In his 13 years working at Valley Regional Hospital, Nick Swift says this is by far the most challenging time to be in health care.
“Things are pretty stressful at the given moment. We’re dealing with a lot of patient volume and acuity, and it coincides with a lot of staff vacancies. So we’re dealing with more with less, in a sense,” the nurse educator said in an interview.
“I think the stress has mounted over the pandemic and is continuing to grow. We’re at a point now where I would say in my 13 years of working here, this is probably the most pressure-filled environment I’ve ever experienced.”
Health care worker burnout was recognized long before the pandemic, but overcapacity, underlying systemic issues, and the ongoing impact of COVID-19 have exacerbated and highlighted the problem.
At Valley Regional Hospital, an initiative intended to address the spiritual, emotional, and psychological needs of health care workers is making a difference.
While most people have heard of Code Red (fire) and Code Blue (cardiac arrest), the colour lavender has now been added to the mix at the Kentville hospital.
Called Team Lavender, the initiative is based on Code Lavender. First launched in 2008 and developed by the US-based Cleveland Clinic, Code Lavender is described as a crisis intervention tool accessible to health care staff, patients, family members, and volunteers “when a stressful event or series of stressful events occurs in the hospital.”
A member of Valley Regional’s Team Lavender, Swift and his team are recognized by their lavender coloured lanyards emblazoned with the motto ‘Our spiritual, emotional, and mental health matters.’
Swift described the initiative as a team approach/peer support group that helps health care workers dealing with stressful or traumatic events but also with accumulated stress that builds up over days, weeks, and months.
“We’ll really provide a lot of validation for their feelings and any concerns they might have and remind them that they’re in positions that are very unique within the workforce,” Swift said.
“Not everyone sees people die every day or who are sick every day. We remind them that it’s quite normal to feel stress or sadness or frustration or whatever it might be that they’re feeling, and that it goes along with the work that they’re doing.”
‘This stuff builds up on health care workers’
Valley Regional Hospital’s Team Lavender initiative was spearheaded by Rev. Dr. Debra Orton. The facility’s spiritual health coordinator for the last 12 years, Orton recalled how during debriefs that followed a crisis or trauma, health care workers would go over technical aspects of incidents but didn’t really look at the emotional side.
“Sadly, throughout the history of health care in Canada and around the world, there’s been that culture that you pick up your chin and you carry on. Health care workers are expected to go, go, go, go from one person to the next, and sometimes the stress levels do require that,” Orton said in an interview.
“However, there was never time to sit down and talk about feelings because it was just a kind of hidden thing…The reality is, whether it’s in the immediate or it takes a couple of years, this stuff builds up on health care workers. We forget that they’re human beings with family members and children and they too have other responsibilities outside health care.”
Wanting to create a safe space for them to talk about their emotions, Orton asked an ICU manager to join a debrief that began with technical issues before moving into the newer territory of exploring the emotional aspects.
Although this was pre-COVID, Orton said issues around accumulated stress led nursing staff to request more of these emotional debriefs.
“Our health care workers give, give, give all day long and they give when they go back home, and so we have to say, ‘OK, so who’s re-energizing them,’” Orton said.
Orton’s research led her to the US-based Code Lavender initiative. With the support of the hospital’s executive team, she adapted the program and was given permission to run Team Lavender as a pilot project.
She believes providing extra support for health care workers is essential, especially in the face of burnout and retention challenges.
“If we don’t keep an eye on them, we could lose them out of the health care system,” she said. “We already know that 20% of new nurses well before COVID leave their profession because of the stress in health care.”
‘You could just see the exhaustion’
The multidisciplinary group (Orton, nursing staff, a physician, a therapist, manager, and others) officially launched Team Lavender in January of 2020, less than three months before the pandemic hit.
“During those heavy periods of COVID at the beginning, when we were in wave one and everybody was learning about what COVID was and how we live in this new world, we met our health care workers in the parking lot while they were changing shifts,” Orton recalled.
“You could just see the exhaustion. Our young people, you could just see how exhausted they were when they were trying to make their way to the cars. And so it was really, really important to keep on top of that.”
Orton said beyond offering debriefs, team members send out follow-up texts and phone calls and regularly conduct hospital walkabouts to build relationships with health care workers throughout the site.
‘We check in and say, ‘Hey, Debra? How are you doing today? How’s everything going?’ Some will tell you a good story about their family life or their pets or whatever,” Orton said.
“And then somebody else might just say ‘I’m having a lousy, lousy day today.’ And so you just talk to them in the moment right there on the floor, if that’s what they want.”
While the team’s focus is on the emotional, spiritual, and psychological well-being of the health care staff and it provides therapeutic value, Orton said they’re not a therapeutic group.
“If a staff person, either after a debrief or during a debrief, felt that they needed more therapeutic support… we bring all the resources with us,” Orton said.
Resources could include information for the occupational health nurse, employee assistance, private counseling, or the doctor’s crisis line.
‘Dark, ominous cloud of COVID’
Although pandemic restrictions and COVID-19 isolation requirements have been lifted here in Nova Scotia, hospitals are still feeling its impact as the virus continues to infect people.
“It’s lingering, it’s still with us, it’s still here, it’s still present. Even though our communities are lifting a lot of restrictions, we still feel it here in the hospitals,” Tamara Strong said in an interview.
A nurse in the hospital’s women and children’s unit, Strong said although strict policies are still in place in hospital settings (masks, limits on visitors), they continue to feel the strain of nursing and support staff retiring early and people being re-deployed.
“We’ve been really feeling it here in the hospital with internal staffing. We just feel there’s like a dark ominous cloud of COVID that we’re still living with,” Strong said.
“It’s still very much real for us and still very much present for us here in the hospital.”
With mandatory masking gone and people gathering in larger groups, Strong said children are becoming sick with common viruses to which they weren’t previously exposed. That results in an uptick in community illness and in hospital visits.
“I feel like on top of our day-to-day tasks and working with the families that we do work with, it’s just another layer that we have to consider,” Strong said.
Although working in a women and children’s unit is typically a joyous place where families meet their babies for the first time and young children get better and leave, Strong said there are also times of “heaviness and sadness.”
“Women experience pregnancy loss and families experience miscarriages and stillbirths and SIDS (sudden infant death syndrome), and kids who pass because of childhood cancers,” Strong said.
She believes Team Lavender provides health care teams with a “level of normalcy” by bringing them closer together and making them feel less alone when working through those “harder feelings.”
“It is something that I feel has been needed for a very long time, and it normalizes the fact that what we go through in health care, yes, it does happen,” Strong said.
“People come in, they’re born and then things happen and people pass. But it doesn’t make it any easier.”
In the midst of capacity and staffing issues, daily work stress and the ongoing challenges of the pandemic, Strong believes that over the last two and a half years, Team Lavender has made the hospital a better place for those who work there.
“Without it, it would feel a lot more isolating, you would almost feel like you’re coping through things more alone,” Strong said.
“I feel like I can very blanketly say that people who have participated in the Team Lavender sessions have only had good things to say about it.”
‘Far beyond what we even imagined’
For Orton, the success of the initiative has far surpassed her initial expectations.
“It has ended up being something that took legs on its own far beyond what we even imagined because we thought if we could just help one health care worker, we would meet our goal,” Orton said.
“I believe we’ve gone beyond what our initial goal or mission was, and for that we feel honoured and grateful.”
In August of 2020, Team Lavender conducted a survey. More than 60% of health care workers at Valley Regional Hospital said the team debriefs had helped them process their emotions in the immediate aftermath and that they left the sessions feeling more at peace.
In addition, more than 70% said they would recommend their colleagues attend Team Lavender debriefs.
“I have had some health care workers come back to me and say that it made a difference in their life, that being connected to someone in the community that could offer them some therapeutic support has allowed them to maintain their job and work at the hospital while working through some of the impact of things,” Orton said.
“I’ve had individuals who have come in and said that they were contemplating even leaving their profession, but after seeking that extra therapeutic support they have rediscovered their values, their gifts, their beliefs in working in health care.”
Team Lavender was recently featured in a medical journal article published by Sage, and is garnering provincial and national recognition. Orton has been asked to speak about the initiative at two national conferences and is fielding calls from representatives of numerous health authorities across Canada.
In Nova Scotia, the hope is to eventually expand the Team Lavender project to other hospitals in the Western Zone before rolling it out provincewide.
“I had no idea, none of us did when we started this, where Team Lavender would go,” Orton said. “People have embraced it, have supported it, and continue to do so.”
Wall of hope
One of Team Lavender’s biggest impacts is the Wall of Hope.
Created in 2020 during the early months of the pandemic, the display in the hospital’s spiritual health centre is the result of a health care manager expressing concern about stress levels among staff.
A heart was painted in the middle of a large blank wall and the idea was to invite everyone working in the hospital to leave a hand imprint.
Orton and a couple of nurses were the first. They weren’t even done washing their hands when people saw them and began flocking to the centre to participate.
It ended up being a wall of hope not only for health care workers in those early and uncertain days of the pandemic, but also a way to commemorate those whose lives were lost during Nova Scotia’s mass shooting, the NATO Cyclone crash in April 2020, and the Snowbirds plane crash in May 2020.
“We were lined up for days with health care workers from laundry, from food services, our RTs, our lab technicians, our X-ray technicians and our maintenance folks, our doctors putting their hands on the wall,” Orton recalled.
“And people came to cry. They came to grieve. They came to support one another. They sat there in peace and quiet between shifts or during their lunch hour. And they continue to do that.”
Team Lavender members have recently been told by hospital staff that the hospital was never as united as when the wall of hope was created.
Orton wants to continue building on that momentum.
“You know, we’re a family of health care workers and we need as a family to keep our eyes on one another and support one another,” Orton said.
“I think that’s what helps to get us through these tough times.”
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