• A trauma nurse faces the tragic loss of a young patient close to his own son’s age.
  • A transporter must bring an infant who died in the Neo-ICU down to the morgue.
  • A pharmacist hears that his patient had an anaphylactic reaction to a medication.  He discovers the medication allergy was documented but not acknowledged during the patient’s admission.
  • A housekeeper learns that a long-time patient she has grown close to has coded and is now in an intensive care unit.

What do all these hospital employees have in common?  They are ‘second victims’ of a tragic patient outcome.  For years, many have suffered in silence, trying to retain the expected stoic façade. 

But, now, at HUP, a new program will proactively provide immediate ‘emotional’ first aid to those who need it.

Lingering Feelings of Inadequacy

Studies show that health-care providers often have strong feelings of guilt or inadequacy following an unanticipated bad outcome or medical mistake. “They feel responsible and may see it as a personal failure,” said Jill Huzinec, RPh, director of Patient Safety, who’s leading the initiative. A recent survey of HUP employees mirror these results. Nearly one-third reported experiencing personal problems after an event.  Even more concerning:  30 percent seriously contemplated leaving their profession as a result of the event.

“It’s a stigma in the medical profession; you don’t get upset ,” she said. “You just go on to care for the next patient.  But how can a provider help someone else when he or she is suffering emotionally?”

While most staff are resilient and will recover after a traumatic event, “this program is essential for those adversely affected by it.”

Huzinec said the new program -- Care for the Care Provider -- will be available to any employee who might be emotionally traumatized by an event: all disciplines, all departments, all shifts. And it will be available 24/7.  “No one should have to wait till Monday to talk about their emotional distress related to an event that happened on Saturday night.”

The program will also support those who have experienced violence in the workplace, such as employees who have been attacked by patients or family members.  “They’re all victims.”


A Three-Tiered System of Support

The program’s ‘Rapid Response Support System’ comprises three tiers of support. A leader in the department or unit, such as the supervisor, manager, or charge nurse, who has been trained in basic ‘emotional’ first aid, will provide the first level.  “Staff are supposed to inform a supervisor when an event happens.  This is the perfect opportunity to see if that person needs a brief respite – five minutes to take a walk, clear their thoughts or just talk with someone,”  she said.  “We need to offer this support proactively, not wait until for the employee seeks it.”

An adverse or unexpected event usually affects many more on the unit or department than the involved care providers. “Two things need to happen after an adverse event:  determine how to prevent the event from happening again and provide emotional support for the staff,” she said, adding that the entire team needs to involved in the discussion.

“We want to continue strengthening a non-punitive environment, ensuring that people feel comfortable speaking about the event and its emotional impact.”

In the program’s second tier, specially trained peers will provide the support. “They’ll have their finger on the pulse of what’s going on in the unit at all times,” she said. “If  support peers observe an increased level of stress in their area, they can call a huddle, a moment to talk. This lets the staff know someone is listening and is there to support their needs.”

The third tier will be for employees who need professional counseling from those specially trained to do so, such as a chaplain, EAP (employee assistance program) personnel, social workers or clinical psychologists.

Huzinec said that training for Tier 1 and 2 is planned to begin in June.  The scheduled go-live date is July. 

“We want staff to know this kind of support is available, is confidential and is nonjudgmental,” Huzinec said. “It is a human response to feel sad when someone dies or when something bad happens to a patient….. We want to make this support system part of normal practice, a part of our culture of safety.”


Photo above: Offering emotional support to a staff member after an adverse event (enacted by Kirsten Smith, MSN, clinical nurse specialist, and Angelo DeFeo, BSN, of Dulles 6) is a key component of HUP’s Caring for the Care Provider program. 


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