of ANA's newly branded wellness committee for this 2025 fiscal year membership year. And I'm the former chair of the health and wellness committee. And I mentioned that because this is the first year that we've combined forces, so to speak with the peer assistance panel from previous years and the health and wellness committee from before into what we are now, which is the wellness committee. And I'm joined by a few colleagues from the wellness committee for a panel discussion tonight with Riga Garcia, who is the CEO of Parkdale and also CRNA. And our purpose tonight was we were hoping to shed light on the occupational hazards of substance use disorder that exists for residents as well as CRNAs and really to highlight ANA's partnerships with both Parkdale and the ANA 24 seven helpline. So we'd like to also really give everyone a general idea kind of of how this whole process works, what to do if we find ourselves with the opportunity to assist someone in accessing the substance use resources that we're really just so fortunate to have available to us as ANA members through our partnerships with Parkdale and the ANA helpline. But first let me introduce our panel of subject matter experts. We have Riga Garcia. He's the CRNA and Parkdale founder and the current CEO. He has been on peer assistance panel since 2016, I believe. He's also a well-known speaker nationally. He's an author. He's really considered a thought leader in the area of substance use disorder. And to say that he has served us well in this realm for a number of years really feels like an understatement here. He educates so many students, so many CRNAs. He really does a lot for us. And so we're so grateful to have him. We also have Dr. Crystal Honeycutt. She is CRNA and program director at Lincoln Memorial University. Dr. Honeycutt serves as a peer assistant, I'm sorry, a peer, state peer advisor. She's also vice president for the Tennessee Professional Assistance Program. And in addition to serving on AANA's wellness committee, she serves as the chair of TANF's wellness committee. Also well-published, she's got many interests in this realm as well. Also joining us, we have Kevin Kim. He comes to us by way of Minnesota. He is a third-year resident registered nurse anesthetist at Augusta University in Georgia, where his doctoral project is focused on combating biases and optimizing anesthesia care in patients with substance use disorder. Kevin's prior work and interest also though have involved breaking the stigma of mental health issues. And finally, we've got Dr. Lee Taylor, also a CRNA and assistant program director for Fairfield University's Nurse Anesthesia Program in Connecticut. And she also practices there as a CRNA. Dr. Taylor has published numerous articles on recovery in the workplace, and she serves as state peer advisor there as well, and also is the vice chair of this year's AANA wellness committee. So, okay, let's dive in here, everyone. Wow, Rigo, I don't know if you ever even get a chance to kind of like look from a 30 foot thousand view and say, man, that escalated quickly, but I think the rest of us kind of do some, you know? And I guess that's kind of where I want to start with a couple of questions with you, if that's okay. Yeah, yeah, of course. Just honored and grateful to be here, certainly. And it certainly wasn't part of the plan to go down this path and take the education and the training of anesthesia to end up here, but it's been quite the journey for certain. And some of the information that we're getting along the way, hopefully we can just kind of disseminate that and share that back to everyone in the organization and to the people that are still yet to come through, and it'll be helpful and hopefully save them some pain and heartache that so many of us have to go through to get this information. Well, we thank you again for sharing all of that with us. So with the support that you get from the ANA and your work through with Parkdale, really, I know that you've served so many CRNAs and resident registered nurse anesthetists alike across the country who've faced challenges with both substance use disorder and mental health issues. Can you speak to this a little bit and explain really how all of that evolved? Sure, sure. So, you know, it wasn't, you know, relatively speaking, it wasn't that long ago that I was searching kind of in the dark for some help and assistance myself. You know, substance use disorder touched me very profoundly and not only affected me, but it affected the people around me and, you know, hiding behind those layers of the actions that we see with the substance use disorder was just this kind of percolating mental health situations, you know, no different than what a lot of us go through, you know, raising up and going through childhood and early adulthood, the stressors of school, the stress of the job, you know? So it wasn't that much different in many regards, but it did come to a kind of a head in early 2011. And I found myself desperately searching for some resources. I had no idea what to do. I had no idea where to turn. As a result, I probably said a little too much. I made a couple of mistakes, but I was very fortunate as I was going through an old package of information that I had from one of our previous ANA meetings, I found a phone number. It was a helpline phone number, and I had no idea what it was. I had really nothing to lose. So I called this line and it was answered, which really surprised me. It was answered by another CRNA several states away from where I was at. And I was real skeptical and I had my expectations pretty low. How much could this person really help me? But within a few seconds, I realized a lot of things that really kind of, I would say would be the first step in how we got here today was probably on that phone call. Looking back at it now, I didn't get a clear cut path direction on what to do, what to say, where to go to treatment, how to take time off, how to protect my license. But what I got was overwhelming support and a shared experience from somebody else who had been there before. And that at that point was like, I hit the jackpot. I had been feeling my way through the dark for such a long time on this isolated, sometimes self-imposed island where I thought nobody could relate to me. And maybe I almost didn't deserve the help because of my indiscretions. Now I have this complete stranger who called me and I was speaking with her between surgical cases. She was actually in a case and then answered the phone and talked to me. Just the thought of somebody being available to answer that phone and reach out to me, answer the questions, just be a sympathetic, nonjudgmental ear, and then start to form some kind of plan on what the next steps were gonna be moving forward. It made all the difference in really my mental health and any kind of hope that I had to kind of get out of that situation that I was in. That was my first experience back in 2011 with it. I have come to find out how much went into that phone call. I saw the tail end of years of work and years of effort and years of volunteering. A lot of people went before that situation just to get things in place, to have somebody answer the phone when I needed it. And that really touched me. It really moved me. It really inspired me. But I had a lot of work to do before I could do anything with that inspiration. I had to get better. I had to get healthy. So that's really how it all started. It put me on an educational knowledge search of how I can be part of that. I wanted to be part of that. And that gave me the resources and the tools and the support that I needed so that I could move forward and get help, get healthy, get whole, get spiritual, get grounded, everything that I needed to do. And that in a nutshell is what we try to do when we're answering the phone call today. And when we're trying to reach somebody who's having their worst day, at least professionally, and they're calling for some guidance and assistance, that's the first thing we try to do is give them a shared experience, a little glimmer of hope, a little bit of, you know, I don't have to do this alone. There's a whole army behind us waiting for you. And I can almost feel the same sense of relief on the other end of the phone that I felt personally way back in 2011. Wow, that is a very impactful story. And I mean, you said so many things that just really stood out there. That shared experience we know is so important because we can just live inside our heads so much and think that no one else is going through this. No one else would understand. And it's just, yeah, it's so important to share those things. And I think another thing that you said in that that really stood out is that, you know, so many of us are here because of somebody else and doing the work that we do because we literally are standing on the shoulders of giants. And big things start from such small little things and it takes a long time to get there. But I mean, it's worth it. It is worth the fight. It is worth every little step. And I'm so glad that that person was there for you and I'm so glad that you just, you know, found that inspiration and keep giving it. So thank you so much. That's amazing. So it brings me to my next question here for you. And, you know, I know that you have, like we said, you've been working for a while with the peer assistants, you know, what do we say, since 2016 or so, and you play a significant role in supporting the 24-7 helpline as well. Will, can you kind of explain for everyone what the AANA helpline is and what services are available? And, you know, what are you seeing as far as trends and information? And, you know, how's that significant? And does it inform really even our standards of practice and that sort of thing? Sure. Yeah, that's certainly a lot of information there. So I'll try to disseminate it down to maybe a little timeline. So let's go back a little bit further from when I made that first phone call and somebody was there to help me. As I couldn't have stated any better, standing on the shoulders of giants, there were groups of people and volunteers, and it was just by the good intentions of their heart, they said, hey, we need to formulate some kind of system where somebody can call into this helpline and they could talk to some live person as best as we can. So it started off with a group of volunteers. And these volunteers had this 1-800 number that they would pass around to each other kind of on this rotation 24-7. And sometimes you would get a live person and sometimes you would get a, hey, I'm in surgery, I'll call you right back. And then they would call right back. And, you know, sometimes the first four or five people, like a call tree, a decision tree, sometimes the first four or five people couldn't get to it. So if I only get to the sixth person, it would ring and then they would scramble for some resources as best that they could. If you were lucky, the person who answered the phone was somewhere near your state and had some kind of familiarity with what you were going through. And that was the foundation. That in itself, to implement that kind of system for an entire membership organization across the country, it almost blows my mind to think of how much they were able to accomplish with a handful of volunteers with good intentions and a lot of ambition and desire for doing it the right way. I came in on the tail end of that. So I used the resources in 2011. By 2013 or so, I started working individually with CRNAs. And then Claudia, who's my wife and she's a nurse, she started working with their families. So we realized that, you know, the addiction and the mental health that affects the patient is also collaterally impacting the family members. So that's really how we started getting involved with, I guess you could say, you know, peer assistance on a very informal basis. In 2016, we were already starting to develop Parkdale, which is the treatment center. We had been open for about a year. And I'm part of the call tree where, you know, sometimes it's my turn to answer the phone and sometimes I'm in this position that will eventually get to me if no one answers. And we said, hey, listen, instead of everybody trying to scramble to answer the phone as best as we can, how about we funnel them to a team, a dedicated team that's committed to answering the phone as much as we can, 24 seven, and we can do this. So around 2018, we finally took over the answering phone, answering the phone and providing services and resources because what was happening on the backside with the development of Parkdale is we were getting a very, very quick, thorough crash course on how every state works across the country and how the alternative to discipline works and how the resources work and reporting requirements that were individuals to every state. So it was that educational information that was real, real helpful when we started answering phone calls from Indiana and answering in California or New Mexico, we could give them appropriate resources in almost real time. The second thing that enabled us to do by running the treatment center at the same time was become real familiar with the good treatment centers across the country. So now instead of together looking over a web search of treatment centers near your location, we developed a repository and a list that was vetted by the ANA to provide actual resources and contact personnel and admission criteria for treatment centers across the country. So just with that change with the ANA's assistance, we were able to localize all the calls to one team that were trained up and educated up and rotated through, answer the phone calls live, and then provide local resources all on the same phone call in addition to the shared experience. So that was back in 2018. We evolved our relationship with the ANA. It has evolved to the point now where we're the official partner, mental health and substance use disorder, a partner of the ANA, providing all of our resources that we can and opening them up completely to the membership organization and to the students, and most importantly, or just as importantly, to their families as well. So now when they're calling, we can connect folks with mental health clinicians in their area or some of our clinicians, treatment resources, and what has evolved to be something that we didn't really anticipate, but it's beautiful in its own right, is an incredible alumni program of people that have used the services before that are now ready to give back and help the next people kind of up. So we have hundreds of CRNAs that are ready on the standby to, again, provide their shared experience and help them through that. So with the ANA Helpline Resources, it's a peer assistance, confidentially driven, answering service, helpline service that provides a shared experience, a sense of fellowship, a sense of wellbeing and support, and then as many resources as we can give, all the way from treatment itself to resources locally, to pairing you up with somebody back in your state. So some of the highlights of the program are that it's confidential. That's the ANA has no access to the information that comes through the program. Answering it from the treatment has this kind of sense of patient information, privacy, HIPAA privacy. So the information that is collected is truly meant to advocate and to help support the members who are calling in for assistance and help. So in terms of trends and what we're seeing, it's really fascinating. We're now at the point where we're having five, six, seven years of data, and we can start to see trends, start to see things that will help us change our practice, quite frankly, especially with things, big Sentinel events like COVID, for example, that almost wreaked havoc on a lot of people's mental health. I know certainly myself and some people maybe on this call, and certainly some people that are listening to this broadcast, the mental health concerns after COVID were quite significant. But some of the things that we can see, like in 2018, we had near 400 calls come through the helpline. And we said, wow, that's a lot of calls. That's almost one call, more than one call a day. But not all of them were for substance use disorder and mental health. It became kind of the catch-all for everything. Hey, I need to renew my license, and I need to, you know, how do I do this, and renew my fees. So then when we kind of partitioned that off with some options on the helpline, then we got some realistic numbers. So, you know, I'll give you the numbers here. For the last five years, since 2019, 129 phone calls came through that needed help with SUD or mental health. Something that required intervention. Someone who was on the other end of the phone, not having a good day, and just reaching out for somebody, anybody, to give them some assistance and help. So the numbers went from 129 to 143 to 126. In 2022, it dropped to 96, and that's real significant. Why did it drop so much? Well, that was the year that COVID really kind of hit the top. So if you think about what happened, all hands on deck, cancel your vacations, everybody come back. Nobody's looking for impaired providers, because we're all kind of doing double duty and taking on a lot of different roles here. So a lot slipped through the crack. So when we started looking again, back after COVID, you can imagine, 133 went back up. And the numbers of admissions kind of correlate with that as well. Collectively, we're over 400 CRNAs and rRNAs have been treated on the inpatient treatment side for it. We're seeing real significant trends on usages of medications. Five years ago, the primary drug of choice was opiates, for example, and now it's alcohol. Propofol never used to be a factor, and now it's a significant factor. So we're starting to see these trends bubble up before, and then we can make recommendations in terms of practice or awareness, or things like prevention or early identification with suggestions on drug testing, for example. So the information that we get, we try to sift through as much as we can and then package it up nicely, share it back with the membership organization for two reasons. Number one, it will call to alert some of the trends and the data, the trends that we're seeing out there in the profession. And I think maybe just as importantly, if not, it validates, when people read the data, it validates what they may be feeling. So when they see 150 people call for SUD and mental health issues, and their drugs of choice are alcohol and Propofol, it might resonate with somebody. So folks, let's get it done. And the last data point that I'll share with you, I think is really important, is that the vast majority of the calls that come in are from someone other than the person who needs the help. And that really speaks to this communal presence that we have in our organization of helping each other out. You know, when we're down, we pick each other up, we support each other. So we have more colleagues and employers and family members calling and saying, hey, I'm worried about my husband and my son, so-and-so, can we rally the troops and then present this to him to get him some help? So that's really exciting for me, it's really reassuring for me, to know that not only do we have this resource for the CRNA, but the resource is being used significantly more by the people around the CRNA, who sometimes is too deep into that addiction, into that mental health to even know or want, or are able to get the help that they need. Yeah, that, I mean, although sad, it's still, that makes me feel good that the message is getting out there. One, if you see something, say something, and two, that people are caring enough to do that. And yeah, that, like I said, even though that's scary, it feels good and validating that people are doing that. So, all right, wow, that's, you have been busy. And I guess that's why I said, like, from that 2018 point where I'm coming in as the Johnny come lately, I'm like, that escalated quickly. That's what it feels like, you know? So yeah, gosh, you guys have been busy. So, okay, so I'd like to kind of turn to the committee now and ask a few questions that, you know, kind of might be representative and on the minds of many of us, really. Nothing tricky here for anyone, and we'll keep everything within everyone's wheelhouse and areas of expertise here. But Rigo, this is really kind of, this will be putting, I guess, our committee to the test here. And we're hoping that you'll chime in and tell us if we're on the right path with our Q&A here. And you can see if we've done our homework and give us any adjuncts or supplements along the way. Does that sound good? Absolutely, absolutely. All right, all right. How about we start with Dr. Honeycutt? Does that sound good with you, Dr. Honeycutt? That sounds fun. Okay, all right. What role do you believe faculty play in normalizing conversations around mental health and wellness? And how do you think the ANA help a lot part of that dialogue? Well, I think with faculty, speaking for myself, and I always tell people when I talk, I'm like a hammer, I see a nail. So when I talk, I talk about students. So with me, normalizing mental health disorders is to role model that, to talk to them about what is available, mention it early and mention it often. And bringing guest lecturers, because students, and Kevin may not admit this, but students sometimes hate to hear their faculty talk So sometimes bringing someone in with that shared experience allows them to kind of normalize it, to have a face with what's going on. So speaking personally, I've invited guest lecturers in, and when I invite them in, I leave the room. That way, if there's anything that a question needs to be asked, they don't feel like that I'm watching them, right? That I'm involved in any of the discussion. So I think that's one of the things, is opening the dialogue, letting them know the helpline exists, and letting them know that, for example, I'll tell the students, sometimes they won't come to me out of fear of, what if my faculty sees me as weak? What if something happens and they don't? All of it, not really the accurate perception, but it is a fear. And so I will talk to the class and say, as a group, this is the hotline number. And if one of you is struggling and you can't come to me, or you can't bring something to me, here's who you can bring it to, and they will help guide you. As CRNAs, we tend to, we're good at so many things, right? We're good at a lot of things. And we're a little bit, maybe a little bit cocky because we're CRNAs, but we're not mental health professionals. So it's great to have access 24 hours a day, seven days a week, to someone who can link us to those resources. So I guess to answer your question is just make the resources aware, make the students aware of the resources, let them know there's no shame in seeking mental health, and it's okay to be stressed, and you're human. You're human. Yeah, that sounds good. It sounds like you really focus on making it just a psychologically safe environment for everybody to feel like they can reach out, get help, and feel that space is safe enough to do that. Because I can see your point there that if they feel like all eyes are on them, they might not feel comfortable in sharing, so yeah. Kevin, let's go to you now. So how much of an impact do the stressors of balancing life and training have on residents' mental health, do you feel like? Yeah, I think as long as anesthesia training has existed, everyone has kind of known a very big impact, but within the past few years, I feel like we're finally talking about it, and people are having sympathy with each other, and it's not just like this stoic training that you have to make it through to be part of the club, if that makes sense. Nurse anesthesia training, residency, have their unique set of challenges. That put us all at risk for mental health issues. Anxiety is a huge one, depression, substance use disorder, of course. I think for me, one of the biggest things is this constant fear of making a mistake at clinical. When you have that on top of hard preceptors and the surgical team being super scary, and all of that's really hard to maneuver around. The biggest thing for me is stigma of mental health. I think physicians, doctors, nurse practitioners, nurse anesthetists, we all think that we can't have our own problems, if that makes sense. Like a healthcare worker can't have their own issues or it'll look bad. I wouldn't want my healthcare worker to have issues is kind of what the thought process is there. Double fold goes for mental health too. So breaking that stigma and having us talk more about it is really helpful in the mental health of our residents. And having professors talk to us is really helpful. And on top of that too, we have our own lives. Former ICU nurses were pretty established, clinical training with pets and houses and families is just, it's really tough. And then you tie it in with substance use and how much exposure we have on the daily to opioids and all that stuff and how much responsibility we as residents have. It all can kind of lead to this downward spiral to what we have, mental health issues, substance use disorder, depression, anxiety, everything that everyone's kind of silently dealing with in their own way. It's a lot. It's a lot. Rigo, do you have anything to add to what Dr. Honeycutt or Kevin has? Yeah, I think it's these two aspects from a student's perspective and the educational perspective is really kind of where it starts. It's really where it all starts. And for Dr. Honeycutt and all of your colleagues out there in the educational realm, in my opinion, it's probably the most difficult position to be in when confronting and dealing with a substance use disorder from one of your students. I can't think of any other spoke in the wheel, so to speak, that has it more difficult. You have to think about it all, the patient's health, the institution where the precepting is happening, the student and their wellness and what their career and what their future looks like, the integrity of your institution as an educational institution, the reporting requirements by wearing all those different hats, state, local and federal. And then on top of that, you have an attorney somewhere five stories up who's making decisions on the best interests of risk mitigation. So my heart always goes out to the educators because it's incredibly difficult to have to kind of walk it back after it happens, which leads me to my second point. An ounce of prevention is worth everything. So those educational symposiums that you do and bringing in those speakers, it absolutely 100% makes a difference because we ask them another data point that we collect. When did you first start hearing about education and awareness? By far, the ones that ended up with us in the treatment center got very little bit of education and training when they were going through the process of school. So those little things that you do now in terms of training and reaching the student early on, it at least normalizes the discussion which leads to kind of what Kevin was saying about the stigma. The stigma really has to start at a grassroots campaign one person at a time. You know, we do kind of a real fascinating when we're working with schools and institutions, we ask a real fascinating question and everyone who's listening to this, I would ask you to ponder this question as well. If you had a problem today and we ask, you know, CEOs of a hospital and they're the farthest and all the C-levels at the high up in the organization, if you had a problem with drugs or alcohol, would you raise your hand and ask for help within your own organization? And by and far, nobody ever raises their hand. So the point is, if you wouldn't even ask for help in your own organization, which you're in the driver's seat of, how can you expect anybody else to ask for help? And that's all predicated on the stigma of mental health. It's like a badge of courage and a badge of pride that I can walk through the fire. And, you know, one of the biggest mistakes that I made personally, that I see a lot of the providers who come in is thinking that this idea of resilience is how much you can take and keep going and take it and keep going and take it, keep going. When I have come to learn that the resilience is quite the opposite, it's knowing when to stop and hit the pause button and catch your breath and reorganize and regroup and then get back at it again. So working on the stigma really has to start with this phone call, with this webinar, with everybody who's taking the time out to listen to it, and then spread that word in a grassroots campaign kind of manner. And that's when we're gonna move the needle. That's where we're gonna make big differences if we continue to do that. And I can't overthink the educators enough for being right in the middle with all these decisions coming at you, trying to make the best decision and hoping that you don't mess too much up. So the point is to all of that is we can help with that also with the helpline. Give us a call. We can certainly help navigate some of those really difficult decisions that you may be going through the first time or the second time. The team that answers the phone, they've been through it hundreds of times. So they can certainly help guide some of those directions if you need some help with that. Wow, good stuff. And I'm not sure where the marketing team is, but if we can just go ahead and get that on a t-shirt, resistance isn't how much you can take, it's knowing when to pause and just go ahead and sell them that at the next convention, I think we're good. Let's just put it at the table. That's great. I think we all need to hear that message more than once probably. All right, let's move to Dr. Taylor and talk a little bit about workplace issues. Dr. Taylor, what specific barriers do you feel like CRNAs face in seeking mental health and substance use disorder support? And how might these obstacles really impact their wellbeing and patient care even? Thank you, Donna. I think, when I think back, why did I wanna be a CRNA? I think about that moment that I learned what a CRNA does and the perception of the CRNA. Everyone in the room looks to the CRNA to kind of lead us. And when things are going bad, the CRNA is the one that pulls us up and is calm. And so I think the number one barrier is just the culture of our work. Everyone views us as having it together, having all the answers, and that there's no weakness there. When in fact it's the opposite, none of us are invulnerable. But what we have to change is it's not that the vulnerability is a problem or a sign of weakness. And that's kind of touching on that stigma we've talked about. That's one of the main facets, I think, that we have to de-stigmatize that just because you have weakness doesn't mean you're incapable of being a CRNA. And then stigma, we've talked a lot about that. There is this pervasive stigma within our community that if you have a mental health issue or a substance use disorder, then you're not a competent provider. And those things aren't mutually exclusive. But I think I'll take it a step further in the workplace that there's the stigma that if you have a mental health disorder or a substance use disorder, then you also worry about your professional judgment and your professional reputation. That if I have these things, well, I can't make good judgment. And then my colleagues are gonna look at me and think, well, they can't take care of my mom or I don't trust them to take care of someone that I care about. And then Rigo touched on, I think there is also a lack of resources in the workplace or they're resources, but we're afraid to utilize them or we don't know about them. So I think I would encourage everybody here listening today. Find out, do you have employee assistance programs in your workplace? If you do, do your colleagues know about them? Because I think that's a big piece that's missing. And if you don't have those employee assistance programs, the AANA has so many resources on the website. I'll just ask everybody to look back on the website. We have resources about mental health. We have resources about second victim phenomenon. The resources are there with our peer support network. And then we're starting to roll out our wellness advocacy network as well. So I think if you don't have the resources in the workplace, the AANA is a good one to start. Thank you so much. Yeah, that's true. So many of us, I think, you know, don't think to tap into the resources that are available at work. Or just don't, you know, don't even know about them. And yeah, I like to encourage people to, you know, tell a friend, tell a friend about them. Because a lot of times there's stuff that there's, there's, gosh, there's discounts, too, that people don't know about. And it's like, get you some of that. I mean, get in there. So yeah, it's good stuff. Thank you for that. Let's go back to Dr. Honeycutt. Dr. Honeycutt, how do you encourage students to seek help when they face personal and professional challenges? And what role do you see the AANA helpline playing in that process? You know, just kind of reiterating what I said before, kind of goes hand in hand, just the continued encouragement, and make it a topic of conversation that is just a topic of conversation. We wouldn't have a problem if someone said they were diabetic. You know, we would not ostracize or we would not say, well, I can't believe you're trying to be a CRA, and you need to take glucofage. That's crazy. So just making mental health the same. And you know, whenever I have to counsel student, be it struggles in clinical or struggles with classroom, whatever brings them to my door, one of the first things I say is, you know, we have counseling. And kind of to follow with what Dr. Taylor said, knowing the resources you have available. So if you're in a university setting, you might have counseling services at the university. If you don't, we have the helpline, who, again, are people who can guide us to help individuals. We don't have to go it alone. So, you know, I always encourage students when they come to me, you know, if they're struggling on exams, have you talked to a counselor? Have you, you know, talked to somebody at the university? And they make, you know, I say it so much that some of them make a joke, they'll say, did you know we had counseling services available? And I'm like, why, yes, I did. I did know that. But that, that's what I think. I think just making it a conversation. And, you know, really meaning it, you know, I've seen, I've seen individuals and not just CRNAs, but we've seen individuals in healthcare that will say things like, you know, so and so has anxiety. Well, they don't really need to be in the anesthesia field. I hate to tell them, more people than that person have anxiety. You know, there's lots, you know, lots of things. And like I said, we don't ostracize someone for hypertension or diabetes. Why do we ostracize them for other issues? So, you know, and like I said, I think that the helpline and the AANA and the resources are there for our taking. And we just need to utilize them. Rico, what do you think? Are we suggesting the right resources here? We're talking about the student resources and workplace resources. Have we left any out in what we're offering? You know, I kind of give it to you in an example. I work with some schools and I'm in a rotation with them where we go there and we do, you know, every two years when we get both of their classes, we'll do a presentation for them on substance use disorder and kind of tell my story. And it works really well. And then the directors of the program will say, hey, remember, you guys have time off work. You have sick time. If you need help, and this is how they'll say it, if you need help with a medical issue, if you need help with mental health, if you need help with substance use disorder, just let us know and we'll get the help that you need. I can't even, I can't tell you how many phone calls I've received as a direct result of that conversation saying, hey, I think I need to take some time off, or even as simple as, can you set me up with a counselor one-on-one because they have permission to, and they believe their instructors. So as Dr. Honeycutt was saying, normalizing that conversation is absolutely imperative. And those little things that you do and those little corrections that you make at the SRNA, rRNA level is going to, it's going to change the trajectory tremendously downstream when they're practicing and they're healthy and they're whole. So I wanted to say that. The other thing I wanted to say as well is, you know, one of the beautiful things of the process of recovery, right, the addiction is not necessarily a beautiful thing, but the recovery process is, because once our folks, our SRNAs, your colleagues, my colleagues, go through the process, they are forced to reprioritize what's important. And it's not paying off the student loans, and it's not picking up all that extra overtime, and it's not rushing to the front of the trauma bay to get the big case. It's not that. It's leaving, taking time off, vacation, family, it's that. So if we can collectively start doing that at Kevin's level, right, as soon as you get out, you know, keep your, keep your living modest and keep your expectations on, I want a healthy life. And I am not a CRNA. I am not that. I am, I do that for a living. It's my nine to five. One of the biggest detriments that I see, societally speaking, that plays into what Dr. Taylor was saying was, we pin these superhero capes on each other. And sometimes we pin them on ourselves. And sometimes, especially with like through COVID, every healthcare provider was a superhero. Well, superhero, it was very difficult up on a pedestal with the spotlight and the superhero cape to take it off and saying, I'm hurting, I'm broken, I need help, I can't do anymore. That's very, very difficult for them to do. So normalizing the stigma of that, taking care of ourselves is the best thing that we can do. And we learn that as we're students, which reminds me of a quote that what dear friend of mine says, he's a CRNA as well. And he says, if we don't take time for our wellness today, we'll be forced to make time for our illness tomorrow. And that's something that has been proven time and time again. So my take home message is what everyone here has articulated so well is prioritize your wellness today. Do those things that you need to do. No is a complete sentence and it's okay to not be okay. You know, you make a heck of a point too, when you talked about the permission. I have said it before. We've all been in the hospital setting and what I affectionately say as institutionalized for so long that we most of the time can't even step out to use the restroom without somebody's permission first. And so why would we think that it's okay to step away and get help without permission? So that is, that was like, that's a boom moment for me when you said that it's like, we, we really do. I feel like that is huge when we give people permission to go take care of themselves, because I find myself in that same situation. Sometimes I wait until somebody is giving me permission. You now need to go take care of yourself. Oh, okay. You know, so that that's huge. So thank you for pointing that out as well. Okay. We're gonna move on Dr. Taylor. I want to go back to you. How, how can employees effectively support CRNAs in the workplace to enhance their mental health and address substance use disorders? Yeah, so many things. I think number one is education. Providing your, your CRNAs, the education behind, behind wellness, things that they can do to take care of themselves. What does the institution offer that's available for them? If there's an employee assistance program, providing them with those phone numbers, so they know how to get in touch. Peer support. I know we think, you know, when I hear peer support, I think about our AA and a peer health line, but I think there's so much that can happen in the workplace with peer support, establishing peer support systems, not just for those moments where you need them when a critical incident has occurred and you need to debrief about those, but mentorship programs for new hires and, and the different phases of the workplace that people can relate because we know that if you can relate and develop those strong interdisciplinary relationships, then that's going to help combat burnout. That's going to make you happier in the workplace. Training, providing, not just training for how to be a CRNA and caring for our patients and, you know, doing our annual training about the Belmont, but we also need to have training about taking care of ourselves, good sleep habits, good nutrition, going to the bathroom, you know, like it sounds so simple, but you have to take care of yourself at work. And then I think taking a look at your policies, how are you presenting yourself as an organization by your policy? Are you using stigmatizing language in your policies? That's got to go. We're not labeling people as addicts. We're not saying substance abuse. You know, we need to really pay attention to the language because if you have language in your policies, then you're just further stigmatizing your employees from wanting to come forward and get help. And then I think we kind of touched on this a little bit, but providing flexible scheduling, that's going to do several things. If you are giving people permission to use their time off to take care of themselves, then Rigo said it better than me, but you're preventing illness later on, you know, give people, allow them to use their vacation time when people are off, not calling them in. And then, you know, working with your employees, like I'm a young mom, I need a different schedule than maybe somebody else and working with those providers on what they need and works, works best for them. And that's just going to look at the provider as the whole person and not just as the CRNA. Yeah, we, I feel like we definitely have to think out of the box. Now we're being, we're being, honestly, we're being forced to, because it's just different than it was several years ago. And, and it's, it's not the same, the landscape isn't the same. And if we want to, you know, have providers, we're going to have to think outside of the box. So Rigo, thoughts on that one? Yeah, no, it's very, very well said, very articulated. It's, it's, it's where it all kind of comes to a head, right? We're talking about prevention. We're talking about that as, as early as education, as a student. But where the road meets the rubber is, is that the employer, and, you know, you can tell a lot about society, about how they treat their elderly, and you can tell a lot about an employer, how they treat their employees that need the help the most. And, you know, that was probably, that was always a point of contention with, with me as I was going through it. And I remember having this little period of animosity that at that point, I had given 15 years of my career and sacrificing to help perfect strangers and sacrifice time with my kids and my family. And then the one time I needed to be a patient, I felt in a lot of regards that I was pushed away and shunned away and kind of given the scarlet letter of addiction. So the way that we treat our employees at the work is going to, is going to say a lot about our culture. And, you know, the beautiful thing about that is if they do, if the employer does it the right way, and actually reenters them or has a avenue for reentry, it's going to snowball. The whole wellness campaign, the whole culture at that institution will snowball. If you have an ounce of prevention upfront and a reentry program at the back end, and your employees start to see that, then they're going to say, oh, there is a way where I can raise my hand and ask for help. And I don't have to be put on a list and reported and fired and all of these things. There actually is a path. So you only have to do it one time the right way, and it will multiply after that. Kevin, I want to bring it back around to you for a final question here. If a classmate approached you with concerns about another friend's or even a preceptor's well-being, how would you support them in referring that peer to the resources that we have, you know, like ANA's helpline or other resources? Yeah, you know, I think the biggest thing really that we've been talking about, you know, with Dr. Honeycutt is just having approachable faculty makes such a huge difference in students' lives. Personally, for me, you know, at my program, every single one of my professors is somebody who, you know, smiles at me down the hall or asks me how my family is doing, and that it has made such a big difference. And I remember one week, I had probably the worst week of my life when it came to tests and life and everything, and I went into my faculty's office and just and talked about it, kind of, you know, in the other perspective from Dr. Honeycutt. And I just remember her being so empathetic towards it, and she kind of slid the school counselor's phone number across the desk and pointed me in the right direction. And it, you know, it's something I don't think I'll ever forget in my life, and it left such an impact. And, you know, I hope faculty do realize how much of an impact they can have on their students and their students' success, because she very well could have just said, you know, life is hard, CRNA school is hard, and kind of shoot me out the door. But she didn't. And, you know, it definitely changed my outlook on life and on my profession and, you know, the service I want to give to the rest of my professional community. Additionally, as we've been talking about, there's the resources we have. Our anesthesia committee is probably one of the most supportive in terms of mental health for its professionals. AANA and its websites are so easily digestible. It's just aana.com slash, you know, you can put wellness or depression or stress and a website will literally pop up. So those are the two places I would start. You know, the 24-hour hotline is there as well. And, you know, multitude of different environments and different avenues. You know, there's just so many different ways, as anesthesia professionals, especially nurse anesthetists, that we can go to help each other and get help. Well, what a role model you are, Kevin, for, you know, being such a wellness advocate, you know, for our profession, for your fellow classmates. And thank you for, you know, being on this committee, serving it with us. And thank you for being on here tonight. I just want to say a couple things before I give Rigo the final words here, but we hope really that this was helpful for everyone. You know, and wherever you are on your path in anesthesia or your mental health recovery, wherever you are, we hope that you realize that you are definitely not alone. It's okay to struggle. It's okay to talk about our struggles. And, you know, if you see something, please say something. ANA and Parkdale all here to help and support you and offer you the resources to help. So with that, I want to thank everybody on the panel, and I'm going to give it over to Rigo to close this out and have the final words. Well, thank you. And thank you for each one of you for your tireless efforts and your work and being here tonight, taking time out of your day. You know, I just want to really highlight that, that this is all a volunteer campaign. This is just a group of people here, and there's an army behind you that are ready to help our colleagues that are in need. And, you know, this is a perfect testament as, you know, Kevin just articulated, you know, what do you think Kevin's going to do when he goes out and he sees someone that's struggling and needs help? So planting that seed early, it's going to prosper and it's going to spread throughout our entire organization. So my final thoughts to you are, please call if you need help, reach out, ask for somebody. This is a community that really cares. This is an organization that really cares about its members like I have never seen in any other organization before. It's a safe place. It's a confidential place. And we're here to do nothing more than to share our experiences of strength and hope with you, put our arms around you, help you recharge that battery and get back to your life and get back to your career. And then come back if you need another tune-up. That's what we're here for. So take care of yourselves above anyone else. Stay humble, stay grateful and stay in touch.

American Nurses Association

wellness committee

substance use disorder

nurse anesthetists

mental health

Parkdale

support systems

stigma elimination

employee assistance programs