Nursing Director’s Successful Advocacy Delivers Critical Staff Support

In February 2022, in response to two unexpected fetal deaths, trained peer supporter Jennifer Hiller, BSN, RN, C-EFM, RNC-OB, listened thoughtfully and compassionately to the concerns and feelings of seven nurses and one obstetrics technician from the Labor and Delivery department at Salinas Valley Health.

Hiller then discussed available resources and documented the interactions using a newly implemented Peer Encounter Tracking Form. For two of the people, Hiller initiated follow-up to ensure the staff members had their emotional needs met.

The compassionate and essential interactions directly resulted from the commitment, drive and transformational leadership of Critical Care and Emergency Services Director Carla Spencer, MSN, RN, NEA-BC. Spencer not only understands the toll that adverse events have on direct-care nurses and other staff, but also knows that addressing staff wellness – a critical component of employee engagement – is a priority for Salinas Valley Health leadership.

Implementing BETA HEART

Before the COVID-19 pandemic, Spencer had overseen initial steps to implement a BETA Healthcare Group and Hospital Quality Institute initiative called BETA HEART® (healing, empathy, accountability, resolution, and trust). The program helps healthcare organizations implement a reliable and sustainable safety culture. The work had been deferred because the initiative required substantial staff participation and the organization faced staffing challenges related to the pandemic. But in June 2021, Spencer revived BETA HEART implementation with a focus on its Care for the Caregiver domain. She understood how important caregiver support is to staff wellness and that executive leadership had set an organization-level improvement goal for its employee engagement scores.

“Most importantly, our staff knows they have the support they need in difficult times.”

Carla Spencer, MSN, RN, NEA-BC

This particular domain demands an intense investment of resources, which remained a challenge; training more than 50 staff peer supporters alone would require over 400 hours. Spencer began the effort by garnering executive approval for the resource investment with a carefully documented presentation to the executive team. Next, she presented the approved resource request to leaders and secured their commitment to learn about the qualities of an effective peer supporter, help identify possible peer supporters, explain expectations to potential candidates, and direct these candidates to the application and approval process.

Spencer then screened the candidates and ensured they had completed the pre-work and enrolled in the eight-hour training. Ultimately, 55 staff members received the training and successfully passed the course to become peer supporters.


The final step before full implementation was a housewide Care for the Caregiver launch and celebration, during which representatives from the Care for the Caregiver steering committee set up a table in the cafeteria with flyers about the program and other promotional items. In addition, the team visited every unit on both day and night shifts to share information and give away the promotional items.

Feedback to date has been extremely positive. Many staff members are clearly grateful to receive support they didn’t know they needed. “Our overall engagement score increased from the 85th percentile in 2021 to the 86th percentile in 2022, despite the fact that during the pandemic, many hospitals and medical centers faced challenges with engagement scores,” Spencer says. “In addition, our safety culture scores are higher than the national average, demonstrating how this initiative provided critical support to an organization-level goal. Most importantly, our staff knows they have the support they need in difficult times.”

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