Taking Care of Our Caregivers

by Jessica Dudley, MD - July 06, 2020

For frontline caregivers, emotions have run high during the pandemic: anxiety about getting the virus and then exposing their families; fear of being re-deployed to jobs they had not previously done to treat a disease they’ve never seen; grief about the loss of patients, family members or colleagues; sadness about those who have lost their jobs or been furloughed. While we have seen the remarkable support for health care workers pouring in from communities across the country, less visible has been what leaders are doing within their own organizations to help their physicians, nurses, and the entire workforce cope.

To discover what these organization have done, and to learn from them, Press Ganey convened a virtual group of physicians, nurses, and other patient-care professionals from more than 50 organizations across 25 states who are leading efforts to support clinicians. Over the past 12 weeks, this “caregiver collaborative” has met virtually to discuss the unique challenges of frontline caregivers during the pandemic and share experiences and strategies. Topics have included caregiver safety, staffing, ethics, financial uncertainty, racial and social inequities, communication, physical health and emotional well-being.

Here are five emotional-support strategies the collaborative members’ institutions have launched or expanded to address caregivers’ emotional needs.

1. Encouraging Messages

At many institutions, leaders and managers highlighted caregivers’ compassionate work and emphasized the need for self-care.

Intermountain created a “caregiver going home checklist” that invites doctors, nurses and other caregivers to reflect on their important work and prepare for the transition to home:

1. Acknowledge one thing that was difficult: Let it go.
2. Consider three things that went well today: Be proud of the care you gave.
3. Check on your colleagues before you leave: Are they okay?
4. Are you okay? Your leaders are here to listen and support you.
5. Now switch your attention to home: Rest and recharge.

Valley Health System, in Bergen County, New Jersey, instituted weekly recorded calls from the CEO and COO to staff cell phones with words of support and gratitude; posted notes of appreciation in elevators, on badge readers and digitally in the lobby; and sent daily texts to nursing leaders reporting patient discharge numbers and providing messages of hope and encouragement.

2. Space to debrief and recharge 

Providing staff with ways to connect, either on site or virtually, encourages mutual support and a sense of community for those working in some of the most challenging units. At many institutions, now-vacant family lounges were re-purposed for staff use and stocked with snacks and drinks.

At Boston Medical Center, a team of psychiatrists and social workers rotate through ICUs and the ED, where they connect with staff and offer information about resources. Employees can also drop in to one of the unit family rooms to chat informally with a member of the behavioral health team during scheduled times.

Valley Health System created virtual peer groups called “resilience lounges,” which are offered twice a week. Hundreds of employees, including nurses, social workers, and administrative assistants, have attended these sessions. These groups use the caregivers’ going home checklist (with an added gratitude section) to structure the discussion.

3. Resilience resources

These include meditation, fitness and yoga instruction, meals to go, and facilities on site to shower and change before leaving for home.

Stony Brook Medicine provides clean scrubs to every staff member (including lab and environmental services workers and others) so that they can change before heading home. This eliminates the need to take scrubs home to launder, helping to control the spread of infection.

Boston Medical Center early on developed a suite of mindfulness practices ranging from physical movement to meditation, available both on demand and in live sessions. Sessions are free and available to the entire health care workforce as well as to family members. BMC is also transitioning a previously developed in-person, eight-week mindfulness-based stress reduction training to a virtual program.

4. Facilitated support groups 

Many institutions have developed virtual support groups that use trained facilitators to help build peer-group communities and provide behavioral strategies for dealing with the emotional challenges of caregiving during the pandemic.

Brigham & Women’s Hospital in Boston offers physicians and other clinical staff virtual “wellness huddles” led by a peer support specialist and joined by a behavioral health professional (either a psychiatrist or psychologist). Groups meet virtually through a secure online platform with video capabilities. Mini-lectures offer basic instruction in behavioral strategies for dealing with stress, anxiety, insomnia, grief, uncertainty, safety and trauma, and may be tailored to specific needs of the group. This introduction provides a jumping off point for discussion; while many participants speak up and share their experiences, no one is required to and some just listen. During its first 10 weeks, the program offered 47 huddles with 17 different departments or programs.

Columbia University Irving Medical Center in New York City established CopeColumbia which, among a number of support services, offers peer support groups, 30-minute, structured, virtual sessions facilitated by a psychiatrist-psychologist or psychiatrist-psychiatrist pair. Following a facilitator’s guide that applies evidence-based principles from cognitive behavioral, acceptance and commitment therapy approaches, facilitators frame the session, ask participants about recent difficulties, and then reflect on adaptive coping strategies, harnessing the power of the group to foster teamwork and community. The group concludes with appreciative inquiry (e.g., what went well this week), promoting expressions of gratitude. Initially offered to physicians, the groups now include all employees across the medical center. The groups emphasize peer support rather than formal psychotherapy, to acknowledge the unique circumstance of the Covid-19 pandemic; this helps participants normalize, process and accept a range of challenging feelings, enhancing resilience. The ongoing program launched in March and has facilitated more than 184 groups, reaching more than 950 providers.

5. Rapid access to mental health support

As caregivers often do not seek out mental health support, many institutions actively promote resources, often through Employee Assistance Programs (EAP), and in some cases, departments of psychiatry or social work. Recognizing the increased need for support, many also instituted additional services.

Intermountain Healthcare provides an emotional health relief hotline to community and caregivers, available from 10:00 AM to 10:00 PM seven days a week. Resources include information on self-care, at-home support and crisis response across the state of Utah.

Brigham & Women’s Hospital transitioned its in-person rapid access mental health program for its physicians to a secure, virtual platform often available the same day or, if not, within 24 to 48 hours. The program provides a free 30-minute, confidential consultation with a psychiatrist or psychologist to any physician feeling stressed, anxious, overwhelmed or burned out. If ongoing treatment is needed, the program schedules follow-up visits with a mental health provider, including connecting physicians to community resources and providers who have volunteered to support frontline clinicians during the crisis.

Versions of the five support strategies described here have long existed but have been dramatically expanded to meet caregivers’ needs during the pandemic. As this pandemic subsides, provider leadership should evaluate whether some should be continued in their expanded form. While some of the stressors frontline clinicians are experiencing are unique to the pandemic (such as fear of infecting loved ones) others are more like amplified versions of stressors clinicians have always experienced. Programs that support peer communities, validate clinicians’ extreme stressors, provide acute mental health care and help with chronic issues like burnout can address the long-standing challenges clinicians face every day, during a pandemic or otherwise.

The author would like to thank Pamela Bell, Natalie Dattilo, Laurel Mayer, Mary McCarthy, Anne Pendo, Susannah Rowe, Nicole Rossol and Jo Shapiro for their valuable contributions to this work.

Jessica Dudley, MD, is Chief Clinical Officer at Press Ganey and an assistant professor of medicine at Harvard Medical School.