MILWAUKEE — For Carlene Brennan, lending an ear comes naturally.
“I’ve always been told that I’m a good listener,” said Brennan, a registered nurse in radiology at Froedtert and The Medical College of Wisconsin. “I’ve always been one that I feel like people come to.”
These days, she’s been putting those listening skills to use — on her fellow health care workers.
Brennan is signed on as a peer supporter in the “Supporting Our Staff” program at Froedtert & MCW. Along with around 200 other trained volunteers, she’s trying to make sure that health care workers remember their own wellbeing while they’re looking after patients — and, of course, in the midst of the COVID-19 pandemic.
“Learning to lean on each other and take care of each other during this time was super important,” Brennan said.
The program is designed so that whenever providers and staff are feeling stressed or upset, peer supporters, like Brennan, are there to offer “emotional first aid,” said Dr. Alicia Pilarski, an associate professor of emergency medicine.
Pilarski is the medical director for the program, in partnership with Dr. Timothy Klatt, the program’s director of patient safety and a professor of obstetrics and gynecology. Just having someone to talk to can make a huge difference in combating stress and burnout, the program’s leaders said.
Health care workers face a lot of distressing situations, Pilarski pointed out. Adverse outcomes stick with you; potential errors have high stakes; and sometimes, even the best care can’t stop the natural progression of a disease.
Amid all of these challenges, though, Pilarski said that the health care field doesn’t always encourage its own to ask for help.
“For a long time, it's been expected that if you're going into medical school and residency” — or health care in general — “this is going to be a hard job. That you need to kind of grin and bear it,” Pilarski said. “It's a tough job, but, you know, you have to be tougher.”
Pilarski wanted to change that. Working in emergency medicine, she’d seen firsthand the “laundry list” of emotions after a hard case — sleepless nights thinking about what could have gone differently, stress about going back into the clinical environment — and believed that no one should be left suffering alone.
She and her team established the “Supporting Our Staff” program in January 2019, and it’s been growing ever since.
The program has three tiers, Pilarski explained. The first tier focuses on generally raising awareness that dealing with distress is normal, and letting workers know they have somewhere to turn for support.
“It just really helps to normalize that we’ve all been through something,” Brennan said. “And we are human.”
The second tier is made up of the volunteers like Brennan, who get trained to offer emotional support to their colleagues.
These peer supporters respond in a few different ways: The program has a pager system for people to reach out directly, and the team has recently started making rounds through different units in the hospital — “bringing support to them,” Pilarski said. Plus, if the team hears about any adverse patient outcome, they make sure to check in with everyone involved to see how they’re doing, Brennan said.
Finally, the third tier, for those who need some additional help, brings on psychologists and psychiatrists with a more advanced background in mental health.
Over the two-plus years since the program kicked off, a lot of their efforts have been supporting workers who couldn’t stop the natural progression of a patient’s condition, Klatt said.
“We don't take losing easy, and you just can't overcome everything,” he said. “Humanity's a rather frail condition.”
Klatt remembers early in his own career, he was brought on to help with an especially tough delivery when a patient was losing a lot of blood. The next day, he was still feeling down about the case — until his partner reminded Klatt that, in the end, he’d saved the patient’s life.
Having an emotional response to a case can be a sign that you’re a good provider who cares about their patients, Klatt said. But within the peer support model, you can lean on coworkers to offer some perspective and reframe those feelings.
“Maybe one of my colleagues will see that I'm hurting a little bit and encourage me, pat me on the shoulder and help me see that there's nothing wrong with me,” Klatt said. “I’m not weak, I’m not damaged — this is the normal response as I grow.”
Of course, COVID-19 has brought its own share of struggles for staff and providers.
In a survey of more than 1,000 health care workers last year, Mental Health America found that almost all of them (93%) reported they were regularly feeling stress. And a large majority also said they were experiencing anxiety, frustration, burnout, or feeling overwhelmed.
Pilarski said the peer support pager has been going off more frequently since the start of the pandemic. Dealing with so many unknowns — in terms of how to help their patients, and how to keep themselves safe — made for a scary time in health care, the program leaders said.
“For the first time, a lot of people were heading home worried they were going to, because of their chosen profession, transmit it and hurt their loved ones,” Klatt said. “So it’s a huge stressor on top of all the other stressors.”
Now, with the pandemic dragging on into its second year, Pilarski said she’s approaching it as “a marathon, not a sprint.” But she’s hopeful that the work to improve the health care system for providers and staff, including these types of peer support efforts, will have impacts beyond the age of COVID-19.
Running any sort of peer support program is still a pretty new idea for health care institutions, Klatt said. And he added their model is also “innovative” because it brings in supporters from across the whole hospital and throughout the whole care team — from residents to nurses to lab techs — instead of just focusing on the physicians.
“To provide great health care to a patient, it requires a team,” Pilarski said. “And the same goes for taking care of one another.”
At this point, Pilarski said, the program has trained peer supporters across almost all departments and units at Froedtert & MCW. But even 200 trained volunteers is only “scratching the surface” for the size of the institution, she said, and they’re constantly working to expand their reach.
The Froedtert & MCW team is also helping out other groups who want to start up programs: Pilarski said they’ve helped advise teams at the Milwaukee VA and Children’s Wisconsin on their peer support model. And they’re starting these conversations early in providers’ careers, emphasizing ideas of wellness and resiliency when they’re training residents.
In the end, their goal is a big one: To create a healthier culture for working in health care. The “Supporting Our Staff” team believes it’s an essential change so workers can better take care of themselves and the patients who rely on them.
“In health care, you walk in the door, it's almost like it's an expectation that you're going to be stressed at work. It’s, ‘Too bad, you're in health care, you signed up for this,’” Brennan said. “And we’re trying to figure out a way to change that mindset. Having high stress all day, every day, is not how it should be.”