Leading the way to Healing

  • Stressed NurseThere was no class in nursing school that taught me how to deal with watching dueling pediatric CPR’s in the same trauma bay. There was no multiple choice option for when to cry with a mother who is lying over her child who is unconscious, with little expectation of survival. There was nothing in college that taught me how to deal with my feelings of grief, guilt and fear. The expectation of “sucking it up and moving on” has always been present and so far it has worked, I suppose. 
    Being a nurse in a Level I Pediatric Trauma Center is not for the faint of heart. It is not for the weak or the sensitive.  And two years ago I found myself managing the entire department. Being a mother of four had always meant I “didn’t do peds”, it was too close to home. It is hard to outrun your fears when you are leading them. 
    Where do you find the strength to hold it together while hearing the scream of a mother who has just lost her child? When do you stop seeing her long brown curly hair in your dreams? Why does everyone else seem to be “handling it” and I still struggle? Death or serious injury of a child is perceived as the most traumatizing event for Emergency Department nurses, and yet, in the Pediatric Emergency Department, we choose to deal only with children. When do we stop overlooking the symptoms of distress and begin to teach proactive tools to prevent burnout and PTSD? For me, that begins now. 
    As I approach the final day of Critical Incidence Stress Management class, I understand that ‘normalization’ is a term that needs to become familiar. It is okay not to handle the death of a child with grace and poise.  It is acceptable to cry with a family who has just found out their child has cancer.  It is even normal to grieve beside a child whose mother died in the car on the way to her 10th birthday party. It is okay. We in nursing leadership roles need to be supportive of our staff’s stress and the difficulty of coping. Mandatory referrals to the Employee Assistance Program may not be the most humane way to treat those who work long hours in high stress environments. It is no surprise that ED nurses have some trouble coping when they are dealing with a third death for the week. Perhaps we need to better equip ourselves to become the help we hope we have when it is our turn to experience distress.
    Critical Incidence Stress Management (CISM) training is available and very useful.  It should be part of every manager’s orientation. Understanding that sometimes listening without planning your next move is enough to get your employee over the hump. In fact, it may be all they need to allow their own coping skills to engage to finish the healing process.  CISM is not therapy, it isn’t even counseling, it is listening and normalizing, it is providing basic needs and referring if all other options are exhausted. It is caring about our employees and helping them learn new ways to cope. It is about ensuring that paperwork isn’t the first thing on our minds.  It is about making our staff’s emotional, mental and spiritual health our priority. It is about humanity and the basic need to feel connected. It is bigger than the event, the department and even the organization. 
    Our patients deserve the best treatment, the best care and the best chance of survival.  As leaders, our staff also deserves the best available care and chance of survival. Pediatric care is not for the faint of heart and supporting our staff will demand we use ours more often. Caring more about who people are above what they can do for you is a staple in leadership.  It is part of caring about who they are and caring about how they feel in times of stress and distress. It is about checking in on their mental health as well as their emotional health. It is about simply slowing down enough to care.