The tragedies that play out in hospitals affect not just patients and their
families, but the nurses and doctors who care for them.
In one day, a hospital staff could treat a child gravely injured in a car
accident, lose a patient to a terminal illness and comfort a family member
whose loved one is in surgery.
Healthcare workers develop a sort of emotional armor, but it can wear thin.
Many say they need space to decompress after regularly witnessing the
most devastating moments of people’s lives.
“If we carried every single one of these deaths with us, we wouldn’t
even be walking anymore,” said Darlene Warren, a nurse at St. Joseph
Hospital in Orange. “You have to get rid of it.”
Hospital administrators nationwide are increasingly recognizing the toll
of health workers’ day-to-day duties and the risk of burnout and
symptoms similar to post-traumatic stress disorder. The problem has been
garnering more attention amid recent mass shootings and destructive fires.
Jessica Thomas, a critical care nurse who started a program at USC to address
secondary trauma, said caregivers who don’t talk about their suffering
might shut down and stop bonding with patients altogether.
“It’s really hard to admit you can’t handle it,”
Thomas said. “But the very thing that makes us good caregivers,
in terms of being able to connect with people, can also be the most dangerous
thing for your career when you get your heart broken.”
‘It reminds you of your brother, your sister, your mother, and that’s
when you cry’
At lunchtime on a recent weekday, dozens of staff from St. Joseph Hospital
shared stressful on-the-job experiences. The hospital recently began a
program called Code Compassion that hosts these regular meetings.
One woman described an agitated patient who grabbed a nurse and pulled
her too close, frightening her. Another said her staff were upset after
a patient repeatedly asked not to be seen by healthcare workers of a certain race.
Linda Boose-Shutes, a nurse at the hospital, said seeing hundreds of deaths
doesn’t make you immune to loss.
“It reminds you of your brother, your sister, your mother, and that’s
when you cry,” she said.
The Code Compassion program also allows employees who feel stressed to
call the hospital operator, who alerts a staff member who will come find
them and bring water bottles, cookies and pretzels.
That gives the employee a few minutes to talk about and process their negative
feelings, said Gemma Seidl, the program’s architect and executive
director of critical care for the hospital.
“There wasn’t an avenue for ‘take a deep breath and I’ll
take care of it,’” she said.
First responders can also suffer from PTSD
In 2004, North Hawaii Community Hospital launched one of the first such
programs, called Code Lavender.
The hospital, in the northern part of the Big Island, offers aromatherapy,
reiki and pet therapy. The Code Lavender program was named after the emergency
alert Code Blue — but instead references essential oil that promotes
relaxation — and was started for patients, but soon expanded to
include staff, said hospital spokeswoman Lynn Scully.
Because it’s a small community, staff may know the young boy who
was brought in after a serious skateboarding accident, she said. Patients
may be related to someone who works at the hospital. Anyone who needs
a few minutes to recuperate can call a Code Lavender and talk to colleagues
in the hospital chapel.
“There’s no on-stage and off-stage, you have to be ready to
go all the time,” Scully said. “You have a really hard job
— sometimes it’s even harder when it’s stuff like that
— and we’re acknowledging that.”
Studies have suggested that repeatedly dealing with trauma leads to more
anxiety in healthcare workers, as well as more drinking and other coping
behaviors. Researchers say that years of helping people in stressful situations
can cause symptoms that mimic the PTSD that’s common among people
who’ve suffered a traumatic experience firsthand.
The U.S. Department of Justice created a
Vicarious Trauma Toolkit to address the work-related trauma that first responders, social workers
and others may have after working with victims of crimes or other tragic
events. Vicarious trauma can cause people to feel hopeless, fatigued,
aggressive or scared.
USC’s Thomas recalled a 26-year-old man who was in the hospital for
months and died waiting for a heart transplant. The nurses had befriended
him and his family as they kept his spirits up.
“It’s like losing a friend,” she said. “It was
If an organization doesn’t address that pain as normal, the negative
feelings can chip away at workers’ identities and make them feel
as though they’re not cut out for the job, said Thomas, who is the
clinical director of the Emergency Department at USC Verdugo Hills Hospital.
It can also cause them to become less compassionate over time, a phenomenon
known as compassion fatigue.
Healthcare leaders need to create a place where workers can say they’re
not up for a certain task and be met with, “‘It’s OK,
I still respect you and I think you’re awesome,’” Thomas said.
Thomas started a Code Lavender program at USC two years ago that delivers
a “healing” basket with tea, lotion and other calming products
to anyone in need. Her program was inspired by one at
Cleveland Clinic, where she used to work.
Jessica Shaw, a professor in the Boston College School of Social Work,
said the need for such programs for caregivers and first responders has
become especially clear in the aftermath of mass shootings and other major
“We have folks who are in hospitals just mopping up blood. …
We need to really attend to their health,” Shaw said.
At St. Joseph Hospital, a Code Compassion has been called 12 times since
the program was launched in July. Once was in October, when staff were
worried about a colleague who was at the music festival in Vegas that
was terrorized by a gunman.
Seidl said hospital staff have been asking her to hold the group meetings
“Times have changed, and there’s so much craziness on top of
what we do,” she said.