Health care systems must stop exploiting nurses’ tender hearts and begin supporting them

“Code yellow!” someone screamed.

I dipped in and out of consciousness, in and out of panic.

Eighteen years as a nurse myself and I knew one thing for sure: It was a burst ectopic. The fetus was not viable. I had lost a lot of blood.

I could die.

As I contemplated the possibility of never waking up after surgery, my nurse leaned in close, took my hand, and said, “It’s OK. I’m here and you’re going to be OK.”

Another sad thought then occurred to me: It had been years since I’d been able to offer that kind of compassionate care to one of my own patients. I was so burned out that, when my nurse reached for my hand, my knee-jerk reaction was to pull away. I was not used to being cared for. My skin had become too thick, a coat of armor that protected me from the piercing stories of loss and grief that punctuate the lives of those who work in health care.

Nurse. It’s such an evocative word, both a noun and a verb. It is something we nurses live every day — a healing action of courageous care that we offer to our patients from the depths of our humanity. When I woke up from surgery, the years of work — of really difficult grieving and personal reckoning — that followed helped me learn a simple lesson: You can’t pour from an empty cup.

I’ve been thinking about this a lot now that the Biden administration and health officials are telling us that Covid is over. Now what happens to the nurses, doctors, the techs, the dietary staff, and environmental services who are still holding the bag of grief and trauma that they carried for these three years?

Many cultures have mourning rituals that help those who have lost to process and grieve. Jews sit shiva. Middle Eastern cultures hire professional wailers who pay homage to the deceased through weeping, singing, and lamentation. Some cultures wear a memento mori (Latin for “remember that you must die”), a token that memorializes the deceased. And in most cultures, those who have lost are given time — some 12 days, or 40, or 49 — during which they are surrounded by family and loved ones while they mourn, and process, grieve, and, most of all, remember.

But there is no place where health care workers can collectively mourn, grieve, and remember.

The very real repercussions of post-Covid burnout are starting to show. A study recently found that 100,000 nurses left the workforce during the pandemic. This is something we nurses have seen throughout the past three years. But now it’s backed up by numbers. So, where do we go from here? How do we help frontline workers begin to heal?

I’ve spent a lot of time thinking about healing — about resilience. I lost my mother to cancer when she was only 49. My brother passed away at 30. At the age of 26, my young sister, then a vivacious and healthy mother to an 8-year-old daughter, became, and remains, a quadriplegic. After every loss, I found myself unable to “bounce back,” unable to “just be strong.” I felt guilty and angry about it. I had no idea whom to turn to for help or support, so I turned to the only thing that allows me to soften and grieve my losses while also experiencing my joy and comfort: dance.

When my sister became ill 10 years ago, I was working my way through an MFA in dance while also moonlighting as a nurse in the ER. I took a break from school and work, and moved into her hospital room with her. And in that tiny, darkly lit room, I rediscovered my own healing powers — not as a nurse, this time, but as a human. My sister’s favorite song was “Party in the U.S.A.” by Miley Cyrus, which I would blast for her — ad nauseam — while dancing around the room and making a fool of myself to make her laugh.

She couldn’t speak, but she could still laugh.

When I eventually went back to grad school, I wanted to chase that laughter — a communication so pure that it didn’t fail my sister even when everything else did. I’d long realized that dancing, that moving our bodies and playing, brings us back to a place of childhood innocence and enthusiasm. There’s plenty of research that tells us exactly that: Music relieves anxiety. Moving — whether through dance, exercise, or walking — is a balm for the soul. And I had a hunch that bringing people who needed to grieve together to play, to dance, would create a space where they could heal, too.

The “workshops” began in 2016 when a few nurse friends joined me to move, cry, play, reflect, talk, be silly, and discover a little relief in sharing something with someone who knows, who gets it. We curated music that helped us soften. At one point we played “Eye of the Tiger” over and over again as we danced around, laughing so hard at the unexpected silliness of the moment that we cried. I told everyone that the workshops were therapeutic but not therapy, so there was no expectation to share, to talk, to process. Yet everyone did because of the camaraderie we created.

After one of these early workshops, one nurse pulled me aside to tearfully explain that she hadn’t realized how much grief she’d been carrying around in her body until she put it down. A burden shared is one halved, as they say — especially when you’re sharing with kindred spirits.

We continued to meet monthly all the way up until Covid — and then we had to get creative. We met virtually and in parks, sharing our voices and our Covid stories with each other and the streets of Denver.

During a time when the world was calling us “superheroes,” we had created a space where we could talk about how we didn’t feel like heroes at all. We were scared, angry, raw, and vulnerable. Dancing together allowed us to share these truths about what it was like to be putting ourselves at risk when the rest of the world was on lockdown. Doing this work together really reaffirmed that we heal in relationship with others — we could honor ourselves and one another in a way our hospitals and communities didn’t know how to do.

Looking back now, I realize that nurses are something much greater than superheroes: We are humans who care and hold the fragile humanity of our patients in our hands daily. We are worthy of being cared for, just as we care for others.

The Clinic, as it’s now called, has come a long way since those workshops. In research approved by an institutional review board that we hope to publish in the next year, we found that the workshops decreased burnout, secondary traumatic stress, and turnover, and increased empathy, self-compassion, and satisfaction.

Since Covid, hundreds of nurses and other health care providers across the U.S. and Europe have taken part to process their grief and remember their joy. This summer, more than 500 Kaiser Permanente nurses in Northern California will join me for these dance sessions. At a local hospital in Denver, I’m training peer responders in hospitals to create collective grieving spaces through arts and play workshops. I will be working with their peer support teams that offer 24-hour psychological first aid and other innovative peer support modalities. These spaces are vital to our healing, individually, collectively, and for the nursing profession as a whole.

But dancing isn’t the only way to offer nurses spaces to feel their emotions and tell the truth about who they are and what they need. Wyoming health care workers take songwriting workshops to express burnout creatively while their counterparts in Washington, D.C., are using knitting as a creative outlet for stress. The Nocturnists is a celebration of storytelling as a way to process trauma and burnout. These are meaningful grassroots efforts to address a very real need, and every health care system should welcome and nurture them.

To be well — to care well — we need more than just free pizza for lunch. Free pizza doesn’t raise morale. Feeling seen and cared for — listened to and not dispensable — is what raises morale.

Of course, these workshops are no substitute for nurses being paid more. But they are an example of the kind of ongoing, sustainable, innovative mental health and wellness support that reaches beyond the typical employee assistance program. These workshops and other support should be embedded in nurses’ workdays, not an addition they need to take on, on top of all they are doing.

How we process the past three years will hinge on whether these systems decide to prioritize our mental health, whether they’re farsighted enough to see the impending mass exodus from health care due to burnout and pandemic-related trauma, and whether they are willing to invest both financially and personally in new efforts.

For too long, health care systems have taken advantage of values-driven people who continue to care because they see the need. We continue to care past what is healthy, past what we can handle, and this pandemic has taken many of us to the brink. They must stop exploiting our tender hearts and begin supporting them.

Tara Rynders, MFA, BSN, B.A., R.N., is a registered nurse, dancer, and founder of The Clinic, a compassionate collaborative that combines arts, music, movement, and caring science to create immersive experiences and workshops for health care professionals.