June 3, 2022
Working in health care is physically and emotionally challenging. Burnout is common and statistics on health care worker suicides are sobering. On this episode of Talking Pediatrics, guest host Dr. Gabi Hester will speak with several Kid Experts about resources and strategies to support health care workers when they are in need.
Dr. Gabi Hester: Before we begin today’s episode, I want to note that some of the topics discussed may be triggering. If you’re thinking about suicide, are worried about a friend, loved one or colleague, or would like emotional support, you can call the National Suicide Prevention Lifeline at 1-800-273-8255. In addition, there are local resources available at Children’s Minnesota solutions to thrive at 866-542-3252.
Dr. Angela Kade Goepferd: This is Talking Pediatrics, a clinical podcast by Children’s Minnesota, home to The Kid Experts where the complex is our every day. Each week, we bring you intriguing stories and relevant pediatric health care information as we partner with you in the care of your patients. Our guests, data, ideas and practical tips will surprise, challenge and perhaps change how you care for kids.
Welcome to Talking Pediatrics. I’m your host, Dr. Angela Kade Goepferd. It is no secret that we have a crisis on our hands in health care. Even before the COVID-19 pandemic stretched us beyond our limits, many of us were already experiencing burnout. And now that several of our teammates and colleagues are leaving the profession of health care in droves, what can we do about it? On today’s Guidelines with Gabi, Dr. Gabi Hester interviews some Kid Experts at Children’s Minnesota about peer to peer support programs, as well as the second victim phenomenon, to help us understand how we can better care for ourselves and each other to survive this moment that we are in, in health care. While many of these stressors and challenges are building and accumulating, there are things that we can do as health care team members to prevent this crisis from continuing.
Speaker: Welcome to Guidelines With Gabi.
Dr. Gabi Hester: Health care is an incredibly challenging profession. Even before the added stressors and challenges of the COVID-19 pandemic, studies using data from the Centers for Disease Control found that nurses were at higher risk for death by suicide than the general population. Similarly, 2018 data found that one doctor commits suicide every day in the United States, the highest suicide rate of any profession. Many more leave the profession unexpectedly or deal with significant issues like burnout. While many of the stressors and challenges are insidious or slowly building and accumulating, there are unanticipated events that may precipitate a healthcare team member to enter a state of crisis. In 1999, the Institute of Medicine published To Err Is Human. In this landmark report, we learned that as many as 98,000 people die in hospitals every year from preventable medical errors. A more recent study published in The British Medical Journal in 2013, suggested that medical error was the third leading cause of death in the United States.
The impact on patients and families of these preventable errors is profound. However, the Center for Patient Safety has also described second victims who are health care providers involved in unanticipated, adverse patient events, medical errors, or patient related injuries who then become victimized in the sense that they as providers are traumatized by the event. Today, I’m so pleased to be joined by several of The Kid Experts at Children’s Minnesota. Natalie Lu is a registered nurse and quality and patient safety coach. Philip Johnson is a registered nurse, caring for patients on medical surgical, intensive care and HEME/ONC units. And Abby Davis is a board certified staff chaplain focused in the NICU and infant care units.
We’ll be talking today about the second victim phenomena, as well as a unique program at Children’s Minnesota geared towards supporting health care team members called peer to peer support program. Today I’ll be using the term “provider”, which will encompass a wide range of team members in a health care setting, including nurses, pharmacists, physicians, chaplains and social workers. So I’d love to hear from each of you, why you chose to become a peer to peer supporter. Abby, maybe we can start with you and tell us a little bit about experiences that you’ve had in the health care system that raised this as an issue for you and how you chose to enter this program.
Abby Davis: As a chaplain with the spiritual care department, I’ve always seen it as part of my job to support staff. It’s actually in my job description. So it’s always been something that I have done. If I know that a nurse has been a primary nurse for a patient and that patient maybe died over the weekend when I wasn’t here, I try to check in the next week to see how they’re doing. So when I heard about the peer to peer support program, I was just drawn to that. And it was actually kind of interesting after I did the training, I then got my badge with a little label that says peer supporter on it. And I did see that one of the resources of people that you can call, if you think somebody needs extra support or you need extra support is to call the spiritual care department.
So that was really nice to see. I think for myself, some of my experiences at the hospital, oh, I rely so much on the other chaplains, the social workers, child life, and the nurses, everybody that I’m working with I think especially for bereavement at the time of death, it can be a very bonding experience working together. And I think the more we work together and support each other, the more helpful. I think one of my hardest days was when I was actually all alone. I was the only chaplain at the hospital and I actually had three deaths in one day, a long term oncology patient, a long term NICU patient, and then a pediatric patient who I hardly knew. And I found that when I had a hard case at the hospital, I would often get into my car and the radio would come on.
It always seemed to be Tears In Heaven by Eric Clapton. And I would cry and sob in the car and get it out of me. And that day when I had the three deaths, the radio came on and it was Another One Bites the Dust. And I was like, oh, it’s how that day sort of felt where I felt like I had just sort of been beaten up myself a little bit. We all have those days when we also just don’t have that time to just sit there and cry or process this with people. And I think being at a pediatric hospital, I think when I have a hard day, it often means that it was the worst day of somebody else’s life. Right. So that’s a hard part of it too.
Dr. Gabi Hester: Yeah, exactly. Philip, you’ve worked in a number of different care settings, including the intensive care units, medical surgical units, hematology, oncology, really sick kids. And we know, I’ve talked a little bit about error in the introduction today, and we know that unfortunately, medical errors still occur in the hospital setting, whether it’s one that we as health care providers participate in ourselves or unanticipated event in a patient that we may know or be caring for, we all have that risk and those days where really that hits really close to home. Can you tell me a little bit about any experiences that you might have had over the course of your career that really highlighted why this program is important and needed?
Philip Johnson: I would say I’m six years a nurse. I still consider myself newer. Like I am still learning, I’m finding my groove, but when I started, I think you’re constantly met with so many new things. So many challenges of doing your best and your best doesn’t feel enough. And sometimes that piles up and you start to gain that confidence. And as I was moving into the PICU, I thought to myself like, oh, I’ve made it, I’m now going to be an amazing nurse and I’m going to help the sickest of the sickest.
And as that exposure piled on, my personal life wasn’t that great either, but the main thing that I experienced in the PICU was quite daunting because a lot of things happened all at once. It was about an hour and a half prior to shift change. You have to get out on time, you have to do everything in your power to make sure this child has it all under control. I left there completely torn apart and I don’t want to say too, too much, but it messed with my head. And also I talked to another nurse and she helped me find the peer to peer support program. She told me about solutions to thrive, and I talked with them. I wasn’t seeing a therapist and I went from there and I started finding solace in talking to people that went through the same experience.
Dr. Gabi Hester: Natalie, why did you become a peer to peer supporter? Are you able to share a little bit with us?
Natalie Lu: So as a nurse, I’ve been involved in many moments where unexpected things have happened and I’ve found myself either suppressing the tears and waiting until I got in my car to cry it out or going on to another case, another patient, another situation down the hall within my assignment and feeling like I never had a release valve to process the unexpected or hard outcome that I had just undergone. And so what I value in peer support is that as a team, when we can recognize within each other really hard things that we see and do at work, and then sometimes have to just put on the back burner to keep on keeping on and do the next thing. Even though I have a really supportive network in my own family and friends, when the people who I work alongside can real time approach me and have a conversation like a peer support, emotional first aid dialogue, it makes a big difference.
It’s dealing with things real time with people who get it and who have often also been a part of the situation. So I believe so deeply in this, and I want everybody, I want all healthcare workers to get this training because I think when unexpected things happen, we’re going to talk. And I feel like this framework really gives us a productive way to talk and to support each other and to keep moving forward and to not circle round and round and admire the problem too much. It helps us to acknowledge what’s happened to give that space and then to keep moving on together.
Dr. Gabi Hester: Natalie, you mentioned earlier that there’s a training program for people who want to become peer to peer supporters. Can you tell us a little bit about what that program looks like?
Natalie Lu: Stemming from the train, the trainer program that comes from the Center for Patient Safety out of St. Louis, we create a about a four and a half hour program where we start with why, we ask the individuals to bring to their introduction why they’ve elected to become peer supporters. And that really sets the tone for then defining the problem together, acknowledging and understanding that it is part of our day to day work. But there is an element of preventable harm in that no one needs to be isolated when going through things like this. So after defining the problem, we walk through the six stages that evidence tell us, not that the stages necessarily happen one, two, three, four, five, six, but identifying that these are the six stages of second victimhood. And then we do a little bit of role playing. We provide an opportunity to watch what a peer to peer encounter looks like together.
We talk about what went well, what could go different after watching one example together. And then we practice approaching. We work in learning pairs and we just provide for an opportunity for all of us to let our mouths find the words that we will use as we approach our peers with an offer for a conversation like this. Typically, we’ve heard from so many participants that even if they don’t get out and start offering peer support right away, we have found that people indicate that it is just a very healing and cathartic experience to be together in a room full of healthcare workers who are identifying why it’s important to have a framework for conversations like this.
Dr. Gabi Hester: You mentioned the six stages of second victimhood. Could you just briefly review what those are?
Natalie Lu: Stages one through three, we categorize as impact realization, right? So stage one is chaos and event response. It’s really all about stabilizing the victim. And then stage two leads into intrusive reflections, kind of that, that kind of talk that can be really heavy to walk around with. Stage three is all about restoring personal integrity. It’s dealing with those thoughts that you’re going to have when you walk onto a unit and wonder, what are my peers thinking about me? I was involved in an error. Really processing things more externally. And then in stage four, we move into that enduring of the inquisition. Oftentimes when unexpected events or outcomes happen, there are a lot of people within a healthcare system who want and need to have conversations with those who were closest to the event, risk, patient safety, et cetera. Stage four really holds those moments of enduring those questions.
And then stage five is typically the stage where the individual, the second victim identifies with obtaining some emotional first aid. Now that doesn’t mean that it is not appropriate to offer it sooner than that. We talk about peer support in terms of opting in or opting out. And what we know from the research is that typically only about 15% of second victims will opt in or seek out a conversation like this. Whereas 85% will respond and welcome and appreciate being approached by a peer for a conversation like this.
And then stage six is about moving on. And that can happen in one of three ways. That can happen in an energy of thriving. I learned something from this and ultimately I’ve processed it. I’ve reached for healthy coping mechanisms and ultimately I’ll be stronger coming through this. Next is surviving, moving on and not necessarily coming to terms with what happened, but almost still moving through the motions of work as a shell of one self and surviving, not thriving. And then another way that the research indicates we’ll move on is in that dropout, just leaving the unit, leaving the profession. It’s defined often as a career transition that’s a direct result of a single unexpected patient event even. And so moving on can take on any of those characteristics.
Dr. Gabi Hester: Tell me a little bit about what training was like for peer to peer as a support program. What sorts of things did you learn and how have you carried those forward into your current work? And let’s start maybe with Philip.
Philip Johnson: Yeah. We talked to slides and how to approach someone who is going through that experience, because it’s quite important to not give advice immediately. You want to listen and validate their experience and ask them like, do you want advice? Or how would you like me to help you? There’s a certain element to approaching it without bias or judgment of the person or the experience. And as I moved forward, found my own journey into the HEME/ONC world after PICU. I’m still met with people who are going through so much strife and sickness, but I feel better prepared in my own self and to help families and coworkers who may make medical errors or have a really bad day. And I let them come to me. I have that peer to peer supporter on my badge and I welcome open arms.
Dr. Gabi Hester: I love, Philip, how you mentioned your connection with families in that setting too. And I imagine some of the tools and strategies you’re learning in this program and then facilitating conversations probably translates beyond supporting a peer or colleague, but maybe to supporting patients and families, and then likely outside into the rest of our lives with our personal relationships and friendships. So, Abby, I want to turn to you for a moment. Tell me a little bit about what being a part of the peer to peer program has meant for you and how that’s really helped career growth and just building connections for you.
Abby Davis: Yeah, I think especially, I think in the past couple years with COVID and everything else that’s been going on and the short staffing that we’ve had too, I think that has caused a lot of stress for everybody. One of the things that it’s helped me with is just really leaning into supporting people, checking in with people, whether it is something going on with them personally or something connected to the hospital. And I think one of the things about the training that I appreciated too, is when it talked about things like confidentiality with your peers. I think there’s a lot of support that happens, but I think sometimes then there becomes a discussion in the break room and everybody talks about it. And I think there’s something about peer to peer, which number one, I think empowers people to really step up and check in with their colleagues as well as remember, okay, I’m not here to judge.
I’m here to support. It’s just really helpful to not just be like, Hey, I’m being a nice person checking in with people and then I can go talk about it, but really, okay. This is an intentional thing where I am checking in with folks and trying to support them. And it might be a nurse who is so busy and can I get you a glass of water? Have you eaten anything today? Let me grab you a granola bar. Sometimes it’s those simple things.
I know a stressful thing for some of our nurses is when they have to bring a child that’s died down to the morgue and to do that alone could be very hard. So oftentimes they’ll bring another nurse with them. I’ve gone down before. Again, I think sometimes we all think, oh, I’m tough. I can do this on my own, but it sometimes just feels so much better when you have someone there besides you. Just having, as Philip said, having the peer supporter badge on there, I think people sometimes say, what is that? And it can start the discussion. And I always let people know that they can also get trained to do it. I think that people often forget that the spiritual care department is here to support everybody here, staff and patients kind of wherever you’re at, not just religious stuff, just any kind of emotional, spiritual thing people might be going through. So some ways it’s nice having it on there too, to just remind people that we’re here to support our peers.
Dr. Gabi Hester: You’ve each spoken a little bit about some of the traumatic experiences that you’ve encountered that led you to seek out support. When you are now in the role of the supporter, what strategies do you use to maintain a sense of your own wellbeing as you’re providing support for those other people?
Philip Johnson: In supporting another person, I’ve removed myself and my experiences from the conversation. No, there’s no comparing. There’s no one upping and really being attentive and listening to the other person, whether it be the parent, the coworker. In the HEME/ONC world, when the parent has found out their child has cancer or some sort of blood disorder, the world crashes. And there’s really no solution that you can provide except to listen and help guide them to a place where they feel safe and comfortable.
Dr. Gabi Hester: Abby, what about you? How do you make it so that you’re not pulling that trauma and stress upon yourself? How do you do that?
Abby Davis: Yeah, I’ve been at chaplain children’s for 25 years. I think one of the things that I have discovered is how important empathy and compassion is here. And I want to be present with people when I’m with them. So I try not to take on all of the world’s problems, which can be hard these days, to be honest because some of the people hear I’m a chaplain or hear I work at Children’s. So that must be so sad. And then they start telling me about the sad story of somebody they hardly know. And I just try to keep centered on that so I can be really present for folks when I’m with them one on one. One of the things that Phillip said less about me, but more about just the work is we’re talking [inaudible 00:21:45] about that safe space, again that sort of confidential, safe space that we’re there to support. We’re not there to report to their manager, just trying to support people and in that safe space.
Dr. Gabi Hester: As a hospitalist, I certainly have encountered times where I think this type of program would’ve been super helpful for me. Now that I know a little bit more about it, how do I access this type of support within our organization? Understanding it might be different at other places.
Natalie Lu: So within our organization and I think most organization’s kind of go about this, this program lives within the office of patient safety because caring for ourselves and caring for each other are building blocks to offering that type of care to the patients and families who trust us with what they’re going through. And so by way of the resources that we put on our intranet, we can be accessed. And so the program, as more and more people train as peer supporters, we keep a live list on our intranet site so that if people want to look and see who is a peer supporter on my unit, it’s that easy. And then we also partner with our experts who work in our be well program and just try to promote it whenever and wherever we can, as one of the ways that we can be processing the things that are happening in our day to day.
Dr. Gabi Hester: Well, thank you so much for your time today. And it was really just helpful to speak with you and hear about your experiences. And you may have convinced me to become a peer to peer supporter. I think it just sounds like such a fantastic program. So thanks so much for sharing that today. Appreciate it.
Speaker: Take home points.
Dr. Gabi Hester: Number one, second victimhood is a form of preventable harm. We don’t have to suffer through this alone. Keep in mind that conversations can change people. Number two, peer to peer support programs are just one of many ways to deal with stressful situations. Other local resources include solutions to thrive, critical event debriefing, and the be well program. Number three, while there are six stages of second victimhood, the right time to have peer-to-peer support conversations is any time and every time. This type of support can always be offered as a way to move forward.
Dr. Angela Kade Goepferd: Thank you for joining us for Talking Pediatrics. Come back each week for a new episode with our caregivers and experts in pediatric health. Our executive producer and showrunner is Ilze Vogel. Episodes are engineered, produced, and edited by Jake Beaver. Amy Juba is our marketing representative. For more information and additional episodes, visit us at childrensmn.org/talkingpediatrics, and to rate and review our show, please go to childrensmn.org/survey.