RELATE: Helping supervisors support their frontline staff — and prevent burnout
As Director of Education and Training at the Camden Coalition, Renee Murray has talked with hundreds of people around the country who do one of the toughest jobs possible: supervising and teaching frontline healthcare staff who work with the country’s most vulnerable patients. From their conversations, she discovered that most of the supervisors, whether nurses, social workers or other healthcare professionals, had never supervised or taught anyone before, and many were struggling.
That news didn’t surprise her. “I had only been a nurse for 2 years when I was suddenly in a position where I was supervising, guiding, and supporting other nurses, community health workers, and social workers who were engaged with individuals who were living with complex health and social needs,” says Renee, RN, BSN, FNE-CSA, who has been at the Camden Coalition since 2012. “It’s not out of the ordinary to be in a situation where someone says, ‘Okay, you’ve been doing good work with patients — now go lead the team,’” she says.
The trouble is, there was no existing framework out there for teaching mentors and supervisors how to best guide others working with clients in the challenging complex care field.
The Camden Coalition’s RELATE training is designed to fill that need, one that has become more pressing than ever. It’s well known that the ongoing pandemic has also spawned its own epidemic of burnout, and that healthcare workers are particularly vulnerable. A March 2022 survey of more than 3000 doctors and nurses by Elsevier Health found that 47% of U.S. healthcare workers, depleted and dissatisfied, planned to leave the profession within two to three years. RELATE, a uniquely supportive framework for mentoring frontline staff, is meant to stem that tide.
What makes RELATE unique
When most of us think of traditional supervising, we imagine being directive with those we are overseeing: giving suggestions, recommendations, or next step action items. RELATE turns that paradigm on its head by shifting from a directive, “I’ll fix-it” mode into something more collaborative, something that creates a sense of agency in both in care team members and the clients they care for.
“It’s natural for us to want to fix and do everything for patients—like, oh, you’ve missed an appointment with your doctor? We can schedule a new appointment for you,” says Renee. “The problem is, while we may improve the person’s quality of life in the moment, they often don’t end up with the skills to continue healing when we aren’t there.”
Supervisors, it turns out, tend to do the same thing with their frontline staff. “We provide the answers, the solutions,” says Renee. “For instance, someone would tell me, ‘Mr. Smith got kicked out of his detox program and the shelter. He has nowhere to live.’ And I’d immediately respond, ‘Let me make some calls for you and see if there are other open beds somewhere else he can go.’”
The problem with that approach is that it strips away opportunities for staff to learn and problem-solve on their own. A huge part of RELATE is getting supervisors out of that directive mode, creating space for their staff to reflect and problem-solve. “There are always times a supervisor needs to be more directive, say, in high-stakes moments and life-or-death situations,” says Renee. “But RELATE teaches that jumping in and fixing shouldn’t always be a supervisor’s first reaction.”
Reversing the “great resignation” with a different kind of support
As Renee knows, nurses seem to be particularly vulnerable to burnout. Lack of support may play a significant role in that. Many studies have shown that the fewer years of training nurses have, the more susceptible they are to classic symptoms of burnout such as exhaustion and depression. And a June 2022 study of more than 33,000 nurses over two years of the pandemic found that 40% of RNs reported high rates of burnout, and that 1 in 5 planned to leave their job within a year.
“Any way you slice it, patient-facing work is hard, physically, mentally, and emotionally,” says Renee. For frontline staffers working with those who are experiencing homelessness, living with substance use disorders or long histories of trauma, and/or facing systemic barriers to care, the work can be especially draining. Add in the pandemic and that takes things to a whole other level.”
RELATE is designed to prevent these difficult situations and emotions from becoming barriers for frontline care workers. “Too often, we take this stuff home with us,” says Renee. “I can’t tell you how many times I’ve sat with staff I’m supervising, and someone has their head in their hands, and is saying, ‘I’m so tired. I just don’t know what to do with this patient anymore.’”
That’s a prime signal of burnout. But learning strategic tools that help people process emotions can build resilience. “Without that, it’s hard to keep going year after year,” she says.
RELATE: The nuts and bolts
RELATE was first created as a complement to the Camden Coalition’s COACH framework, which teaches care teams how to form authentic healing relationships with their clients that lead to lasting behavioral changes and improved health and well-being.
Renee helped design and implement COACH in 2014, and has taught the framework, virtually and in person, to more than 900 individuals working in complex care ecosystems across the country. “Initially, we took both frontline staff and their supervisors through COACH, then continued with the supervisors on to RELATE,” she says.
Now, RELATE is available as a standalone course to anyone, anywhere, who is training and supervising frontline care workers. “Supervisors, it turns out, need guidance and mentoring too.”
The letters of RELATE stand for six core competencies that supervisors should be mentoring their staff in:
R for RELATIONSHIPS: “Forming a trusting relationship with participants is really at the center of it all,” says Renee.
E for EMOTIONS: “E is my favorite,” says Renee. “It’s about naming emotions and signaling to your staff that it’s okay to have real, raw emotions without being judged — but we don’t want these emotions to become barriers to our work. This competency gives staff space to become self aware of their emotions and learn to process them.”
L for LIMITS and BOUNDARIES: This is about defining what it’s okay to do and not do for participants — and for staff. It also helps with self care.
A for AGENCY: “It’s important to honor and respect people’s abilities to make their own decisions,” says Renee. That includes supervisors, their staff, and participants.
T for TEAMWORK: the essence of this collaborative approach. Complex Care Is extremely hard work and we need to leverage our teammates to deliver high quality care.
E for ECOSYSTEM: “This refers to the complex care ecosystem that we are working in,” Renee explains.
As important as the individual components are, simply putting a supervisory structure in place that allows mentorship to happen is critical on its own. “I can’t tell you how many times I ask supervisors, ‘What are your touchpoints with staff?’ And they’ll answer, ‘Not many,’ meaning there’s limited support for frontline staff doing hard work.”
That’s a breeding ground for burnout and RELATE can help prevent it. “The RELATE structure is giving supervisors a framework to support their staff to continue in this hard work,” affirms Renee. “I was talking with one supervisor who took our course recently and she said that now, when she finds herself immediately wanting to react, she takes a breath, paraphrases the problem back to her staff, and creates space for that person to learn,” she says. “The supervisors we train are building their own skill sets with the strategies and tools we’ve given them. After RELATE, they know how to take the next steps.”
The next virtual RELATE training will be held November 15, 2022, from 1-4 pm ET. It is open to all supervisors of care team members who work directly with participants, and provides 2.75 interprofessional CEUs upon course completion. Register for the RELATE training here.