Inspire self-care, well-being, and community.

Nurses understand the benefits of healthy be­haviors. They frequently educate their patients about the importance of nutrition, physical activity, sleep, and more. However, many nurses neglect to prioritize a healthy lifestyle for themselves. The American Nurses Association 5-year Healthy Nurse Healthy Nation™ report found that almost 70% of respondents agreed that they prioritize their patients’ health, safety, and wellness over their own. Ultimately, this can lead to elevated levels of stress, compassion fatigue, burnout, and turnover—all concerning trends that we’ve seen throughout the past decade.

Unprecedented levels of stress and heightened workloads during the COVID-19 pandemic exacerbated these long-standing challenges and highlighted the significant role that well-being plays in employee, patient, and organizational outcomes. The 2022 National Nursing Workforce Survey found that 50.8% of respondents felt emotionally drained, 45.1% felt burned out, and 56.4% felt “used up.” In addition, the survey found that approximately 100,000 RNs left the workforce during the pandemic and another 610,388 expressed an “intent to leave” by 2027 due to stress, burnout, and retirements.

Provision 5 of the Code of Ethics for Nurses with Interpretive Statements states, “The nurse owes the same duty to self as to others, including the responsibility to promote health and safety.” To achieve this, nurses can choose healthy foods, strive for adequate rest, participate in exercise, nurture family and personal connections, take part in relaxing and recreational activities, and engage in spiritual and religious practices.

Maintaining a balance between health-promoting activities and meaningful work provides foundational support for nurse well-being. Nurses must take ultimate responsibility for prioritizing and investing in their own well-being, but leaders should foster a work environment that helps nurses achieve this balance. Encouraging wellness activities in the workplace can support nurses in meeting their own self-care needs and develop the resources to survive and thrive in an emotionally and physically demanding healthcare environment.

Wellness challenges

Organizations continue to spearhead activities and programs aimed at improving employee well-being, but many lack desired levels of engagement and participation. In addition, some organizational and system-level approaches require extensive time and resources for successful implementation. A wellness challenge, on the other hand, provides a local unit framework to inspire self-care and well-being by reclassifying mundane health-promoting behaviors into an engaging and fun team activity.

Wellness challenges also can foster healthy competition, teamwork, and community-building. At a time when nurse retention is paramount, enhancing self-care and strengthening social connections can help cultivate a more positive work environment and culture, which translates to higher quality patient care and outcomes.

Elements of success

A successful wellness challenge requires several essential elements, including variety, simplicity, voluntary participation, and leadership support.

Variety. Rather than focusing on a single activity, such as tracking steps in a step challenge, an engaging team wellness challenge incorporates various activities aimed at enhancing physical, mental, emotional, and social health. Variety broadens the appeal of participation among a diverse group of team members, as individuals require different types of motivation. A broad array of activities also ensures wellness challenge accessibility and inclusivity.

Simplicity. Common barriers to healthy habits include personal and professional time constraints. A successful wellness challenge incorporates simple activities that nursing teams can engage in during the workday or immediately before or after their shift, in addition to essential activities centered around nutrition and sleep. The wellness activities chosen for a team challenge should be practical and tailored to the team’s work environment and culture.

Voluntary participation. Don’t force team members to participate in a wellness challenge or penalize those who choose not to participate. Some individuals might not want to engage in healthy habits at work, while others might value privacy about their health behaviors and actions. However, health-promoting behaviors of colleagues who participate in the challenge may influence those who choose not to participate or increase their awareness of the importance of self-care.

Leadership support. When leaders support and encourage wellness initiatives at work, employees see that they’re invested in staff health and well-being. Nursing leaders also must role-model healthy behaviors. By serving as role models of self-care and work–life balance, they can influence the behaviors and engagement of those they lead while enhancing their own well-being in the process.

Power of the positive

Incorporating evidence-based positive psychology interventions such as gratitude, random acts of kindness, and mindfulness into a wellness challenge can enhance outcomes and foster a culture of well-being. Positive psychology focuses on happiness, well-being, and human flourishing, rather than the traditional focus on mental illness. A 2019 meta-analysis found that incorporating positive psychology into the work environment enhances well-being and engagement (positive psychology states).

What we did

The Resilience Committee on our fast-paced inpatient nursing unit recognized the need for a boost in employee wellness and morale. They identified a wellness challenge as a simple but powerful initiative to achieve this. The committee devised a list of 20 predetermined wellness activities to create an engaging and inclusive competition over 2 months. They intentionally chose activities that nurses could easily incorporate into day-to-day life away from the unit as well as throughout busy 12-hour shifts. Activity options included walking 7,500 steps during shift, using only stairs before and after shift, and eating at least three servings of fruits and vegetables during shift. The committee included positive psychology activities (such as sharing gratitude for a coworker on the unit’s “Graffi-titude” board) previously implemented on the unit to enhance positivity and well-being throughout the challenge. (See a Wellness Challenge Results)

To track participation, team members submitted wellness tickets for each activity completed. The top 10 participants were featured each week on a centralized unit bulletin board and the team member with the highest level of participation earned the title of Wellness Warrior. To encourage participation, the Resilience Committee provided small incentives through random ticket drawings.

Of the team members who participated, 93% documented at least one wellness activity during the challenge, with a total of 1,866 wellness activities reported. Baseline and postintervention surveys measured work–life balance (work–life climate scale), burnout (Emotional Exhaustion scale of the Maslach Burnout Inventory), and resilience (brief resilience scale). Postintervention results indicated that work–life balance increased from 38% to 61%, burnout decreased from 62% to 42%, and resilience increased from 52% to 77%. The wellness challenge achieved the committee’s goal of boosting team morale and well-being and led to evolving wellness initiatives and challenges on the unit. (See Wellness Challenge Results)

What we learned

Nurse participation varied based on individual competitiveness. Those extrinsically motivated by winning were the most involved participants. Not only did staff use the challenge as an outlet for their competitive spirit, but they also used it to strengthen their bonds of friendship. Staff members waited for others to finish shift report so that they could take the stairs together. Other staff members walked laps around the unit during lunch or did a 5-minute stretch activity together.

Participation became contagious. Even team members who didn’t submit wellness tickets, including providers and other interprofessional colleagues, frequently joined a daily wall-sit challenge and other activities. This led to a stronger sense of community, one of the unintended positive benefits of the wellness challenge.

Overall, the results of the challenge far exceeded the initial expectations. It created a more positive working environment, enhanced teamwork, and enriched social connections among interprofessional teams.

Replication

To determine if the unit’s culture played a role in the success of the wellness challenge, the Resilience Committee set out to replicate it in vastly different work environments—an outpatient clinic with a smaller team and minimal prior exposure to positive psychology initiatives and a hybrid nonclinical unit.

In the outpatient clinic, the committee implemented a 1-month challenge that included 17 activities (modified from the original 20) determined to be practical for the nursing team and the work environment. The committee used weekly activity scorecards to document participation and simplify the tracking process.

The clinic challenge successfully engaged team members in health promoting behaviors. Baseline and postintervention surveys showed that work–life balance increased from 66% to 84% and burnout decreased from 48% to 27%. The committee used emotional recovery and emotional thriving scales to measure resilience and well-being. Results showed that emotional recovery increased from 62% to 68% and emotional thriving increased from 58% to 73%. Several months later, wellness activities continued, including Zumba Thursdays during the clinic’s safety huddle, regular outdoor breaks and group exercise “snacks,” and messages of gratitude on the new Gratitude Board.

The Resilience Committee also implemented a 1-month wellness challenge with a navigation team of onsite and remote administrative assistants, nurse and patient navigators, and nurse educators. The committee modified the activity options to meet the unique needs of this team. To enable activity submission regardless of work location, the committee sent a scheduled, daily email with a link that team members used to document daily participation.

Wellness challenge participation remained high for the hybrid unit. Team members were recognized for their wellness participation at the department’s in-person staff meeting. Although the Resilience Committee didn’t collect work–life balance, burnout, and resilience data for this challenge, the number of submitted wellness activities and anecdotal reports indicated participant engagement and enjoyment. (See the modified activity lists and participation results)

Take the challenge

A recent study by Aiken and colleagues found that clinicians rated wellness programs and resilience training as the least important interventions to improve their well-being. Nurses prioritized actionable changes that included improved staffing levels, support for uninterrupted breaks, and enhanced team communication. These issues must be addressed to support the nursing workforce, but a wellness challenge offers a simple, low-cost intervention that a team can implement within the constraints of the current nursing climate to boost well-being and positively impact the work environment.

A wellness challenge tailored to team cultures and work environments encourages physical, emotional, and social wellness habits. All you need is a simple and varied list of wellness activities, a champion to motivate team participation, and leadership support. Engaging nurses and frontline teams in health-promoting behaviors not only aids nurse well-being, but also the well-being of patients, organizations, and the nursing profession. With stress, burnout, and turnover rates continuing to soar, we must rise to the challenge of making wellness a priority.

Paige Roberts is a nurse coordinator at the UNC Medical Center in Chapel Hill, North Carolina. Michaela Cline is an oncology nurse navigator at UNC Health Chapel Hill. Haley Hamilton is a clinical nurse IV at UNC Health Chapel Hill.

American Nurse Journal. 2024; 19(7). Doi: 10.51256/ANJ072414

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Aiken L, Lasater KB, Sloane DM, et al. Physician and nurse well-being and preferred interventions to address burnout in hospital practice: Factors associated with turnover, outcomes, and patient safety. JAMA Health Forum. 2023;4(7):e231809. doi:10.1001/jamahealthforum.2023.1809

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Key words: nurse wellness, self-care, wellness challenge