Managing Grief in the Workplace
Self-care is important to a profession that involves long hours, hard work, and unhappy endings, and this is never truer than during a traumatic event in the practice.
Veterinary medicine has a lot of positive perks: puppy breath, kitten noses, happy clients, remarkable recoveries. Yet we also know another side of medicine, where the patients are involved in a traumatic event or illness, and the client is turning to us for comfort. It’s difficult for us as veterinary professionals to provide what the patient and client needs, while at the same time taking care of ourselves.
To see how we can better prepare and help our employees through this time, we’ll address the last but not least law, the eighth of the Eight Laws Governing a Healthy Workplace, which is to have grief processes in place when traumatic events occur onsite.
In “human” medicine, a patient death is often accompanied by a debriefing process for the staff involved. This can involve outside counselors and resources brought in for the staff. However in veterinary medicine, we can experience a string of crises and deaths without so much as a mention of this reality…we often must squelch our emotions in order to move on with other patients and clients. This is dangerous in the long run, and we can strive to prevent this “blanket of silence” that so often pervades our practices. Yet we’ll need to invent what works for our profession and our practice.
We can develop an immediate debriefing form that provides a place to briefly describe the incident, list the employees present, note the attending doctor or lead technician that is responsible for reporting the incident, and provide notice of any employee who needs the management to follow up and ascertain their emotional well-being.
For example, the team struggles with a particularly difficult "Hit by Car" patient that subsequently dies. The attending veterinarian can be responsible for keeping the team gathered at the conclusion of the event, and providing a few words of closure while allowing and encouraging team members to add to the discussion. Perhaps it’s as simple as, “team, you did a great job, he was just too far gone for us to revive”, and opening up the floor for comment. If there’s an employee who seems particularly affected, their name is passed along on this form to management, and perhaps their supervisor follows up by bringing them in a private office to have an opportunity to vent their emotions. This can make an incredible difference for that person, and overall for the practice. It exhibits a compassion and concern for the feelings of your team.
According to Doug Fakkema, “when emotional traumas inevitably occur they must be debriefed quickly, preferably within 24-72 hours. Debriefing is best accomplished by talking about the incident with a trusted colleague or friend…someone who understands someone with a similar base of experience.”
This type of intervention is often called Critical Incident Debriefing. Charles R. Figley, PhD, has provided guidelines on how we can address this important topic with the team:
It may become clear that the causes of the damage [or death] were the insurmountable situations, impossible choices, and too few resources—not the helpers themselves.
Each stress and trauma response may need to be reworked in terms of those realities, and current and FUTURE possibilities…what was done, could be done and may be done, better in the future become part of a coherent and meaningful story of caring. It may be understood how strength, morale, and all the will in the world were insufficient to achieve success in the situation.
It’s important to note that guilt and blame can play a part in these scenarios in the veterinary practice. Guilt may be felt by an employee who didn’t think they responded fast enough or smart enough during the incident. Blame can come from others on the team, and certainly the team sometimes blames the pet’s family as well. This type of response doesn’t do anyone good, not the employee or the team, or even future patients. As noted above, insurmountable situations could involve a patient that needs advanced care that is beyond the scope of this particular practice. Impossible choices most often describes decisions made by the pet’s family, in which the practice team has no say. More importantly, too few resources may apply to tangible products, equipment, and medications, but more often than not, the resource that is lacking is the financial ability of that family to pay for the type of care needed by their pet. This can be incredibly impactful for the veterinary team, who may know they could save this animal, if someone would pick up the tab.
In order to make this debriefing process work, and let the scenario be a learning event, people must be able to talk frankly. In “human” medicine, we hear of M&M rounds, which is morbidity and mortality discussions involving a death of a patient. As stated above, this gives the team the opportunity to learn from the event, in order to possibly help future patients in this type of situation. The team is supported and told that indeed, strength, morale, and all the will in the world were insufficient to achieve success in the situation.
There is no doubt that the veterinary professional sees his or her fair share of trauma. We know that going in, and we are ready and willing to help turn that trauma around. Yet in the case of a patient’s death, the team can be supported so that the practice remains healthy.
Compassion Fatigue in the Animal Care Community, Charles R. Figley, PhD and Robert G. Roop, PhD, 2006