Peer counseling for clinicians provides immediate support — and pays off for the hospital

Nursing school prepared my colleagues and me to provide compassionate care for our patients and their families. Sadly, it didn’t prepare us to do that for each other.

I’ve spent most of my 19-year career in pediatric nursing at Johns Hopkins Hospital. I have countless memories of brave children, loving and supportive family members, and amazing teamwork. But I also remember sometimes feeling doubtful, sad, fearful, or anxious. What’s missing from those memories is the part where I sat and talked about those feelings with a trusted peer — because that didn’t happen.

Things sometimes happen to patients that can shake even the most resilient of health care providers. Sometimes I wonder how I made it through those difficult times, when I questioned if I was right for the job — or it was right for me. During times like that, it is essential to have support to settle you down and keep you going. But we realized that at my hospital there was really only a single option for getting that kind of support: full-on psychological counseling, which often took days or weeks to schedule.

That insight emerged after a team I was privileged to be a member of used a method called root cause analysis to identify underlying factors contributing to staff anxiety. We then created a system that would provide Johns Hopkins Hospital staff members with immediate trusted peer support any time of the day or night.

The Resilience in Stressful Events (RISE) program that we developed in collaboration with faculty members from the Johns Hopkins School of Public Health provides timely, confidential support to any employee who experiences a stressful patient-related event, such as a patient death, unexpected deterioration in a patient’s condition, ethical situations, and the like. In an effort to define our scope, we focus on patient related or clinical events because as peer responders that is what we can relate to.

The program works like this: An employee in need of support calls the RISE phone number, which is posted all around the hospital. The call is answered by a member of the RISE team. These individuals, who have received peer responder training, all work in the hospital and so understand the complex environment and the stresses that can be created by delivering health care. The RISE responder helps the employee talk openly about the experience and process his or her feelings. The interaction is designed to promote the confidence and autonomy that can help the employee find strategies that lead to recovery.

When we began to develop the program, we did not have the kind of scientific evidence that usually drives program development. Instead we had stories, support from the hospital leadership, and willing, passionate individuals. At first, RISE got very few calls. But each one convinced us that creating a peer support program was the right thing to do.

Since launching the program late in 2011, it has reached more than 700 employees.

RISE isn’t the only peer support program in the country. Some other hospitals and health care organizations have developed their own programs. What’s unique about RISE is that my colleagues and I have shown that our program, and likely others, more than pay for themselves.

We knew that RISE was benefiting individual health care workers. We suspected that it was also helping the hospital save money. When an employee is motivated to call RISE, this implies a high-risk situation for the institution, since without help the employee may need time off, or even quit. Both are expensive for the hospital. In the meantime, she or he may not perform at the same level as usual, putting quality of care and safety at risk. We believed that RISE helps get employees back on track, reducing those risks and ultimately saving the hospital money.

Since nurses makes up most of the health care workforce at the Johns Hopkins Hospital and are the most frequent users of RISE, we looked at its impact on nurses.

Our analysis, published recently in the Journal of Patient Safety, found that the program was saving the hospital as much as $1.8 million a year. We found that the annual cost of the RISE program was about $656 per nurse. However, the expected annual cost of not having the program in place was $23,232 per nurse — or a net cost savings of $22,576 per nurse. It is likely that if we were to include in the analyses other types of health care workers, the return on investment would be even larger.

Although we looked only at RISE, it’s likely that other peer-support programs have similar payoffs.

Once RISE was running smoothly and having a positive impact on our health care workforce, we partnered with the Maryland Patient Safety Center to create “Caring for the Caregiver,” a curriculum that other organizations can use to implement peer support. Our analysis showed that a small upfront investment of time and money can have a large payoff for a hospital’s staff and the hospital itself. More important, it likely translates into better quality of care for patients and their families.

The RISE program has shown me that it is possible to do well by doing good. And I’m glad to know that my colleagues and I can now more easily provide compassionate care for each other as well as for our patients and their families.

Cheryl Connors, R.N., leads the RISE program at the Johns Hopkins Hospital and the “Caring for the Caregiver” program.