Ashleigh Boyd

Geriatric care is a calling. The relationships that caregivers form with their patients at nursing and acute geriatric facilities are unique within the healthcare industry. 

The average stay for a patient in a nursing home in the United States is 485 days according to Long-term Care Providers and Services Users in the United States, 2015–2016: Data from the National Study of Long-Term Care Providers.

During that time, the most intimate of life’s moments are shared between perfect strangers. With more than a year together and the closeness of the care required, it would be difficult not to form greater bonds than would normally be experienced between caregivers and patients. 

While working with the senior population, nurses and clinicians can also expect to endure verbal and physical attacks, many times on a daily basis, from confused and often terrified patients. These assaults are clearly unprovoked. Patients with varying levels of lucidity are unpredictable, and from moment to moment, it is impossible to know whether they will recognize or fear you. The National Study of Long-Term Care Providers also determined that over 47.8% of nursing home patients suffer from Alzheimer’s or some form of dementia. 

The most difficult part of this situation is the emotional toll this takes on the caregiver. To dedicate your life to the care of the elderly, and have those you’ve come to hold dear look into your eyes with absolute terror, would shake the core of even the most seasoned nurse or doctor. 

The Center for Victims of Torture defines Compassion Fatigue as “the negative aspect of our work as helpers. There are two parts. The first part concerns things such as exhaustion, frustration, anger and depression typical of burnout. Secondary Traumatic Stress is a negative feeling driven by fear and work-related trauma. It is important to remember that some trauma at work can be direct (primary) trauma. In other cases, work-related trauma [is] a combination of both primary and secondary trauma.”

This isn’t a new phenomenon, nor is it a specifically American issue. The study “Nurses’ Reports on Hospital Care in Five Countries,” which appeared in Health Affairs, found high levels of job dissatisfaction and emotional exhaustion among nurses.

In the United States, 41% of Pennsylvania hospital nurses reported being dissatisfied with their job. The objective of “A Comparative Study of Stress and Burnout Among Staff Caregivers in Nursing Homes and Acute Geriatric Wards was to compare levels of stress and burnout among staff caregivers in nursing homes and acute geriatric wards of general hospitals. It was first published in 2003 and found at that time the “levels of stress and burnout among staff caregivers are moderate in acute geriatric wards, but significantly higher than in nursing homes.” 

A 2012 McKnight’s article explored this exact issue. Which begs the question: With so much effort put into the study of this problem, with more than two decades of intelligent inquiry, why did so many nurses who leave the profession still cite burnout as the primary reason? More than 400,000 did so in 2018, according to “Our Take: Building a Flexible Nursing Workforce.”  

The standard remedy employed for decades by administrators to this ever-present danger to healthcare workers has been the healthcare huddle. The Institute for Healthcare Improvement explains that “the overall goal of the safety huddle is to review the previous day’s work to identify safety issues as well as to proactively identify safety concerns for patients to be seen on the current day. The purpose of the huddle is to share information and highlight concerns to be followed up – not solve issues.”

Equal amounts of scholarly effort have been expended upon compassion fatigue among nurses in geriatric care and healthcare huddles, and yet both are still occurring in nearly the exact same fashion and at the same frequency as they were at the turn of the century.

With the introduction of the additional stresses placed upon our nurses due to the COVID-19 pandemic, and now vaccine mandates across the U.S., new methods must be explored to reduce the lasting effects that secondary traumatic stress, burnout and compassion fatigue can have. 

Studies on the effects of neurofeedback on alcoholism and post-traumatic stress disorder offer hope of new possibilities. A study of neurofeedback for chronic PTSD concluded that “compared with the control group NF [Nuerofeedback] produced significant PTSD symptom improvement in individuals with chronic PTSD, as well as in affect regulation capacities.” 

Albert Einstein is quoted as having said, “We can’t solve problems using the same kind of thinking we used when we created them.”

A more holistic approach to the concept of mental health protection for front-line healthcare workers is needed. Perhaps if the focus of our morning meetings were to be  the facility as a whole — the patient, clinician, the staff and administration — then the goal of these conversations could be to protect all the lives affected by the unit, patient and nurses alike. Perhaps then, these huddles might finally solve the problems that, to date, they have merely successfully highlighted.

Ashleigh Boyd is a tenured critical care nurse with first-hand experience in multi-disciplinary care. She currently works as a bedside clinician at a moderately-sized hospital in St. Louis, and is the creator of Treat The Nurse©, an emotional self-debriefing tool to help reduce stress and burnout.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.