Interview with Kerry Paul Appleton, a Mobile "Resilience Coach"

Healthcare systems around the country are working on solutions to the problem of physician burnout. At North Memorial Health Hospital in Robbinsdale, Minnesota, one answer is Kerry Paul Appleton, a mobile "resilience coach".

Kerry Paul Appleton, Resilience Coach, North Memorial Health Hospital, Robbinsdale, MN

MED: You were a pediatric intensive care nurse. How did you end up in this job? 

KPA: In my own observations, I started thinking about who is taking care of us as healthcare workers? There was no good answer. At my previous institution, part of my role involved mentally preparing nurses to work in a ICU with children and babies. Resiliency work became a side hustle for me. I sought extra training in peer support and critical incident stress management before I got an offer from North Memorial to do this full time. 

Interestingly, I was doing some contract work last winter for a company called Critical Incident Stress Consultants. I was hired to so some assessments and in those assessments, it became clear to leadership that something needed to be vastly different. They discovered that the Employee Assistance Program, which usually has pretty low participation, was not enough. People value relationships and it matters who they are talking to about sensitive subjects.

MED: What do you do as a "resilience coach"?

KPA: Every day is different. I am a mobile unit so I drive anywhere people want me to. I also take a lot of virtual meetings. The scope is to create and manage resilience-based programs for healthcare professionals. I do coaching with teams and individuals and manage our Heartmath program. This is a program that we bought into. It is essentially emotional regulation on the go. They are techniques that you can teach people how to use that don't take a lot of time and space and that allow them to manage themselves in the moment. We now have 9 certified Heartmath trainers.

MED: How have people responded to you?

KPA: This is brand new for so many people and it has taken some time for people to be ready. My approach is to show up and be very consistent so that people get to know me and feel safe opening up to me. One tactic that has been very helpful is unit-based huddles where I come twice a week for six weeks and share information in short bursts. That is what people have capacity for, especially on the job. I think the biggest part of my work is allowing space for people to share what they need to share. 

MED: How do you help people open up?

KPA: I approach the work as a peer. I'm not a mental health provider. I'm very cautious to stay in my lane. It is not my job to diagnose and treat. My job is to validate and normalize. If what they need is beyond me, I serve as a bridge to people who can help them. So that, if they choose, they can stay in the work that they worked so hard to do.

MED: How do you think COVID played into the problem of caregiver stress?

KPA: Stressors are always going to be part of this job. These were a problem before COVID came. We have been writing about burnout for the last 15 years. COVID was an accelerant that pushed people to the brink. But there has also been a silver lining: It finally became so loud that organizations could no longer turn a blind eye to the problem. They realized that there needs to be some accountability around the emotional impact of doing this work. That hasn't always been there. Most organizations are very focused on making sure people have the skills to do the job they were hired to do.

MED: Do you have your own story of burnout?

KPA: Part of what brought me to this work was that I was in a bad spot and I didn't know it. It can be way easier to care for other people than it is to care for yourself. I signed up for a training on critical incident stress management. And what I realized on the first day, for the first time, was that I was not OK. At the time, I didn't have the words to articulate what was going on. I just thought I wasn't meant to work in that environment. I want to give people the words. So that, if they choose, they can stay in the the job they wanted to be in.

MED: What made the difference for you?

KPA: Awareness was key as was understanding the science. A lot of the self-care things I was hearing about seemed kind of fluffy. What really got my attention was learning what physiologically was happening inside of my body. Now I truly believe in slow deep breathing and I can buy into the strategy because I believe in it. I understand the physiology.

MED: What advice do you have for healthcare professionals experiencing feelings of overwhelm or exhaustion?

KPA: We have physical and emotional reactions, but we also have cognitive and behavioral reactions to stress. It can be a bit “Aha!” for people when they start to see it. When yo are aware that you are responding to a stressor, you can choose whether you want to stay there or pivot to something else.

Learning to pay attention to this and be more mindful takes a lot of different shapes and forms. Stay curious. If you tried something ten years ago, try it again. Yo have continued to evolve as a person. Throwing your hands up in the air and saying 'I tried and it didn’t work' isn’t helpful. The idea is to reprogram ourselves to view this work in a much different way. We are not programmed as a society to value that and it almost feels a little selfish. But we have the capacity to do so much more when we are supporting ourselves. We can't show up in a meaningful way otherwise.

MED: What do you see as the advantages of this work from an institutional standpoint?

KPA: There are better healthcare outcomes and better delivery. It doesn’t have to cost a lot of money but it impacts bottom line with less turnover. And you have people showing up happy to be there and bringing their best selves to that space, no matter what the challenge is. Fifteen years ago it was patient care quality and safety was a big new focus. Now every hospital has that department. I wonder if resiliency will be that way in ten years? Will every hospital have this?