

Dr. Diana Copley (13:54):

We have hospital site leads at each site.

Carol Pehotsky (13:57):

Okay.

Dr. Diana Copley (13:57):

As part of a large organization, we recognize that each hospital has its own culture, knowing people that you're familiar with and comfortable with. So each hospital has an Emerge Stronger site lead.

Carol Pehotsky (14:07):

Okay.

Dr. Diana Copley (14:08):

They can go to their site lead if they need to talk about a debriefing event they had.

Carol Pehotsky (14:11):

Mm-hmm.

Dr. Diana Copley (14:11):

We keep the peer's name anonymous though.

Carol Pehotsky (14:14):

Okay. Yeah.

Dr. Diana Copley (14:15):

Once they're matched with it, they don't talk about who the peer was, just how they felt after the event.

Carol Pehotsky (14:19):

Mm.

Dr. Diana Copley (14:19):

Maybe I'm second guessing the things I said.

Carol Pehotsky (14:22):

Sure.

Dr. Diana Copley (14:22):

So the hospital site lead can talk to them about those. We also have Dr. Laura Hoeksema, who's the program lead.

Carol Pehotsky (14:28):

Mm-hmm.

Dr. Diana Copley (14:28):

And then I have the privilege of serving as the nursing institute lead.

Carol Pehotsky (14:29):

Oh, very good.

Dr. Diana Copley (14:32):

So if there's a nurse peer supporter who needs additional support, they can reach out to me. So we do encourage them to utilize those options. Additionally, we meet together as a group every quarter.

Carol Pehotsky (14:42):

Oh, great.

Dr. Diana Copley (14:42):

We have ongoing education,-

Carol Pehotsky (14:44):

Oh, nice.

Dr. Diana Copley (14:44):

... different topics that people can request.

Carol Pehotsky (14:46):

Yeah.

Dr. Diana Copley (14:46):

And then at the end of every meeting, we allow some space for people to bring up anything that, that's been on their mind or anything that's been bothering them.

Carol Pehotsky (14:53):

Wow. And within our organization, if somebody wanted to be a peer supporter, is that something, for lack of a better term, they, they do on the clock? Is that a volunteer? How do, how do we make sure we've accessed people in that timeframe and that they feel like they have the space to offer this service?

Dr. Diana Copley (15:08):

Yeah. So when we're looking for who our peer supporters are,-

Carol Pehotsky (15:08):

Mm-hmm.

Dr. Diana Copley (15:10):

... we'll start there,-

Carol Pehotsky (15:11):

Sure. Yes, please.

Dr. Diana Copley (15:12):

... how do you become a peer supporter?

Carol Pehotsky (15:12):

Yeah.

Dr. Diana Copley (15:13):

A lot of our peer supporters are self nominated.

Carol Pehotsky (15:15):

Mm-hmm.

Dr. Diana Copley (15:15):

They're like, "I want to help colleagues." Many of them have experienced second victim phenomenon themselves.

Carol Pehotsky (15:20):

Oh, gosh, yeah.

Dr. Diana Copley (15:20):

And they want to pay it forward.

Carol Pehotsky (15:22):

Mm-hmm.

Dr. Diana Copley (15:22):

Which is amazing, and I think those are excellent strong peer supporters. But it's people who are respected and trusted by their peers,-

Carol Pehotsky (15:28):

Mm.

Dr. Diana Copley (15:28):

... people who are non-judgmental.

Carol Pehotsky (15:30):

Yeah. (laughs)

Dr. Diana Copley (15:30):

... people who want to be a skilled listener, people who are empathetic. And then most importantly, I think, the people who are committed to attending to the suffering of their colleagues. They know that their-

Carol Pehotsky (15:31):

Wow.

Dr. Diana Copley (15:40):

... colleagues are in pain-

Carol Pehotsky (15:42):

Yeah.

Dr. Diana Copley (15:42):

... and they want to be there to help them.

Carol Pehotsky (15:44):

Mm-hmm.

Dr. Diana Copley (15:44):

So some of those individuals come to us through manager nomination.

Carol Pehotsky (15:47):

Mm-hmm. Mm-hmm.

Dr. Diana Copley (15:47):

The manager might say, you know, "You were great at this. I think you should help others."

Carol Pehotsky (15:50):

Yeah.

Dr. Diana Copley (15:51):

Some of them, it's from colleagues they've already helped.

Carol Pehotsky (15:53):

Oh.

Dr. Diana Copley (15:54):

In our program, we have an option-

Carol Pehotsky (15:55):

(laughs)

Dr. Diana Copley (15:55):

... for caregivers to nominate another caregiver to become a peer supporter,-

Carol Pehotsky (15:59):

Oh, how nice. Yeah.

Dr. Diana Copley (15:59):

... and we'll reach out to them.

Carol Pehotsky (16:00):

Excellent. So we're very fortunate to have this program. We have listeners that are in nursing school, that are not part of the Cleveland Clinic, so a lot to unpack there. We'll start with the nursing student. So hopefully, those of you who are listening who are students, (laughs) we're not scaring you off from the profession, that, you know... So what kind of words of wisdom would you give for them about, "Well, what if I have this event? And what if I become a second victim?", what, what encouragement would you give them?

Dr. Diana Copley (16:26):

I think the first thing I want to say is to make sure that when you are looking at what unit you want to practice on-

Carol Pehotsky (16:26):

Mm-hmm.

Dr. Diana Copley (16:32):

... as a new graduate,-

Carol Pehotsky (16:33):

Mm-hmm.

Dr. Diana Copley (16:33):

... look at the teamwork.

Carol Pehotsky (16:34):

Mm.

Dr. Diana Copley (16:34):

Look at the environment. You really want a unit that when something happens, whether it's a healthcare error or even an adverse event,-

Carol Pehotsky (16:34):

Yeah.

Dr. Diana Copley (16:41):

... the team goes, "How can we support each other?", not, "What did you do wrong?"

Carol Pehotsky (16:45):

Mm. Mm. Sure.

Dr. Diana Copley (16:45):

And I think coming at it from that approach,-

Carol Pehotsky (16:47):

Yeah.

Dr. Diana Copley (16:47):

... that every single day, every nurse wakes up, whether that's day shift, night shift, afternoon shift, and they are coming to that practice setting because they want to do good for people.

Carol Pehotsky (16:47):

Yeah.

Dr. Diana Copley (16:56):

They want to heal people, they want to make an impact in people's lives. And I think having that mindset is really helpful. If you are a nurse and this is a topic that you're interested in for your unit,-

Carol Pehotsky (16:56):

Mm-hmm.

Dr. Diana Copley (17:06):

... I think one of the things we have to recognize as nurses, and this is actually what my study focused on, uh, for my doctoral program,-

Carol Pehotsky (17:12):

Yeah.

Dr. Diana Copley (17:12):

... was a local level initiatives,-

Carol Pehotsky (17:15):

Okay.

Dr. Diana Copley (17:15):

... because we did not have a peer support program at that time.

Carol Pehotsky (17:17):

That's right. (laughs)

Dr. Diana Copley (17:18):

Is we as nurses, when I surveyed the nurses, they all said they would help each other, 100%.

Carol Pehotsky (17:19):

Oh, wow. Yeah.

Dr. Diana Copley (17:24):

I will help my colleagues.

Carol Pehotsky (17:26):

Yeah. Mm-hmm.

Dr. Diana Copley (17:26):

When I asked them if they would seek support for themselves,-

Carol Pehotsky (17:29):

Yeah?

Dr. Diana Copley (17:29):

... it was only 45%.

Carol Pehotsky (17:31):

(laughs) We're the worst.

Dr. Diana Copley (17:33):

So we did some education and we were able to get that up to about 95%.

Carol Pehotsky (17:34):

All right.

Dr. Diana Copley (17:38):

So I think that's an example that as nurses, sometimes we might need a little bit more information.

Carol Pehotsky (17:38):

Mm-hmm.

Dr. Diana Copley (17:43):

When I talk to nurses about what second victim phenomenon is, a lot of them will pull me aside afterwards and say, "I've experienced this."

Carol Pehotsky (17:50):

Mm-hmm.

Dr. Diana Copley (17:50):

Three in four nurses have.

Carol Pehotsky (17:51):

Wow.

Dr. Diana Copley (17:53):

They just didn't know it had a name.

Carol Pehotsky (17:54):

Sure.

Dr. Diana Copley (17:55):

So knowing what it's called,-

Carol Pehotsky (17:56):

Mm-hmm.

Dr. Diana Copley (17:56):

... knowing kind of what the precipitating events are,-

Carol Pehotsky (17:59):

Mm-hmm.

Dr. Diana Copley (17:59):

... and knowing what symptoms to look for, not only in ourselves, in our colleagues, it's that sleeping, sleeping is often one of the symptoms-

Carol Pehotsky (18:06):

Oh, really?

Dr. Diana Copley (18:07):

... we hear from nurses, like,-

Carol Pehotsky (18:08):

[inaudible 00:18:08]

Dr. Diana Copley (18:07):

... "I can't sleep. I want to sleep too much. Difficulty concentrating. Headaches."

Carol Pehotsky (18:12):

Mm. Mm-hmm.

Dr. Diana Copley (18:12):

And when you think about the role of nursing, those make your job really hard.

Carol Pehotsky (18:16):

No kidding. (laughs)

Dr. Diana Copley (18:17):

It could also be things like, say that nurse was always the happy nurse at work,-

Carol Pehotsky (18:17):

Mm-hmm. Mm-hmm.

Dr. Diana Copley (18:21):

... and suddenly they're a little bit more withdrawn. Walking up to them and saying, "Hi, you know, I'm a little worried about you,"-

Carol Pehotsky (18:21):

Sure.

Dr. Diana Copley (18:26):

... "do you want to talk about the event you had last week?"

Carol Pehotsky (18:28):

Yeah.

Dr. Diana Copley (18:29):

They might say no,-

Carol Pehotsky (18:30):

Mm-hmm.

Dr. Diana Copley (18:30):

... but it means a lot to have another colleague reach out to offer support.

Carol Pehotsky (18:33):

Absolutely. So there's resources out there. Is your work published? Where would I find that?

Dr. Diana Copley (18:38):

It is. I actually graduated from my doctorate program-

Carol Pehotsky (18:38):

Mm-hmm.

Dr. Diana Copley (18:41):

... in May of 2020.

Carol Pehotsky (18:42):

Oh, my gosh, girl. (laughs)

Dr. Diana Copley (18:43):

So in the interest of being persistent, it's never too late to pursue something you're passionate about.

Carol Pehotsky (18:43):

That's right. (laughs)

Dr. Diana Copley (18:48):

I finally, this year, was able to publish my doctoral work.

Carol Pehotsky (18:48):

Oh, great.

Dr. Diana Copley (18:51):

Yeah. It's the Second Victim Phenomenon Educational Program Evaluation, and it can be found in the Journal of Nursing Professional Development.

Carol Pehotsky (18:59):

That's fantastic. So somebody's really inspired by our discussion today and they'd like to start something in their own hospital, in their own health system, what are some of the first things they should do?

Dr. Diana Copley (19:10):

Find a team.

Carol Pehotsky (19:11):

Yeah?

Dr. Diana Copley (19:11):

Find a team who is passionate about this topic who will come along beside you. We had a very slow roll out initially.

Carol Pehotsky (19:18):

Sure.

Dr. Diana Copley (19:18):

We actually started at a couple hospitals, because what our big goal was that whenever somebody reached out to have peer support,-

Carol Pehotsky (19:18):

Mm-hmm.

Dr. Diana Copley (19:24):

... we could say, "We have a peer supporter for you." And one of the things we recognize is that sometimes peer supporters are busy.

Carol Pehotsky (19:31):

Yeah. (laughs)

Dr. Diana Copley (19:31):

Peer supporters might have things going on in their own life.

Carol Pehotsky (19:33):

Right. Right.

Dr. Diana Copley (19:34):

And so we wanted to be able to create a space for our peer supporters that if we reached out and said, "we have somebody to connect you to," they could also say, "I'm busy right now," or,-

Carol Pehotsky (19:42):

Sure.

Dr. Diana Copley (19:42):

... "I have a lot going on in my own life." So we wanted to have a pool of people really trained-

Carol Pehotsky (19:47):

Yeah.

Dr. Diana Copley (19:47):

... and ready before we launched this system-wide. So first, find your team.

Carol Pehotsky (19:47):

Mm-hmm.

Dr. Diana Copley (19:51):

Second, find people who are passionate about supporting other caregivers and start training.

Carol Pehotsky (19:56):

Mm-hmm.

Dr. Diana Copley (19:56):

There are some fantastic examples in literature of different training programs. Our program's a four-hour course-

Carol Pehotsky (20:02):

Okay.

Dr. Diana Copley (20:02):

... with the ongoing quarterly connections-

Carol Pehotsky (20:04):

Nice.

Dr. Diana Copley (20:04):

... where we talk about the additional training. And then they of course can always reach out for additional support. And I think listening to what people are saying and listening for feedback.

Carol Pehotsky (20:13):

Yeah.

Dr. Diana Copley (20:14):

I know our first year that we launched, I think we were really hoping, especially during the pandemic, for a lotta people to reach to peer support.

Carol Pehotsky (20:20):

Sure.

Dr. Diana Copley (20:20):

But what we ended up hearing, and I think this is a true measure of success that's really hard to actually measure, is that I didn't have any formal consults this year, but I helped a lotta nurses on my unit. And that's really the goal.

Carol Pehotsky (20:33):

Oh, so they're taking that to wherever they go, those peer supporters are.

Dr. Diana Copley (20:36):

Yeah.

Carol Pehotsky (20:36):

Which of course they are, they're those people, right?

Dr. Diana Copley (20:36):

Yeah.

Carol Pehotsky (20:36):

So that's fantastic.

Dr. Diana Copley (20:39):

We're hoping to create the cultures that-

Carol Pehotsky (20:40):

Absolutely.

Dr. Diana Copley (20:41):

... we have a peer support program if you need help,-

Carol Pehotsky (20:41):

Mm-hmm.

Dr. Diana Copley (20:43):

... but that you feel comfortable enough turning to your colleague and saying, "Hey, can we talk about this?"

Carol Pehotsky (20:47):

Mm-hmm.

Dr. Diana Copley (20:47):

Or your colleague reaches out to you and say, "I want to have a chat with you. I'm worried about you and I care about you."

Carol Pehotsky (20:52):

Oh, my gosh, that's fantastic. You know, those of you who have been listening throughout this show's existence know that we've spent a lot of time talking about speaking up, speaking up if there's been an event or there's going to be an event, and this is really speaking up in a different way to say,-

Dr. Diana Copley (20:52):

Mm-hmm.

Carol Pehotsky (21:04):

... "I need help," or, "I think I see something in you that says I want to help you."

Dr. Diana Copley (21:08):

I really want to applaud any nurses that are listening that every nurse is a leader.

Carol Pehotsky (21:13):

Absolutely.

Dr. Diana Copley (21:13):

I truly believe that to my core. And I think as nurses, when I talk about peers, I'm hoping you will support other nurses.

Carol Pehotsky (21:13):

Mm-hmm.

Dr. Diana Copley (21:20):

But I would also encourage you to think about other caregivers we practice with every day.

Carol Pehotsky (21:24):

Well, sure, yeah.

Dr. Diana Copley (21:24):

I know I had a learning opportunity several years ago-

Carol Pehotsky (21:28):

Mm-hmm.

Dr. Diana Copley (21:28):

... after a cardiopulmonary event.

Carol Pehotsky (21:28):

Mm-hmm.

Dr. Diana Copley (21:30):

And the EVS worker had been in the room at the time of the event.

Carol Pehotsky (21:30):

Oh, gosh.

Dr. Diana Copley (21:34):

Did we check on them?

Carol Pehotsky (21:34):

Yeah.

Dr. Diana Copley (21:35):

Did we offer them enough support?

Carol Pehotsky (21:37):

Right.

Dr. Diana Copley (21:38):

And so as a nurse,-

Carol Pehotsky (21:38):

Mm-hmm.

Dr. Diana Copley (21:39):

... be that leader in reaching out to peers who maybe don't have a nursing title but are as equally important on our team.

Carol Pehotsky (21:44):

We, we need each other and we need to support each other.

Dr. Diana Copley (21:44):

Mm-hmm.

Carol Pehotsky (21:46):

That's fantastic. Well, we could talk about this all day, (laughs) but we, we probably need to start wrapping it up. Before we get to the final questions, I just want to say, you know, we're going to be, uh, interviewing a panel of clinical nurse specialists in an upcoming episode, but you do such a lovely job of showing the, the importance that clinical nurse specialists can have to the nursing profession and their organization. So thank you for all you're doing for our caregivers.

Dr. Diana Copley (21:46):

Thank you so much.

Carol Pehotsky (22:07):

And now we're going to let our audience learn a little bit more about you in non second victim Emerge Stronger ways. So our first speed round question is, what's something you wish you knew as a brand new nurse?

Dr. Diana Copley (22:19):

I wish I knew that I was human.

Carol Pehotsky (22:21):

Mm. (laughs)

Dr. Diana Copley (22:21):

And I think that does go a little bit in line with-

Carol Pehotsky (22:22):

It fits right in. Yeah.

Dr. Diana Copley (22:23):

... second victim phenomenon. But I had a lot of imposter syndrome. I think a lot of nurses have that.

Carol Pehotsky (22:24):

Mm. Sure.

Dr. Diana Copley (22:28):

We come out of nursing school thinking we have to be perfect on day one.

Carol Pehotsky (22:31):

Yep.

Dr. Diana Copley (22:32):

It's going to take time to learn, it's going to take time to grow.

Carol Pehotsky (22:35):

Mm-hmm.

Dr. Diana Copley (22:35):

Give yourself some grace.

Carol Pehotsky (22:36):

Mm-hmm.

Dr. Diana Copley (22:36):

Find yourself some mentors. And then as you start to feel more comfortable, mentor others, and that will really help with your own growth.

Carol Pehotsky (22:43):

Love it. And who's been one of your nursing influences?

Dr. Diana Copley (22:47):

One of my early nursing influence has actually since retired.

Carol Pehotsky (22:50):

Mm-hmm.

Dr. Diana Copley (22:51):

Kathleen Hill was a clinical nurse specialist.

Carol Pehotsky (22:53):

Ah, yes, the legend. (laughs)

Dr. Diana Copley (22:55):

Uh, in the surgical intensive care unit.

Carol Pehotsky (22:55):

Yeah.

Dr. Diana Copley (22:57):

And before I even knew what the CNS role was,-

Carol Pehotsky (22:58):

Right.

Dr. Diana Copley (23:00):

... she had tapped me on my shoulder and said,-

Carol Pehotsky (23:00):

Mm-hmm.

Dr. Diana Copley (23:01):

... "You know, I think you'd be a great CNS one day."

Carol Pehotsky (23:01):

Mm-hmm.

Dr. Diana Copley (23:04):

And through her mentorship and influence, she was able to introduce me to other mentors and help me grow in ways I didn't think was possible.

Carol Pehotsky (23:10):

Absolutely. Talk about having fingerprints on a million different patients and nurses, so, excellent. Thank you so much for joining me today.

Dr. Diana Copley (23:16):

Thank you so much.

Carol Pehotsky (23:20):

As always, thanks so much for joining us for today's discussion. Don't miss out, subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing. Until next time, take care of yourselves and take care of each other.

(23:54):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.