Self-Care is Not Selfish - Dr. Bern Melnyk, College of Nursing Dean at Ohio State University

DR. RISHI DESAI: Hi, I'm Rishi Desai. Today on Raise the Line, I'm happy to be joined by Dr. Bernadette Melnyk, who goes by Bern, Dean of the College of Nursing at Ohio State University. Since arriving at Ohio State in 2011, Bern has overseen the nursing program. In 2015, Ohio State's master's program in nursing was named among the nation's top 25 by U.S. News & World Report, putting it among the top 5% of nursing programs nationwide. Thank you so much for being with us today. 

DR. BERNADETTE MELNYK: It's good to be with you. Rishi, I'd like to add that I actually have a joint position at Ohio State. I'm also the university's first chief wellness officer. So, I spearhead population health and well-being across the university for faculty, staff, and students.

DR. DESAI: That's awesome, and maybe that's a good place for us to start, because I don't think a lot of folks are familiar with what a wellness officer does. Do you mind just talking a little bit about your background and what got you interested in healthcare and wellness in the first place?

DR. MELNYK: You bet. I left sunny Arizona nine years ago to come to Columbus, Ohio. Actually, the way it happened was, I was dean at Arizona State University when Buckeye Nation called me and said, "Bern, we see how you've exploded your college in Arizona. We want you to come to Columbus and do the same thing here." I said, "I am humbled you thought of me, but I have no intentions of making a lateral move.” 

But I had been studying corporate wellness for about three years. I was flummoxed at the fact that corporations saw the value of the employee wellness, but when I went to search for chief wellness officers at an academic institution in the country, I couldn't find any. So, I threw my dream out there, and I said, "I'm humbled you thought of me, I'm not interested in making a lateral move, but if there were an opportunity to combine the dean's job with the university-wide leadership role as the chief wellness officer, I might come and talk with you all." It just so happened, our former president Dr. Gordon Gee, called me the next day to say, "Bern Melnyk, what's all this hype about a chief wellness officer, and what would you do for Ohio State if we were to create this pioneering position?" That's how it all happened. So now, there's many universities throughout the country, and academic medical centers, who are appointing CWOs with the goal to improve population health and well-being.

DR. DESAI: Wait, but you didn't tell me the critical part of that story, because on a phone call, you have not a lot of time, and I'm not sure how much background he had at the time about what a wellness officer can do. How did you make it clear that this would align with the university's missions? How does it align? Does it save money? Does it help with marketing? What sort of alignment do you find is most resonant when you're trying to pitch the need for wellness?

DR. MELNYK: That's an excellent question because I have a philosophy "In God, we trust, but everybody else had better bring data to the table.” I live by that philosophy, and I made the argument with the evidence. I shared return on investment data. We have so much research to show. If faculty and staff, any employees—if they're happy, healthy, and engaged, they're more productive. There's less turnover. There's less absenteeism and presenteeism. We've got to switch that paradigm to one of wellness and prevention. So, I just give a lot of data, and I have great evidence to support this particular role. 

DR. DESAI: Given what you just said about evidence, one thing that was always striking me is, there sometimes is a mountain of evidence over here and then you walk over here and you see how people actually do things in the real world, and you're like, "Wait, they're not doing any of the things that we have evidence for." Knowing all the evidence that you're talking about, and knowing that—My mind is very concrete, I like to see examples. What would be one example—If you were to walk over to the mountain of evidence, pluck out one thing, walk over to the place where people are doing things, and if you could wave a magic wand and get them to just do the thing that you think they should do—what would it be? What would be that intervention that everybody knows works, and "Gosh, darn it. Why don't we just do it?'

DR. MELNYK: Yes, I focused on healthy lifestyle behaviors because again, we've got a ton of evidence that 80% of chronic disease can be totally prevented if I could just get everybody across the nation to engage in 30 minutes of physical activity every day. People think, "You're crazy, Bern. I could never do that." I said, "Yes, you can. You can cut your Zoom meetings down from 60 minutes to 50 and take some micro-recovery breaks during the day, and boom, you hit it.” I tell people at least five fruits and veggies a day. Don't smoke. If you don't drink alcohol, don't start, but if you do, limit it to one drink a day. Then, Rishi, everybody asks me, "Bern, how big can that drink be?" I tell everybody, "Not the size of the alcoholic beverages we get at Vegas." So, the problem, the character builder, I should say, about behavior change, is most people don't make change unless crisis happens or their emotions are raised. So, I always say the magic formula to get people to change is the evidence plus emotional story. Those two in combination get people really contemplating and motivated for change. 

DR. DESAI: Given what you just said about a Zoom meeting, I obviously would have to cut this short. So, I'm going to go... [laughs] I think what you're saying makes a lot of sense. With behavior change, it's hard to change people's behaviors. In fact, that's probably the hardest thing to do. Have you found—maybe in your own life, or with friends and family—Is there anything that... is advice that feels like it's not in the mainstream? Is there any sort of nonintuitive thing that has been really quite helpful for you or your friends and family that they'd love for kind of more people to kind of adopt or learn about as a way to change behavior? I'm just curious if you have any tricks or tips to doing the things that are maybe so obvious but hard for people to do.

DR. MELNYK: Visual triggers like the background that I have on my background on Zoom today like, "Take your dose of vitamin G every day." Putting visual triggers at key places can really help people with that change. Most people fall off the wagon after a week. So many people set a January 1, New Year's resolution, and by January 30th, most people fall off the wagon. I think what's key, that I tell everybody to do, you've got to write down your goal, not make it so big that you fall off the wagon quickly, but you put that goal where you can see it—where you brush your teeth every day, where you go to sleep—to make sure you meet it. If you fall off the wagon, it's okay. Get back on the next day and ride it again. 

DR. DESAI: Wait, Bern, did I hear you correctly? I also have to now brush my teeth daily? Is that like another...

DR. MELNYK: [laughs] Yes.

DR. DESAI: The list is growing, Bern. I've got to say, I didn't expect it to be this long. One thing that folks can't see, but I'm just going to read it out, it's in your background, it says "Take your vitamin G, or gratitude, today." There's a lot of evidence—we were talking about this briefly—about the value of that. 

One thing that I found helpful in my own life is, there are many things that I will not do if I think it's going to help my health because I'm just lazy, but I will do them if I think it's going to help my kid. When I say I have a four-year-old son, I'm motivated by that, much, much more than I'm motivated for myself. I had learned about this. So, I started this practice, where before bedtime, he has to tell me something he's grateful for. Of course, like most games or activities, you reciprocate. So now, I've gotten into the practice of it, and that kind of reverse-engineered me being healthier. 

I'm curious if you find that to be effective with parents, specifically. Do you find that parents will do things, if you convince them that it's a good thing for their kid, then all of a sudden now, as role models, they kind of have to do it, too. Is that a strategy you've seen work?

DR. MELNYK: Absolutely. It works for pets, too. So, people will often walk their dogs if they know it's going to help their dog's health and experience the benefit. So, you're right on. Rishi, my mother stroked out and died in front of me with a sneeze when I was 15 years of age. You can imagine how traumatic that would be for a teenager—really for anybody, let alone a teenager or a child. What was sad about my mom's story was, she had a history of headaches for over a year, and my dad kept saying, "Please go to the doc. Figure out what's wrong." She visited her family physician one week before she died, was diagnosed with high blood pressure and given a prescription for a blood pressure medication that my dad found in her purse after she died.

DR. DESAI: Oh wow.

DR. MELNYK: I suffered from terrible post-traumatic stress, depression, anxiety for a few years, and there was no help for me in my little rural town of Republic, Pennsylvania. You know the story, what doesn't break us only makes us stronger. As a result of what I went through as a teenager, that's just fueled my passion to become a nurse, then a nurse practitioner, then a psychiatric nurse practitioner, and go on to get my PhD so I could develop and test cognitive-behavior-therapy-based interventions to improve mental health in children, teens, and college-aged youth.

DR. DESAI: Wow, what a story. I mean, that's really helpful in understanding how that event—that sneeze—essentially changed your life. You reacted in a way that I think a lot of us wish we would react in, in terms of finding a way to channel that energy into something that's quite positive. 

I'm curious, you work with a lot of clinicians, and one of the things that I've always found interesting is that a long time ago, clinicians, surgeons famously would have these bloody scrubs and it was kind of a mark of pride even, like, "Oh, this is how I do surgery. I'm bloody. This is just who I am." Now, the opposite is true, right? You don't want a surgeon that's carrying infections from person A to person, B, and everyone knows this.

Now, similarly, there's kind of almost a bravado around sleeplessness. Sort of like, "Oh, I'm on my 36th hour. Oh, I'm on my seventh cup of coffee, and I'm just going to pull an all-nighter." At every stage—learning stage or professional stage, there's not a lot of pride in like, "Yeah, I got my 8 hours last night," or "I got my full non-REM and REM sleep." Do you see that in any particular field shifting or changing to where it's not a source of pride? It's not a good thing if you're not sleeping well—as one of the many pillars of good health—but that one, in particular, strikes me because there's such an egoism around it. I'm just curious what your thoughts are on that. 

DR. MELNYK: I don't see that as much in our younger people. I work with residents at Ohio State, just like nurses, pharmacists, but the younger people seem to really want to establish more synergy between work and home, because if you take a look at the population health of nurses, physicians, other healthcare clinicians, it's not good. We often take great care of everybody else, and we don't prioritize our own care.

I have the privilege of serving on the National Academy of Medicine's Action Collaborative on Clinician Well-being and Resilience. There's about 60 of us all throughout the United States that are working on evidence-based solutions to decrease the high percentage of burnout, depression, suicide that we're seeing in clinicians. I think the really important point here, the C-suite in every healthcare system across the country must get in tune to fixing system issues that we know lead to burnout and depression because that is compromising the quality and safety of care. 

When our clinicians are burned out and depressed, they can't engage. There's interference with concentration and functioning. In fact, I have a hot study coming out on May 1st in the American Journal of Critical Care. It was a national study with critical care nurses that once again showed the high rates of burnout and depression. Poor physical and mental health predicts the number of medical errors that people make. So, it's a healthcare quality and safety issue not to create wellness cultures, fix system issues, and take what we know works—evidence-based interventions—and get them implemented in the real world sooner than 17 or 20 years.

DR. DESAI: Yes. One of the things that's kind of ironic about that is that I feel like we take these steps in healthcare to try to prevent errors and improve quality. One of the big steps was the electronic medical record. Almost every patient has had this exact experience to the T, where your clinician is looking at the laptop and kind of just vaguely talking to you but not really talking to you. Then about eight minutes later, they leave. Seven and a half of those minutes were spent with eyes on the laptop, 30 seconds were eyes on the patient. That leaves everyone feeling like their cup is empty, because you don't feel like you had any sort of emotional connection. The physician or the clinician feels like they didn't get to be a human—because they didn't—and the patient feels like they weren't listened to. 

I'm curious to get your thoughts on that. Do you feel like—You mentioned the word burnout, and there's this phrase I was introduced to recently called "moral injury." It kind of gets to this idea that it's a systems issue, and it's everything you're saying. One big part of that system is a laptop, right? What's your sense on how do we remove the screen from these environments, where the screen isn't actually making anyone feel better or safer? It's actually making everything worse. 

DR. MELNYK: Yes, I do think we must make changes in that EHR, and  the other thing is, I mean, think about it. Most clinicians have come into their professions because they love being with and caring for people. Now, only about 25% of the time clinicians are able to interface with people. So, it's robbed the joy out of that care reason that people came into the profession. It gets back to these system issues, providers who are tasked with doing things not up to their level of scope of practice. So, we've got to fix that, too, doing things that could be attributed to somebody else on the team, to give clinicians more time to spend caring for their patients. 

Paradigm shifts, Rishi, take decades to happen, right? I hate to say it, but I've got a button, and, in fact, I should send it to you. It says, "Because we've always done it that way," but I have a slash through it because we've got to stop this. I've been pounding the evidence-based-practice drum since the late 1990s. I got a huge multi-million dollar gift from the Helene Fuld Trust out of New York City to start the Fuld National Institute for Evidence-based Practice, and our team works with  healthcare systems all throughout the world on how to improve quality and safety of care through evidence-based practice. I will tell you, most people probably wouldn't sleep tonight if they knew what I've seen over the last five to 10 years in working with many healthcare systems. 

I'm an optimist, so I'm going to keep banging the drum. Although I so hoped, by the time I reached this age, that evidence-based practice would be in the DNA of every practicing clinician so I could stop doing all these workshops and keynotes and presentations. I tell you, if I'm blessed enough to live to be a hundred, I'll still be out banging the drum.

DR. DESAI: Well Bern, I had a lot more with this interview that I wanted to share with you and extend this out, but I have a pretty long list of things I have to do now. I have to eat five fruits and vegetables. I've got to take a nap. I have to walk my dog, and I have to brush my teeth. With all that in mind, I was hoping you could leave us with one piece of advice for new clinicians that are up and coming and starting out in this, what I would call fairly new way of thinking of wellness side by side with sickness. Quite frankly, wellness should supersede sickness in the sense that an ounce of prevention is worth a pound of cure. Given that, we should be focused much more on wellness. What are some thoughts or ideas you might share with them on that front?

DR. MELNYK: I just want to leave by telling people, “Find your reason. Find your why.” I didn't have a mom to see me graduate from high school, college, go on to have my three beautiful daughters. When I get up in the morning, if I don't feel like doing my... I have an elliptical right next to my desk, Rishi, so that I can cut my Zoom meetings and jump on that elliptical and get my 30 minutes in a day, but my why is my family. Because even if I don't do it for myself, do it for the people who love you, who want you to be around for a really long time. It is not selfish to take good self-care. It's an absolute necessity, because we cannot keep pouring from an empty cup. 

DR. DESAI: Yes, I couldn't agree with you more, and I think that that's a good point to kind of close on. It's the idea of filling your cup and whatever that means, and everyone has a different and very unique way of doing that. So, Bern, I sincerely appreciate you and your reminder for me to take my vitamin G, my gratitude. I can't thank you enough for being part of the program today.

DR. MELNYK: I was delighted. Stay well. 

DR. DESAI: On that note, I'm Dr. Rishi Desai. Thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.