Resiliency: An Essential Skill for Preventing Burnout and Compassion Fatigue

Nancy McCool, LICSW, ACHP-SW,AHPSW-C

The Covid-19 epidemic exacerbated the already critical situation of burnout and compassion fatigue among healthcare providers. Today, healthcare systems continue to struggle to hire and maintain a skilled workforce. Proposed solutions for supporting staff include proactive mental health treatment and support for caregivers experiencing burnout and improvements to the efficiency of electronic health records.

A large part of the attraction for those who choose to work in healthcare is compassion satisfaction. It derives from caregivers’ positive feelings about their ability to help others, and it also includes feelings of camaraderie among colleagues and the significance felt from contributing to the greater good. When burnout and compassion fatigue erode compassion satisfaction, self-care strategies are one of the most effective and extensively recommended methods for attaining it.

Unfortunately, routine self-care has historically seen poor participation among healthcare workers, due in no small part to the culture of the medical field surrounding emotional exhaustion, which is seen as “just part of the job”. Clinicians may be aware that stress is an occupational hazard but may not be aware of just how much they have been affected by it. Stigma and isolation are barriers to the success of well-being efforts, and the ethos that vulnerability is a sign of weakness is reinforced regularly. As a result, programs that rely on self-referral often fail because they require clinicians to admit they need help, thus reinforcing the stigma around asking for it.

Programs in the workplace to enhance resilience skills, to prevent, rather than treat, burnout and compassion fatigue, and promote compassion satisfaction provide opportunities for team members to immediately apply what they learn to their day-to-day-work, thus experiencing the beneficial effect of the intervention in real time. When healthcare workers can address work stress at work, they have more emotional capital to spend with their families and loved ones.

As the lead social worker on the inpatient palliative care team at UMass Memorial, I wanted to create a wellness program that would support the concept that resiliency is a skill that can be mastered and that doing so could mitigate distress for our team. Our wellness program is supported by many of the research findings, including leadership buy-in, peer support, practicing resilience as a community, short self-care interventions that take place at work, providing a safe space for debriefing and sharing of ideas, and practicing gratitude. The main parts of the program are listed below:

Leadership support: The leadership of the palliative care team fully support and participate in the wellness program

Peer support: A “Buddy System” was created to provide one to one support. Two colleagues are paired together. They check in with each other once per week via their shared preference of text, phone, email, or in-person. This provides a work environment of support and validation. It allows for addressing work related stressors at work.

Opportunities to practice resilience skills as a community:

Shout Outs: The palliative care weekly interdisciplinary team meeting (IDT) begins with Shout Outs. This is an opportunity to publicly thank a team member for their teamwork, support or help at a crucial time during the week.

Reading of the names: The names of the patients who have died are recorded in a book and read aloud by a team member during IDT. Colleagues who may have cared for that patient can say a few words about them if they wish.

The Cleveland Clinic Pause: A team member then reads the Cleveland Clinic pause, which honors the personhood of someone who has died, and the work provided by the healthcare teams. It is followed by a moment of silence. “Let us take a moment to pause and honor our patients. They were someone who loved and was loved. They were someone’s family member and friend. In our own way and in silence, let us take a moment to honor them. Let us also honor and recognize the care provided by our team.

5 Minutes of Wellness: If time allows, 5 minutes of wellness includes one of the following: chair yoga, mindfulness meditation, quick journal exercise, music, or gratitude.

Gratifriday: After Friday morning rounds, the team takes a few minutes to write 10 things for which they are grateful. They can share with the group what they’ve written for that day.

A yearly retreat: This is an opportunity for the palliative team to get together in a non-work environment and participate in wellness activities.

Access to resources: Since team members may have different needs and respond better to different kinds of wellness activities, all team members have access to wellness resources, including resources provided by UMass Memorial, as well as meditation sessions (walking, guided, and silent) yoga videos, CBT resources for countering negative thinking habits and relieving anxiety, journaling, access to art supplies, and musical instruments. All these resources are designed to provide a short respite (usually 5 minutes at the most) for team members to access throughout the day as the need arises.

It’s worth considering implementing a wellness plan tailored to your group’s needs. For almost 3 years, the UMass palliative care team members continue to perceive the team wellness program as a useful, easy-toimplement intervention for mitigating personal distress, burnout, and compassion fatigue by providing a strong sense of support and connection to team members. Some have reported that it has reduced their emotional stress by giving them a safe person and environment to express their feelings and practice self-care without stigma. This program could be adapted to the unique needs of other healthcare teams owing to its simple design, leveraging of existing relationships and low cost. A strong team wellness program, especially the peer support “Buddy System” means that healthcare workers need not wait until they exhibit signs of stress before they ask for help, nor need they admit that they have a problem before they can access support.

Bibliography:

1. Nancy McCool, Jennifer Reidy, Shawna Steadman & Vandana Nagpal (2022) The Buddy System: An Intervention to Reduce Distress and Compassion Fatigue and Promote Resilience on a Palliative Care Team During the COVID-19 Pandemic, Journal of Social Work in End-of-Life & Palliative Care, 18:4, 302-324, DOI: 10.1080/15524256.2022.2122650

Nancy McCool, LICSW, ACHP-SW, AHPSW-C is the lead palliative care social worker in Division of Palliative Care at UMass Memorial Medical Center Email: Nancy.mccool@umassmemorial.org