Case managers and other healthcare workers (HCWs) are dealing daily with patients experiencing difficult health situations. When a patient dies, case managers may experience grief that they barely acknowledge because they know their role is to move on to the next patient. But over time, such grief can build up and contribute to stress and burnout.
There are different dimensions of burnout, including the state in which someone freezes and is no longer able to communicate in a normal, personable way. This is known as depersonalization, says Jennifer Gray, PhD, MPP, associate professor of public health in the School of Health Studies at Northern Illinois University.
Younger staff in particular might need mentorship opportunities that discuss grief and bereavement. Without support and some training, they might lack skills that help them cope with losing patients, Gray says.
A focus on handling grief and patients’ deaths should be part of any healthcare organization, but it is especially important in nursing homes and other settings where staff will lose many patients to death, she adds.
Healthcare organizations can help their staff cope with grief and prevent workplace burnout with the following:
• Change policies to acknowledge emotional needs of staff. Organizations also could adopt a policy of allowing staff time off to attend patients’ funeral or memorial services.
“Give them time to attend a service so they do not have to use one of their vacation days,” Gray says.
Employees who spent a lot of time with the deceased patient and are having difficulty with their grief might need a few days off, she adds.
One simple change is to provide staff with as-needed resources such as grief support and counseling. Sometimes a healthcare professional grieving over a patient’s death can be helped by co-worker support. Organizations can encourage this natural support network by teaching staff a few skills in communication and listening.
“Gauge whether or not that person needs more time, and be a good listener,” suggests Eboni Green, RN, PhD, co-founder of Caregiver Support Services in Omaha, NE. “Let that person express sadness.”
Case managers can look out for one another by noticing when a colleague who used to be happy on the job now seems negative, Green suggests. Co-workers who have major changes in mood and attitude could be in pain and do not know how to tell anyone about it — so ask them what’s going on, she says.
“Ask, ‘Why are you so angry?’ And then it will start flooding out,” Green says. “It’s not that these are not loving and kind people; it’s just that there is a compiling of these losses.”
An organization can help encourage staff grief support by providing an in-house memorial service for recently deceased patients.
“If there’s a support group or in-service that case managers can put on, then that provides additional coping skills for frontline caregivers,” Green says. “It would be good if they offer it at least annually.”
And these support services also are very helpful to case managers — even if they are not as acutely affected by patient loss.
• Learn self-care. “Give yourself permission to be sad,” Green says. “Maybe you could sit down with another case manager to talk about how you’re feeling. The big thing is to not burn out, to take time off when you can, and get the rest you need.”
Self-care might include taking breaks during the work day, practicing mindfulness or meditation, deep breathing, listening to relaxing music, exercising, eating well, and getting enough sleep.
“Maybe we don’t realize how self-care is, and so we should set a reminder to take time — five minute chunks — for ourselves each day,” Gray says.
“You have to learn how to establish good emotional boundaries so you’re not taking so much of the emotional overload on yourself,” Gray says. “You need to separate yourself emotionally from that patient’s life and have your own life that you go back to at the end of the day.”
One way to view this is to think of emotional well-being as a bank. Stress reduction activities increase the emotional bank funds. But when a patient dies or some other stressor occurs, the emotional bank loses funds, Gray explains.
“As a healthcare professional, you are drawing on those emotional resources to support people who might not be emotionally stable themselves,” she says. “What kind of tools do you have in your toolkit that can help you put money into your own emotional bank?”
• Set up a notification system. Case managers often work in settings where they see patients for limited periods of time. So if a patient dies some weeks or months after the last time the case manager called or visited the patient, then the case manager might not know about the death until it’s too late to attend a memorial service.
Healthcare organizations can create a system in which employees who opt in can receive notifications when a former patient dies, Gray says.
Healthcare leaders might view adding grief resources as yet another task that they do not have time to perform. They are focused on mandated training requirements and finding time for all of those, Gray notes.
“Trying to fit in grief and bereavement as a training topic can be challenging,” she says. “But it’s also in some cases raising awareness that the emotional health of staff and families is really important, and the organization needs to put resources into that if they want to do well as an organization and be successful on all fronts.”