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.”
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 2
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 3
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)
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 4
“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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 5
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 6
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 7
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 8
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
%
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 9
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
%
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 10
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 11
These two predictorvariables account for 12%
of the variability(R²=0.120)
However, Resilience isour only significantpredictor (p<0.001)
Predicting Burnout
-.209
-.026
These two predictorvariables account for 15%
of the variability(R²=0.120)
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 12
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 13
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
%
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 14
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)
These two predictorvariables account for 50%
of the variability(R²=0.501)
Work Engagement is ouronly significant predictor(p<0.001)
Predicting Compassion Satisfaction
.349
.104
These two predictorvariables account for 21%
of the variability(R²=0.201)
POS is our onlysignificant predictor(p<0.001)
Predicting Burnout
-.082
-.288
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 15
These two predictorvariables account for 13%
of the variability(R²=0.133)
POS is the onlysignificant predictor(p<0.001)
Predicting Secondary Traumatic Stress
-.049
-.212
These two predictorvariables account for 37%
of the variability(R²=0.370)
Work Engagement isthe significantpredictor (p<0.001)
Resigned Resilience?
.524
.185
Qualitative QuestionDefine Resilience
88%
12%
Answer No Answer
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 16
WHY ?
PROFESSIONAL
FACTORS
Professional Areas
0
10
20
30
40
50
60
%
Key Areas Identified
•Supervision
•Training
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 17
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 18
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 19
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
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 20
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?
CLEAR Annual Educational ConferenceRegulator’s Approach to Ensuring Registrantsare Resilient
New Orleans, LouisianaSept. 11-13, 2014
Council on Licensure, Enforcementand Regulation 21
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]