This article is for all of the frontline healthcare teams working at hospitals across the country—thank you!
I am blessed to have worked with top-notch leaders who frequently informed our team: "If you come to me with a problem, it would be helpful if you had an idea for a possible solution." That's how this article started.
As a healthcare professional, you know there's stress, and then there's traumatic stress. The kind of stress that stays with you and is not always easy to manage but makes you hunker down and keep going because that's who you are; that's what you do.
When the rest of us are asleep or celebrating holidays with our loved ones, healthcare professionals across the country are leaving their families to go and care for ours.
But when you add the dynamics and challenges of a global pandemic like the coronavirus to your career, which is already stressful, learning how to cope now needs to be significantly more comprehensive.
Here are seven strategies to consider when navigating traumatic stress in an acute, fast-paced, healthcare organization:
Your career in healthcare challenges you to have difficult conversations with the patients and families you serve. Because of this, physicians and nurses use the defenses necessary to manage their emotions during each interaction they have.
When you consider that there are over thirty defenses you can use to manage your feelings and hundreds of words to express the feelings and emotions you have, this can be a challenging process—almost an art form. Because while you're feeling these feelings, you need to maintain composure, professionalism, and tact while having some of the saddest conversations patients and families will hear. "I'm sorry; she's not going to make it through the night." "We have the results of your tests, why don't we sit down and discuss them." "Your son has been in an accident; we'll bring you in to see him in a moment, but first, I need to explain his injuries…"
When I worked with an Emergency Department team preparing for a code, I never witnessed anything other than intense professionalism, compassion, and collaboration. Some nurses later described their mental preparation as "putting on my game face" to help them work as quickly as possible to save each patient's life in their care.
When I think of what the term "game face" really means, my thinking is that this consists of the top defenses used to help our teams cope with the challenges faced daily.
While a "game face" may work for a problematic code or a high-volume period, it will not work for the length of a global pandemic.
Sir Isaac Newton's third law states: "For every action, there is an equal and opposite reaction." In this case, this means that for every "game face" period you (as an experienced healthcare professional) use, you should have an equal amount of time to focus on being present for your colleagues and the patients in your care.
Presence means drifting back a little (and yes, this is a relative term that depends on your ability to do so during your shift) and having more authentic, supportive conversations with your colleagues and patients.
The most important lesson is not to just hunker down and use your defenses to navigate through each shift. Take the time to validate the work being done by your team so that you all feel supported.
Analyze your shift when it is over, the experiences you had, and the lessons you learned. Ask yourself the following seven questions:
- What was the most challenging situation I experienced during my day?
- What was the most difficult conversation I had with a patient or colleague?
- What was the most intense emotion I felt?
- What was the best part of my day?
- What did I see one of my colleagues do that inspired me or made me change the way I do something?
- What was something a patient or colleague told me that was supportive or motivated me during my shift?
- What is something positive I learned about myself today?
These debriefing type questions are essential to ask because their answers anchor the lessons and experiences you attained during your shift.
Across the country, there is an increased awareness that you have exceeded selflessness as a result of your presence every day at your hospitals and clinics without always having the equipment, support, or staffing you need.
Keep going, but don't lose sight of these three key points:
- Selflessness is an admirable quality, but please pay attention to your needs as much as you do for everyone else in your care.
- Set your team up for success by modeling leadership and professionalism—even if it's not in your job title.
- Anticipating your team's needs will help provide support and cohesion while also reducing unanticipated stress or complications.
In any healthcare environment, you will have conversations with patients, and families are some of the most difficult ones to hear. Your goal is to have the conversations you need to have as tactfully as possible, taking into consideration their feelings and emotions.
The more authentic you are, the more comfortable and engaging your conversations will be. The other important factor to consider is paying attention to micro-expressions.
Micro-expressions are the split-second non-verbal expressions you see on the faces of the people you're speaking with. If they appear to be questioning what you're saying or don't understand the words or terminology you may be using, stop the conversation and check-in with them. Ask: "Tell me what you heard me say," or "Do you have any questions that I can answer before I continue?"
Remember that, like you, the patients and families you are communicating with are also using their defenses to help them manage their feelings and emotions related to their care (or the care of their loved ones). They may feel scared or anxious because they may not understand the terminology or acronyms used.
Some examples of the defenses we use include intellectualization, rationalization, humor, and sarcasm—just to name a few. While they help us cope with our emotions while we continue to work in our departments, they also serve to conceal emotions like sadness, anger, frustration, resentment, stress, and irritability, among others.
These defenses are appropriate, and healthcare professionals have a way of using them all in an immensely self-protective manner that supports you and your team throughout your shift.
The challenge is making sure you can talk about your feelings when the time is right. Strategies such as talking to colleagues, journaling or video blogging, exercise, and talking to family members or friends are all essential when discussing your feelings. Most importantly, make sure you take the time to get them out instead of "stuffing them" or completely detaching them.
Your intuition is critical. It's that gut feeling you have that tells you "look a little closer at this lab result," or "pay more attention to the nonverbal expressions of your patient," or "listen closely to what your team is telling you about how stressed they feel."
Your intuition is equally as crucial as your intellect and professional experience, especially when having critical conversations with patients and families. Whether it's a pause in a conversation, a look on a patient's face, or a sense that something's not quite right, it's essential to pay attention to your intuition and listen to it.
One of the biggest challenges in healthcare is not always knowing who will be coming through the door next, how acute their symptoms will be, and who they may or may not have with them for support.
From your interactions with them, you will learn that your patient is a father or mother, sister or brother, partner, or spouse. The more time you spend with them, the faster they will transcend from the "patient in room 4" to someone with a name, a family, a legacy. You may not have the time necessary to know all there is to know about them, but you will have enough time to engage with them in a manner that shows you their challenges, vulnerability, strength, and heart.
Keep an open mind about who they are, as their relationship with you may be the last interaction they have.
Navigate To Your True North
You chose your career in healthcare for a reason. However, a global pandemic may not have been on your radar, and now the challenge becomes how to navigate your emotions, conversations, interactions, and stress.
You: Develop a routine that will help you navigate these difficult days ahead. While you can't always predict what's going to happen, you can control how you respond to it. The more of a routine you can develop for yourself, the less stress you will have.
Your career: What's your why? Why did you decide to have a career in healthcare; what was it that attracted you to working with patients and families? The more grounded you are in your reasoning and the foundation of your career, the easier it will be to cope with your stress.
Your team: Pay attention to how your team is doing. Are you all working collaboratively and cohesively? If you notice that a colleague has called out, check in with them. While they may say they're "handling everything," they may not be. They may attempt to show you that they can keep up with the team and the demands of what's going on when, in fact, they may not be able to, which is difficult to admit when you know your team is depending on you. Take the lead; you will stay stronger together.
Your family: How are you communicating with your family, and how are they managing the "perfect storm" of the stress of your career, being isolated at home, and not knowing how long this global pandemic will last?
Establish a routine time to check in with each other. The more you can build a set routine that works for you and your family, the easier it will be for all of you to navigate your stresses and challenges.
Your children: Pay attention to the way that you're communicating with your family. They know you are under a lot of stress that they may not comprehend (especially if you have younger children). Tell your family a little bit about your day. Using age-appropriate feeling words like "happy," "sad," "good," or "bad" will help them understand a little more about the care you are providing and help reduce their stress.
Here's the thing:
Retaining an experienced top-notch healthcare professional is critical. Nothing good comes from losing a highly qualified professional on a top-notch team. And this is my "why" for coaching and training the healthcare professionals who care for all of us. My goal is to help healthcare teams nurture and navigate their careers while improving relationships with family and friends and colleagues at work and creating a better work-life balance.
Let's get to it.
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Additional Recommendations & Resources
- Video: Martin Alderton: COVID-19 Helping carers and parents help younger children understand the Pandemic
- Article: (New England Journal of Medicine) The Code
- Article: (Harvard Business Review) How to Deal With Constantly Feeling Overwhelmed
- Certification: International Critical Incident Stress Foundation: Information on how to become certified in Critical Incident Stress Management
- Article (Mayo Clinic) Covid-19 And Your Mental Health
- Article: (New York Times) How to Find A Hobby
- Article: (Work It Daily) Looking Forward: A Post-Crisis Playbook For Winning On The Other Side
S.A. Leys is a healthcare consultant and coach with 20+ years of expertise in management, program development, process improvement, coaching, and training for nurses, physicians, and the healthcare teams who care for all of us. Visit us on the web at www.Coachingfornurses.io.