Peggy Ann Berry, PhD, MSN, RN, COHN-S, CLE, PLNC earned her doctorate from University of Cincinnati in 2015. She is a past Graduate Nurse Intern to DOL OSHA, a NIOSH Education and Resource Grant recipient and an American Nurses Foundation Scholar. She is a Founding Fellow with the U. S. Academy of Workplace Bullying, Mobbing, and Abuse and a past Graduate Nurse Intern to OSHA, past Malcolm Baldrige Examiner, and a past senior examiner with The Partnership for Excellence.
Dr. Berry is a member of the Alliance of Nurses for Healthy Environments and the Ohio Nurses Association, as well as past chair and member of the Environmental and Public Health Caucus. Peggy has been advocating for clean air, access to potable water, chemical transparency with fracking solution, and methane regulation by congressional and state visits, press conferences and social media with and for the Alliance of Nurses for Healthy Environments, Ohio Environmental Council, Sierra Club, and Mom’s Clean Air Force. In addition to being the LWV Ohio volunteer lobbyist, she has been an environmental advocate since 2012, participating in EPA and OSHA requests for testimony on chemical transparency and Methane New Source Rules, collaborating across many NGOs to promote clean water, air and tillable soil. She has presented and published on the human health effects of workplace bullying, climate change, and migraines.
As I was driving home one late evening, sunset was occurring. For the first time, I noticed how the sun’s rays touch the tips of the trees. I imagined the trees reaching up to touch the last rays of the sun before it set for the evening.
And, I am #grateful. I am grateful to really observe what was happening around me, had been happening all my life, but had not seen it before. I am grateful for this insight below.
How do you find your tribe? One obvious way to find your tribe is a shared profession or interest. Shared interest is what you have in common. It is the glue that attracts and holds a tribe together.
Last week, I attended a two-day program on the challenges of mental health in the workplace. The conference was in person with occupational and environmental health nurses. We have common bonds of shared knowledge and responsibilities of caring for workers either in industry or healthcare with its triumphs and challenges. In that space, we commiserate and offer solutions to each other as we navigate the complex arena of occupation and environmental health. This group is my tribe (I am in the red sweater).
Another highlight of tribe is “we’ve been there, done that, and recommend you don’t do what I did” group. A good tribe mentors through shared knowledge. We lift each other up and through the complexities of the legal issues in occupational and environmental nurses. Kanjee and Bilello (2021) emphasize healthcare can get a little too tribal, losing trust in other professionals and suggest three actions to prevent silos within a profession – get to know each other, emphasize shared tribal affiliations (as healthcare providers instead of a specialty), and consider inter-professional projects.
Tribes can be a source of strength and meaning within mutual identity and key knowledge as occupational and environmental health nurses. The best tribes embrace diversity and collaborate to enhance productivity and creativity. Occupational and environmental nurses embrace others (Rosa Beth Moss Kantner, 2013).
My added advice? Know yourself, find your tribe, support group, mentor, happy place. And be there.
In countless discussions about workplace bullying, mobbing, and abuse, we often speculate on whether the chief aggressors may have narcissistic, psychopathic, or sociopathic tendencies. These conversations may be informed by some clinical knowledge of the symptoms of, and differences between, these personality disorders. Other times, they’re based on bits of information picked up from the media and popular culture. In any event, given the relevance of this general topic to workplace mistreatment, I thought it might be useful to appeal to some experts in taking a closer look.
I spoke to the EPA listening panel on June 16th regarding Methane reduction as a member of the Alliance of Nurses for Health Environments. Although a worldwide issue, Ohio is at high risk with Methane exposure. As of 2021, the Ohio oil and gas threat map indicated that 3.3 million people live in immediate threat radius of 103,084 active oil and gas wells, compressors, and processors. Over 780,000 schools are in that threat radius. It is estimated that 29,817 childhood asthma attacks are related to oil and gas ozone smog. Four counties have elevated cancer risk concern. In 2019, the Ohio Department of Health’s data showed approximately 1.25 million Ohio adults have been diagnosed with asthma. The childhood lifetime prevalence for Ohio is 11 children out of 100 have an asthma diagnosis. Methane and other volatile organic compounds (VOC) are toxic, being released by drilling. Peer-reviewed research links oil and gas production wells to babies born prematurely with low birth weights as well as increasing the risk of death. Methane and chemical releases associated with past and present oil, gas, and fracking affect human health. We need to support commonsense Methane rules by promoting renewable energy. I have been giving testimony since 2012 on the ill effects of Methane and other VOCs.
EarthWorks has done a remarkable job of making the invisible VISIBLE as seen in this video
There is so much damage that must be repaired. I have said before that my interests lie in prevention – we need educate on the hazards of our lifestyle and plastics dependence and how it affects our health. Then we need clean up past transgressions to the environment to promote health and prevent it from continuing to happen by sustainable living (I think that is a blog it itself). Some have been fortunate not to live in areas inflicted with air and water pollution but as our population grows and industrial and human energy grow, more neighborhoods see oil and gas production wells, both horizontal and vertical, which spew Methane and other VOCs. We need commonsense rules on the oil and gas industry and more renewable energy projects to offset coal and gas plants. Natural gas is far from natural. It is Methane and other VOCs plus radiation, same as coal. So, I am recommending two programs – Repairing the Damage: How invest in environmental reclamation can create good jobs. I am involved with ReImagine Appalachia and Ohio Environmental Council.
In addition, another program I am intimately involved with is A-Z Plastics. Each year we create zooms for education on the plastic pollution in our lives and what can be done. As I said, I can talk till I am blue on the dangers of Methane and plastics. But are the politicians and policy makers listening? This will be a great program and if you check out their webpage, there are links to all the programs, including me as a moderator on Union Solidarity. We are a group of environmental activists from different environmental groups concentrating on the effects of plastics in water and living bodies.
I will be at both of these programs in the audience. I hope I see you there. One last thing, get involved in the environmental issues. Feel free to comment. I want to know how we can improve the environment for all of us. As always, Rosie is at my feet sleeping through my zooms and writing.
This is my dog, Rosie, sound asleep on my lap. This is trust, something to be valued from our canines and other humans. How often can we damage a person’s trust in an individual, or for that matter, the government, medicine/science, or religion when memes, gaslighting, aggression, or violence are used to “power over” and shake the foundational beliefs of someone?
Nurses are the most trusted health professional in the world. And, as Rutherford (2014) stated: “Nursing’s trustworthiness is an intangible asset that warrants protection, as trust once lost is hard to recapture.” But, what happens when a nurse loses trust in her manager? When I was writing my dissertation, I truly wondered how trust factored into staying in the workplace after bullying. If a nurse lost trust in her/his manager, that they would protect her/him from the bully, would they leave the unit, transfer out, stay and become a bully themselves to stop from being bullied? How does trust factor into this situation?
If I were to do a survey today, would nurses trust their employer to do the right thing, keeping them safe from violence, provide adequate staffing or appropriate personal protective equipment (PPE), and assisting with psychological first aid when the CoVID pandemic overwhelms? In Social Exchange Theory, people treat each other equally; they help each other. If this exchange is perceived as unequal, unfair, or with unwarranted aggression, distress occurs (Emerson, 1976; Lazarus & Folkman, 1984, Berry, 2015 ).
Work relationships create occupational stressors or buffer against other occupational stressors influencing appraisal and coping (Berry, 2015). If trust is broken with the organization through inability to protect during a pandemic, I would surmise moral injury would occur with posttraumatic stress symptoms. Many nurses will leave the profession. And, 2020 and 2021 will be pivotal years for healthcare professionals.
These are just random thoughts as I cope with my son’s CoVID diagnosis. As a nurse mom, I am distressed by this diagnosis but I am equally concerned about the nursing profession. I know our profession has survived the Spanish Flu, Smallpox, polio, and other pandemics. But it hit home here, in my family today while others try to shake the very foundations of science and trust regarding vaccines and pandemic.
Please, give health professionals a break. Take the vaccine. Wear the mask until we reach herd immunity through vaccination. And, please, stop the trying to cast distrust on the need for vaccination. we have to be better at protecting and caring for each other for nurses to continue to care for us.
Thanks for reading.
Emerson, R. M. (1976). Social Exchange Theory. Annual Review of Sociology, 2, 335-362.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York, NY: Springer Publishing Company
Rutherford MM. The Value of Trust to Nursing. Nurs Econ. 2014 Nov-Dec;32(6):283-8; 327; quiz 289. PMID: 26267958.
Oh yeah, my dissertation is somewhere out there to read.
I recently read among women, nurses have a higher rate on suicide than the general population. JAMA Psychiatry published this on April 14, 2021 https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2778209 and it is based on data from 2007 – 2018. Can you imagine if the year was 2020? It has been a hard year for nursing and I suspect, 2021 will continue to be difficult with the pandemic. Occupational and environmental nurses, whether staffing hospitals, clinics,, or industry need to know the potential signs of someone contemplating suicide. This is why I asked Judy A. Jobe, RN, BSN, a NISOH ERC master’s student to write this blog as credit for her MSN program:
“The suicide death of a coworker is considered a psychiatric emergency for nurse managers and coworkers left to process the feelings associated with this type of grief. The occupational health nurse (OHN) can assist nurse managers and coworkers in the grieving process. It is critical for the occupational health nurse to understand the psychological, social, and emotional implications for coworkers (suicide survivors) left to grieve the loss. Appropriate support and guidance immediately following the suicide death of a coworker will assist individuals through the normal grieving process and avoid suppressed emotions that may lead to personal and departmental dysfunction.” (Lynn, C., 2008)
Suicide is the 10th leading cause of death in the United States. It was responsible for more than 47,500 deaths in 2019. (CDC, 2021)
In 2019, 12 million American adults seriously thought about suicide, 3.5 million made a planned suicide attempt, and 1.4 million attempted suicide. (CDC, 2021)
The suicide rate is expected to increase by 8.4% in 2020-2021 (McIntyre, R. & Lee, Y., 2020) due to increased social isolation and depression related to COVID.
These are sobering statistics in a time where a pandemic rules our lives: social distancing, masking, not being able to see people’s faces, not being able to hug or show we care by simple hand holding. As OHN’s, we continually evaluate our employee’s mental health and physical health. Healthcare professionals are stressed. COVID leaves no one untouched, and OHNs have been taught to look for signs of depression and possible suicidal ideation. We educate ourselves and our employees on suicide prevention, offer EAP services, make getting help easy and anonymous. Suicide prevention programs are everywhere, in every business environment, and most employees can tell you all about prevention and the resources available.
But what happens when one of your employees commits suicide? What can you, as the OHN, do for your employees at this time? How do you help your employees?
The unexpected and sudden death of a coworker often leaves fellow employees shocked and confused, lost in grief and despair, completely disrupting the “normal” workplace environment. Elisabeth Kubler-Ross originally defined 5 Stages of Grief®– denial, anger, bargaining, depression, and acceptance (EKRFoundation.org, 2021). Since her original publication in 1969, two additional stages have been added: shock at the onset and hope at the end, which have been suggested to help round out the model. The Stages of Grief are fluid, and one may go back and forth between them.. Individuals vary in their grief responses. It is essential to be supportive and accepting on where individuals are in their grief process. This is especially true when hospital staff, a team, lose a member. The daily stressors, both work and personal, make it challenging to work through grief. Suicides are more like sudden accidents; family and friends do not have time to adjust. Complicating the grieving process is the reality of the death and regrets for what may have or have not been said. Initially, co-workers may also feel a heightened sense of responsibility and guilt. They may keep asking themselves “What did I miss? What could I have done differently?” They tell themselves they somehow could have prevented it.
As the OHN, the suicide of a coworker is a traumatic crisis requiring intervention. Often referred to as suicide postvention, it can be defined as the “efforts made by individuals, organizations, and the local, state/tribal, and federal governments to assist those who have been impacted by suicide, and to reduce the harmful effects of exposure to suicide (Jordan, J., 2017)”. In 2015, the National Action Alliance for Suicide Prevention published a document titled Responding toGrief, Trauma, and Distress after Suicide: U.S. National Guidelines (Cook, F., 2017).These guidelines call for the development of postvention programs. To this date, the most recognized and widely used model is the U.S. military’s TAPS (Tragedy Assistance Program for Survivors) Suicide Postvention Model™ (Ruocco, K. et al., 2021). Still, all models encourage primary postvention resources (Andriessen, K. et al., 2019). The following guidelines are taken from Cynthia W. Lynn’s 2008 article in Workplace Health & Safety When a Coworker Completes Suicide:
Support and Education
The OHN plays an essential role in communication with the employees, establishing immediate, on-site resources such as chaplaincy services, critical incident stress management (CISM) teams, counselors, and crisis intervention support teams (CIST).
Being a visible, available presence for the employees. Making frequent rounds in all areas, all shifts.
Posting available resources
Hold survivor support meetings with the aid of the EAP
Acknowledge the feelings-Anger, guilt, fear, confusion. Many times the survivor will focus on what could have been done to prevent the suicide. These feelings are normal, but the focus should be on healing and moving forward. Focusing on the life of the victim can help survivors understand they are not responsible for others’ actions.
Allow coworkers and employees to express their grief in the way they feel comfortable. Not everyone grieves outwardly, and each person grieves on their own timeline. This is where providing resources such as EAP contacts can benefit these employees.
The OHN, as always, should be an active listener and be prepared to make appropriate referrals for those experiencing suicidal ideations, dysfunctional grieving, depression, PTSD symptoms, etc.
Here are some resources available to help your employees and coworkers:
As I sit in my study watching fat snowflakes drift past the window, my mind wanders to the warmer times of summer walking through the protected lands of the Allegheny Land Trust. From the depths of the woods, it is easier to feel part of the web of life that holds all of us. The forest ecosystem moves in a succession of interconnected living things toward a climax community, the equilibrium point where the annual production and import of resources exactly matches the annual consumption and export of resources. It is a self-perpetuating condition where the living systems are in perfect harmony with the supporting physical environment. The ant and the snail are no less partners than the mighty maples or the bear that occupy the climax community, all are interconnected and essential for sustained balance. Natural ecosystems progress through a succession unique to each place…