This nurse quit because of the stress. Now she helps others stay on the job.

Kerry Appleton wanted to be a nurse since she was a child, and yet her dream job in pediatric intensive care often left her in tears.

The stress drove her from front-line care after 16 years, but it prepared her for what came next in 2021 — when North Memorial Health hired Appleton as one of the first resiliency coaches in U.S. health care.

"It can be really hard to come back again" after losing a patient or suffering anxiety over tough medical decisions, she said. "The woulda, coulda, shouldas really stick in your mind."

North created Appleton's position at the height of the pandemic to help workers deal with the personal risks and patient deaths from COVID-19. But leaders of the Robbinsdale-based health system said she has been just as vital in the post-COVID world in which burned-out caregivers are leaving the profession.

Soon-to-be-published results from the Minnesota Healthcare Workforce Survey demonstrated the need. The share of inpatient nurses planning to leave their jobs in five years increased from 18% in 2019 to 21% in 2022. Of those planning to leave, the proportion listing retirement as the reason declined, while the proportion citing burnout increased from 6% to 21%. Burnout increased at lower levels among outpatient nurses as well.

Research is scarce on whether resiliency coaches make a difference, but a Canadian study found that hospital workers who received coaching during the pandemic were less likely to experience disrupted sleep, post-traumatic symptoms and burnout. North's vice president of human resources, Shannon Sloan, said she just knows that workers stick around after visits with Appleton, even after enduring injuries or assaults on the job.

"We're able to retain them. We don't lose them," said Sloan, who predicted that "if it weren't for Kerry, they wouldn't be back."

Burnout was an underlying concern that drove Twin Cities and Duluth hospital nurses to strike amid contract talks last year, and influenced legislation this spring to regulate hospital staffing levels.

The Minnesota Hospital Association last month recognized Appleton and North, which pays workers for spending time with the coach, even after-hours. The association also commended programs at Windom and Waconia hospitals to boost nurse morale, and HealthPartners' effort to reduce physician burnout from the overwhelming flow of messages and reminders from electronic records systems.

Appleton had transitioned from nursing at Children's Minnesota to training new nurses before she took the job at North, but she said her front-line experience makes her relatable — even though today's patients are sicker and families are more agitated.

"Society has changed," she said. "We are now post-pandemic and a lot has happened in the last three years."

What hasn't changed is the tendency for health care workers to care for others, but not themselves, or even to recognize how stress is hurting them, Appleton said. Most people need three to five sleeps to recover from highly stressful events, and yet she said they blame themselves when they haven't bounced back the next day.

"I lean a lot on the physiology of stress response to help people understand what is actually happening within them," she said.

Appleton said she sometimes meets with care workers off-site at public libraries, because being back at the scenes of high-stress events can be triggering. She advises them on such techniques as breathing exercises and drinking water, which can help tamp down stress-induced adrenaline.

"You don't need a yoga mat. You don't need a 30-minute break," she said. "You can do it anywhere and no one will even know that you are doing it."

The coaching service is promoted to North's incoming nurses and other caregivers, because the loss of new workers can be particularly painful for hospitals after they spend weeks or months training them.

Bridget Peppin thought it all seemed a bit cheesy when she sought Appleton's help last year, and was encouraged to use breathing to cope with the stress from her work as North's operations director for specialty care. But she had to try something, because the demands were piling up and she would carry the stress home to her family.

"I was struggling with letting go of the last fire that I was trying to put out," she said.

To her surprise, the breathing exercises helped. Appleton would practice with Peppin on the phone and made the activity feel normal. Peppin said she learned to appreciate five-minute breaks if that's all the time she had between tasks.

It worked so well that Peppin took the advice home and taught breathing techniques to her twin toddlers.

"I have this breathing ball that I hand to them," she said, "and they take deep breaths now when they get really mad."