Processing Clinician Grief and Burnout During, and Outside of, a Pandemic

By Matt Phillion

In the worst stretches of the COVID-19 pandemic, healthcare professionals were profoundly impacted by the rigors and trauma of their work. Experiencing daily challenges associated with the harsh realities of COVID-19 brought the topic of grief and burnout to top of mind for many practitioners.

Yet clinician burnout as a whole did not originate during the pandemic. Stephanie Queen, senior vice president of clinical services and chief nursing officer of Air Methods, an air medical transport organization, began researching clinician grief and burnout as far back as 2004 to better help her colleagues—and herself—with the experience.

“My entire career I’ve been surrounded by death and dying,” says Queen. “I started out my nursing career in adult oncology and transitioned into pediatric oncology, and since the early 2000s I’ve really focused on pediatric ICU and critical care. In school, they do a great job of preparing you for how to physically care for the patients, but a gap still exists in preparing nurses for how you’re going to be changed by the things you see.”

The trauma that medical professionals witness isn’t “normal” for an average person’s experience—let alone the trauma associated with COVID-19, unprecedented in our lifetimes.

“At the beginning as we were preparing—and I remember first hearing about it in January of 2020—it was reminiscent of swine flu or Ebola,” Queen says. “But burnout and compassion fatigue were compounded by the pandemic. While others were isolated, we were still going to work—others had the ability to work from home, which was a beautiful thing, but for those of us who were still out there providing care, we faced concerns about our own mortality, and particularly from the Air Methods standpoint, we were seeing the worst of the worst, transporting potentially positive patients.”

For herself and others in leadership roles, concern for the staff keeps them up at night, Queen says. Keeping up with best practices and adapting to the latest recommendations is one thing, but the simple act of encountering seriously sick patients remains a shock to frontline staff. The weight of it has taken a toll on healthcare, Queen says.

“It was hard even before the pandemic,” Queen notes. She recalls that during her research, she came across literature stating that 55% of nursing staff said they would not enter the profession if they had a chance to do things over.

During COVID-19, many clinicians found themselves pushed to their limits—working in organizations that were over capacity, or transporting very sick patients. Adding to clinician stress was a change in care-seeking behavior. Queen notes that more patients avoided care until the last minute because of fear of COVID-19, which meant that systems were seeing even sicker patients.

“We’ve tried to relay the message: Don’t wait, seek care,” she says. “But the volumes were so low, even in pediatric care.”

Caring for the carers

Air Methods actively decided to continue providing services during the pandemic. “We chose to transport COVID patients, and felt very strongly that we had to do it,” says Queen. “It was important for us that these patients were able to be cared for, no matter how unknown the situation.”

The organization adapted quickly, sending resources to hot spots where ventilators and other equipment were in short supply. But Air Methods also had to keep its staff’s well-being in mind. “Our biggest concern was that we wanted to provide care in the community, but how do we keep our employees safe?” says Queen.

This started with communication. Queen describes talking with staff in New York early on, and how they agreed with and were up to the task of providing pandemic care—but leadership had to remain available to any questions or concerns.

“We were making sure we were talking to them, ensuring they had the support, having a lot of open platforms to answer questions,” says Queen. “And we specifically talked to them about grief. You want to first help them to recognize the symptoms of burnout, and make sure they’re well rested and able to recognize the burden placed in their hands.”

This open communication helped enable peer support between clinicians and other support staff. “We wanted them to know that what you see is not normal, and it’s OK to not be OK, to say, ‘I’m having a rough day,’ ” says Queen. “It’s about supporting them transparently.”

And this meant sharing those concerns from the top down. Queen says that if leaders are willing to demonstrate such openness and admit when they are struggling, staff will feel empowered to express those struggles as well.

“I had one mentor specifically who said, ‘I’ve done this for so long that I give all I have when I’m at work, and when I get home I have nothing to offer,’ ” she says. “We pride ourselves in caring for others, but often don’t take care of ourselves.”

Sympathy versus empathy

In her research, Queen came across documentation on the difference between sympathy and empathy, and says that empathy is a place where healthcare has room to improve.

“In healthcare, often we want to just fix it—that’s what we do; we fix our patients,” says Queen. “But often what you need to do is sit alongside someone. You look down that well and the person might be there struggling, and empathy is sitting down with them and saying, ‘It’s OK. I can’t fix it, but we’re going to talk about it together.’ Empathy is just looking down the well and saying, ‘Yup, looks pretty dark.’ ”

As with admitting to personal struggles, leadership must set the tone by demonstrating and normalizing the practice of empathy for frontline staff. Healthcare is good at debriefing on the facts, but not necessarily at squaring off with emotional challenges. “I’m looking at ways to debrief emotionally,” says Queen. “We’re good at debriefing medically.”

Peer support programs can be a huge step forward. Weeklong courses, for example, help staff become trained as trauma counselors, supplying methods for peer support, stress management, survivorship, and dealing with traumatic incidents before and after.

They also look at the topic of suicide, which for many years has been an oft-unspoken challenge for healthcare workers. “Despite our best efforts, we can’t save them all, and there’s guilt that surrounds that,” says Queen. “Sentinel events have two victims, and the second victims are the healthcare workers who live with the event.”

Grief is personal

There is no one right way to help clinicians with grief and burnout, which means helping an individual clinician can be challenging.

“The way you manage and deal with grief is personal,” says Queen. “You can’t force it on anyone. It’s about consistent caring, something I call 40 seconds of embarrassing bravery. Asking, ‘Are you OK?’ Just asking a simple question, allowing them to meet you, listening, and being brave enough to say it. Sometimes it’s the toughest personalities who need to talk the most. You can’t pressure them, and they have to do it in their own time.”

In the past few years, Queen says she has seen some of her colleagues walk away from medicine completely due to burnout, and she wonders if she could have reached them. And this impact extends well beyond clinicians, she notes—it also includes first responders, communications staff, pilots, and maintenance workers.

“Early on in my career, I was struggling and didn’t realize that I was,” she says. “And often for those who can recognize it, there’s no formalized program to reach out.”

Even today, with an increased awareness of mental health, organizations and leadership need to be very aware of grief and burnout. “You hear about compassion fatigue, but what’s buried in there is grief,” she says. “There’s no formalized pattern. You push it down because you have to be ready to care for the next patient, and it’s damaging to do this.”

With the right open dialogue and the right resources, colleagues and leadership can learn to help both others and themselves.

“Over time, you really can say, ‘This was my experience, and everyone has personal experiences. I really do need to take care of myself,’ ” Queen says. “We talk about work-life balance, but if you’re not taking care of yourself and if we’re not taking care of them, we can’t expect great outcomes. Making sure we are taking care of our staff is what keeps me up at night.”

The industry is ready for this kind of improvement, she says. “The colleagues I’ve collaborated with all share the same sentiment. We need to talk about this. We need to talk about what support looks like,” says Queen.

Spreading the message that it’s OK to not be OK, and to talk about that fact, is the change the industry needs, she says. In healthcare, clinicians will likely witness life-changing events that are impossible to fully prepare for, but they still need to be in the room and professional.

“Talking is the best medicine,” Queen says. “And you can’t make them talk, but you can make sure they have resources and [let them know] that it’s OK to not be OK. Making sure they know it’s nothing that needs to be stuffed in a corner. It takes a special person to do this job.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.