Acknowledging emotions of the healthcare workforce: enabling understanding of what we need

An emergent theme in my work with health and care colleagues over recent months has been grief. Anger has been shared at being unable to give the care and services we were once able to or would like to give. Holding space and bringing awareness to emotions is increasingly needed to sustain and support the workforce during this challenging time.

A senior leader in a team I was working with recently, shared anger and despair in relation to working in the NHS, seeing high levels of demand daily that would be seen perhaps one or two days per year just 5 years ago. The level of demand was described as unrelenting, with little time for staff to pause, reflect, see the impact of what they do and often the attention is on what they haven’t been able to do. The team described going home feeling like they had failed, they hadn’t been able to give enough. They described a realisation that there had been denial that this was happening, they had bargained and hoped that it would pass and levels of demand would return to the previous levels, this had now given way to anger. The senior leader likened this to the Kubler Ross stages of grief.

The ‘aha’ moment that the anger was part of a grieving process felt deeply important. I facilitated a space that allowed the emotions and anger to be present, seen and validated, enabling the team to acknowledge where they were. What was realised through enabling pause, a slowing and a space for listening gave way to the beginnings of a new way of seeing what they faced. Pausing, resting and digesting are described as part of the soothe system of Paul Gilbert’s Emotional Regulatory Systems. We often neglect our soothe system needs and have over developed threat and drive systems, described in more detail below.

The group wanted to know how they could move their grief on to acceptance. My question to them was “what do we need when we are grieving?”. Grief cannot be rushed, it isn’t linear, it’s often messy, we can’t neatly ‘treat’ it and it go away. We can’t fix grief. Grief lives with us, it becomes part of us. I believe we need to offer grief space to be, surround it with care and compassion, allowing it to unfold. Hold space for grief.

Acknowledging what our health and care services have become is an important step for us all as givers and recipients of the services. From acknowledgement, we might be able to take steps towards acceptance. This will require dialogue about the compromises and the losses we can begin coming to terms with.

For this team it was about how they could find a way to feel satisfaction about what they had been able to do rather than focus on what they hadn’t. They wanted to leave their shift having ‘completed’ their work, the department to be clear, the targets to have been met. We are rewarded internally with dopamine when we complete tasks and reach targets, this is part of our ‘drive’ system. When we don’t or can’t meet our drives, our threat system is activated (cortisol and adrenaline), which may drive us harder to seek completion (and dopamine). For our over developed threat and drive systems to come into balance we need to find ways to activate our soothe system (releasing oxytocin and endorphins). This can feel counter intuitive and in the NHS it may feel counter-cultural when we are used to driving hard to reduce the threats.

This team began to explore how they could find meaning and satisfaction when the ‘to-do’ list was never cleared, the department never empty and targets unachievable. Reframing how we can feel a sense of achievement may help us to sustain ourselves in workplaces where demand is always high and where we can’t deliver what we would like to for every patient. Vitally those working in health and care need regular opportunities to ‘rest and digest’, pause, receive and give praise and gratitude, identify what has been achieved despite the challenges and keep remembering what brought them into their roles.

Teams require opportunities to relate to each other, share experiences and to feel heard and understood, activating the soothe system. The soothing system helps to reduce the toxic effects of the threat and drive systems (see nicabm.com).

Workplaces that cultivate and create cultures that actively recognise emotions, acknowledge the importance of and enable soothing, are more likely to sustain those working in them and begin to bring balance to our over developed threat and drive systems.