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Best Practices to Help Improve Short-Term Challenges from Supply Chain Delays
/wps/portal/GESPRA/root/public/Resources/Resources/!ut/p/z0/04_Sj9CPykssy0xPLMnMz0vMAfIjo8zizR0dXT0cDQx93f0cXQ0CjV3C3F08wwwM3Mz0C7IdFQFCINbA/Posted Date: Dec 01, 2021
Effective Date: Dec 1, 2021
Many operators may be experiencing delivery issues with Broadline Distributors due to continued labour shortages, now exacerbated by the COVID-19 Delta variant. There is little that employers can do about unpredictable absenteeism or to create workarounds when it happens. Unfortunately, as a result, some distributor deliveries continue to miss regular delivery windows or are being pushed to the following day.
In addition to labour shortages, manufacturer product shortages continue to be a challenge. Fill rates into distribution are at historically low levels, which creates the need to substitute, or if there are outages, creates the need to buy from other distributors.
While you face these unprecedented challenges, here are some recommended best practices to help improve the short-term situation for both your business and your trusted distributors:
1. If you are a member of GESPRA, login to the portal regularly (eGESPRA.ca > Program Updates & Alerts section) and read your monthly INFO-G newsletter for Supply Chain updates, information on product shortages and availability and price fluctuations.
Not yet a GESPRA member? Click on Contact Us > Interested in becoming a Member to get with the program!
2. Communicate your forecasted demand, especially for busy upcoming weeks and holidays, to your distributor account representatives or hospitality suppliers as early as possible so they can assist in planning. Discuss lead times required on key items that may impact your menu offering or client demands.
3. Order early, ideally before 10 am on the day prior to your scheduled delivery day. Placing orders early will reduce the likelihood of service delays. Be prepared for the possibility that your distributor may implement other measures to help ensure the highest possible level of service. This may include earlier cut-off times or other restrictions, like requesting smaller orders than usual or changing delivery days.
4. Manage inventory within your location. Avoid having critical items delivered for next day events; instead, try to order 3-4 days ahead of time. If possible, keep 2-4 days of additional inventory on your shelves in anticipation of any service disruptions.
5. Balance your orders: A light order (50 cases) on Tuesday and a heavy order (150 cases) on Friday create load challenges. Try to keep your order volume consistent.
6. Consider changing your delivery day or time to a window that will result in higher on-time service (consult with your distributor representative on options, including key/night drops) and do your best to refrain from off-day deliveries to ensure higher service levels.
7. Consider placing multiple (2-3) orders instead of one large monthly housekeeping and chemical ‘replenishment’ order to reduce one-time large deliveries that strain operations.
8. Know your delivery schedule – order for deliveries to be made on your routed day. Off-day deliveries present a challenge by interrupting the planned scheduled route. If your order is delayed, your master food distributor will notify you as soon as possible and will attempt to re-route the delivery for the next day.
9. For the upcoming holidays, make sure to place your large orders early in the week prior to the start of any planned events.
Make sure to continuously watch for communications on from your broadline distributors as well as updates on eGESPRA.ca to stay ahead of potential delays and disruptions. We are closely monitoring distributor fill rates in an effort to help mitigate any potential impact to your operations.
Stealth Health: Improving Your Product Offerings…One Secret at A Time!
/wps/portal/GESPRA/root/public/Resources/Resources/!ut/p/z0/04_Sj9CPykssy0xPLMnMz0vMAfIjo8zizR0dXT0cDQx93f0cXQ0CjV3C3F08wwwM3Mz0C7IdFQFCINbA/Posted Date: Nov 17, 2021
Effective Date: Nov 17, 2021
It may be hard to believe, but, Canadian manufacturers have been making changes to their products for the last 10 years with the goal of improving the health and well-being of Canadians…and not saying a word about it!
The concept is called “stealth health.” It was coined by a scientist at Yale University (Dr. David Katz) who had the idea of creating healthier habits for daily living. Stealth health can be defined as: making changes to ingredients or recipes to improve the nutritional attributes of a food or product without promoting or advertising the added benefits.
Stealth health can take many forms, such as:
• Improving nutrient density (e.g. adding healthy multi-grain flours and oats).
• Including ingredients with added health benefits (e.g. the explosion of cranberries and almonds in many snack bars).
• Reducing or eliminating unhealthy ingredients (e.g. lower in sodium or reduced fat snacks).
• Cleaning up the ingredient deck so that consumers know what is in the product and can name every ingredient without researching it.
With all this potential good news, why would manufacturers not want to promote the added health benefits? It is for the simple reason to protect the brand and the perception of the customer. Consumers may not want their favourite brands to change, so the last thing manufacturers want to do is alienate existing customers by forcing health claims or the perception that a product will not taste as good anymore. The formula changes to recipes must be carefully executed and often can happen gradually over time. Let’s reflect on one of the best executions of stealth health: the Oreo® cookie’s evolution to a healthier option.
In the early 2000’s a lot of attention was being paid to the risks of Trans fats and the high level of hydrogenated oils used particularly in the baking and snack industry. At the time, Nabisco made an announcement they would work towards removing these unhealthy oils from all of their products, and they went to work. By 2006 their famous Oreo® cookie contained no Trans fats, however there was an absence of a large marketing campaign to highlight this; the packaging ingredients were updated but you never saw a “no Trans fat” tag on the package, and customers never tasted the difference. Extensive product development and work went into formulation changes to ensure customers wouldn’t see any noticeable difference in the Oreo® cookie. The result…higher sales! Legacy customers stayed with the product, and consumers paying attention to Trans fats could see from the ingredient deck that the cookie did not contain any; therefore, incremental sales were achieved.
Some manufacturers have chosen to go all out to promote the perceived added health benefits, for example potato chips are being marketed as cholesterol free (surprise, they always were!) were not because of improved formulations, the interest in consumers for healthier snacks drove interest in promoting the product as a possible healthier snack item.
What does this mean for you? Providing choice and balance in your product offerings. Pay attention to the top sellers while also ensuring that at least 10% of what you offer caters to the health-conscious customer group who want to indulge without feeling guilty about it.
Looking for other Stealth Health products for your cafe bar or micro-market operation? Let GESPRA help you to find the perfect mix of products for your residents. Take advantage of GESPRA preferred pricing on hundreds of essential items and assistance from a dedicated locally-based Account Manager, in addition to a wealth of easy-to-use tools and helpful resources to help you run your operations more efficiently and effectively.
About the Author:
Brian Emmerton is a Registered Dietitian and the Vice President and General Manager of GESPRA, a leading supply chain solutions provider for non-commercial clients and hospitality organizations across Canada. Brian has been working in foodservice and consumer affairs for over 30 years to help clients source food and nutrition options that deliver experiences that enrich and nourish lives.
A No-Cost, All Encompassing Approach to Motivating Your People
/wps/portal/GESPRA/root/public/Resources/Resources/!ut/p/z0/04_Sj9CPykssy0xPLMnMz0vMAfIjo8zizR0dXT0cDQx93f0cXQ0CjV3C3F08wwwM3Mz0C7IdFQFCINbA/Posted Date: Nov 03, 2021
Effective Date: Nov 3, 2021
In the face of the pandemic, thousands of long-term care employees have demonstrated an unprecedented level of care and commitment to their residents, their families and to each other. This shared common enemy served as a powerful focal point for people at all levels in organizations to come together to fight, at times to grieve, and in the end, to celebrate shared wins.
For the most part, employee motivation was not an issue. The severity of the pandemic (the potential loss of life and livelihood) provided all the motivation people needed to stay focused, to get the job done right, and well.
For leaders, two important lessons must be gleaned from this experience:
1) Your people CARE!
2) Your people HAVE motivation!
Moving Into The Post-Covid-19 Period
So now what? As the severity of the pandemic is reduced, what is happening to the motivation levels of your employees? With the neutralizing or corralling of the common enemy, you may experience a drop in employee morale to pre-pandemic levels, or even see them plumet further. Exhaustion, and dealing with ongoing controls and expanded work demands, may undermine peoples’ motivation to push on through to the end, as the wait for the “good old days” seems indeterminable. Motivation may become a challenge for many people.
For leaders looking to shepherd their Homes into a post-pandemic period of positivity, it is more imperative than ever to focus on employee motivation. Good leaders know that their success is measured by how well their people do their jobs, and when motivation wanes, everyone suffers.
The good news is that even after all you have gone through, you can create a culture in your Home comprised of highly motivated employees - without spending all of your fiscal resources. In fact, all of the strategies shared here are no-cost approaches to promoting highly motivated staff.
This article focuses first on the two major myths regarding human motivation, and then examines a three-step process to accelerating employee motivation.
Debunking the Two BIG Motivation Myths
Myth #1
And the first big motivation myth is… $$$$. Just as the Beatles declared years ago (Can’t Buy Me Love), money will not buy motivation. Paying people more money does not result in more motivated employees demonstrating improved productivity or heightened morale.
In some jurisdictions we have seen attempts to positively impact the workplace by paying a pandemic bonus to front line nursing staff. Not only did this demoralize all other employees who were going above and beyond and received nothing extra, it did not address the core issue – the lack of staff to deal with added care responsibilities.
While these front line care staff may have felt somewhat vindicated with the added bonus, based on Silver Meridian informal research with leaders and employees, front line care staff would have appreciated more “hands on deck” to help with the work, rather than a bonus to do the impossible. And of course, since everyone was working to capacity before the bonus, increasing wages did not relieve the pressure or result in the provision of more and better care.
There is one caveat to the money and motivation issue. If people are underpaid (i.e., they are paid less than others in comparable positions of responsibility and scope), then the lack of reimbursement is usually a de-motivator, impacting productivity and morale in a negative manner (such as the non-payment of a pandemic bonus to people other than front line care staff!).
Myth #2
And for the second big myth… it is your job as a leader to motivate your people.
Balderdash! Not true! Absolute rubbish! A complete misrepresentation of your role as a leader! In fact, you have the responsibility of motivating only one person… YOU! That’s it!
Now do you feel a little more relieved? One less task on your plate!
And who is responsible for motivating your people? They are! The reality is that human motivation comes from within. Your people are just like you – they do what they do because there is something in it for them, something that they want that inspires them to be motivated. We know the expression “You can lead the horse to water, but you can’t make him drink” – unless he wants to drink. What would prompt him to drink? If he is thirsty, then he drinks.
The role of leaders is to respond to the “thirst” that resides in every person – the thirst or desire to have something, do something, be something - anything that inspires them to be motivated. People are motivated to change when they see a benefit for them. This leads to the universal truth.
Three-step Process to Fostering Employee Motivation
So now that we have these two myths out of the way, we can focus on how leaders can INSPIRE others, and thereby increase the likelihood that they will be motivated to change.
We call this approach Inspired Leadership, recognizing that truly great leaders know that to elicit change in others, they must find ways to inspire them to want to change. And by change, we are referring to any action or response that represents something different than what is currently happening. So, whether you are looking for someone to do something different as a result of a change in a procedure, changing the way an individual deals with others (or with you, the leader), or any other form of change, the key is to inspire the other(s) to want to change because they see a benefit for them.
So here are the three steps to fostering employee motivation:
1) Step One: Look Inside You
2) Step Two: Monitor What You Do
3) Step Thee: Respond to What They Do
The first two steps are about what you need to reflect on within yourself, in order to become a leader who inspires others to be motivated. The third step focuses on specific actions you can take with others – actions that connect how you project yourself, to what people see as benefits that inspire them to be motivated.
Step One: Look Inside You
During stressful and uncertain times such as we are experiencing, and continue to experience, it’s normal to feel anxious, frustrated, overwhelmed, and even scared. Chances are, most people around you have been experiencing similar emotional responses. Ignoring such feelings can result in seemingly unrelated sporadic outbursts (one of those “where did that come from?” reactions), and at the very least, subtle telling signs of frustration or fear (involuntary physical responses, such as sighs, eye rolling and look-aways).
When experiencing such stress, it’s easy to infect each other with anxiety and fear. As a leader, it is imperative that you not only confront such feelings, but take the lead, and consciously commit to countering them with more positive responses within yourself.
The first step to countering such feelings, so you will act in ways that inspire others, is to look inside yourself, and search for what is most important to you. By focusing on your positive hopes and aspirations, it allows you to reframe your thoughts and perceptions of what is going on around you.
Here are some fundamental questions to reflect on in this personal internal journey (we will explain the numbers shortly!):
• What do I most value? (3)
• What inspires me, gets me excited; what do I want to do more of? (2)
• What turns me off? (3)
• How do I want to be seen as a leader? (1)
• Where do I want to be in my life within the next 3-5 years? (2)
Your responses to such questions will point you to what inspires and motivates you.
From this reflection point, take a few minutes to relate your responses to the following:
your Home’s (1) Mission; (2) Vision; and (3) Values. Using the numbers (1, 2, & 3), match your responses to your Home’s corresponding Mission, Vision or Value number. While your personal Mission, Vision and Values may not be identical to that of your Home, you are looking for congruence. As long as they are not in opposition to each other, then you know you are personally working in the right place.
Taking this deep dive into your own personal points of inspiration, to see what motivates you, is essential. Before you can take Step Two in this motivational process, you really do have to examine what is most important to you.
Step Two: Monitor What You Do
While Step One helped you focus on what inspires you, Step Two is about paying attention to these personal points of inspiration!
We are reminded of the story (attributed to the Cherokee) of the talk between an elder and a young child. The Cherokee elder told his grandson about the battle that goes on inside people. He said, “My son, the battle is between the two ‘wolves’ that live inside us all. One is Unhappiness. It is fear, worry, anger, jealousy, sorrow, self-pity, resentment, and inferiority. The other is Happiness. It is joy, love, hope, serenity, kindness, generosity, truth, and compassion.” When the child asked “Which one wins?”, the elder responded, “The one you feed”.
While staying in this more positive state of “happiness” is a challenge during such times of high demand and stress, we can take steps to protect ourselves from these emotional contagions by feeding the positive wolf within.
For example, monitor and reduce how often you engage in venues where fear feeds on itself, such as social media, cable news, and frenzied conversations with friends and coworkers. Verify resources, distinguishing between people who are speculating, and those who have sound information.
Also, take care of your mental health. Commit to exercising, practicing mindfulness and meditation, volunteering, and seeking out positive, high-quality connections with others — even if they’re virtual. Simple wellness practices like these will help you build resilience and positivity, which will influence how others perceive you.
Step Three: Respond to What They Do
Now that you are clearly focused on what inspires you, and are committed to feeding your inner happy, positive wolf, your actions and interactions with others will be more inspiring to those you work with and lead every day.
Keep in mind that the following strategies and approaches are not sequential and are often successfully employed through a “blend” of interactions.
Lead with Optimism: Even in dire circumstances, you can still lead with optimism, helping your team stay resilient amidst uncertainty. First, be a role model. Lip service alone won’t work. Also, keep in mind that a positive outlook is easier to adopt as a group, so help employees foster a sense of connection with each other.
This can be as simple as:
- Celebrating when a team or department hits a milestone
- Starting meetings with each person saying one thing they’re grateful for
- Review progress – Flip chart and post accomplishments from Day 1 to now
- Create an “Appreciation Wall” for everyone to post messages of encouragement
- Share and celebrate good news stories – both internal and external
As a leader, you have an opportunity to set the conditions for a collective positive outlook on your team. Take advantage of it.
MBWTA – Managing By Walking and Talking Around: Ideally, make it your mission to get out of your office and connect with people at least twice, every day. Even at the best of times it can be a challenge to get out from underneath the pile of tasks you face. But just as you abhor task-oriented care of your residents, you too need to re-frame your focus on the bigger picture of what is most important, and connect with people. Otherwise, you performing as a task-oriented manager – not a leader.
A side bonus – You are more likely to sense when something is “off” when you are circulating, and by dealing with issues in the moment, when they are minor concerns, you save time and aggravation of having to deal with it later when it comes through your door as a major issue.
Catch People…Doing Things Right (CPDTR): Yes, we know you do this now, but do you do it well, and enough? We often ask people in training sessions to put up their hand if they are tired of being told they are doing a good job. The reality is everyone loves to be recognized as a valued, respected member of the care team, and acknowledging what is valued inspires people to do it even more. The practise of praising more is one of the most impactful behaviours a leader can have to positively inspire others.
Here are four simple suggestions that make for better, more impactful, praisings:
- Praise specific behaviours – focus on what the person did or said - avoid generalizations.
- Link the praise to your Home’s values.
- Praise immediately – don’t wait for their PA session!
- Praise “routine” actions – good care in LTC is not about episodes of high drama, but rather, it is about doing the small, caring things in residents’ lives that are meaningful to them.
Ask Questions - Listen More – Talk Less: People feel inspired and motivated when they feel valued and respected for their contributions. Asking people how they are doing, or asking for suggestions, are only effective if you listen and show an interest in what they say. By asking questions, you are encouraging people to become a part of the solution, and contributing to the solution is an empowering, inspiring place for most people to be!
Boost Morale with a Thank You: Closely aligned to CPDTR, don’t underestimate the power of symbolic awards, such as private thank-you note. To maximize their effect, it’s essential to customize these rewards to each unique context. Ask yourself: Are you the best messenger, or would this expression of gratitude be more impactful coming from someone else? When is the best time to offer the message? And should it be communicated privately or publicly? Whatever you decide, your message can be short and sweet — as long as it’s thoughtful. When employees feel that it’s sincere, a symbolic gesture of recognition can go a long way.
Enter Into THEIR Homes: Take your expressions of gratitude and praise to an even higher level by sending them home – to the employee’s home. Sending a personalized note of acknowledgement, or a birthday card with a personal message, to where the employee lives is a powerful way for you to share your praise, and for the person to be seen as special by the people that mean the most to them. Handwriting the message (and the outside name and address), is the finishing touch to the personalization of your message!
Our Home’s Vison: An ideal Home Vision is not about what your Home is, but what is a realistic goal of how your Home aspires to be seen in the future. By reinforcing this Vision, by bringing it to life in your daily practice, it can serve as an inspirational rallying cry for everyone. When you incorporate your Home’s Vision into your discussion every day, you hear yourself saying things like “How will this help move us forward with our Vision to being recognized as…?”, or “Wow, that brings us one step closer to realizing our Vision of…”.
Such acknowledgements reinforce where the Home is headed, and represents an opportunity to inspire people, as they realize they are helping as you move forward together.
Help Your Team Make It Over the Finish Line: Pandemic fatigue. Mental fog. Work/life blur. Whatever you want to call it, you and your people may be going through some version of it right now.
As a leader, it is imperative that you help focus everyone on what’s important over the long term, not just what is urgent right now. That short-sightedness can set the team up for failure when the crisis is over. This ties into the focus on the Home’s Vision, noted above. The Vision helps people see beyond the immediate obstacles, and towards a longer term goal.
Make room for foolishness: While dealing with essential work responsibilities must be done, occasionally making time for fun and levity is also important. Declaring a time for some spontaneous fun and laughter, such as a “Foolish Four” minutes of making faces at each other, or sharing your most embarrassing teenager moment, can help to alleviate the strains of the day. It is helpful to declare the time (duration) up front, to encourage people to not get carried away for too long of a period. Try to make the activity a “leveler” - something that everyone can do, regardless of education or position in the Home. And perhaps most important, make sure you, the leader, take part in the foolishness!
Summary
Good leaders recognize that their role is to inspire others, such that they are motivated to excel. Motivating others to change is not something you can buy or demand as a leader. Rather, it is about what you as a leader believe, what you project, and what you do to inspire others, such that they want to change.
This is not about spending money to motivate people.
This is about being an Inspiring Leader.
About the Author
Ron Martyn is the Co-Owner of Silver Meridian. For over 20 years, Silver Meridian has helped LTC managers hone their leadership skills, by empowering and energizing people, and becoming recognized as Inspired Leaders in the provision of care (English only). Go to Silver Meridian (https://silvermeridian.com) for more details. For information on the new Winter intake for the, Online DOC/ADOC Leadership Certificate Program (Accredited), click the following link: https://silvermeridian.com/employee_focus/the-doc-adoc-leadership-certificate-program/
The Sweet Story on Sugar
/wps/portal/GESPRA/root/public/Resources/Resources/!ut/p/z0/04_Sj9CPykssy0xPLMnMz0vMAfIjo8zizR0dXT0cDQx93f0cXQ0CjV3C3F08wwwM3Mz0C7IdFQFCINbA/Posted Date: Oct 13, 2021
Effective Date: Oct 13, 2021
Much attention has been focused on health risks associated with Canadian diets for many years and after a heightened attention about sodium and salt intake, the next bandwagon coming to the forefront appears to be sugar.
Why is sugar becoming the next ‘naughty’ ingredient? The fact is that we Canadians have a love for the sweet taste and pleasure derived from both the natural (fruit sugar in fruit juices) and added sugars (found abundantly in many products to enhance the flavour) in our favourite foods. Increasing obesity rates (particularly in young children), higher incidences of diabetes and heart disease, emerging diet trends focusing on sugar elimination like Keto, and an increased attention to ingredients and food sources has raised the attention to this potential big bad category!
The question is, do we consume too much sugar? Well, many health experts will say yes, but believe it or not, there are some interesting trends that demonstrate we are actually consuming less sugar than we used to:
• The overall amount of added sugar consumption in Canada has declined in the last 20 years. Food preferences and intakes have changed, while ingredients and formularies of ingredients that contain sugar have also undergone small reductions. The proliferation of sugar substitutes has greatly increased as had variety of low-calorie products (sugar free soft drinks in particular), as consumers looks for lower calorie options with the same sweet sensation.
• Canadians consume an average 30% less sugar than our American counterparts. It is predominantly due to the lower amount of regular soft drink consumption. Is it because of fewer choices or a higher proliferation of low-calorie carbonated beverages? The answer is no. Canadians simply reach for water or unsweetened beverages more often (and remember water and sparkling water consumption continues to climb!).
In recent years, some provinces have tried to regulate consumption of sugar through health programs such as school food guidelines and standards. These regulations impacted our industries ability to offer traditional choices that were available through vending and self-serve areas. For the most part, Canada currently does not have any nutritional guidelines related to the quantify of sugar Canadians should or should not consume, however Health Canada suggests choosing foods with little or no added sugars.
So how will this impact our business going forward? Health Canada’s new nutrition labelling requirements which have been worked on for years, are scheduled to be completely implemented by December 31, 2021. In addition to sugar being a mandatory item on the nutrition label, packaging requirements will also change under this new legislation as symbols indicating a product is high in sugar will have to be identified. Stay tuned!
How do we ensure our business thrives even given these potential bumps in the road? Here are a few things to pay attention to:
• Choice & Selection. Offering residents choice and selection in all categories ensures that you are providing a variety of options without added or natural sugar; both impulse purchases and regular frequent offerings can help you demonstrate your commitment to healthy choices. Some residents may look for more natural sources of sugar (i.e. honey) as a preference. Remember to display a mix of both sweet and salty snack options in your impulse section of micro markets, feature areas, as well as in any combo packages you offer.
• Sugar Free Options: This trend is growing, we recommend that 20% of your beverage offerings are free of sugar (e.g. water, sparking water beverages such as Bubly) or low-calorie offerings. It may seem like a lot, however over your entire portfolio is it quite simple to do
• Say Tea! There is an opportunity to focus on tea as it is currently a growth category. Hot and cold tea consumption continues to climb and provides strong revenue opportunities while offering choices with health benefits (and interesting exotic flavours)
Whether your residents have a sweet or salty tooth, staying on top of trends is critical. It can help to keep your residents interested, demonstrate that your services reflect the current marketplace drivers, and provide your business with a competitive edge.
About the Author:
Brian Emmerton is a Registered Dietitian and the Vice President and General Manager of GESPRA, a leading supply chain solutions provider for non-commercial clients and hospitality organizations across Canada. Brian has worked and researched consumer behaviors for over 30 years to assist clients in following trends and practices that can drive revenue and growth opportunities.
Protecting Nurse Well-Being in the Face of Burnout and Moral Distress
/wps/portal/GESPRA/root/public/Resources/Resources/!ut/p/z0/04_Sj9CPykssy0xPLMnMz0vMAfIjo8zizR0dXT0cDQx93f0cXQ0CjV3C3F08wwwM3Mz0C7IdFQFCINbA/Posted Date: Sep 29, 2021
Effective Date: Sep 29, 2021
Darlene Legree Co-owner, Company Principal, Silver Meridian
The past 18 months represents the most stressful time in most nurses’ careers. Nurses working in long term care have confronted the COVID-19 pandemic with determination, courage, and compassion. Now, nurses are encountering another more personal challenge…burnout and moral distress. By prioritizing self-care and workplace wellness strategies nurses can proactively protect their personal well-being.
Nurse Well-Being and Implications for Long-Term Care
Prior to the pandemic crisis nursing in long term care was already a stressful job with high levels of clinical and leadership responsibilities that required the balancing of effective and compassionate resident care with sector limitations (underfunding, staffing shortages, limited resources, legislative standards, inspection requirements etc.) The COVID-19 pandemic has compounded these issues and this prolonged physical and mental strain has resulted in many nurses experiencing fatigue, potentially leading to burnout and moral distress, and impacting the sustainability of the nursing workforce.
Nurses recognize they must now prioritize their personal well-being. Taking care of themselves protects their own mental and physical health and improves their job satisfaction, workplace engagement, and performance.
Given the significant importance of nurses’ contribution to quality and safety, both for the people who work in, and the residents that live in, long term care, it is essential that all stakeholders truly understand and support nurses as they seek to protect their well-being in the face of burnout and moral distress.
Burnout
Even the most resilient nurse could experience feelings of being overwhelmed and not coping well as the pandemic progressed. The communication overload was enough to make anyone feel frustrated and anxious. These feelings, plus the grief associated with the loss of life and the heightened fear that if not already, it could happen here, or the risk of exposing family members, left many feeling emotionally or physically drained. And now as we move into the 4th wave nurses must brace themselves once again and draw on their inner strength to lead their team through this recurring pandemic. As a result of these difficult conditions, nurses are at a high risk for burnout (Sriharan et al. 2021). Burnout is in response to chronic workplace stressors, which of course the pandemic crisis has now become.
Over and above feeling completely exhausted (emotionally and physically), the nurse may have a sense that they are no longer effective, experience little to no job satisfaction, have headaches and irritability, with increasing cynicism and detachment. When dealing with these symptoms the nurse may initially begin to miss work deadlines, procrastinate, be late for work, complain of feeling persistent tiredness or have physical illness. As the symptoms intensify there is increased absenteeism escalating to sick leave and ultimately the nurse quitting their job and leaving a profession they had once loved and were committed to. We need to support, not stigmatize nurses, if they do experience burnout. It is not a sign of being an ineffective nurse or of not being able to cope. Instead, we all share responsibility in preventing burnout and to work on personal and professional solutions.
Moral Distress
Doing the right thing for both the resident and the staff ensures that nurses maintain their professional integrity and ethics. During the pandemic difficult and complex decisions were made that were often outside of nurses’ control. In fact, the nurse may have felt a different action was the “right” thing to do in the best interest of the residents. Often external constraints made it nearly impossible to take what the nurse felt was the right course of action. A common example was isolating residents even though the nurse felt it was causing increased anxiety, agitation, and confusion for the majority of the residents. Not being able to act accordingly resulted in nurses feeling powerless, guilty, and experiencing moral distress. Other causes of moral distress may be working with inadequate resources (supplies or staff shortages), being pushed to function outside their usual scope of practice, lack of collaborative decision-making and juggling the need for efficiency with the needs of residents. All of these conditions and actions contribute to a decline in quality care and can be a source of moral distress (Pijl-Zieber et al. 2008).
Moral distress results in negative emotions such as anxiety, anger, resentment, and frustration as well as physical symptoms such as insomnia, bouts of crying and headaches. Moral distress is closely aligned with burnout and both impact quality care, staffing shortages and lack of job satisfaction (Sriharan et al. 2021). It becomes a vicious cycle where nurses feel stressed and overwhelmed, experience burnout, leave their jobs, resulting in staff shortages which then fosters conditions for nurses to experience moral distress, which then accelerates further staff turnover. Again, proactive strategies are required to limit conditions that contribute to the moral distress experienced by nurses, and to support nurses as they grow to understand the meaning of moral distress and determine preventative strategies.
Personal Protection Strategies
My Plan, My Way
We have all read or heard the messages about the importance of self-care. The abundance of advice can seem overwhelming and result in feelings of guilt and anxiety. How can I possibility fit self-care into my life when I have so many other higher priority commitments and responsibilities? If by the end of the day you are feeling exhausted, it can be difficult to find the energy and motivation to focus on self-care activities when all you really want to do is watch a mindless TV show.
But wait a minute, is this really a problem? We know that we look at the resident from a holistic perspective, considering their physical, emotional, social, mental, and spiritual needs. Isn’t this the same philosophy we should apply to self-care? We understand that each of us is a unique “whole” person and recognize the interdependence between our biological, social, psychological, and spiritual selves. Therefore, isn’t it reasonable to suggest that the focus of self-care should be on you, and as such only you can determine what approaches will work best to replenish and revitalize your body, mind, and spirit.
To shift your thinking away from the litany of recommended self-care activities that you feel obliged to try, reflect on things you do that relax or energize you. For example, getting together with a friend. Does this leave you feeling calm and happy or drained and upset? What about taking a walk? Do you return feeling positive and optimistic or negative and tired? Monitor your feelings and do the things that make you feel good and limit the things that make you feel bad! So go ahead, take control. Protect your personal well-being by creating a self-care plan, based on your terms and needs. And, if at the end of viewing a mindless TV show you reflect and think that was relaxing and enjoyable, add it to your self-care plan. If you feel frustrated and irritated, it would be a good idea to remove it from your plan. After all, it’s your plan, your way!
Attitudes That Impede Self-Care
All or Nothing
A hindrance to self-care is the attitude that either you fully commit to self-care, or there is no point to doing anything. Realistic self-care is a step-by-step process. You try one achievable activity, monitor how it makes you feel, and if it works, add it to your self-care plan. Success is realized when you make small changes over time, as you continue to grow your personal self-care plan.
Some have said that self-care seems selfish, even self-indulgent. This is simply not true. Being selfish focuses on “me” and doing only for oneself and not giving to others. Conversely, self-care benefits you and everyone else. It ensures that you don’t deplete all your personal energy, enabling you to effectively take care of others.
Silo Thinking
Another self-care attitude negatively impacting success is when self-care is considered so personal that it cannot be integrated into other aspects of one’s life. However, self-care plans work best when integrated with your personal and professional life. For example, if exercise through walking provides relief and a sense of accomplishment, wearing a step counter and monitoring steps at work and away from work overcomes one silo in your life.
Put It Behind You
It is easy to criticize yourself and hard to practice self-forgiveness. When you hear your internal voice chastising you for slippage from your self-care plan, as difficult as it can be, let it go. By practicing self-forgiveness, you reduce your anxiety and stress, boost your positivity, and set the stage to reflect and learn from your experience. You are doing the best you can right now. Remember to apply this same principle to others as they too are doing the best they can. “If you are more accepting of others, then you inevitably become more gentle with yourself” (Brene Brown, 2017).
Workplace Protection Strategies
Given the urgency of nurse shortages in LTC it is imperative that organizations look to strengthen well-being protection strategies to retain current employed nurses and recruit others. By integrating employee well-being into the values of the Home, it will hold everyone accountable to advocate and support workplace well-being strategies.
Communicate and then Repeat and Repeat Again
During this COVID-19 crisis communication remains a key success strategy. Between frequent meetings, team huddles, emails, and printed messages, effective communication is fundamental in sharing new and updated information. Communication needs to timely and transparent, and leaders need to listen and acknowledge concerns. It is important to keep these communication techniques open, post-pandemic, to avoid information gaps and to support nurses in their leadership and clinical practice. On the other hand, poor communication practices will serve to increase frustration and stress.
Engage and Empower
During the pandemic nurses have demonstrated their critical thinking skills and determined innovative solutions that not only impacted the nursing department, but the organizational level as well. Managers need to continue to harness this potential, so nurses feel recognized and empowered.
Continuing to engage nurses in decision-making and seeking their input and feedback also fosters this sense of empowerment, builds healthy work relationships, and creates a positive work environment.
Working Together
Well-being involves a broad range of feelings, attitudes, and both internal and external experiences and conditions. It is subjective and includes physical and mental dimensions. Strategies are not a “one size fits all” making it more challenging for workplaces to support nurses’ well-being. Managers and nurses should work together to determine wellness initiatives that encourage active participation. This collaborative approach will ensure that the voices of nurses are heard, and that what is important to them is reflected in the program. Utilize available tools to assess employee wellness, or the organization can create their own assessment tool.
Well-Being Support
Nurses should know their well-being is vital to the success of their Home and be encouraged to share when and why they are feeling stressed. Their managers should reinforce that feeling stressed is not a sign of weakness, but is in fact normal, and invite the person to a private or group meeting or have an informal conversation to discuss their feelings and conditions contributing to their stress. However, managers should not wait for the nurse to report feelings of anxiety and stress, but instead check-in regularly and be alert to signs of burnout and moral distress.
Managers should also make sure that there is a safe place for nurses to gather and reflect on the pandemic experience. Reflection allows nurses to hear others’ perspectives, share emotions, and to find a sense of meaning from the pandemic experience. This process is an important step in restoring confidence and re-vitalizing commitment to the Home.
Summary
Nurses working in long term care have demonstrated extreme resilience throughout the COVID-19 pandemic. They have been able to adapt quickly and successfully navigate through this complex and rapidly changing work environment. There has been a substantial amount of professional growth and a deep sense of accomplishment. They have been steadfast in providing compassion and support to colleagues, staff, residents, and families.
Now is the time for nurses to pause and reflect on their personal well-being. They should consider how the pandemic has impacted their mental and physical health and commit to self-care actions that will protect them from burnout and moral distress. Long Term Care organizations should also prioritize initiatives that support the well-being of their nurses to ensure they have the energy and positive approach to guide their teams and residents through upcoming uncertainties and towards the new reality of long-term care.
About the Author
Darlene Legree is the Co-owner of Silver Meridian. For over 20 years, Silver Meridian has provided leadership training and support to staff working in the long term care sector (English only). Go to Silver Meridian (https://silvermeridian.com/) for more details. For a free copy of "8 Steps to Positively Connect with Others' click on the following link: https://silvermeridian.com/8-steps-to-positively-connecting-with-others/
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Food for Thought: Nutrition for the Aging Brain
/wps/portal/GESPRA/root/public/Resources/Resources/!ut/p/z0/04_Sj9CPykssy0xPLMnMz0vMAfIjo8zizR0dXT0cDQx93f0cXQ0CjV3C3F08wwwM3Mz0C7IdFQFCINbA/Posted Date: Sep 21, 2021
Effective Date: Sep 21, 2021
What do blueberries, carrots, raspberries, and broccoli have in common? They’re colourful fruits and vegetables that are packed full of important antioxidants such as, vitamin A, C, E and polyphenols. Antioxidants are naturally occurring components in food that may help prevent and/or delay cellular damage caused by aging, environmental pollutants and certain behaviour patterns including smoking, and excessive alcohol consumption. While aging is natural, it can be associated with significant changes to both the body and the brain that can occur slowly or quickly over time.
According to the Alzheimer’s Society of Canada, “1.1 million Canadians are affected by dementia.”[1] Dementia is typically seen in older adults over age 65, and older women tend to be affected more so than men.[2] However, younger individuals can develop Alzheimer’s, too. To help raise public awareness about this condition, September has been deemed World Alzheimer’s month.
Preventing Alzheimer’s
So, what’s the connection between food and brain health? Although genetics and aging can play a role in increasing dementia risk, evidence reveals that lifestyle factors, including diet may help to reduce one’s risk level.[3]
When it comes to diet, a systematic review reveals that the Mediterranean, Dietary Approaches to Stopping Hypertension (DASH) and the Mediterranean-DASH Intervention for Neurodegenerative Delay or MIND diet are all associated with reduced dementia risk; however, in this review, the MIND diet was more strongly associated with less cognitive decline and a lower risk of AD.[4]
MIND Diet & Brain Health
The MIND diet combines elements of the Mediterranean and DASH diets and emphasizes the importance of including fresh, whole and minimally processed foods that include the following:
- Fruits and vegetables, particularly berries and green leafy veggies
- Legumes (lentils, chickpeas, fava beans, kidney beans)
- Fatty fish (trout, herring, salmon, sardines)
- Whole grains (oats, barley, quinoa, whole grain breads/cereals)
- Lower fat dairy (1 or 2% yogurt or milk)
While the MIND diet is not a vegetarian diet, emphasis is placed on plants and plant/fish proteins with less attention given to animal foods (meat, poultry, high fat cheeses).
Brain-Heart Connection
Research shows that what’s good for the heart, is good for the brain when it comes to preventing and delaying Alzheimer’s disease. The high antioxidant and polyphenol content found naturally in plants along with the omega-3 fats present in fatty fish have anti-inflammatory effects on the cells and tissues that may help protect both heart and brain health[5].
Key Diet Principles
To help lower your risk of Alzheimer’s disease, keep the following diet principles in mind when making food choices and planning meals and snacks.
- Eat plants: research consistently shows that people who include more plants and who follow a vegetarian diet are less likely to develop heart disease, diabetes and certain cancers[6]. Additionally, eating more plants is associated with protecting the brain from cognitive decline[7].
Nutrition Tip: Aim to include a fruit or vegetable at every meal. Have 3 meals a day so you can be sure to get an adequate amount of fruit and vegetables in your diet. Choose fresh, frozen or unsweetened canned options.
- Go for colour: vibrant colourful foods indicate high antioxidant and polyphenol content that protect against oxidative stress and inflammation that can lead to disease progression[8].
Nutrition Tip: Add colour to your meals by selecting foods that are blue, red, orange, purple and green so you can benefit from their healthful properties. Try adding blueberries to oatmeal, include a kale salad with lunch, snack on carrots and incorporate another green leafy vegetable at dinner.
- Include fish: aim to include fish at least twice a week and benefit from the healthful effects of omega 3 fats. The World Health Organization (WHO) Dementia Guidelines report that higher intakes of fish, fruit and vegetables are consistently associated with a reduced risk of dementia[9], and many studies showed how fish in particular is correlated with less memory decline in healthy subjects9.
Nutrition Tip: Think of ways to include fresh, frozen or canned fish. For example, have canned sardines on toast or add canned tuna or salmon to a green salad. Baked, grilled or pan-fried trout are quick and easy ways to prepare fish.
Whenever possible, choose fresh, whole, minimally processed foods to maximize your fibre and nutrient intake. Additionally, nutritional supplements are not a replacement for food. A systematic review by Butler et al revealed how supplements did not contribute to preventing or delaying cognitive decline or dementia in older adults[10]. Diet is only one way to lower your risk of Alzheimer’s. Remember to focus on a variety of colourful frutis and vegetable and include plant and fish protein sources more often.
About the Author:
Maria Ricupero is a Registered Dietitian and Certified Diabetes Educator with a nutrition consulting practice in downtown Toronto, Canada. She has taught at two Ontario universities, is published in peer reviewed journals and is frequently invited to present at professional conferences both nationally and internationally.
[1] Alzheimer’s Society of Canada. Finding the way forward. 2018-2019 IMPACT REPORT. https://alzheimer.ca/sites/default/files/documents/asc_2018-2019_impact-report.pdf
[2] Chambers, L, Bancej, C. & McDowell, I. (2016). Alzheimer Society of Canada. https://tinyurl.com/w3rrbmuh
[3] Alzheimer’s Society of Canada. (2021). Risk Factors. https://alzheimer.ca/sites/default/files/documents/Risk-factors_Alzheimer-Society-Canada.pdf).
[4] van den Brink et al. (2019). The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH
Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer’s Disease—A Review. Adv Nutr 2019;10:1040–1065.
[5]Tublin et al. (2019). Getting to the Heart of Alzheimer Disease. Circulation Research. 124:142-149.
[6] Melina V., Craig, W. et Levin, S. (2016). « Position of the Academy of Nutrition and Dietetics: Vegetarian Diets », Journal of the Academy of Nutrition and Dietetics, 116(12), 1970-1980, doi: 10.1016/j.jand.2016.09.025. PMID: 27886704.
[7] Livingston et al. (2020). « Dementia prevention, intervention, and care: 2020 report of the Lancet Commission », The Lancet, 396(10248), 413-446.
[8] Bianchi, V., Herrera, P.F & Rizzi Laura. (2019): Effect of nutrition on neurodegenerative diseases. A systematic review. Nutritional Neuroscience, DOI:10.1080/1028415X.2019.1681088.
[9] WHO. Risk reduction of cognitive decline and dementia.
[10] Butler et al. (2018). Ann Intern Med. 168:52-62