COLUMBIA — On her birthday more than 30 years ago, Carol Nierling was working in labor and delivery, caring for a woman who'd had a healthy pregnancy. Shortly after being born, the woman's baby died unexpectedly.
Nierling was so saddened by the death that she sought support from an older nurse. But it wasn't an easy thing to do. Some people in medicine think medical staff should be able to deal with any issue on their own, she said, though they're at particular risk of encountering emotionally distressing situations.
The forYOU Team has won three awards, including the Blue Cross/Blue Shield Patient Safety Programs Award in 2009, the MITSS HOPE Award in 2009 and the ISMP Cheers Award in 2011.
Sue Scott has worked with eight other hospitals to help them set up similar programs. She is also working with St. Jude Children's Research Hospital in Memphis to create a scoring tool that will require staff members to do a self-assessment each month to evaluate their mental state.
To help spread the word about the program, Scott has also worked with Becky Miller, the executive director of the Center of Patient Safety in Jefferson City. The center, a nonprofit organization that provides services, education and training on patient safety, has offered training sessions throughout the state to help other hospitals implement similar programs.
It has also set up a private LinkedIn group for people who have been trained to start a program, and the center is also hosting a training session in Illinois.
Being expected to deal with a death alone is unfair and unrealistic, Nierling said.
"That just isn't the way life is."
Each year on her birthday, Nierling, who retired in April, says she takes a moment to think about that woman and her loss. She does this because she learned in her 45 years of nursing that her feelings as a caregiver were legitimate and worthy of attention.
"We're not immune to the things that go on around us," Nierling said.
That philosophy underlies University Hospital's forYOU Team, which is a rapid response program designed to provide assistance to caregivers after a traumatic event, such as the death of a patient.
"It's a recognition that sometimes caregivers need help," Nierling said.
The 'second victim'
Sue Scott, manager of patient safety at University Hospital, has worked as a registered nurse for 36 years. Over the course of her career, she has learned that building personal connections with patients and their families makes staff members more susceptible to emotional distress — a condition Scott calls "becoming a second victim."
She decided to do something about it.
Scott gathered a group of the most dedicated people she knew from within University of Missouri Health Care, and the group of 15 met to discuss how they might help one another. The group decided to develop a response team that would be available to help colleagues and assure that people are strong enough to care for the next patient.
The forYOU Team made its debut in March 2009. With no external funding, the volunteer-based program has grown to more than 100 participants including nurses, doctors, therapists, pharmacists and other health professionals.
The team has helped approximately 900 hospital staff members through team debriefings or one-on-one sessions.
To join the team, Scott asks for at least two or three years of professional experience. Aside from volunteers, individuals can also be nominated by supervisors to become a member.
Dealing with trauma
Trauma centers are classified as level one, two or three. University Hospital is a level one trauma center, meaning it provides the highest level of surgical care to the sickest, most injured patients.
The forYOU Team is designed to help caregivers get past these traumatic situations. Members do debriefings — talking to nurses and physicians after a death or a particularly difficult situation — and let staff members know there's someone there to help them cope.
Nierling, who began her career as a nurse in 1968, saw how the team worked before she retired. She worked at University Hospital for more than 28 years, including 20 years in maternal/child, which includes labor and delivery, and eight years as the manager of trauma services.
"Even though the staff that work with trauma patients are specially trained to do so, there are certain patients who may have a particular impact," Nierling said. "Sometimes if it's a very young person — that's difficult for a team to handle."
Building relationships with a patient's family, especially in trauma situations, is often the first step for caregivers. When the patients wake up, sometimes nurses are "the only link to let the patient know what went on," Nierling said.
For example, because of University Hospital's proximity to Highway 63 and Interstate 70, Nierling said staff deal with a lot of car accident victims. This often involves head trauma, which can limit the victim's memory of the event.
"Lots of people are there for the patients and their families, but the forYOU Team is there to help staff members deal specifically with what went on," Nierling said.
The program can help staff "get back to 100 percent" after a particularly adverse event and to help reduce turnover, said Becky Miller, executive director for the Center of Patient Safety in Jefferson City. "Without help, some people think they shouldn't do this anymore, and we don't want to lose good people," she said.
Scott also acknowledged the importance of relationships with a patient's family.
"When you're taking care of a patient, you're also taking care of their family members at some of the most vulnerable times of their lives," Scott said.
But dealing with the patient's family is not the only factor that can negatively influence a caregiver's emotions. Scott and Nierling both mentioned a possible connection between the patient and the caregiver's personal life.
"If you have a sick or injured child, the staff working that case might have a 2-year-old at home and it creates a connection for the clinician that makes them more vulnerable," Scott said.
Nierling said that although people think of Columbia as a big place, sometimes the patient is someone the caregiver knows, and that can make the situation even more emotionally complicated.
The impact of loss on medical professionals is one of the main interests of the first-person story website "Pulse: Voices From the Heart of Medicine." Created by a team of medical professionals including Paul Gross, a physician and an assistant professor in the Department of Family and Social Medicine at Albert Einstein College in New York, it publishes first-person stories about giving or receiving health care.
Gross said he hadn't heard of the forYOU Team, but his experience working in hospitals has persuaded him that "such a program that offers help and support is a great idea."
Medical professionals deal with stress in a multitude of ways, Gross said, including talking with colleagues. Aside from this, he said, running or swimming, talking to a significant other, seeing a therapist, or writing about experiences can help.
"Whatever is done to create a culture to stop and talk with struggling employees is a good thing," Gross said. "The medical culture is not like that. People think they have to keep marching. I think it's almost like combat, where somebody drops and you have to keep moving."
The forYOU Team approach slows down that march and gives the staff person who needs help a "safe zone" in which to feel cared for, Scott said.
"When you take care of patients, you have to have a full cup of passion," Scott said. "Sometimes your cup gets empty, and to provide the best care for a patient, you have to refill it."
Scott says there are special patients she will never forget, and certain dates have significance. Like Feb. 12, the birthday of a critically ill young boy she was caring for in the early 1980s. He fought for his life for a long time before eventually turning the corner and surviving.
Even with a positive outcome after a long hospital stay, Scott said, she still remembers how difficult it was for the boy's family and the emotional toll the experience took on her.
"Sometimes it hurts to care," Scott said.
Supervising editor is Katherine Reed.