Hui-Wen (Alina) Sato, MSN, MPH, RN, CCRN, is a pediatric intensive care nurse in Southern California and blogs at http://heartofnursing.blog. A direct link to her recent TEDx Pasadena Women 2017 talk should soon be available online.
I have had a couple of recent conversations with nurse coworkers who have been close witnesses to patient deaths that were particularly difficult. They told me how challenging it was to process the experiences with fellow nurses—even those whom they considered as good friends—in the hours and days immediately following the patient deaths.
Some conversations in the break room or in carpool rides would go into the medical details surrounding the deaths, but stayed away from discussing personal emotions beyond general statements such as “It was just really sad.”
Other conversations, they told me, were comprised of awkward silence—as opposed to a more intentional therapeutic silence, a deep listening. In both scenarios, my coworkers said they’d felt a lack of quality and depth in these encounters. While they hoped for an opportunity to talk with colleagues, who would surely understand the experience and details better than anyone else, ultimately they felt that they were left to sort out their thoughts and feelings alone.
Even in a unit where we constantly express gratitude for a strong sense of teamwork, my colleagues and I still struggle to help each other through the deeper experiences of grief and trauma.
A missed opportunity?
And at times when I’m in the charge nurse role and staff members are responsible for end-of-life care, I struggle to know how to help my staff—despite the fact that I’ve written, given speeches, and am a self-confessed overthinker about these types of issues.
I can recall one shift when I was in charge and we lost a patient after a rapid decompensation from cancer-related complications. I went to the nurses’ station and found the bedside nurse in tears, sitting with her neighbor who was also crying. They looked at me and said it was one of the hardest deaths they had ever witnessed. I offered them a few minutes off from the unit to absorb the experience and just breathe. They were grateful, but declined.
And although I knew we three nurses shared the same spiritual beliefs, and I considered offering for us to pray together, I hesitated. Finally, I just asked them to let me know if they needed anything at all and assured them I’d do all I could to support them. We left it at that.
Wrong place, wrong time?
I am wrestling with the question of why we hesitate or struggle so much to talk more with one another as colleagues about how our traumatic experiences affect us. Is it just a matter of how busy we are, of the impossibility of stopping long enough to process an experience? Yet we talk about all sorts of other issues in the break room and carpool rides, be it personal relationships, life changes, or even politics.
Is it that intense emotions would seem jarringly out of place during a shift focused on being present for our patients as competent and reassuring clinicians? Is there truly no room in our shift for the catharsis of our own grief, when time allows, so that we can be more present for our patients?
Or is it a cultural mindset we have developed about what it means to be a “strong” nurse? Does our definition of strength really not allow for vulnerability, sadness, and questions? Does the nursing culture hold enough space to allow one another to verbalize struggles as we all grow our muscles of resilience? And if not, how can we make that space?
A learnable, perhaps teachable skill.
As I thought through my own hesitations about how best to support my grieving colleagues, I realized that I simply have not practiced the skill of comfortably being present and supportive with colleagues at such moments.
When I was a new nurse, I learned my hands-on skills, and I learned how to be a bedside presence for my patient and their family. When I was learning the charge nurse role, I learned to facilitate throughput, manage emergencies, and staff the unit safely. But I had never specifically been taught skills such as using therapeutic silence, asking intentionally open-ended questions, and responding with reflection and follow-up questions.
Perhaps we simply have not identified these as skills that we could all benefit to learn as nurses to help ourselves and one another as a team. Perhaps we assumed these were skills some people simply had and others did not, or assumed these were skills that nurses would somehow learn on their own over time.
We are good at asking “Are you ok?”—which usually seems to obligate the respondent to just say yes. We are less comfortable asking questions that allow for the expression of unresolved, conflicted feelings, and with resisting the real temptation to try and direct the conversation towards some quick and tidy resolution.
I recognize that having these conversations with colleagues may not be for everyone after a traumatic or particularly grievous patient encounter. They can and should not be forced.
But for those nurses who would benefit from more of these types of conversations, I wonder whether or not we can begin challenging ourselves and each other to venture into these conversations, giving grace for the struggle to learn how to use silence, questions, and listening in more effective ways?
What greater good we might be able to do for one another as we work together through so many powerful and painful situations?