HERSHEY, Pa. — Sixteen years ago, the son of a dying woman opened Penn State Health Chaplain Kelly Fuddy’s eyes.
She was working as a resident chaplain in a hospital intensive care unit holding vigil for the woman, when the son — a military veteran in his 50s — asked the attending nurse, “How long do they let you do this job before they pull you out?”
The nurse looked at him. Midnight shifts like this one were typically quiet. Earlier, however, monitors shrieked, ambulances flew in, health care workers rushed through halls, and families wrestled with hope and tragedy.
“This is like a war zone,” the man explained. "In the military, the tours of duty are generally six months or a year before a service member goes home."
The nurse laughed. “I’ve been doing this 21 years straight,” she said.
“It was a light bulb moment,” said Fuddy, who today is the staff-assigned chaplain at Penn State Health Milton S. Hershey Medical Center.
Fuddy has continued to work as a chaplain, but for much of the past year her job has been new. Instead of patients, she offers comfort to caregivers. The Milton S. Hershey Medical Center and Penn State Health Children’s Hospital are among a small number of medical centers in the U.S. that assign chaplains specifically to health care workers.
Both Fuddy and her counterpart in the Children’s Hospital, Laura Ramsey, say jobs like nurse, doctor, therapist, environmental services technician and caregiver offer big rewards for hefty tolls.
Health care workers are buffeted by stressors at hospitals around the world. According to the U.S. Centers for Disease Control and Prevention, among them are the ongoing risk for hazardous exposures to pathogens like COVID-19 and other infectious diseases, hazardous drugs, long work hours, and rotating and irregular shifts.
The danger is something called compassion fatigue ― an emotional paralysis that stanches a caregiver’s ability to care.
“It’s different for everyone,” said Ramsey, who experienced the early signs of it herself at her previous job as a patient-focused chaplain. After the day-in, day-out involvement in crises, tragedy and loss, some people have symptoms similar to post-traumatic stress disorder (PTSD) with physical manifestations, like racing pulse rates or feeling as though they might pass out when they walk into life-or-death situations. Others feel emotionally disconnected, Ramsey said. And some “start playing mind games with themselves” and find ways to cut corners or avoid difficult situations during work.
They combat it, both chaplains say, with self-care. And that’s where the chaplains come in. For centuries, the job of a chaplain has straddled both mental and spiritual realms ― where compassion fatigue lurks.
Delivering compassion
The job is three-fold:
- Managing crises — Fuddy and Ramsey regularly work with health care workers who are dealing with the after-effects of crises. They hold debriefings, where those affected talk about what they’ve gone through and attempt to get past it.
- Residual stress — The chaplains often support employees dealing with the accumulation of all the stressors of the job, and they help health care workers develop strategies for dealing with the day-in, day-out pressure.
- Proactive work — Fuddy and Ramsey meet with both recently graduated nurses and longtime professionals to help them head off the potential for problems like burnout and compassion fatigue. They offer courses in resiliency.
For some of the health care veterans, their work has been revolutionary.
“Having been a nurse for almost 25 years, this was not something that was discussed when I was in nursing school,” said S. Natasha Smithies-Race, nurse resource coordinator. “Nobody talked about the emotional and mental toll that seeing death and sickness would take on you. I almost lost my career because of this, so I am happy to see health care finally starting to talk about this ‘ugly’ subject.”
Validation from someone not at the bedside
Like clinicians and other chaplains at Hershey Medical Center, Fuddy and Ramsey make rounds and huddle with their colleagues. Ramsey attends a 9 a.m. session at the Pediatric Progressive Care Unit, where the nursing team discusses what’s coming up for the day and what happened on previous shifts.
One day in late October, for example, at a meeting where the staff dressed in Halloween costumes, Ramsey learned of a nurse who was assaulted by a patient overnight. She planned to follow up.
Dramatic as it sounds, Fuddy says those kinds of things happen frequently — patients in pain lashing out at caregivers.
After her meeting, she circled the hallways and introduced herself to staff she hadn’t met and checked in with old friends. “If you ever feel like you want to grab a cup of coffee,” she said to a new nurse there on her first day, “I’d be happy to.” She shook hands with passersby and complimented health care workers on their Halloween costumes. The encounters were quick.
“Honestly, the rounding is the hardest thing,” she said, “because everyone is so busy.”
But deeper work flows from these passing pleasantries. A few months ago, Ramsey bumped into Renae Epler, a nurse manager in the Pediatric Progressive Care Unit. Epler needed help. Her department had just begun accepting intermediate patients ― those who are medically stable, but unstable enough to need specialized care ― for the first time, and the added responsibility was stressing out her staff. “We were prepared,” Epler said, “but we weren’t mentally there yet.”
She and Ramsey ducked into an office and talked for a half hour. They developed a plan to give her staff a chance to express themselves about what they were going through in huddles and writing down their feelings.