Building Mental Health Supports for Palliative Care Teams

Palliative care organizations that integrate employee feedback into their staff development policies have a fighting chance in battling ongoing burnout and turnover in the field.

The palliative care workforce is facing a wide range of challenges that impact their ability to thrive in the field. Providing serious illness care can be emotionally and mentally taxing on interdisciplinary teams. The last few years in particular carried exacerbated pressures on palliative care workers, according to Beth Lown, chief medical officer at the Schwartz Center for Compassionate Healthcare based in Boston.

Lown is also an associate professor of medicine at the Harvard Medical School. Founded in 1995, the Schwartz Center provides education, training and support to hospices, hospitals, palliative providers and other health care organizations in the United States, Ireland, New Zealand and the United Kingdom.

Palliative care leaders that seek employee feedback on their evolving and diverse needs stand to benefit when it comes to recruitment and retention, she said at a recent conference from the Coalition to Transform Advanced Care (C-TAC) and the Center to Advance Palliative Care (CAPC).

“People in the workforce and coming into it are significantly traumatized from a pandemic amid social injustices,” Lown said at the C-TAC–CAPC Leadership Summit in Washington, D.C. “The workforce is very, very diverse and that needs to be taken into account. The most important thing is that people have a safe space for reflection … because you need to provide relational human space.”

A state of stress

Palliative professionals of all walks are navigating symptoms of burnout, including social workers, grief counselors, chaplains, physicians and nurses. Preventing burnout and turnover has become a rising priority amid rising demand and sparse resources.

Nearly a quarter (24%) of palliative care nurses say they have experienced emotional exhaustion, while depersonalization and feelings of low personal accomplishment are prevalent among 30% and 28%, respectively, according to a 2020 meta-analysis of 15 studies.

Common challenges reported in the palliative workforce include workload volumes, technology issues, administrative demands, coping with witnessing and experiencing grief and difficulties with taking time off from work or maintaining work-life balance.

Understanding and supporting the well-being of interdisciplinary team members represents a “key concern” when it comes to the ability to provide quality end-of-life and serious illness care, according to researchers in a 2022 study published in the American Journal of Hospice and Palliative Medicine. Researchers pooled a group of nurses, home health aides, social workers and chaplains during a three-month period to examine ties between employee well-being and turnover.

During that time frame, workers reported low levels of well-being that indicated a higher potential risk of burnout. Compassion satisfaction scores decreased from 44.5 to 42.1 among workers, while burnout scores increased to 20.5, up from 17.6 initially, the study found.

“Well-being and turnover intent represent key aspects to the promotion of a healthy workforce,” researchers stated. “Alarming levels of burnout and low levels of well-being have been documented in health professionals across care settings. Not only do high levels of burnout, low well-being and high turnover affect health professionals, but they are associated with poor patient care.”

Developing an “action roadmap” for retaining palliative care professionals takes time and collaborative efforts among leaders and staff, according to Lown.

An initial step leaders can take is to assess their current staffing policies and engage employees for their feedback on challenges they encounter around them, she said. This can show palliative care organizations “where they are now and where to look in the future,” when it comes to internal process breakdowns that can wear on staff, Lown stated.

Another important step is developing an organizational culture that routinely engages employee feedback on their largest challenges and mental health support needs, she added. This allows an organization to build up trust among employees over time and provides an opportunity for leaders to both understand and address their biggest pain points in retention, Lown indicated.

Having a supportive and trustworthy employer has been a leading reason health care workers across the continuum choose to stay or leave an organization, she said.

A “key principle” for palliative organizations to focus on is the element of employee engagement and having a way for staff to voice their concerns and also bring suggested solutions, Lown stated. Collaborative trust-building can go a long way in reducing burnout and helping staff have better access and awareness of the mental health supports available to them, she said.

“We want to help make it easier and normal for people to get the support and access to mental health and really invest in reducing stigmas,” Lown said at the conference. “That’s building trust by being an organization that builds customizations that help mental health and well-being and those key principles that contribute to the mental health of the workforce. It’s creating a safe and trusted environment that [is] embedded into organizational culture [and] means that workers are involved in designing, creating and implementing solutions that they think will address all forms of stress [with] team cohesiveness, fostering mutual respect and collaborative learning.”

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