ginnyhanrahan and jenny bulbulia,coru irelandhealth and social care professionsin ireland tel +3531...

CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient

New Orleans, LouisianaSept. 11-13, 2014

Council on Licensure, Enforcementand Regulation 1

Regulator’s Approach to EnsuringRegistrants are Resilient

Ginny Hanrahan and Jenny Bulbulia, CORU Ireland

Resilience

“The world breaks everyone, and

afterward, some are stronger at thebroken places.”

Hemmingway, A Farewell to Arms

“The oak fought the windand was broken, the willowbent when it must andsurvived.”




Regulators Responsibilities

• To protect the public by promoting highstandards of professional conduct,education, training and competence forregistrants

• Continuing Professional Development –but how about life getting in the way

Normal Distribution Curve

Unacceptable

Acceptable Good/Very Good Excellent

Right Touch RegulationProfessional Standards Authority UK

• Identify the problem before the solution

• Quantify the risks

• Get as close to the problem as possible

• Focus on the outcome

• Use regulation only when necessary

• Keep it simple

• Check for unintended consequences

• Review and respond to change




Identify and Quantify theProblem

“Caring for others skilfully involves a high degree ofself-giving. Whilst the self can certainly grow andflourish in this altruistic experience, it can alsosuffer.” (McAllister et al, 2009)

The “Cost of Caring” (Figley, 1995)

The “Hazards of the Healing Professions”

(Zeidner, 2013)

What is Resilience?

“A dynamic process wherein individualsdisplay positive adaptation despiteexperiences of significant adversity ortrauma” (Luthar and Cicchetti 2000)

A display of “manifested competence”(Masten and Coatsworth 1998)

“A two dimensional construct includingthe experience of adverse conditionsand the presence of positive skills incoping with these conditions”

( Beddoe,Davys Adamson 2013)




“Or rather than attempting to achieve‘conceptual clarity’ or a consensus ofmeaning, resilience should beconsidered a rubric or ‘umbrellaterm”.

(Grant & Kinman, 2013)

Is Resilience always a goodthing?

• “Resigned Resilience”?(Strategic Review of the Nursing and Midwifery Council 2012)

• Resilience in Adolescence – “I only havemyself to rely on”. (Hunter & Chandler, 1999)

Get as Close to The Problem asPossible

Evidenced BasedResearch




Research

Fostering Resilience at a personal,professional and organisational level:

an international study of registeredsocial workers

Jenny Bulbulia & Michael S Gordon

Trinity College, Dublin, Ireland

A strengths based approach

If 1 in 5 physicians are affected by burnout,what are the other 4 doing right…?

(Zwack & Schweitzer, 2013)

“As yet, little is known about fundamentalissues such as what resilience means tosocial workers and how it can be supportedeffectively in training and practice.”

Grant & Kinman, 2013




Research Questions

1. What is the Professional Quality of Life of thiscohort?

2. What are the personal, professional andorganisational factors that impact professionalquality of life?

3. What is the nature of resilience in thiscontext?

4. What is the role of the Regulator in fosteringresilience?

Methods

RQ.1 PROQOL (Stamm, 2010)

RQ.2 RS14 (Wagnild, 2009)

Brief Cope (Carver, 1997),

DSQ40 (Andrews et al., 1993),

SPOS (Eisenberger, 1984),

UWES (Schaufeli & Baker 2003)

Questionnaire

RQ. 3 What is your understanding of“resilience” as it relates to yourprofession?

RQ. 4 Online Focus Groups andInterviews




As of 31st July, 2013…

• 129 participants

• Countries: Ireland, England, Wales,Scotland and Northern Ireland, CanadianProvince of Saskatchewan

Work Country

42%

58%

Canada Uk and Ireland

Gender

15%

85%

Male Female




Age

4.7

20.9

14.0

30.227.9

2.3

25 or less 26-34 35-44 45-54 55-64 over 65

%

Educational Level

6.20.8

4.7

50.4

37.2

0.8

Diploma AssocDegree

Cert/NQSW Bachelor Masters Doctorate

%

Years Employed

15.517.1

12.4 11.6

20.922.5

5 or less 5 - 9 10 - 14 15 - 19 20 - 24 25 or more

%




Bulbulia & Gordon, 2014Trinity College, Dublin Ireland

Preliminary Analysis

Personal, Professional and Organisational

Emerging Trends …..

ProQOl Total Scores

0.0

33.3

52.7

75.2

66.7

47.3

24.8

0.0 0.0

Compassion Satisfaction Burnout Secondary Trauma

Low Average High

Resilience

1.65.4

15.5

23.3

34.9

19.4

Very Low Low On the LowEnd

Moderate Moderateto High

High

%




WHY ?

PERSONAL FACTORS

Relationships-Psychological Factors

Scale Resilience SelfCompassion

CompassionSatisfaction

.64** .43**

Burnout -.35** -.20*

SecondaryTrauma

-.33** -.34**

Resilience .53**

**Correlation is significant at the 0.01 level (two tailed)* Correlation is significant at the 0.05 level (two tailed)

These two predictorvariables account for 41%

of the variability(R²=0.406)

However, Resilience isour only significantpredictor (p<0.001)

Predicting Compassion Satisfaction

..356

.136






However, Resilience isour only significantpredictor (p<0.001)

Predicting Burnout

-.209

-.026



However, Self-Compassion is ouronly significantpredictor (p<0.05)

Predicting Secondary Traumatic Stress

-.116

-.085

Other Personal Factors

Defence Mechanisms and Coping Styles

• A Neurotic or Immature Defence Style is apredictor of Burnout and Secondary TraumaticStress

• A Negative Coping Style is a predictor ofBurnout and Secondary Traumatic Stress




Work Life Balance - Factors

56.646.5

22.5

72.179.1

31.8

92.2

%

Work Life Balance• Significant positive relationships were found

between

– Compassion satisfaction and family time

– Resilience and family time and group activities

• Significant negative relationships were foundbetween

– Burnout and family time, socialising and grouprecreation

– Secondary trauma and sport, cultural activities,family time, socialising and group recreation

It is difficult to detach myself frommy job

33.3

60

6.611.1

40.748.1

Never/almost never Rarely/sometimes Often/very often

High Low

HIGH - For participants who are high in compassion satisfaction andmoderately high/high in resilience

LOW - For participants who are average/low in compassion satisfaction andLow/very low in resilience




WHY ?

ORGANISATIONAL

FACTORS

Utrecht Work Engagement Scale

07.8

82.2

9.30.8

Very Low Low Average High Very High

%

Perceived OrganisationalSupport

25.6

79.1

3.5

Low Medium High

%




Relationships –Organisational Factors

Scale UtrechtWork

Engagement

PerceivedOrganisational

Support

CompassionSatisfaction

.71** .43**

Burnout -.25** -.46**

SecondaryTrauma

-.18* -.37**

Resilience .61** .39**

**Correlation is significant at the 0.01 level (two tailed)* Correlation is significant at the 0.05 level (two tailed)



Work Engagement is ouronly significant predictor(p<0.001)

Predicting Compassion Satisfaction

.349

.104



POS is our onlysignificant predictor(p<0.001)

Predicting Burnout

-.082

-.288






POS is the onlysignificant predictor(p<0.001)

Predicting Secondary Traumatic Stress

-.049

-.212



Work Engagement isthe significantpredictor (p<0.001)

Resigned Resilience?

.524

.185

Qualitative QuestionDefine Resilience

88%

12%

Answer No Answer




WHY ?

PROFESSIONAL

FACTORS

Professional Areas

0

10

20

30

40

50

60

%

Key Areas Identified

•Supervision

•Training




Frequency of Supervision

6.2

38

45.7

2.3

7.8

Never Irregular Monthly Fortnightly Weekly

%

Quality of Supervision

3.1

32.8

45.3

18.8

Negative Inadequate Adequate Effective

%

Purpose of SupervisionAdmin/case management

26%

74%

No Yes




A qualitative enquiry

“The question of what constitutes good oreffective supervision is thoroughlycanvassed in the supervision literature withlittle consensus as to a definitivestatement.”

(Beddoe et al, 2014)

Training Received

39.5

56.6

3.9

45

51.9

3.1

Yes No Don't know

Resilience Burnout

Quality of Training

16.3 18.4

65.3

22.8

8.8

68.4

Poor Average Good

Resilience Burnout




Training

• Preliminary analysis indicates that lack oftraining negatively impacts on:

• Resilience

• Work Engagement

• Compassion Satisfaction

• Perceived Organisational Support

• Self Compassion

Training needed

70.8

5.4

17.8

69

StronglyDisagree

Disagree Uncertain Agree StronglyAgree

%

Who should provide training?

89.1

89.1

45.7

81.4

Practitioner/Registrant

Employer

Regulator

Educator/CPD

% agreement




Professional Quality of Life

Multiple Pathways that are complex,dynamic and interacting…

The Person

The Organisation

The Profession

Focus on the Outcome

• What are the desired outcomes of a“Resilient registrant”?

• What does having a good “ProfessionalQuality of Life” actually mean?

To consider together…

• How should regulators implement thisinformation

– Through review of approved trainingprogrammes ?

– Continuing ProfessionalDevelopment/Competence Assurance?




Speaker Contact Information

• Ginny Hanrahan CEO/Registrar, CORU – regulatingHealth and Social Care professions in Ireland Tel +35312934751 (office) +353860405850

• Jenny Bulbulia, Council Member of CORU/Barrister/PhD student, Trinity College Dublin, [email protected]

• Dr. Michael S Gordon, Trinity College Dublin, [email protected]

ginnyhanrahan and jenny bulbulia,coru irelandhealth and social care professionsin ireland tel +3531...

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