Fruitful Strides in Self-Care
Tunin in to their employees' needs, more hospitals offer programs to help nurses develop the healthy habits they educate their patients about, but often have little time to practice

By Cathryn Domrose
January 13, 2003

When her hospital built a gym on the floor above her office, Susan Finch found she had no more excuses not to exercise. "That's what finally got me in a gym," said the former chief nursing officer and now house supervisor at Presbyterian Hospital in Albuquerque, N.M. "When they put it over my head, I said, 'What more do I need?' "

Directors of hospital wellness programs say they are trying their best to reduce the excuses. They offer yoga and exercise classes to match all shifts. They set up weight reduction programs, hold health fairs, teach stress management sessions. They offer discounts for gym memberships or set up fitness centers within the hospital. They develop disease management programs and offer free health assessments.

At least one hospital gives employees a certain amount of money each year to spend on active lifestyle improvement.

But for many nurses-caught up in the rigors of 12-hour shifts, skipped breaks and lunch hours, exhausting workloads and family demands-even a gym over their heads or a 7:30 a.m. yoga class is not enough to get them to take care of themselves the way they should. Of all hospital employees-clerks, therapists, pharmacists, maintenance workers-nurses are the hardest group to get into hospital employee wellness programs, say program directors, many of them nurses themselves.

Nurses who do participate say the wellness programs are a huge benefit that helps them develop the healthy habits they constantly educate their patients about, but often have little time to practice themselves. They credit the wellness programs with helping them make changes toward a healthier lifestyle that they otherwise wouldn't have made, and encourage their fellow nurses to find the time to take care of themselves.

Healthy, wealthy and wise

Employee-sponsored wellness programs started springing up in the mid-1980s, as large corporate employers realized that healthy employees might save money on insurance costs and work more productively. According to the Wellness Councils of America, an organization that works with employers to create healthy workplaces, the average annual health care cost per person in the United States exceeds $3,000, and lifetime costs per person are about $225,000.

As hospitals helped create preventive care and wellness programs for the community, many began to become aware of the wellness needs of their own employees.

"There's a lot of stress in our industry," said Frank Rossi, senior vice president of human resources for Cook Children's Health Care System in Fort Worth, Texas. "Both occupational and nonoccupational concerns add to the total bill of how healthy our employees are."

Cook Children's is developing a comprehensive employee wellness program, Rossi said. It plans to unveil the first part of the program in about six months. The entire program, which will take about three years to complete, will focus on disease management, occupational health and wellness, he said.

Cook Children's now has a number of wellness programs in place, including smoking cessation classes, a workout gym, a health education program linked to prescriptions and a concierge service that takes care of employee errands, such as dry cleaning and shoe repair. The comprehensive program will bring those things together, Rossi said.

The health system decided to create a comprehensive wellness program because "we wanted to make sure our employees really take care of themselves," Rossi said. "When you're working 10 to 12 hours per day, it takes its toll on people. We're trying to balance their workload."

Two years ago, Samaritan Health Services based in Corvallis, Ore., started a yoga program for employees, offering to pay for classes given by approved instructors at community centers.

"We really wanted something that would interest nurses," said Kim Schlessinger, MN, ANP, a certified occupational health nurse specialist who directs employee health and safety at Samaritan Health Services. "With nurses, it was important to find something that would address both the physical and psychological part of their jobs because their jobs are so stressful."

The program has since expanded and includes a Weight Watchers at Work weight reduction program-popular with nurses, program coordinators say-and a variety of classes. Employees also can sign up to use a cardiac fitness gym at one of the hospitals.

In September, Samaritan Health Services began offering employees up to $300 to spend on specific wellness programs "that encourage employees to develop better lifestyle habits," said Lea Houston, MA, wellness program coordinator at Samaritan Health Services.

Employees also can attend free classes at the Heartspring Wellness Center at Good Samaritan Regional Medical Center in Corvallis, Houston said. The wellness center, which is open to the public, is part of Samaritan Health Services' complementary care program and offers classes on everything from smoking cessation and combating insomnia to personal empowerment for health.

In addition to an employee fitness center that offers programs on exercise and weight control, Mayo Clinic in Rochester Minn., has an employee health promotion committee that works to inform employees about healthy lifestyle choices. Among other programs, the committee sets up monthly displays in the cafeteria on themes such as diabetes, skin cancer and happy, healthy holidays, said Betty Kolb, RN, a member of the committee and a nurse in the division of preventive and occupational health medicine. Nurses say they use the information for their patients as well as themselves, Kolb said.

Kolb said the committee uses the health expertise in the hospital to create various programs for employees. For smoking cessation programs, the committee will work with the nicotine dependency center; for cholesterol screening, it will consult with the cardiovascular health department.

"We can call on some of these resources that are already here rather than reinventing the wheel," she said.

Other hospitals use programs from outside sources, such as Weight Watchers. Parkland Health & Hospital System in Dallas uses a weight loss program developed by a health management program in Boston. Cook Children's plans to incorporate a Web site developed for corporate wellness programs by the Mayo Clinic in Rochester.

Many programs start with free health assessments for employees, then work with employees and personal caregivers to develop goals and programs for those with medium-to-high risk of health problems. A program for people with diabetes, for example, might incorporate diet, exercise and one-on-one counseling.

"We have people who have been taken off insulin," said Eden Pineda, RN, manager for occupational health and wellness at Parkland.

Sometimes, individual nurses look for ways to keep themselves and their co-workers healthy. Some start walking clubs or group exercise sessions. A nurse in the intensive care unit at Childrens Hospital Los Angeles helped start a yoga program, said Beth Maldonado, employee assistance program manager there.

Although the nurse no longer works there, a group of ICU nurses faithfully attends the 7:30 a.m. yoga class after working the night shift. >>

Finch started a Weight Watchers At Work program a year and a half ago at her hospital, after losing considerable weight on the program herself. Employees collectively lost 2,400 pounds in a year, she said, and she herself has lost 100 pounds.

But whether the programs are formal or informal, nurse-driven or hospital-organized, involving nurses is their greatest challenge, organizers say.

"On the whole, nurses are a hard group to motivate," Schlessinger said. "It's a tiring job and it's hard for them to find that little extra time to do physical activity."

'Who has time?'

Nurses' round-the-clock shifts, irregular days off and demanding work schedules also contribute to the difficulty of finding time to exercise or attend wellness classes.

Finch said her Weight Watchers program received great response from housekeepers and clerical workers, but few nurses participated because they couldn't get away from their jobs for half an hour to attend weigh-in sessions and meetings.

Maldonado originally scheduled three yoga classes-at 7:30 a.m., 5 p.m. and 7:30 p.m.-to catch the nurses as they ended their shifts, but only the 7:30 a.m. class attracted enough participants to continue.

Part of the problem is the increasing demands of an industry in which people often are forced to do more with less, Maldonado said. She used to look forward to attending the 5 p.m. yoga class each Friday as a refreshing start to her weekend.

But as her job demands became greater, she found herself at her desk until 6 or 7 p.m. Or when she did finish earlier, she found she didn't want to stay at work another instant-even to attend a relaxing and beneficial class.

After a 12-hour day, many nurses need to rush home to their families, said Mary Genna, RN, a cardiac rehab nurse at Valley Medical Center in Renton, Wash. "I've noticed that the nurses who use the fitness center don't have little kids."

Part of the problem for nurses, Pineda said, is that many still believe their primary job is to take care of everyone but themselves. As a younger nurse, Pineda said, she always put her family and her work first. But as she's grown older, her attitude has changed.

"Now I know I need to take care of myself," she said.

Cash carrot

Valley Medical Center used to offer employees a cash bonus for participating in its wellness program, said Anne Grimes, MN, RN, director of the hospital's wellness services. Employees who exercised three times a week, ate five servings of fruits and vegetables daily, participated in various classes on lifestyle habits, read certain health materials and recorded their progress in a diary received up to $350.

"That program was very popular," Grimes said. "We had at least 60 percent of the staff participating in it." The nurses especially liked the stress reduction classes, she recalled, and came bringing blankets and pillows to spread on the floor. But last year, the hospital cut the cash incentive and the nurses stopped coming.

"Of all the hospital employees, I would say that nurses are the least likely to participate in a wellness program," Grimes said. "You really need to have some little reward for them to come."

Darlene Parrott, MSN, RN, a nursing education specialist in prevention and wellness, admitted she started participating in the employee health program at Banner Health System because of a cash bonus. Parrott now works for the program, Employees Choosing Healthy Options, at the Phoenix-based facility. ECHO offers a health assessment for all employees, then works to develop lifestyle changes.

After the program stopped paying participation bonuses, Parrott said, enrollment dropped somewhat but not as much as she had expected.

But even without the bonus and even if she didn't work for the program, Parrott said she would continue to participate. "It really did raise an awareness of how sedentary I was," she said. The program helped her to eat better, lose weight and develop an exercise routine.

"It was one of those priorities I had let go of," she said. The wellness program helped her to realize she could fit exercise and proper diet back into her schedule.

Many nurses who participate in hospital wellness programs can't say enough about how happy they are to have them.

Genna was thrilled when Valley Medical Center opened its fitness center because she could take her aqua aerobics classes right after work instead of driving across town.

"It is so convenient," she said.

She admits her schedule allows her more time for exercise than that of most staff nurses. She finishes work at 4 p.m. and doesn't have to rush home to young children.

But, she said, she also has made exercise a priority in her life. "I think you have to make time," she said. "You have to make that contract with yourself. You have to have the discipline."

Jody Paradis, RN, a nurse in quality improvement peer review at Samaritan Health Services, said she would not have started attending yoga classes if the hospital hadn't offered to pay for them. In the classes, she has learned how to ease stress and stay calm in a crisis.

"Of all the things the hospital does, this is one of the best," Paradis said. "It's really a morale booster for people who participate." She credits her yoga class and regular walking sessions with improving her attitude and mental sharpness at work.

"We can't help our patients be healthy," she said, "unless we're healthy ourselves."

Contact Cathryn Domrose at kaguilar@well.com

Create and run your own wellness programs

The irony of health care workers-the ones telling everyone else what to do to stay healthy-who don't practice good health habits themselves often frustrates directors of health and wellness programs. But actually, they are just like the rest of the population, said JoAnne Herman, Ph.D., RN, an associate professor at the University of South Carolina in Columbia.

"Behavior change is tough because we all have our established patterns," said Herman, a certified stress management educator. But it doesn't mean people can't or won't change. Sometimes, they just need a little push. Herman and directors of wellness programs at various hospitals offer these tips on starting and getting nurses and other staff members involved in wellness programs at work:

Consult staff. When planning a wellness program, collect input from the staff as well as a consultant to decide what kinds of classes and programs to offer and when to offer them. Many program directors said they used surveys to find out what nurses wanted. When staff members at Samaritan Health Services in Corvallis, Ore., responded overwhelmingly that they wanted a weight reduction program, directors there brought in Weight Watchers at Work. The program has a huge waiting list and the hospital is looking for more instructors.

Offer programs for a variety of shifts. "It has to be there when the people need it, not when it's convenient for the health promotion staff to provide it," Herman said. A drop-in program staffed with people who can provide information about diet and exercise is ideal, she said. But many wellness directors said they do not have a budget to provide that kind of service. Instead, they try to provide classes at the end or beginning of every shift, though they have had to cancel some classes for lack of attendance.

Have classes that begin and end at a specific time. "People are not going to make a huge time commitment," Herman said. Most will probably balk at the idea of a lifetime of aerobics or yoga, but six weeks sounds like something they can do.

Encourage group or paired exercise. Hold contests between units to see who can log in more walking miles or do more hours of aerobics or lose the most collective pounds. Working with another person or a group increases success in both exercise and weight reduction, Herman said. "It gives you some peer support and some peer satisfaction."

Try to find incentives and rewards for participation. Many wellness program directors say they offer gift certificates, T-shirts, water bottles and other small prizes as promotions when employees sign up for a wellness class. Eden Pineda, RN, manager for occupational health and wellness at Parkland Health and Hospital Systems in Texas, said she is working with her hospital's insurance company to find a way to offer some sort of cost reduction for employees who participate in wellness programs. The rewards don't have to be monetary or even material, Herman said. Her cardiac rehabilitation program "graduates" patients from one phase to the next, rewarding them by moving them to something different.

Include a maintenance component. "It's easy for people to change their behavior for a short period of time," Herman said. But keeping them eating well or exercising is difficult. She suggests seasonal programs such as "Staying fit during the holidays" or "Making and keeping New Year's resolutions" to help keep staff members on track.

Look for creative ways to incorporate healthy habits into the workplace. Anne Grimes, MN, RN, director of wellness services for Valley Medical Center in Renton, Wash., hired physical fitness specialists to be part of her patient lifting teams. The specialists teach and remind other employees how to use proper body mechanics to avoid injury when moving patients. They also teach noon exercise classes for nurses, demonstrating exercises that will strengthen muscles used in lifting and increase flexibility. Because classes are only 15 to 20 minutes long and nurses can exercise in their regular clothes, attendance has been good, Grimes said.

Look at what the hospital is feeding its staff. When the university hospital where Herman works was doing research on a nutrition program, the cafeteria began offering a daily low-fat, low-calorie entrée. The item proved so popular that it was continued even after the research ended. The cafeteria now also offers an attractive salad bar and other alternatives to high-fat, high-calorie meals, she said.

Try a "Walk the Hospital" program, with a walking trail through the hospital corridors or outside on the grounds. Nurses who don't have time to walk a full two or three miles at a time can walk nonstop for 10 or 15 minutes a few times a day. "It makes it really convenient to go out and exercise," Herman said. "It's a stress management technique as well."