Q&A with Tim Cunningham, DRPH, Co-Chief Well-Being Officer of Woodruff Health Sciences Center

Rethinking Resilience


a portrait of Tim Cunningham

Tim Cunningham, RN, DrPH, MSN, FAAN, didn’t take the conventional path into nursing; he followed his red clown nose into it.

The new co-chief well-being officer for Woodruff Health Sciences Center has volunteered for two decades with the nonprofit Clowns without Borders, which brings laughter where it is needed most: in hospitals, refugee camps, and conflict zones around the world. 

The adversity and resilience he witnessed while clowning in the most dire of circumstances inspired his pivot into nursing and his subsequent focus on resilience and well-being in public health. He now draws on those experiences as he works to improve how the health care system supports nurses who are burned out, stressed out, and overworked from the pandemic.

Q. What parallels do you see between your clowning and your nursing experiences? 

A. There’s a concept called compassionate resonance. It occurs when, as a nurse, you walk into a space of suffering. You see the suffering. You see what’s going on. And for a minute, you experience it. But then you do something to reduce the suffering, to change the energy in a room by simply listening, being present, and improvising in the moment. Not improvising to be funny but by being present and authentically compassionate. From compassion, we find laughter. We find joy. We find love.

That’s what we do as clowns. We see the space. We improvise with the space. And in changing the energy, hopefully people end up laughing and feeling better. So, clown and nurse—it’s the same thing, just different outfits.

Q. What are your goals for your new role as co-chief well-being officer?

A. Dr. Chad Ritenour and I were asked to set up this office so that we can do a few things. One, support people who are offering real-time here-and-now interventions around well-being. 

Two, to build bridges across the Woodruff Health Sciences System. When I got here in 2019, I learned that the right hand often has no idea what the left hand has done. There is so much great work going on here. How do we build awareness of it and, in doing that, name and elevate the individuals who are doing good work and bring those voices forward. 

And then third, support meaningful research. We don’t need any more cross-sectional surveys to measure how much burnout we have, because we know we do. We need studies that measure what’s making that better. We want to see what tangible change can look like and how we can support it.  

Q. How do you define resilience?

A. I don’t like the word resilience. It’s overused and causes harm if not used properly. For example, you’re a nurse who is working insane hours, doesn’t have the supplies you need or break coverage. If I say, “You just need to be a little more resilient. Go do a little more yoga or meditate more. You need to fix yourself, even though you are not actually broken.” We are putting the burden of blame and resilience on the shoulders of the people who are suffering.

So, if I had to define resilience, resilience is about systems and structures that create work environments in which individuals can be their best selves and that provide meaningful policy that supports health care workers when they receive violence from patients. 

Q. What systems, structures and policies should leaders scrutinize and implement?

A. Policies that give someone support when they experience bias. Policies that support rest and hydration. Policies that care for the individual and not the bottom line. That’s resilience. It means building well-being rooms on units where people can pause and take a breath. It means changing cultures. It means changing the way we support leaders to help them authentically and compassionately focus on the humans who work for them.

We need to look closely at scheduling. A lot of people are leaving the workforce because they don’t want to work 12-hour shifts anymore. A key cause of burnout is a loss of a sense of autonomy. So, how do we, as leaders, build as much autonomy as possible into our workflow so our nurses can feel autonomous? 

It’s also about addressing abuse and incivility between professions. It is leaders not tolerating that any longer. But it’s not punishing people for it; it’s supporting people to help them think differently. 

So you have to think about these larger systems. It’s not about, ‘Hey, go do some yoga.’ That tide is turning, and that’s really exciting. 

Q. While those changes are in progress at the macro level, what tools can clinical teams proactively incorporate into their daily routines to improve resilience? 

A. I prefer the term agility to resilience. Agility tools are evidence-based tools, things that you can do in the moment to reground and reach into yourself to be present. We know the more present you feel, even if you’re suffering, can lead to better outcomes over time: less stress, burnout, and distraction. 

Some tools are things that an individual can do, such as focusing on their breathing. But some tools also broaden out for leaders. For example, incorporate a pause at the end of a tough meeting, to reflect on the wisdom and knowledge that everyone brought to the table,  to reflect on how we can use that to improve the lives of our patients and families. We sit in silence a few seconds, then go about our work. 

Agility tools are unit based. Leaders need to ask what tools their teams are already using, elevate the voices of the individuals doing that work and share it with the team, which can then change the culture of the unit and the system. 

Q. What advice from your book, Self-Care for New and Student Nurses, is especially relevant for nurses right now?

A. You’re good enough. You’re strong enough. And you’re wise enough. It begins with that. Everything else is learning authentically from others the tools that you can practice every day to continue to build up that self-care

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