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Critical incidence stress management for health care workers

The HOPES team: Anu Aygun, Nicole Markovits, Nancy Barbach, Adrian Mazur, Rachel Bosswick, Christine Milner, Gina Covelli, Amy Nadel, Jonathan Fish, Jessica Salisbury, Jedidah Harris, Abby Slaven, Lauren Horowitz, Brittney Whitford, Christine, Marigliano
The HOPES team: Anu Aygun, Nicole Markovits, Nancy Barbach, Adrian Mazur, Rachel Bosswick, Christine Milner, Gina Covelli, Amy Nadel, Jonathan Fish, Jessica Salisbury, Jedidah Harris, Abby Slaven, Lauren Horowitz, Brittney Whitford, Christine, Marigliano

Cohen Children’s HOPES team provides valuable coping mechanisms for clinicians experiencing stress and burnout symptoms. One anonymous provider tells how it has opened avenues.

Stressful moments in medicine can lead to taxing emotions within health care workers. If ignored, these can contribute to burnout and symptoms can begin to set in.

Speaking on anonymity, a provider within the Division of Hematology/Oncology and Stem Cell Transplantation at Cohen Children’s Medical Center recently discussed his/her experience with these situations. He/she is referenced as Clinician X.

The division sees 200 new childhood cancer cases each year. Based on a national childhood cancer survival rate of nearly 80 percent, approximately 40 of these children will die. To help deal with the stress that often comes with seeing the devastating impact cancer has on kids, Clinician X found a resource in the division’s Helping Our Peers Endure Stress (HOPES) team, a 15-member all-volunteer peer support team dedicated to improving the wellbeing of staff members who can benefit structured peer support after a critical incident.

HOPES was spearheaded by Jonathan Fish, MD, a pediatric hematologist/oncologist and founder of the Cohen Children’s Survivors Facing Forward program, in response to the burnout epidemic that has permeated health care nationwide.

“Medicine as an institution never evolved beyond the need to handle bad situations and just move on,” Dr. Fish said. “There is an archaic mentality and an expected toughness during your training. This mentality never shifted.

“When bad things happen, rather than taking it home and dealing with it on one’s own, there are structured ways to address critical incidents. We take a proactive approach — let’s make sure that we are taking care of ourselves.”

Since inception earlier this year, HOPES has provided valuable assistance to about 75 individuals, including Clinician X.

Overwhelming stress

Seeing kids with cancer each day can weigh on your heart enough. And when a child passes away, it can leave an emotional hole that may be difficult to heal without proper coping resources.

Telling the story of a one-and-a-half-year-old who suffered from leukemia, Clinician X presented a roller coaster experience.

“It was ups and downs,” Clinician X said. “I felt like I was going with the family throughout the entire process. Even though the family hoped for a cure, they came to terms with it. There were a lot of emotions. When the child passed, it ended up being a peaceful death at home. I had all this stress building up that I didn’t realize. I didn’t have time to reflect on it until he passed away.”

Death is an unfortunate yet true part of health care. Clinician X knows this. Add in unique situations that carry even more emotional burden, and the stress can be overwhelming.

After X endured the experience of the child with leukemia, another negative experience arose. This time, a family of a sick child refused traditional medical treatment and became verbally offensive.

“They tried to use intimidation,” Clinician X said. “They labeled staff members as good or bad and were very accusatory. They had no trust in the medical team.

“I wasn’t terrible at my job. This is a human reaction. The constant pages and phone calls and emails about the case. It was like being hit left and right. I would dread coming to work.”

Clinician X found relief in HOPES, which offered opportunities to openly discuss these feelings and symptoms. “Both of these cases were emotionally challenging for me,” Clinician X said. “The one thing I learned is that this hospital supports staff members. You don’t feel like you are alone. 

“When you’re in school, you’re not taught to take care of yourself. I learned on the job, and pushed down emotions. Rather than just moving on to the next case, here we can speak with other team members. It builds confidence to feel connected.”
 

quotation mark This is an approach that can be broadened. A year into it, our team is still highly committed. It’s very easy to get it integrated. It’s part of what we do for new staff and new fellows. It’s a culture change and any culture change takes time, but we are very encouraged.
Jonathan Fish, MD

How does HOPES work?

Dr. Fish developed HOPES based on a model established by the International Critical Incidence Stress Foundation, which works with emergency organizations like police, fire, EMS and some military branches. He solicited volunteers at Cohen Children’s to develop and implement HOPES, joining team members from various disciplines.

“We respond to critical incidence, bad deaths, medical errors,” he said. “It’s not to address the medical care or management of the patient, but to address the staff and their responses to these incidents to make sure they are OK and doing well.”

HOPES members underwent a three-day formal training in November 2017 and the team began its work earlier this year.

Depending on the situation and personal preference of the employee, HOPES offers three services — debriefings, defusings and one-on-one conversations.

For debriefings, Dr. Fish said two or three responders assemble within 72 hours of the incident to review the situation and allow the employee to express how the incident impacted them. Debriefings are structured and utilize stress management techniques that can help identify when someone is at real risk. If needed, HOPES will refer employees to Northwell’s Employee Assistance Program.

Defusings are group discussions that happen within hours of an event. “These are used if something bad happened,” Dr. Fish said. “A team will be deployed immediately to counsel with those directly involved. They allow the employees to express how they feel. We also evaluate whether they can get home safely and work their next shift. One-on-ones can be offered at any time or with anybody.”

Moving forward

Clinician X took advantage of HOPES debriefings.

“For me, when I heard other people speaking about it, it was a sense of relief,” X said. “It was so unbelievably helpful in having the opportunity to share my reactions. You aren’t provided that opportunity on the day to day.”

HOPES offers that, and Dr. Fish said he hopes it can be expanded to other divisions within Cohen Children’s, and ultimately to hospitals across Northwell Health.

“My personal hope is for it to be heavily utilized,” he said. “This is an approach that can be broadened. A year into it, our team is still highly committed. It’s very easy to get it integrated. It’s part of what we do for new staff and new fellows. It’s a culture change and any culture change takes time, but we are very encouraged.”

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